Thursday, March 31, 2011

"Depression Myths," a study of AOL writing

Greetings, citizens!

Today I am going to analyze an article written by an AOLNews staffer, Jordan Lite, drawn primarily from comments he obtained from one Doctor David Sommers, later referred to as "Duckworth." (I cannot for the life of me understand why, but I will play along and hope I have just missed something here.) Hopefully this will help give my sometimes too-philosophical rants a grounding in the concrete realities of mental health discourse.

Please read the article in question before proceeding.

First, let me just say that the author has some interesting wording in differentiating between "depression" and "the blues," which I guess I can't exactly fault, but still feel odd about. "The blues," in this context, seems very invalidating, and I think that any upset or moodiness, whether full-blown depression or not, still deserves to be taken seriously.
Anyhoo, that being done, I am going to discuss the article's handling of each myth.

1. "Myth: Depression only affects women. Fact: Depression affects everyone."

Well, right from the start I'm upset because we are talking about "depression" as a mysterious entity that affects people, which displaces the sense of affliction from social, or even physical causes, onto a blameless "illness" that can only be studied by Psychiatry. Temporarily ignoring this somewhat fetishistic practice, (fetish, in this case, meaning "an object that stands in for something else, while absorbing all of its potency), I will concede that it is true that everyone is capable of being depressed. It pains me to hear of "depression" as a "thing" that affects people, however.

As a quick side note, a recent guest on the Colbert Report suggested that it is always important to "start with 'a person' first;" he was referring specifically to developmental disabilities, suggesting you never call someone "Autistic," but rather, "'a person' with Autism." Though this still suggests that Autism is an entity, it takes away some of its autonomy, as the entity now only has meaning by being "with" the person in question. This is different from something like "depression" because the condition of Autism is, as far as I can see, life-long and innate - though please, please correct me if I'm wrong here. I stop to mention it here not because it really relates to my argument directly but because it is a very important thing to think about.

Getting back on track, then, the article explains how depression "affects" everyone for various reasons and how people find various ways to cope with it; how men are more likely to seek alcohol or drugs, and are therefore less likely to be diagnosed as having "depression," but they still "have" it. Barring the over-medicalized language, I agree with this assessment. The state of being depressed can happen to anyone for a variety of reasons, but I believe women are more likely to be identified with it because of social scripting. But it does happen to men and in some ways it can be even more crippling when it does, because there does still exist a stigma against men being depressed.

Don't believe me about the stigma? AOL had to write an article just to address the myth about it. Sad.

As another quick sidenote, this stigma about men and vulnerability is all-pervasive - rape is another particularly virulent one, which I mention because it is extremely important, AND because it leads to poor mental health when a man is not believed about his survivorhood. 

2. "Myth: Depression is an adult problem. Fact: Children can get depressed, too."

Agreed, 100%. The article hits on a very important point here when it addresses that adults are often better able to articulate their feelings of depression and therefore have more of a voice to be heard; children and teenagers will usually express their pain in other ways, ways that the adults in their life are not necessarily trained/willing to read. Personally, my depression was written off almost exclusively as "teen angst." I don't believe that exists - I think people get depressed when, in the teen years (sometimes earlier), they realize how horrible the world can be and see it starting to affect them more.
I think we will all be better off when we stop making excuses for other people's misery - that is, explaining it away as something that doesn't require attention - and start taking care of each other.

3. "Myth: Depression isn't a medical problem; you could get over it if you wanted to. Fact: Depression is a medical problem that can require help to get over."

What I like (by which I mean hate with the white hot passion of a thousand suns) about this one is how, like is so often done in Psychiary, "getting over it" is pitted as a direct and exclusive opposite to "medical problem." They work oh-so-actively to suggest that if you can't solve a problem through pure grit and willpower, it must be a medical issue that requires a doctor to save you. By that logic, failing a math exam is a medical problem! More poignantly, by that logic, getting robbed at gunpoint is a medical problem.

Some things you can't fix or solve on your own, but that doesn't mean you have a medical problem. Virtually every experience imaginable becomes coded in chemical and cognitive pathways in the brain; it's called "learning." And sometimes, medicine/therapy can help to intervene in those pathways and alleviate some of the negative emotions that come with. But in my experience, more often than not, this kind of tinkering will deal with half of the problems at most, while burying the remainder under self-doubt. Even when medicine acknowledges the social influences largely responsible for feeling depressed, it puts the onus of not being depressed about it on the person in question: it suggests that depression is caused by your own natural inability to handle being in a depressing situation. Medicine can't do anything about the hurtful people in your life, so they relentlessly encourage you to focus on how you need to change.

