Thursday, February 24, 2011

How "symptoms" let jacks stay jacks forever

Salutations, New Mad Nation!

I have a bit more vigor this week than I have in weeks past, and I've been reading up on my social revolutionary texts, so I am quite enthused about today's Madness. This week, I will be addressing the institutional mechanism known as "symptoms," and how this discourse (structure of language and power) allows hurtful, ignorant people to remain that way indefinitely, thus furthering the gap between the Mad and the Chill; the marginalized and the powerful.

To begin with, I'd like to reaffirm a point I have made before and will make again and again: clinical psychiatry is not perfect. It is a very new science in the history of sciences - even in the history of psychology itself - and is based on quite a bit of speculation and other forms of "guess-and-check." As a friend of mine, and strong supporter of this blog, once put it - "It's like people just keep throwing darts of ideas at the wall, and what sticks must be good medical advice..."

Her analogy is incredibly apt. The results that "stick," so to speak, are the ones that seem to effect results, and are therefore labeled medically sound. To give psychiatry some credit, the project is up against some pretty remarkable odds - understanding the inner workings of the human mind is no small feat, so it makes sense that they would have to just try things on occasion. And, many studies are done in an attempt to repeat and verify the results as scientifically accurate. So they do put forth an effort, at least within the realms of their own epistemologies (ways of knowing). But in doing so they often miss things beyond the academy (like more social factors affecting mental health), and my more cynical self wonders is this is deliberate.

The point is, their solutions to problems may be repeatable and demonstrate effect, but not necessarily because their solutions are actually accurate. They are performing a mostly blind guess and check in many actual clinical scenarios, and when something appears to work they call it a success. But is the dart sticking, so to speak, because they hit the right target, or because of some other lucky influence? They will never know, and many of us may never know either. For example, I myself was put on a medicine called Trileptal, which is used predominantly in cases of epilepsy due to its ability to regulate the electrical activity of the human brain. They used this on me while I was in the hospital because of a hunch. "Sometimes this works in certain cases of bipolar, and your EEG's have been a little odd," basically. Except the truth about my EEG scans were that no one could come to any kind of agreement as to what they actually meant!

I "got better" after being put on Trileptal. But was that because of the medicine, or because I had been allowed to live out some of the torment building up inside of me, and was starting to regain my own control? I am beginning to suspect it was the latter, and that all the Trileptal did was make me yawn a whole lot and get me dizzy/cross-eyed on a regular basis. Oh, and make me totally chemically dependent so that missing a dose can cause pretty damn serious problems. Guess what? I've decided to stop taking that stuff.

Now, I have said all of this as a way of illustrating my preliminary point to this blog: medicine gets things wrong. Frequently. Yet for some reason, people on the outside of the system, people who are not being labeled and objectified by Medicine, are completely willing to trust its authority. Someday I will post my complete proto-Marxist Mad Manifesto wherein I fully explain this phenomenon, but for now suffice to say that it makes people feel better to place their trust in something, especially when doing so absolves them of responsibility.

Which Medicine cleanly does, when it comes to the matter of being a good and kind person, which should be every human being's responsibility. But when being hurt by people's cruelty can get labeled as "Depression," why should anyone need to be kind? "You're taking what I said too far...look, don't you think you're being unreasonable? I know you have depression and I just wonder if you've been taking your meds/seeing your therapist/whatever-the-fudge. I'm not going to talk to you like this."

Most women, Mad or not, should be familiar with this argument. It happens over PMS in much the same way - a medicalized situation lists "irritability" and "mood-swings" as "Symptoms." And "Symptoms" mean "Caused by the condition - AND NOTHING ELSE, GOT IT!?" In other words, any behavior you exhibit that can be classified a "symptom" of whatever condition you have, can be completely ignored by all other parties. Your right to emotional agency and adult maturity is completely stripped from you by the word "Symptoms." Because of this, people around you rarely have to change their hurtful behavior towards you. Even if they are "kind" enough to be careful about what they do/say in your presence, they will still think you are being silly and wrong, and this either 1.) Hurts like a mug or 2.) Wears on you to the point that you start to agree with them, which is possibly even MORE damaging in the long run.

