The Trick is to Keep Breathing charts Joy's struggle with mental illness. Joy suffers from depression and anxiety. She has panic attacks. She struggles with both an eating disorder and alcohol dependency. She self-harms.
Joy attempts to keep her mental health issues secret. This is understandable - the book presents little to suggest that her situation is or would be understood by wider society. Mr Peach tries to ignore her problems and encourages Joy to act as if there is nothing wrong. Dr Stead and the Health Visitor also seem unengaged with Joy and her problems.
Society may ignore Joy's mental health issues, but Janice Galloway does not. She represents them in great detail.
Depression makes Joy struggle with everyday activities. Even climbing the stairs becomes a major effort. She becomes almost obsessively aware of detail in the world around her - sounds, feelings, the sight of stains, all become heightened and extreme.
Her use of lists suggests a level of compulsive behaviour; As does her ritualised behaviour, especially around bathing.
Despite attempting to take control of her life, Joy's thoughts are erratic:
I remember everything all the time
She seems detached from what goes through her mind, as if her flow of thoughts is overpowering her ability to process them.
Michael's death has triggered Joy's current problems but Galloway shows this is not an isolated situation.
Descriptions of Joy's past relationships suggest that she has long term issues around self-esteem and attachment. Even when relationships go wrong, such as with Paul, Joy seems unable to let go and move on.
There is a history of mental illness in Joy's background. Her mother died after attempting suicide and several other women in her family have taken their own lives.
The medical profession is presented as ineffectual and incompetent. It fails to treat Joy as an individual. It standardises her condition, presuming that it can be healed with medication.
The doctors fail to communicate clearly with Joy about her condition. Dr Stead prescribes pills but does not explain what they do:
Try taking the yellow things earlier in the evening and the red things later. There’s nothing left to do with the green things on this theme.
He exercises a certain amount of control over Joy. In being vague about her medicine he perhaps implies she will not understand what they do.
In Foresthouse Hospital, the doctors are similarly incompetent:
Dr Two tells me he has been talking to his colleagues. They were agreed about one thing. I am definitely depressed.
That these trained medical professionals have taken so long to reach such an obvious diagnosis makes them seem ridiculous.
When Joy asks about treatment, they are similarly unhelpful and unresponsive.
DR THREE What sort of treatment do you want?
PATIENT I don't know. What do you suggest?
DR THREE Ah, but that’s the whole point. I’m not suggesting anything. You asked to see me and now you’re just wasting my time.
Ironically, it seems is it the doctor is wasting Joy’s time. His ability to reason in circles is an example of his manipulation. The lack of information Joy is given alienates her from discussion about her own health.
Overall, Galloway uses satire and irony in presenting medical professionals. It is significant that the doctors are entirely male. This suggests women could be unfairly dominated by men through the field of medicine.