But all of this is missing the point that you shouldn't have to change if the people who are upsetting you are not also being asked to change, and they rarely are. I think medicine would make flying leaps and bounds if it focused more on helping people who were depressed find ways to deal with being depressed, rather than trying to make depression go away. If you can't deal with the social problem - and that's what depression really is in my opinion, by and large - then at least acknowledge it exists and that medicine can't cure it beyond acting as a salve at best.

4. "Myth: Depression is all in your genes. Fact: Depression runs in families, but genes are not determining factors."

The actual language of the article in addressing this summary is very confusing. The author suggests that identical twins raised in separate settings are likely to have the same status with regards to depression; initially, that suggests genes to me, but then again I also understand that identical twins are often given the same treatment regardless of home life setting, because they are identical. This confounds the nature/nurture argument.
All that aside, I'm glad to see an article suggesting that depression might have something to do with environment, like family setting, which I assume is how they differentiate depression "running in families" from genes being "determining factors." I agree whole-heartedly. A genetic predisposition may make you more likely to experience the feelings of depression, but environment is ultimately what's responsible for it. If there's nothing to be depressed about, you probably won't be depressed. The trick is figuring out what is depressing you, which isn't always obvious, because we don't talk about such things very often in our society.

5. "Myth: Depression is a normal part of being a teenager. Fact: Adolescent moodiness is not the same thing as teen depression."

Hmm. I have mixed feelings about this part, because I think it uses a problematic approach to "normal." If by "biologically imperative," then I agree - hormones and puberty do not a depressed affect make. But in response to the world around us, I would argue that being depressed is a pretty normative response, one that is often quashed by the expectations of our social groups. A teen may feel suicidal but not say anything because they know they "aren't allowed" to; maybe they have lost all interest but no one notices because they aren't allowed to do that, either. Regardless of whether it is a "normal" experience or not, however, the lead weight feeling of depression is different from sadness and anxiety, and I appreciate that the distinction is being drawn. I just hope people will understand that you don't have to be talking about hating all of your friends and wanting to kill yourself before it is "bad enough" to qualify as depression.

6. "Myth: Antidepressants will change my personality. Fact: Antidepressants won't change one's personality."

Feh. The language of this part of the article reminds me of the contemporary semantic debates about what's going on in Libya. No, antidepressants won't change your personality, they'll just change how you feel about yourself and others and the entire world. Okay, I may be going a bit overboard here - maybe - but my point stands that medicine can flatten you out. The doctor Duckworth suggests that there is no consistent evidence concluding that medicine will impede emotional range, but I think that is pure bullshit. Even if no official studies have ever been conducted, or have all been confounded by some extremely high-paid, interest-funded study (psychopharmeceuticals make BANK), I can tell you from personal experience and the experience of my friends and loved ones that many anti-depressants will flatten you like an iron. For another take on this concept, I refer you to the stellar, if somewhat gross, Furi Curi anime (it's only 6 episodes and well worth a dedicated watch).

Kudos to Duckworth for acknowledging that pills can't do much to help with persistent negative thoughts, however, and focusing on what they can do: physical alteration. Sleep, eating, etc. Give me a pill that helps me get to sleep on time and eat what I need and not be exhausted all the time, and I'll show you a pill that anyone who is depressed could probably benefit from, if that's all the pill does. Of course, with side-effects, pills are usually not so forgiving.

7. "Myth: Antidepressants help everyone. Fact: At best, 60 percent of people get better with antidepressants."

More kudos to the team at AOL for acknowledging medical limitations. As the JAMA article suggests, most antidepressant medications are about as effective as placebos, and many are going to come at a high cost anyway. "Psychotherapy" is seen to be more effective. I say we take it a step further in that direction and say that the people causing depression ought to be getting psychotherapy! Or if it is not a person but an overall situation, well, more energy towards improving it, when possible.

8. "Myth: Women with postpartum depression are bad mothers who kill their children. Fact: Postpartum depression isn't a character flaw, and psychosis is rare."

The fact that this myth even has to be addressed makes me want to cry a little, and it shocks and offends me. But if it must be done, I'm glad AOL is trying. I pretty much agree with the rest of the article on this point.

Thanks for sticking with me, citizens, and cheers to the New Mad Nation.


Thursday, March 24, 2011

Extremism and Madness

Salutations, New Mad Nation.

I'm starting to get sick of that greeting. It may be gone by next time. Savor it, just in case!

That said, let's turn to today's topic - Extremism and Madness. One of the forms that Madness can often take is a passionate extremism. The Mad, such as myself, are furious with the world around us for all its injustices (towards us or otherwise). We see the world in a very specific way, pursuant to our careful deliberation on reality, a deliberation necessitated by the threats issued to us by that reality. Though many Mad people undoubtedly have very different conclusions about the nature of things, they are more likely than not to be extreme about it.

