Thursday, January 6, 2011

Some observations on psychiatry's role in distress

Salutations, New Mad Nation.

Katy Perry will have to wait - tonight, I role with the big dogs.

I'm talking about the big P - Psychiatry itself. Perry is just a little "p" and will have to wait her turn.

Gosh, where do I begin on a subject as storied as psychiatry? I suppose a simple definition of terms might be helpful, especially since psychiatry and psychology are often confused for one another, and their meanings have shifted over time. For my purposes, "psychiatry" refers to the branch of psychology that deals with medicine and other clinical means of treating "mental illness" and generally dealing with distress. In other words, what is traditionally referred to as "therapy" - talking it out, learning techniques, etc. etc. - is not what I intend to deal with (today). Instead, I want to focus on the awkward chair in the awkward office, often in the awkward hospital, where the person in the fancy suit across the room from you decides what kind of drugs and/or "treatments" would best help you out - and the hospitalizations that sometimes go hand in hand with this process.

I will freely own from the start, as I have said earlier, that I am very biased against this entire system. It has caused no little discomfort to me and many for whom I care very deeply. Its representatives have belittled me, even insulted me, ignored my concerns outright and substituted their own, and probably gotten me addicted to medicine whose actual ability to help me is HIGHLY questionable. If any other medical practitioner was responsible for this kind of mistreatment they would be fired immediately, or possibly even sued. But psychiatrists tend to get away with it for two reasons:

1. They are harder to come across, since they are frequently booked solid for months on out.
2. They are "sane" and you are "mad." Ergo, your point is moot - and everyone agrees.

Psychiatry can get away with treating people like shit because as soon as you admit to having seen a psychiatrist, people already assume you are wrong, and you have no agency for challenge. After all, if your mental faculties were all about you, why would you be seeing a psychiatrist?

This happens in a variety of ways and on a variety of levels. Your closer friends may trust you implicitly and be on your side, but others will assume "it was just a misunderstanding, I don't think he really meant to insult you. You need to stop being so defensive, you know?" And the more degrees of separation you have, the more likely it is that anyone who hears about the situation will simply assume you are nuts and not to be trusted. This fact, this social reality, weighs very heavily on the minds of those who are dissatisfied with their psychiatric service. It is made worse by the fact that we are often chastised, or even ostracized by those around us if we are not seeing a psychiatrist. So it becomes difficult to cast them off, even if they are infuriating.

Some of us end up without any choice in the matter.

(1st Edit: Please note, the following hypothetical has a somewhat facetious tone to it. For anyone who has actually gone through this experience, please know that I have nothing but sympathy for you, and mean only to convey the harshness of the feelings to those who are unfamiliar; I also do not mean to suggest that they are the only possible feelings in that experience, just an example of what someone might feel based on testimony and my own knowledge.)

For example, let's say one night you take a look at the world and get totally sick of everything you see. Your family wants to care...you think.... but they really aren't getting it right, and by and large everything they do hurts more than it helps. You have a friend or two but they never listen and even when they do they just meet it with platitudes like "Try to cheer up" and "You can't dwell on these things so much." You sometimes enjoy spending time with them in your "better" moods but it's just too damn easy to be reminded of all the pain and outright evil in this world, especially when everyone other than those one or two "friends" are living incarnations of everything that hurts you - greed, wrath, pride, lust, envy, gluttony, sloth; take your pick. You take a look at your own prospects and don't see things improving very much - surrounded by darkness and without a torch, much less a spark to light it. Yeah, it's a bad night alright...no one's around, you're feeling it stronger than you usually do. Maybe you haven't been getting enough sleep because you've been in too much emotional pain to lie still for long enough to sleep. Maybe you haven't been eating because food tastes horrible to you these days. Maybe the constant bombardment of political malady and human atrocities has finally just become too much to take. For whatever reason, you decide that there's no point in continuing, and indeed you would be better off getting off the ride right this second. Maybe the next life will be better than this; maybe eternal oblivion seems preferable. Maybe you're just too sad to think straight about this bleak prospect. But you go for it.

You attempt suicide.

Next thing you know, you're in the hospital. Bright white lights, strange faces, unfamiliar noises all around, your personal effects taken away as you are ensconced in their system: scrubs, no shoes, bracelet ID; if you swallowed something, you have charcoal paste on your lips and in your stomach; if you tried to go by way of injury, you are stitched up or otherwise mended in what can only be described as some awkward blend of the tiniest bit of relief (Oh...alive still...huh....) and a heaping load of shame. Because guess what? YOU FAILED.

