In reply to lanm1192:
Sorry for the rather belated reply, been pondering this.
> Yeah, that and another post on another forum are making me think the best strategy is to spend more time at higher altitudes and gauge my abilities based on that.
That sounds extremely sensible. Test it out in much shorter stints, and see how it affects you.
It's not my area of expertise, but a quick Google found that some places seem to recommend doing some shorter "acclimatization peaks" while you're in Africa as part of preparing for Kilimanjaro anyway, so you can acclimatize more gradually.
I also noticed that the company you're looking at will rent out supplementary oxygen systems:
http://www.peakplanet.com/high-quality-equipment-service/
Going for that on Kilimanjaro would mean extra cost but much less worry about the effects of altitude.
Things to think about (drawing on my experiences with severe depression and anxiety plus autistic spectrum stuff -- so, obviously not the same, but I've had to work out what I can and can't cope with on climbing trips, as a person with some mental weirdness):
Are you usually aware if your mental state is starting to deteriorate, or does it take someone else to point it out?
It could be worth thinking about having an "exit strategy" in place, so if things start getting bad during the trek, you have a mechanism to enable you to turn back and leave (and get somewhere safe where you can get yourself together) with the minimum of hassle, rather than having to continue along with the rest of the group.
The last thing you want is the situation jethro kiernan mentioned hearing about, where you're doing badly but get herded along because the guides just want to get the job done.
JayPee360's suggestion about having someone along who knows you sounds like a very good idea. If not, making sure that someone in charge of the trip is briefed seems critical.
Obviously my issues are different, but for me, when I'm having a meltdown is when I'm least able to start explaining to strangers the details of my diagnoses and mental state and what kind of support I need from them.
I know it's really unpleasant feeling like you have to disclose your medical history (particularly to people who may be misinformed and need to be educated about what your issues actually mean), but it's better than having people misunderstand and over-react if things go bad for you. Especially if you have stuff like involuntary movements which people may notice anyway.
> A big concern is both that I will have voices harassing me the whole time, which I can sometimes ignore and dismiss and other times tend to overwhelm me. During intense physical exertion my tolerance goes down a lot.
Yes, that sounds like one of the biggest concerns. Definitely worth getting your psych's take on that, possible coping strategies, and whether it's realistically going to be manageable or not.
As with the altitude, it could be worth testing the effects of physical exertion out in smaller doses first, and try gradually increasing the duration/intensity over time (which will help with general fitness anyway).
If you're going to get overwhelmed at a certain level of physical exertion no matter what you do, ideally you want to find that out in a relatively safe/manageable context, and not when you're stuck up a mountain!
> I tend to get fidgety and nervous in crowds.
Yeah, I have a very hard time with crowds too (just too much sensory input), and for me, group activities are always challenging. Having private space and being able to retreat from other people is critical to my mental functioning.
So it'd be important to find out about the accommodation and camping, whether you'll be sharing tents, etc..
I also get some benefit from things that let me "zone out" and create my own private bubble even if I'm sharing physical space (so I have coped somewhat with shared dorm-type sleeping space with an eyemask and listening to podcasts on headphones).
On the other hand, I know some people find that sort of thing can make them feel more dissociated/spacy, so your mileage may vary.
If dealing with the group situation seems like it'd be too much or too risky (or just a really grim experience), I'd wonder about seeing if you could hire a guide or two to take you individually, or you plus a friend.
> but figured I could tough it out
Unfortunately, "tough it out" so rarely works with mental illnesses ... (been there tried that).
You sound like you have a lot of self-awareness, and you're considering the risks rather thoughtfully and responsibly.
If you're generally managing day to day, and you can cope with the stresses of travelling in Egypt and Kenya, I wouldn't rule out Kilimanjaro as flatly impossible.
But obviously there are various factors you need to test out first, and a standard trekking package might not be the best way to go.