This is one of the things that is likely to get people (re)branded as "mentally ill" if they are not careful.

If you are surrounded by people who are not as mired in the Academy, your extremism might only be viewed as annoying, or a sign of your stupidity; if you're lucky it might even get you endeared as a lovable cook. But where Psychiatry/the Clinic has its hooks in your peers, extreme attitudes are most often associated with some kind of mental illness. Believing that you are right about something that you have passionate belief for can, when expressed with too much vigor, be seen as a variety of disorders - a manic episode, borderline, antisocial personality, you name it. Whatever symptoms they can attach, they will, because the Academy and its supporters (unwitting though they may be) do not like extreme thinking.

You might say that in a system concerned with mental hygiene, extreme thoughts are considered unsanitary.

Disagreeing with parents can be seen as "Oppositional Defiant Disorder" in the wrong hands. It really isn't a far cry from there to saying that a revolutionary with plans to destroy a corrupt system has some kind of disorder as well. You may have noticed that many crimes are unnecessarily linked with a mental health condition, and I believe this is a deliberate tactic on the part of the American animus to further entrench the sense of "otherness" to social deviance. In short - medicine is used as often as possible to explain away any legitimacy behind the motivations of those in direct opposition to the dominant culture.

It wasn't that long ago that slaves were considered to have a mental illness if they were not happy with being slaves.

I think people fear extremism because they see that when you are passionately dedicated to a set of beliefs, you have few friends and many enemies. And most every message we receive from the culture around us suggests that this is wrong - that it is better to compromise on beliefs, at least a little, in order to preserve peace and harmony. Never discuss politics or religion when meeting a friend's family, for example; in fact, maybe don't discuss those matters with anyone at all. Perhaps people are bitter about having had to let go of their convictions for the sake of convenience? Whatever it is, many people see extreme beliefs and hate it; they will start by calling it immature, but eventually it works up into frustration, anger, and the eventual accusation that there is something wrong with you, because clearly you'd have to be insane to stick to your guns for so long.

Hmm. Maybe so. But I don't think that's a bad thing. Because the peace and stability that ambivalence has been working so hard to uphold is not peaceful or stable to the Mad - it is oppressive and suffocating. What is the point in trying to make peace with your neighbors when their very mode of existence is insulting? Better to avoid them altogether, in my opinion. Many people seem to believe that happiness comes when there is peace between people, and that may be true, but peace is not the same as agreeing not to argue about things you violently disagree about - that is a truce. And a stagnant, muddy truce. A quagmire, even. Not good in my book.

At some point, you may have to try to get over it; somehow, we have to find a way to live and get along. Extremism shouldn't take the form of trying to violently persuade everyone around you, because not only is it rude, but also extremely ineffective. But neither should having extreme views be seen as a bad thing. It is one of the great pleasures of Madness - a freedom from ambivalence. And it is convictions like these that change the world.

How can we call so-called "manic episodes" a mental illness when they have led to some of the greatest breakthroughs in human history, in art, science, culture and exploration? How much incredible development is the result of this beautiful force, this driving rage towards accomplishing what must be accomplished?

And yet, how much horror. Similarly extreme convictions have led to genocide and suicide bombings.

What makes one kind of extremism different from the other? Whenever there is a controversial issue, those in support are always viewed as extremists, but whether that extremism is viewed as brilliance or insanity is entirely up to the history books and who is reading them. I submit to you that there is nothing inherently wrong with extremism - it is Madness, and Madness, like any other identity, is not wrong. It is as prone to goodness and badness as any other identity.

Psychiatry gives nods to the creative benefits of things like "mania." But I feel pretty confident that support would run bone dry once the crosshairs of that brilliance are leveled against the institute itself. People appropriate the language of mental illness to define those who are branded by it however they wish; if you are "Bipolar," and you have a brilliant idea, then those around you will call you "Genius!" if they agree, but "Manic! Did you take your meds?" if they don't.


Thanks as always, New Mad Nation. See you next week.


Thursday, March 17, 2011

Where it shall be okay to not be okay

Salutations, New Mad Nation!


Now, this may seem like a strange thing to say, and I admit it may be a bit over-dramatic, but only maybe - happiness can be a real problem when applied incorrectly.

You see, all emotions have their inherent truth and value. When they are twisted away from those truths, are forced to exist in conflict with them, then real suffering can begin. To whit, even the feeling of happiness can be a terrible burden if it is somehow instilled in you despite wanting to be upset about something; ever had someone try to make you laugh when you're furious at them? Sometimes it works, and you actually feel a bit of happiness coming on because of the funny joke, and it is painful to be happy in that moment because you do not want to be happy.

