Thursday, June 30, 2011

No Madness this week

Due to mentnical (mental/technical) difficulties, Madness will be cancelled this week. Wish me speedy rejuvenation, Citizens, and we should be back to the regularly scheduled Madness next week.

Sincerely,
R

Thursday, June 23, 2011

The Meds

Greetings, Citizens.

About 1 month ago I was able to get off of medication. Truly, a triumph of the human spirit and the support and camaraderie of my friends over an over-medicalized, overly-drug focused Sanity Machine otherwise known as Psychiatry. I did this without asking for the advice of my psychiatrist, and without conferring with my parents, who have heretofore been fairly involved in my treatment. I didn't confer with them because I felt confident they would not be supportive. However, a few days ago I decided I needed to tell my family that I was no longer on medication. I had planned on telling them all along, I was just waiting for the right time, and I thought it was upon me.

Well....perhaps I was right. But it ended badly anyway.

Without getting into a lengthy explanation of the ensuing debate or some kind of undignified he-said/she-said, suffice to say that my family confirmed, with flying colors, their crippling dependence on a medical model of suffering and malady. It was kind of staggering, not so much because it was unexpected, but because of how incredibly unscientific the approach proved to be. They are convinced that I need to be on medication, because I must have some kind of chemical imbalance in my brain, with pitifully little evidence to support this theory. When I pressed this point, they cited my multiple hospital visits as evidence, and even confirmed their belief that an internal chemical imbalance is the only probable cause for such an event.


Why? Why does a self-avowed scientist cast aside all sense of inquiry, all sense of study, for such a ridiculously narrow-minded evaluation of a situation? If you ask me, Occham's Razor suggests "He was hospitalized because he was responding to stimuli" is more likely than "He was hospitalized because he had a strange, unobservable, inconfirmable anomaly in his brain." Scientists shouldn't attempt to classify something based on a cause that can't be studied, observed, predicted. It's one of the reasons why anti-seizure medicine makes more sense to me than anti-depressants - you can directly measure the electrical activity in someone's brain, and it has been repeatedly confirmed that certain electrical activity corresponds to seizures, and that certain chemical treatments can regulate that activity, thus helping the seizure (as far as I know).
And guess what? When they thought my problem might be seizure related, they took EEGs. Several. And none of them provided conclusive results; experts all just scratched their heads. So if anything, the science suggests my problem is NOT medical. Yet still a scientist insists it must be, because surely nothing else could be the cause.

How has this happened?

Some of it is undoubtedly due to personal hangups which are not really my intention to discuss, at least not in direct relation to my family. But some of it is due to the system itself, and the pervasive air of medicine and medical cause that thrums in our zeitgeist. The over-medicalization of health and distress by psychiatry and the media has gone so far as to actually undermine the scientific integrity of practitioners. This is my theory, anyway.

All advertisements for treatment for "mental illness" focus on medical treatment and medical cause; all drugs assume a chemical cause and even most therapy, although it is less often advertised, seems to assume that something is internally wrong. One virtually never sees any ads suggesting external causes for these things, except perhaps in a few rare cases such as domestic violence. And the advocacy community is not helping: the argument is about funding FOR PSYCHIATRY or insurance parity FOR MEDICAL TREATMENT, virtually never about changing the way a community behaves so as to limit the need for treatment in the first place. Even the people trying to make things better for us in the grassroots level, like the folks at NAMI, hyper-medicalize. Given all of this it is no small wonder that even doctors can forget that other things might be responsible for traumatic experiences.

Of course, the way I see it, this is fairly deliberate. After all, the more our health becomes dependent on medicine, the more the entire nation becomes dependent on a new service industry. That's good for the economy in theory, and moreover, allows the engines of our society's status quo to continue turning; because if the problems come from society, then society is a problem. And a cultural institute like psychiatry, whose heritage is the Enlightenment's project of turning the entire world into an encyclopedia, cannot tolerate the idea of society's nature itself being a problem, at least not in this advanced stage. Its office is to be the guardian of morality; the terminology has changed, but "mental illness" is basically the new state of Sin in our culture.
After all, rarely do you hear of a serious crime being committed without mental illness being dragged into the fray.
And only the priest-psychiatrists can heal you of this Sin. And oh, it's not your fault that you are a Sinner, you were guided into it by evil chemicals (or if you're lucky, other evil Sinners), and our holy chemicals can guide you out. But resist our love and our way and you are embracing the Sin, which is a blasphemy against Us and must be punished.