To look at a classic example of what I'm describing, let's examine "PTSD" - "Post-Traumatic Stress Disorder." This brilliant little condition is what describes about 2/3rds of people who go through a traumatic event - TWO THIRDS. That is the majority. That, in my mind, means that the "disorder" should be the 1/3rd of people who don't develop this condition. But that would be normalizing distress, and we can't have that, now can we?

PTSD comes with a horrible reaction called "triggers." Triggers are words, actions, situations, smells, or any other stimulus, that cause the survivor in question to suddenly experience tremendous emotional and mental vulnerability, almost as if they are experiencing part of the trauma all over again - sometimes these triggers will even induce full flash backs. They are incredibly dangerous and it is desperately important that you respect the triggers that your friends who are survivors may have. Chances are you have at least one friend who is, and hasn't shared yet - or may not even realize it. Though PTSD is often associated with surviving war, it is also something that happens to many, many people who survive rape or sexual assault. It can happen to anyone who survives any kind of traumatic situation, even having abusive parents. And triggers can remind people of the experience of that trauma, and that is not something they need or deserve.

However, even while respecting triggers as a significant part of a person's condition, there lies a danger: the dread word "Symptom." Attach that word to the triggers and suddenly, a person having an emotional reminder of trauma is pathologized - it is essentially their own fault for not "putting it behind them," or at the very most gracious it is the fault of some nebulous "disorder" and no one is to be blamed. This will hold even when the person who caused the trigger by saying or doing something triggering was being legitimately hurtful or even invoking the traumatic event. They do not have to look at their behavior and say "Wow, behaving this way can cause people to get that upset? I wonder if I should reconsider my actions." Instead, they look at their behavior and, at best, say "Well, that person has a condition that makes them react that way to what I'm doing. I think I'll just try not to do it or talk about it around them."

This allows people to go on and continue doing hurtful, stupid things to others - people who have a PTSD diagnosis cannot gainsay it because of their "symtpoms," and people without the diagnosis or who have not been traumatized may still be hurt by it, if a little less.

Some triggers do not really require personal inquiry and change. Some people may be triggered by a certain article of clothing; others by a song, or perhaps a certain word. I believe it is fairly obvious that a person should try to refrain from wearing/singing/saying these things around someone for whom they are known triggers, but that is all one should really have to do. But if the trigger is, for example, being overly inquisitive about one's sex life, then we have a bit of a problem. You see, triggers are not always tied to completely irrational causes - sometimes a person can be triggered by a behavior that is a direct foreshadowing of much, much worse behaviors. And the perpetrator may have no intent of committing that worse behavior, but they should still ask themselves: what am I doing wrong, here? How might my behavior be linked to the survivor's trauma, and what can I be doing to change my behavior to avoid situations like this?

Instead, you will get people being totally dismissive; rather than viewing the trigger as a warning sign that their own behavior might be potentially dangerous, they view it as a malfunction on the part of the other person. I believe this is a crucial error: I think that many such triggers are exaggerated (but not inaccurate) versions of the same reactions that many people have, on some level, to the behaviors in question. A "non-traumatized" person might be asked about their sexual practices and feel uncomfortable, but answer anyway because they want to stay involved in the conversation and feel a certain interest at the prospect of this openness. But the "traumatized" person already knows from personal experience that such behavior can be a great way to open the channels for sexual harassment and predation, and so reacts not with discomfort, but violent fear. It is knowledge applied in an acute and rapid manner - it is NOT "just your PTSD."

But as long as the Symptom reigns supreme, people will keep making this mistake, and they will keep doing stupid hurtful things, because the only people smart enough to say anything about their hurtful behavior are bound to be labeled "mentally ill." This labeling renders their arguments pretty much mute. Even my own mother will always assume that "my bipolar" is the cause of something unexpected before she will heed the possibility that I've got a genuine point. To be honest, I don't know if it ever even really gets that far. And, well...that makes me Mad!