And sometimes that's okay! If we were happy all the time, there would be no discontent, no dissatisfaction, and thus no progress whatsoever. Now, proponents of Eudemonia may tell you that when everyone is happy all the time, no more progress needs to be made, for perfection has been attained; they may even be right, but that's not the reality we live in. We live in a reality where things happen that we should be upset about, indeed be Mad about, and when people try to make us feel happy when we should be upset, it is MADDENING.

People do this all the time, however. As in the above example, a person may try to make you happy when you are mad at them in order to resolve the situation; but people go a step further than this and will try to make you happy when you are angry at someone or something else, just because they don't like dealing with anger. This is doubly true when you are hurt by someone else, because people don't like dealing with pain.

One of the questions that people ask most often of someone hurting is, "Are you (going to be) okay?" They ask this question with a very strong implication that the answer should either be "yes" or at best "no, unless you do something that would be very convenient for you to do." Now, having been around lots of pain myself, I understand the desire to make it go away; pain is scary whether it is in you or not. But trying to replace it with an emotion that is inappropriate to the situation is only going to bury that pain more deeply and make it fester, ultimately deepening the suffering. Furthermore, should the person afraid of pain in question succeed in replacing the pain with happiness, there may be added injury from the shock of being forced into an emotional state incongruent with the experience.

I think that on a basic level, most people understand this. What they refuse to understand is how many situations merit being upset. They don't understand that being upset is a natural state of being and that it is okay to live with it for as long as one needs to; at most they pretend to understand this, while asserting that they know how long the person needs to be upset better than the person. Any time someone says "aren't you over this yet?" they are doing this. Now I'm not saying you can never ask someone about their progress in dealing with an issue, but to assume that they have been upset "long enough" is to assume you know the situation in their emotional world better than they do, and that is simply wrong.

People do this because they find our discontent upsetting somehow. Well, I can't criticize a person for wanting to change something that upsets them; that is the principle behind this blog, indeed, this movement I call the New Mad Nation (current citizenship somewhere around 5, but it'll grow). But I can criticize them for being upset with us just for being upset. In my opinion it is selfish and shallow. As human beings, we owe it to one another to bear a portion of each others pain, instead of forcing each other to just "get over it."
I think people are upset by us being upset because of the aforementioned "Rule of Happiness." They believe that happy is the only good way to be, and anything else is pitiable. They believe that happiness is such a good thing that people should always be moving towards it and that if they aren't getting there, then something is wrong with them (or they may even be Bad people themselves). You can see it all over the media; Heroes always either start and/or end very happy, and villains always end sad. Not a terrible message as coincidence, but it seems like the happiness/good heart of the hero is what makes them strong, and that the sadness and bitterness of the villain is what makes them weak. Actually, this is a great topic and I will probably dedicate another blog to discussing things like "strength of friends" and "bitter loner" tropes and how they relate to mental health, but for now, suffice to say that "goodness" and "happiness" are very often linked to the point of synonymity.

This leaves the legitimately depressed person in a bit of a bind. After some things happen to you, happiness does not make sense. A great theoretician, Theodor Adorno I believe, once famously quoth, "There can be no poetry after Auschwitz." His point was that certain horrible events can so strongly alter the soul that former modes of expression are no longer viable. So, for many, it does not make sense to try to express yourself through happiness.

Yet this is expected of us from nearly every corner. Jobs don't want to hire you if you aren't happy all the time. (I just applied to a job that demanded a positive and upbeat attitude ALL THE TIME, which to me seems fucking ridiculous - the job in question was a concierge, but what if the customer doesn't like happy people? Being upbeat and happy all of the time will make such a customer feel alienated and upset, or maybe even scare them away from being able to ask for anything. Stupid.) Many people don't want to be around you if you have a gloomy outlook on anything. Optimism and cheery attitudes are considered the hallmarks of good, successful people, and anything else is looked on as misfit and appalling; a sometimes-acceptable quirk, at best. I maintain that these qualities are not necessary for being good people, or even good workers. It has been scientifically demonstrated that depressed people have a more accurate view of reality, on average, than do people who are not depressed, yet this behavior pattern is considered unacceptable and in desperate need of eradication.

Now, to clarify again, I am not saying that people should all just go and be depressed. What I am saying is we shouldn't clamor for happiness to the exclusion of those who still need to be depressed. Yes, need to be. If the situation is depressing, then we need to be depressed about it, or else we suffer cognitive dissonance and extreme psychic pain.

To the people who believe happiness is the utmost perfection and something to be sought at all costs, all I can see is that you should actually be willing to fight for it then. Instead of bullying your upset friends into "perking up," go out and change the things making them upset. If no such change is possible, accept that happiness may have to wait and be upset along with them. That's what being an advocate is all about.