That's how it feels. Can anyone who has been through the experience tell me I'm wrong?

People make everything about meds. ALL THE TIME. It's like a permanent state of assumed PMS - "You were so moody today. Have you been taking your meds?" "Oh, you weren't on your meds? Well that clearly explains your behavior." It's as foolish as any other of the many baseless assumptions that fundamentalists of all creeds make, such as your homosexuality being caused by not having accepted Jesus into your heart. The only difference is that this brand of fundamentalism is endorsed by the APA, an organization that is solely responsible for endowing a university with the acreddidation necessary to confer degrees in counseling psychology. In other words, even though there are many ground-breaking programs out there that are trying to bring a humanist approach to the psychological and psychiatric field, they will never be able to produce accredited healers because the APA disagrees with their approach. So no one learns about the alternative possibilities...

So it is all about the meds.

BAH. MADNESS.

Sincerely,
R

Thursday, June 16, 2011

Mad Therapy

Greetings, Citizens.

It's Thursday...it's 12:51pm as I begin writing this particular Madness, which is much earlier than I usually get Mad on a Thursday, but I've been feeling particularly Mad lately and I just couldn't wait until this evening to discuss with you a very crucial issue.

Therapy.

Now it should be no secret to regular readers of the Weekly Madness that I am not a huge fan of psychiatry. Psychiatric meds have proven to be little better than a stopgap measure for myself and most of my companions, which I would not have as much of a problem with if it was better understood by the populace as a whole and Psychiatry in particular that this is the case. Though it is undeniably true that some medicine provides concrete and needed help to some individuals, it is equally undeniable that much medicine forces itself on unwilling and un-needing individuals in order to uphold a status quo, in the best of cases (personal vainglory and ambition in some of the worse cases.)

But there are alternatives to psychiatry for treatment, and one in particular that is more or less valued by the system at large, and it is called Therapy. My relationship with this strange entity is long, storied and rather complicated, and from it I feel I have learned much about Therapy's nature and uses. In today's Madness I am going to discuss the pros and cons of Therapy as a model for aiding the mental and emotional well-being of the Mad, and focus in on what specific things can make Therapy helpful or toxic.

I would like to begin with the most important disclaimer of all: the right time to go to therapy is when you want to try going to therapy and have the support necessary to do so. Not when your psychiatrist suggests it, not when your family pushes you towards it, and not when anyone in your life threatens to cut you out of theirs if you don't go to it. With only a very few outlier exceptions, therapy will be more destructive than constructive if you are not there willingly and with the support of those around you.

That said, people will try to "convince" you to go to therapy. To those people, I encourage you to reference my Crash Course in Care segment on being an advocate; to those dealing with such people, well....don't listen to them too much. Therapy has some things to offer and a lot at stake, so it is worth hearing out the testimony of others and reaching your own conclusion about the information presented.

Now, on to the topic itself. The big T. What is it good for, what is it bad for, and what are the signs and qualities of good and bad therapists?

Therapy is dangerous. You are walking into a room with a stranger and sharing your most intimate secrets, with absolutely no assurance of being judged fairly. You have to lay your heart and soul on the line every time you try out someone new, or discuss a new topic with someone familiar. Make no mistake, therapy is a stressful, scary process, even if you have a long-standing relationship with the therapist in question, and so it is best engaged in only if you have some kind of external support system to fall back on. Essentially, Therapy is best used as a supplemental processing tool in a stable, supportive environment. You need to know that, after the Therapy session, you can come back to a friend, roommate, parent or relationship partner who will be able to give you unconditional support in recovering from the session.