Couldn't even kill yourself. Now THAT'S depressing.

As you work to recover from this most recent crushing blow to your ego, you discover you are in what is called an "involuntary hold" at your local hospital's mental health ward. You cannot leave. You are viewed as a list of symptoms. And you are grilled, over and over again, on the who-what-when-where-why's of your emotional history and your decision. You are treated as an immature child who should have known better. You are just a step above cargo, being dispassionately freighted and evaluated from one nurse or intern or doctor to the next, in between lackluster "group meetings" with your fellow failures where you discuss "stress management" and pick music that helps release your feelings.

At long last, they arrive at a diagnosis. Doesn't matter what it is. You have one. You are now permanently and forever the Property of Psychiatry because YOU ARE MENTALLY ILL. Now before they can let you leave you must become "balanced," and they will do that by throwing meds at you.

Don't want them? You won't think to muster that kind of argument because they will be VERY insistent that you take them, won't even really ask you if that's what you'd like, just go right in for it. If you insist on not taking meds, they can't force you....but you might end up taking them anyway because a) You don't realize the danger or b) It will help you get out faster. And it will - it makes your "safety plan" more convincing.

Now that you are Mentally Ill and On Meds, you need an Outpatient Psychiatrist. And you will be stuck with them (or someone like them) for as long as you are on meds. Which will be until a) You are "cured" (this almost never happens) or b) You go cold turkey and suffer some horrible withdrawal symptoms.

All because the world just wasn't doing it for you one night...

Am I being melodramatic here? Maybe the teeeeeeeeeeeeensiest little bit. But my point stands: psychiatry is often thrust upon us unwittingly or even unwillingly because it is revered by the entire culture as the only effective means of dealing with distress, especially when severe enough to cause you to be "a danger to yourself or others." In the Culture of Psychiatry, suicide is illegal, and punishable by internment, followed by medication. Sounds radical, but talk to some people who have been through this process and I'm sure that many of them will agree with me.

Which leaves me with just one big question: does any of this sound like it is actually decreasing the distress of the people it is supposed to be helping!?!?!

No, it doesn't, because psychiatry isn't actually about that. Psychiatry is about creating and maintaining categories of "wellness" and "illness," pursuant to the mental and emotional state of its subjects. Many of its practitioners think they are trying to help people...some of them are probably succeeding. But the institute of psychiatry on the whole is a system of containment, as evidenced most clearly by the Psychiatric Hospital, as described above.

On behalf of psychiatry, I can say this: Meds do something, usually. But whether or not they actually "help" is often a matter of measly guess and check between the doc and the patient. Are the meds helping, or is the person just getting better at dealing? Do they make the person feel better, or just less able to feel pain? Many people suffering from what is called "depression" take their meds because feeling nothing is better than feeling abject misery. Some people take their meds because they work for a few weeks, (and there is a very good chance in many cases that this is simply a placebo effect), and then keep taking them after they stop working because doing so makes them feel even worse.

Sometimes, meds seem to help. There are some cases where they seem to actually, truly keep people's minds more sorted and allow them to deal with their issues. But dealing with the issues, in my opinion, is what is most paramount - and psychiatry often distracts from this issue by focusing on meds, and foisting the burden of "chemical imbalances" on people suffering. This label, "chemical imbalances," says "you are Psychiatry's property and only Psychiatry can fix you," thus effectively blocking out any and all possibility of distress being the result of environmental factors, like trauma or no support structure. Psychiatry does occasionally check for these things, but it is usually under the guise of "these things are making your chemical imbalance worse." Why is there never an investigation into the possibility that this supposed "chemical imbalance," (virtually impossible to prove, by the way), is a result of the circumstantial factors? Because Psychiatry has to own the discourse, and admitting that our society itself is responsible for the patterns they call "mental illness" would be to give its patients over to sociology. Instead of deviants in need of treatment, they would be victims in need of advocacy and activism.

Hmm. What a thought! I might be on to something there....

This brings me to the subject of "mental illness" and what Psychiatry is doing with it, but sadly, I think I will have to save that for another rant as this one is already getting pretty ranty. (I dare say I'm competing with Mo Willems' "Ranting Swede," if not for eloquence, then certainly for candor. (^.^)b)

I would love to hear anyone's stories about how Psychiatry has actually made them more distressed than anything else; how medication interferes with healing; articles/studies that expand on these threads of discussion; or any questions/comments and yes, even (respectful) challenges about the ideas I've presented here. Thank you very much for reading, and as always, I am happy to accept suggestions for future posts.

To the New Mad Nation, I bid my salutations.

-R

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