I believe in a world where it shall be okay to not be okay. Where one's worth is not dependent on one's ability to be happy. Where "health" is measured not by the width of your smile, but the depth of your feelings. After all, the bitterest medicine is often the best thing for your health, while the sugar-sweet candy is what rots your blood to begin with. Too much happiness can be a dangerous thing when society is still capable of producing every human evil imaginable, and much closer to your home than happiness will let you believe.

The truth is often depressing; if you can't be depressed, you can't see the truth.


Thursday, March 10, 2011

Marxism and Mental Illness (part 1, probably)

Salutations, New Mad Nation.

Back on time, finally! With sadly very little to inspire me. But I must post, for it is a challenge I have set myself to keep my academic and revolutionary gears turning, and to ensure that my body of work continues to expand and self-refine. So with some reflection I turn to a more philosophical rant I've been incubating for over a year now. Without further ado:

Marxism and Mental Illness (part 1, probably):

Marx once said that religion is the opiate of the masses. I have mixed feelings about that sentiment, but I fully agree with his suggestion that concepts such as religion are utilized by more "dominant" classes and institutions to quell the sense of rebellion in the oppressed. Psychiatry is now a more relevant example of this practice. While religion is still used for the purpose of quelling insurrection, (to this day, there are many who refuse to engage in the politics of this world because they practice a form of material apathy, or even because they believe that the apocalypse is right around the corner!), it can also be used to incite it (for example, Dr. Martin Luther King Jr.)

Psychiatry can never incite rebellion because it is designed to inhibit the formation of community. People in psych wards and support groups are discouraged from ever contacting one another on the outside, and while in some respects this can be beneficial (keeps the few who are actually "dangerous" from their predations), it also is extremely limiting. People can not form a sense of community around their identity of "mentally ill" because it is an identity forged from the need to "no-longer-be-this." Even without the MI label, the identity of "distressed" in any way is generally viewed as also "dysfunctional" and to be avoided at all costs. This is because of the psychiatric model of evaluation, diagnosis, treatment, that does not allow for the validity of continued distress in response to continued environmental cause.

I want to say that the new opiates of the masses are paxil, lexapro, welbutrin, and zoloft, but this explanation is too pedestrian. The drugs themselves are not inherently the problem. In some cases, it can even be said that these drugs are extremely helpful in bracing an individual to face their situation. The real opiate here is Psychiatry itself, which encourages us not to look at behavior as a valid response to distress, but an invalidating condition that is to be diagnosed and contained. Just like the religion of old, Psychiatry makes the laboring lower emotional classes turn away from the oppression they face from the emotionally privileged, seeking refuge instead in the mostly empty promises of salvation offered by your local P-doc. Obsessed with the concerns of making our emotional and mental state square with the rigor of Psychiatry, we become blind to the circumstances that have engendered this need for some kind of comfort.

Of course, as with religion in an early Leninist approach, I will not say the psychiatry is 100% without its place. There are some for whom medicine is important, or even necessary, at least according to some experiments and testimonials. Perhaps, as with standard religion, there are circumstances where non-social help is required to aid with pain of the soul. But it should never be the case that these things - Religion, Psychiatry or otherwise - are elevated to the status that they obscure our vision of the oppression that faces the emotional proletariat. They should be, as Lenin said, a private matter.

In my opinion, in the public eye, psychiatry has no more place for determining social motion than religion.

Let me elaborate on the concept of the emotional proletariat. Marxism 101 teaches us that there are 3 basic classes in any economical system: the worker class, or proletariat, who own little to nothing and make a living by working for someone above them; the artisans/merchants/shopkeeps/etc. or bourgeoisie, who control some significant aspect of the means of production (i.e. land, facilities, resources, etc.); and the ruling class, who create the sociopolitical and economic structures that largely determine the action of the classes below them. In a typical example, one might say that a farmhand is proletariat, the farm owner is bourgeoisie, and the government that determines the taxes, levies, and other laws concerning the production of produce (or the landed gentry who have paid off the government in question) are the ruling class. It is my belief that this model, while a tad overly simplistic perhaps (these days theorists tend to view class relations as somewhat more fluid than this), is a useful basis for understanding the way that emotional health and value is produced in our society.