Very bad things can happen if you do not have this kind of support network in at least one person outside therapy. If you have no one at all, you may end up trying to find that unconditional support in the Therapist - this is particularly common of survivors of a few particular kinds of abuse. It leads to a very unhealthy relationship that many practicing Therapists will not hesitate to take advantage of in a most destructive way. If you do have a support system, but their support is conditional, or inadequate, or otherwise toxic, all of the work you process in Therapy can be completely undermined by that system. If you make an important realization, they may deny it; if your therapist makes a troubling suggestion, something you really aren't sure about, they may push you to consider it; ultimately, this dynamic creates and fosters the development of a dual state of being, where you are caught between your "true self" and your "patient self," the self you present to your family, friends, and doctors. They will be working on the "patient self" because the "True self" is not being spoken to or allowed to speak.

When I say "unconditional support," what I mean is unconditional support of YOU. That means, if you say "I hate this therapist and I never want to go back," their response is "Great. You never have to." Note: they should not ask about helping you find another one until it comes up organically in the conversation; Therapy must always be your choice.

Now, if you do happen to have that kind of support, then Therapy might be a viable option for helping you to deal with your distress. When the therapist is doing their job well, they will provide a sounding board for you to process your struggles off of, and can help you set goals and specific challenges in your internal processing. This can be extremely helpful for survivors of various kinds of abuse, as well as for people with any kind of powerful emotive cycles. I don't think there's anything wrong with a powerful emotive cycle, but you have to know how to ride it, and a therapist can be very helpful in this respect. Sometimes.

Sometimes they can be remarkably UNhelpful, however. If your issue involves an external source, the therapist's ability to be helpful immediately and sharply declines; if you are lucky, though, they may be able to give you some good ideas for how to deal with those external sources in a way that ends up working out for the better. But this requires you and your therapist to have a similar worldview of "better," and any schisms in this field become more noticeable when third parties get involved. This gets even force when the third party is not a person, but a concept or force.

One of the most destructive pieces of advice I've ever received from a therapist is the advice of integration. It is a very popular concept in psychology these days, and refers to the idea of coalescing the scattered parts of a psyche (or, in the case of people with multiple personalities, their various alters) into a single, working whole, thereby eliminating the conflict between those parts. To me, that sounds about as feasible as solving the Middle East crisis by taking every single country, dissolving their borders, and putting one big border around the whole area and labeling it "Middle-Eastistan." It is my fervent opinion that portions of a persona separate out because they need to. Trying to force, coerce, or even coax them back into a whole is to deny the truth of their purpose.
Now, it is possible that some fragments will eventually fulfill their purpose and, with no more reason to be separated, will begin integration on their own. That is fine. But it should never be assumed this is the case.

Trying to integrate certain parts of my psyche has led to terrible damage to my self-esteem and to some absolutely wild coping mechanisms on the part of those fragments at risk of integration. Reasonably, they resisted. It wasn't pleasant.

Having said all of this, I think we are beginning to get a picture of what Therapy can be good for, and what Therapy can be very bad for. But for Therapy to be good, the therapist must have certain traits, and they must never do certain things.

A good therapist must work for you, never against you. They must directly challenge only the most outright and explicitly dangerous ideas you present, and even then in a gentle, non-combative manner. They are the professional and you are the one who is proverbial on trial, so they owe it to you not to get defensive if you present an idea that they disagree with. If they can't do this, they have failed and should be dismissed.
They must never pressure you, but rather allow you to reach your own decisions and conclusions. They must be ready to engage with your issues in the manner that you wish to engage with them, and not try to force you to look at anything in particular.
They must not be Behaviorist in nature unless you have a phobia so crippling that you would rather go through a very disturbing therapy than continue to endure it, but even then I might recommend trying to find an alternative. I will probably rant about Behaviorism in more detail on another occasion, but the short of it is that in my humble opinion it is the purest bane of all healing psychology.
Edit 1: The following point is concerning therapists and therapy as it exists now. I am not inherently opposed to the creation of a system whereby spiritual and emotional counsel could be wed - indeed, I believe they should be, ideally. But most practitioners in the world we occupy are simply not prepared to do this effectively. That is my belief.
A therapist must never counsel you in spiritual matters. Even if you have the same spiritual worldview, spiritual counsel should remain separate from the active processing of serious emotional issues. Putting these things too close together is a recipe for disaster. Spirituality can help you with emotional processing, and therapy can hep you with emotional processing, but combining the two causes a bleeding over between various areas that just isn't wise to attempt to deal with. If your emotional issues are directly related to a spiritual matter, you may want to avoid personal therapy until you have enough of a support system - even if it is just through online forums - to try to separate these issues in your processing.
Similarly, I don't advise seeking overt emotional counsel from a spiritual figure in your life, but I am less insistent on that point.
This one should be obvious, but a therapist who is rude to you, insults you, belittles your intelligence, invalidates you in any way, or otherwise tries to harm or take advantage of you, is garbage and deserves to be disposed of. Immediately. This is usually hard to do, unfortunately, but if at all possible it should be done.