Hope I was clear tonight, I sense I probably got a bit ranty, and I tried not to stay too far into my theoretical academical journalabulous fantasticry. Would love for comments, questions, and just about anything else. Next week could be just about anything. But it may be about time for another crash course in care - barring, of course, guest suggestions. :)

To the New Mad Nation, I bid my fondest salutations.



  1. I've heard both good and bad things about medication. Aside from side effects (like the ones you mention above and others you've mentioned in other posts here), and the cost of paying for a medication that might be having no positive effect or acting as a placebo, do you find anything else objectionable about medication? Neither of those are an issue in my case, and I'm curious whether you'd have other concerns or objections, if you were me. From my viewpoint, medication has helped me at little to no cost (or at least, it acted as a placebo), but am I just one of the lucky ones, or is there something I'm not thinking of?

  2. Also, something else I just thought of. Regarding triggers, I'd guess that oftentimes people don't want to explain them to people, because then they'd have to get into personal stuff, so is there anything in particular that I should notice that suggests that something might be a trigger for somebody without them having to come out and say it?

  3. Very well reasoned and important questions, Natalie. I'm glad you asked them.

    Many people are helped by medication, whether by placebo or otherwise, it's true. By "helped" I mean they find they prefer their life experience with meds as opposed to without them. I do try to keep the benefits of medicine in mind and I definitely do not begrudge those who actually do reap those benefits. In my estimation, however, those are comparatively rare. The majority of people on medicine that I have spoken to are rather disappointed with the effects - they are preferable to not having medicine, but only just barely.

    As for things you may not be thinking of? Well that is probably the most important question of all. The chief problem with medication from that standpoint is that it can sometimes rob you of your agency in dealing with your issues - it becomes about the medicine, the science, the diagnosis, instead of about you, the person. What I mean is that we can sometimes forget, or even become unable, to fully process the experiences and feelings that have led to receiving a diagnosis in the first place. Of course, in some cases being on meds makes this easier. In others, it might be necessary at the first step, but that step taken, meds might prevent you from going further.

    One of the most commonly reported and dreaded side effects of psych meds is a "flattened affect." Feelings become harder to feel. This applies to sadness, but to happiness as well. It also applies to very important pain, pain we may not want to face but that will linger on inside us as emotional cancer if we do not. Medicine is very good at hiding that cancer. At least, that is my experience.

    I'd also be concerned about developing a dependency to the chemical that could come back to haunt you at a later date. What if medicine doesn't stay cheap forever? What if your use of it saps your ability to cognitively and emotionally process your condition/situation, so that if you are ever without the drug...what will happen? Having almost experienced that myself, I can tell you it is an incredibly scary thing. I recommend people try to get off their meds as soon as possible by finding some kind of alternative process for improving their mental health, if possible, to avoid this kind of crisis.

    When it comes to triggers, you've hit the nail on the head by concluding that people may not want to explain the triggers - indeed, it is usually a very painful story and having to explain it is often only a half-step away from having to justify it, an opportunity to fail and lose even more agency. So you definitely don't want to ask someone who has been triggered to /explain/ the trigger.

    However, if someone ever has a really bad reaction to something, it is safe to assume that something triggering may have happened - and it is okay to ask what went wrong and how you can avoid it in the future. Of course this varies from person to person and how well you know them, but I think as a general rule of thumb it would be fair to say "ask what the trigger is so you can make sure not to trigger it, but don't ask for an explanation unless precedent exists in the friendship."

  4. Finally! A man who understands how women feel about PMS! :P
    Its so incredibly frustrating how society teases with the thought that its ok to just assume that "she's just PMSing". It's not ok. Just because my body may or may not be having shifting hormone levels DOES NOT mean I am incapable of having rational thoughts and reasonable reactions to situatuions.