Instead of produce, let us consider the concept of health and stability. An emotional proletariat would be the group of people who have no agency to produce health and stability on their own, and to do so must work for the emotional bourgeoisie, who control the means of production of health and stability. The ways in which the bourgeoisie are allowed/encouraged to do so are determined by the people "in charge" of health and stability, which in my example would be the Psychiatric Institute.
The lynchpin of this analogy is the language of "mental illness." In my model, "mental illness" stands in place of the taxes, levies and laws concerning produce. "Mental illness" is the way in which we, as a society, create meaning about health and stability. Those who have "mental illness" are not healthy, those who do not have it are. If we consider the perception of "health" to be a form of social capital, everything starts to fall into place. You see, those who are "mentally ill" are the proletariat. Those who are not, but subscribe to a belief in its validity, are the bourgeoisie. And Psychiatry is the landed gentry that determines that this shall be the order of things.
People conclude they are healthy because they aren't MI. In other words, those who have been diagnosed as MI are laboring with their symptoms, their struggles with Psychiatry, in order to produce the feeling of health and safety for their non-MI counterparts. This relates to the idea I discussed a post or two ago, about how the language of MI allows people to not examine their own unhealthy behaviors. The only unhealthy behaviors that seem to merit attention are the ones labeled as MI. This is believed because of psychiatry's omnipresence.

My fellow citizens of the New Mad Nation, WE ARE BEING EXPOITED. Our suffering makes others feel better by comparison - ever hear of Schadenfreude? - without them having to examine their own emotional and cognitive failures. While we struggle to eke out an existence according to the terms defined for us by the upper emotional classes, they can sit happy and contended in the belief that they are healthy and we are sick. They claim they are trying to help us, but all they are really trying to do (unless they've taken my crash course in care or something similar) is continue to enforce the existence of an emotional proletariat by creating a system where both Psychiatry and MI/non-MI stratification is absolutely "necessary" for the health of the people.

Historically, communism doesn't work. That's not necessarily what I'm advocating here - though the idea of a society where health is a value determined communally, and not by some gentrified edict, certainly has its appeal! But I do believe we live in a society of emotional classes where many, if not all, of the "mentally ill" are being exploitatively categorized for the sake of creating a false standard of what "healthy" is - a standard which, not coincidentally, is totally in line with the status quo. In short, psychiatry is the ultimate counter-revolutionary institute.

By the way, those of us who believe we possess the means to determine health for ourselves (virtual bourgeoisie), but who wish to do so beyond the limits set by Psychiatry, are outcast. Not fitting into the system, we are Mad. And sadly, so overarching are those limits, we often end up forced into a proletarian role, as our Madness serves the same function as most MI - making the non-MI feel "healthy" by comparison. Especially if our Madness stems from a non-functioning MI diagnosis to begin with, as it often does. One who suffers emotionally for any reason must eventually end up in one of these categories with society structured in its current manner. They will either "get over it" and remain bourgeoisie, "healthy by comparison,"; they will descend deeper and become the proletarian "mentally ill;" or they will reject, be Mad, and either get completely ostracized or reintegrated as another form of proletarian "other."

This is revolutionary, ground breaking theory. I'm still hammering out the details and honestly, if/when I go to grad school, I plan to focus my studies on developing some form or another of this theory. So...just something to keep in mind.

As to what to do about this? Well, a proletarian revolution wouldn't accomplish much, since we seem to be the minority for now. Perhaps it begins with convincing the majority of the bourgeoisie that this system of production fails; as a result, Psychiatry would eventually have to redefine its own approach in order to retain legitimacy, and maybe this otherizing MI approach will finally be cast aside. Stigma will slowly fade and people will start exploring their emotional and mental weaknesses and strengths with a strong and critical eye, turned towards their needs and fears, as a normal and encouraged part of social growth; those fears will be listened to and communities will evolve to meet everyone's needs, rather than shouting down the MI concerns as "other" and irrelevant; maybe we'll all be good to each other by the end.

Aren't dreams pretty?

Thanks for dreaming with me. To the New Mad Nation, I bid my fondest salutations.


Friday, March 4, 2011

"Mental illness," Disabilities Documentation, and Subjectivation

Salutations, New Mad Nation!

Once again, I apologize for my tardiness. A day late but hopefully not a dollar short - I'd like to deal with something pretty big tonight. I'm going to crack my knuckles here and try to translate one of the preliminary tenets of my ideal PhD on identity and performance theory into "lay terms," while dealing with a very practical issue - how to get institutes like a college or job to give you a fucking break.

As many already know, "mental illnesses" are often considered a form of disability, and there's a fair deal of back and forth between many camps over how exactly to break this classification down with respect to problems like the Americans with Disabilities Act. To the extent of my knowledge, the mentally ill are still not officially covered by it, and you can make of that what you will. If anyone can confirm this point one way or another for me, I would greatly appreciate it. For some insight on the subject of disabilities in the U.S., I recommend everyone check out the archives of this blog here: They have closed up, but the top article should have some nested links to other great stuff.