A therapist must be prepared to act like an advocate for you, which means they are on your side. This means that, as you process, and your opinions start to change, their opinions will also appear to change. This is because they must help you to reflect yourself, and so they must take on a similar affect. This doesn't mean they should outright lie, but rather that they should acknowledge YOUR truth as the most important truth in the room. Anything less is unacceptable.

Please share this list around and please feel free to add to it. See you next time, Mad Nation.

Sincerely,
R

Thursday, June 9, 2011

The Enlightenment and Mental Health

Greetings, Citizens.

I have been reading a book called "The Birth of the Clinic: An Archaeology of Medical Perception," by Michel Foucault. It's a bit of a tricky read for those unfamiliar with academese, but it has some utterly fascinating insights. These are insights that have changed the way that many theorists discuss pertinent issues in today's world, including concepts of performance, identity, and the methods of knowledge creation and preservation (also called "epistemology"). Even halfway through the book, I can already draw some very interesting relations between the developments suggested by the text and the way that mental health works in our modern society.

To spare you all a mind-numbing history lesson, I'll try to focus in on what I found to be one of the key points. In describing the evolution of medicine around the turn of the 19th century, Foucault writes:
"Medicine must no longer be confined to a body of techniques for curing ills and of the knowledge that they require; it will also embrace a knowledge of healthy man, that is a study of non-sick man and a definition of the model man. In the ordering of human existence it assumes a normative posture, which authorizes it not only to distribute advice as to healthy life, but also to dictate the standards for physical and moral relations of the individual and of the society in which he lives" (34 from Vintage Books, trans A.M. Sheridan Smith).
Here Foucault indicates a crucial turning point in the history of medicine and a possible birthing point for the very basis of "normative medicine" that psychiatry depends upon. In essence, the Enlightenment created an historical moment where the principle of "reason" was triumphed to the fullest extent possible, concluding that a scientific process could be utilized to the fulfillment of all of man's needs, including his moral ones. Because of this union of science and politic, medicine becomes a political tool, and is used to prescribe and proscribe in accordance with the perceived prosperity of the state it works for.

In some fields, this makes sense; from a strictly physical standpoint, the study of the phenomenon of "epidemic" and the environmental constituents that make it up, for example, lend themselves very well (although not completely without problem, of course) to the health of both the people and the state. In theory, anyway, this kind of longitudinal study can produce valuable insight into causes and cures of ailments in the physical bodies of people and the state institutes they comprise. For example, this kind of study is what leads to industry health regulations - arguably, a standardized criteria of ways to avoid health that is necessary for body-political regulation.

But as it crosses out of the physical realm and into the moral/emotional one - and admittedly, this can be a very blurry line - the standardization starts to make less and less sense, and it exposes the system for the tool of the powers-that-be that it is.

This ultimately calls into question the entire project of The Enlightenment, something that a grand play called Marat/Sade has done time and again. We observe that revolutionary forces of so-called "reason" still end up preserving themselves through tyrannical assertion of a specific value-set which must crush all who oppose it, however hypocritical this may end being.
Of course the flip side of this is the pathetic lukewarm liberalism of our "postmodern" society which refuses to take a strong stand on anything, and instead just let life happen while absently protesting things that are noisome. Hopefully we can find an alternative some day, but right now the very idea is making my head swell up and clog.