Now why am I talking about this? Because disabilities services and accommodations, as fraught with discursive violence as they may be, are not inherently a bad idea, and I believe they should be designed to extend to people carrying extra mental and emotional weight, so to speak. If you view "mental illness" as more of a "mental injury," as I have argued previously I believe, then a situation like "depression" might be likened to having broken a leg or two, and most institutions are now required by law to provide accommodations to such individuals. For example, professors will give extensions to hard-copy hand ins, since it takes people in a wheelchair longer than their non-wheelchair counterparts to get across campus. This is not unreasonable, I think - just a simple change in the expectations to reflect the capacity of the individual in question.

My heart carries a flicker of hope when I hear about how these accommodations are sometimes extended to students with "documented mental illnesses," because that means people who are depressed might be excused for being late to class a few more times than their non-depressed counterparts; or perhaps a student with some kind of "anxiety disorder" can be excused from an activity that would harm their health, while being assigned a worthwhile make-up activity. This is good, in theory.


But the reality is generally far uglier in terms of logistics, and extremely exclusive towards students who might need these accommodations most. And who is to blame in all of this? As you may have come to expect from me by now, I point the finger most strongly at the concept of "mental illness" itself. Let's start from the archetypal example.

You're a freshman in college. Holy shit. College. Honestly, you weren't even sure you'd make it through high school, but somehow you did, and yes, you made it here. You're out of that house full of horrible memories and your past is in another city/state/country, you're ready to move forward with new friends and a whole new identity. But you can never fully escape that baggage - you're still carrying it, and you've got the feeling it's going to slow you down in college-level academics. After that first week of intros to your classes, you've already realized you're going to have to up your game a bit, and you're not entirely sure how to handle it. Then you hear that there's such a thing as "Disabilities Documentation," and miraculously, it might apply to you! You got "lucky" and got a diagnosis on your way out of high school, so you're prepared.

With a signed letter from your psychiatrist, you march into the Associate Dean (or whoever is responsible for Disabilities services)'s office and have a little sit-down. They explain to you that they will send an email to your profs explaining your situation on your behalf, and then the profs will provide "reasonable accommodation." "Reasonable accommodation?" you ask. Well, turns out the school doesn't have the authority to set any particular requirements for mental illness disability accommodation, it's just heavily encouraged that the profs give you something. All the department can do for you is "negotiate" with the profs on your behalf (until they get tired of you and say "In the real world, we can't do this for you...")

Well, it's still better than nothing. Maybe you'll get a free absence out of this, which is great, because sometimes the depression still gets you at night and keeps you tossing and turning into the sunrise because your guilty conscience is just so good at conjuring those unforgiving phantoms when the moon is high, homework and productivity be damned. So you have your meeting and send out the letter and everything is swell.

Hmm. You've missed a couple of classes right now, and your professors are starting to get a bit edgy. You see, they understand "mental illness" well enough to know that it can be treated, right? But for some reason you're still missing classes. Now they understand that your illness may be affecting you, but why is it still affecting you so much? They sit you down to have a meeting with you. "Are you sleeping?" "Well I'm trying, but sometimes it's hard..." "Why?" "Well I'm, you know...depressed. I 'have depression.' Things can keep me up." "Are you seeing a therapist? A psychiatrist? Taking meds?"
This last part is the crucial thing. They are only willing to forgive your condition for as long as you are seeking treatment for it, and the only kind of treatment that matters, as far as they are concerned, is the kind that acknowledges your condition as "mental illness." It must be quantifiable and scientifically measurable in order for the professor to verify it.
Well, here's the rub. Maybe you aren't seeing that psychiatrist anymore because you're in a new state. Maybe you haven't found a therapist yet because A) School and B) That's really fucking hard. Maybe you don't have a medicine that just "works" for your depression-induced-insomnia because the pills you've tried have all induced night-terrors and you aren't in a hurry to try that again. And the more of these realities you face, the less patience your profs are likely to have. "You need to take responsibility for your illness, I can't keep giving you hand outs," they'll say, holding it against you.
Now, if you actually ARE on meds for your insomnia and you do have a local p-doc and therapist and they are all helping, you MIGHT get sympathy for your plight - you might not, and that is a problem all its own - but you might. If you aren't doing those things, you will get no sympathy whatsoever, regardless of your perfectly legitimate reasons for not doing so.

So already we see how the language of "mental illness" privileges those who are willing to embrace their "ill" identity and get "traditional" treatment. Anyone who has a problem with this is considered to "not be taking responsibility for their illness" and nor worth accommodating. But this is just with a basic case of something that CAN be considered a "mental illness" and often is - depression. Even if you don't identify as "mentally ill" or "clinically depressed," you can allow yourself to be "subjectivated" (that's your grad school term for the day) by the system, and accept the identity they allow you to have, at least in their presence. You can play the part for them to get the accommodations - you can see that p-doc for as long as your insurance will let you, pretend to take those meds, or whatever else you have to do to "legitimize" your condition in your prof's eyes.

Not everyone can do that. Conditions like "Bipolar" are still stigmatized like no-one's business, even in highly academic circles, but with enough insistence on the medical insistence - which often paints the "Bipolar" person as someone who is absolutely out of control without therapy and medicine, thus robbing them of all agency in their emotions and thoughts (see my previous post) - you might be able to get some aid and respect from the profs. The problem here is that you have to accept the illegitimacy that comes with the condition - Bipolar is a form of invalidity that can only be healed by medicine, and LOTS of it. It's humiliating.

It reminds me of Alcoholics Anonymous. I'm not going to debate the validity of alcoholism as a disease (yet, anyway, I have more research to do), but the principle is similar: something is affecting you, you are powerless before it, and everyone hates you until you give up and resign your miserable self to the Higher Power that can save you. But instead of the God or Spirit of AA, it's medicine. Professors or employers might think they are like the concerned friends who are showing you stern support, but all they are really doing is forcing you to sacrifice your personal truth for the sake of their construction of reality. What's worse, this is all probably at great actual cost to your health instead of benefit, if medicine is not right for you, which it may well not be.

But again, horrible as this seems, this is still a much-sought privilege in the kingdom of the Mad/mentally ill. There is the possibility of being a recognized and cared after subject. Even if you are totally humiliated in the process, you are still recognized as part of the caste. When you use the Institute's terms (medicine) to define your reality and others, you are part of the Institute; possibly still sick yourself, but Healing so you still count. Those not using the discourse are "other" and to be cast off or converted. To avoid being a hypocrite here, I might put forth that I tend to otherize anyone not using my discourse either, and my point isn't the crime of othreizing different discourse, but rather, that it seems problematic when all it takes to be "other" and cast off is not wanting to take medicine that doesn't work.

The reality that others face, a reality that keeps many from even attending college, is that their emotional and mental struggles get absolutely no validation because there is no "mental illness" to qualify them, that is, they cannot be diagnosed. There are others who can be diagnosed, but to do so would be to expose impossibly personal truths, something that many are not prepared to do (and given the company in question, they are justified). The first example might be seen in someone who, like me, has experienced "reality warping" where the sense of existence is altered in a way beyond language. Every doc I ever saw just scratched their head about this, but I assure you that it was very real and VERY hampering to my academics. Because of over-medicalization, though, I never could have tried to gain understanding on this issue, because without a diagnosis, it isn't legitimate.
The second example might be someone with DID. (Dissociative Identity Disorder, aka "Multiple Personality.") I'm going to do a profile on this condition some day, but for now, suffice to say that it tends not to happen unless something REALLY HORRIBLE happened to you. Admitting you "have this" might require you to admit that you went through something - it is exposing a weakness to teachers who have probably seemed pretty hostile up until this moment, not something easy or even possible. What's worse, the fact of being multiple people at once can feel extremely compromising - so compromising that it is impossible to bring that truth to light anyway. Besides, if you DO tell a prof or someone that you are Dissociative, then they will know forever and will always be judging you with that in mind, and probably from a really ignorant perspective. Suddenly you are expected to educate your faculty on one of the most personal and complicated conditions of your existence, all because a "diagnosis" and "treatment" plan are required to get accommodation.

Meanwhile, someone who doesn't suffer from their depression all that much because they have a good relationship with their therapist and decent meds, they miss a class or two per semester and get absolutely no difficulty from their prof whatsoever. This is because "mental illness" as a concept has favored them. 

As long as "mental illness" is valid, profs will need diagnoses and treatment plans to even considering granting mercy to a troubled soul, even when such things may be practically or emotionally impossible. In my opinion, this is another reason why the language of "mental illness" is basically unethical. Even if it can accurately describe some, it creates an incredibly unfair dynamic where those whose condition is "medical" get special privileges over those whose conditions are not.

"So Rius, are you saying that people who don't have any kind of medical condition should get disabilities documentation?"

Good question. No, I'm not saying that - I'm saying that the connection of "medical condition" with "disabilities documentation" should be abolished to begin with. In fact, I'm not fond of calling them "disabilities" either, but that is a very complicated point on which I am not qualified to comment (try the above-mentioned blog, instead). What I am saying is that, when it comes to mental and emotional situations, we need some kind of criteria other than "mental illness" and medicine for determining how to give people breaks, extensions, accommodations, and other nice things. I don't know exactly what it is yet, but there has to be something that works better than what we have now. Because what we have now assures that the least "unhealthy" people get the best service.

In other words, the chill get chiller, and the Mad get "sicker." Which consequently makes us more Mad...and thus the cycle continues.

Hope that all makes sense. Please comment to elaborate if you have anything to add, and of course, questions are always welcome.

As always, to the New Mad Nation, I bid my fondest salutations.

Sincerely and with thanks,