So, I think I will end it on that note: just some food for thought for you good citizens of New Madia.

Fare thee well!

Sincerely,
R

Thursday, June 2, 2011

Imperialism and Mental Health

Greetings, citizens!

A somewhat "intellectual" rant for you all this evening, I invite you to consider the concept of Imperialism. In a university setting, and to some extent in politics, imperialism is an extremely salient concept used to denote the tendency of large power structures towards Empire, that is to say, to dominate the resources and means of production of all those around them. Rather than seeking to establish fair and balanced trade, they find an excuse to colonize, either in word or in deed (these days much more in deed than actual word of course), and establish their own system, values and rules in the place of what was once there. It is generally agreed upon that this kind of approach is old-fashioned and unsustainable, and should be left by the wayside; what comes in its place is more likely than not a more subversive and just as potent form of cultural purification, but the point remains that the concept in general is frowned upon.

That is because, on at least some level, our society claims to understand that we should not judge an "other" just because it is "other," indeed we support the idea that difference should be celebrated (in theory anyway). We believe, especially in academia, that it is important to allow cultures to retain the right to define their existence on their own terms.

Unfortunately, that courtesy is not being extended in practice - but more than just on the geopolitical scale, this concept also applies to the Mad conflict. I submit to you, New Mad Nation, that the current medical system, especially vis a vis mental health, is imperialist in nature, and therefore is severely outdated and in need of reform. I hope that this analogy will work even for those in academia who heretofore have been all too happy to leave this subject to "the medical professionals."

Imperialism stems from the concept of a Greater Society, where the Polis, or center of power and "culture," reaches out to the colonies to "civilize" them. This is done purely for the economic benefit of the Polis, but the "civilization" of the colony is offered as a fair exchange. Sometimes, the colony in question will even receive some of the proffered benefits - that is part of what makes imperialism so difficult to resist. It isn't ALL bad; a powerful overlord can offer powerful resources.

I think the parallels to mental health are clear, here: Psychiatry is the center of power and "culture" when it comes to the coveted "sanity" resource, and it sees the Mad as "uncivilized;" not only do we have problems, but we are HELPLESS to solve those problems without Psychiatry's intervention. That, for me, is one of the key issues: this concept of helplessness. Psychiatry insists on itself with all the fervor of an invading empire, which insists that the colonies it invades are helpless to culture themselves, ignorant fools in need of wisdom.

Like with an empire it becomes something of a self-fulfilling prophecy. The presence of an invader damages the natural infrastructure and establishes new cultural norms that leave the colony confused, hurt, and estranged from their resources. In this condition, they DO become helpless to some extent; when enough damage is done by the invaders, only the invaders can help them rebuild. And then the invaders are validated for "rescuing" them; and many of the colonists will come to believe in their invaders because they have no other choice.

Psychiatry claims it is trying to help us, but its major objective is not our aid, but social stability. This has always been the project of mental hygiene: social control. By reaching into the areas with a different approach to society, to emotions, to thought, and instating their own ideals - often by force, and I do mean this literally if you will consider the number of people forcibly interred in mental hospitals which are little better than brainwashing facilities in some cases - psychiatry acts as an empire seeking to consolidate its power. Dissent will not be tolerated - it will be colonized, subjugated, and thus "civilized" until it doesn't desire dissent anymore.

Sometimes psychiatry DOES help people. But at what cost? If psychiatry is ever to be a valid method of treatment, it must be an /option/, not a mandate. And even though it is less of a "mandate" in some senses as it used to be - though not as much less as you might hope - this is only because it has already secured such a prominent social position that it does not NEED to mandate on the overt. It exists as an internalized mandate in the society itself. When a person is in enough trouble, the automatic assumption is that they see a psychiatrist. If the person doesn't want to see a psychiatrist then they are considered to be refusing to accept their situation, or refusing to seek treatment, or in some way refusing/being obstinate: like a stubborn child. Even though you are less likely to be dragged off by psychiatry (though it does still happen), you are now pushed into it by all of the good "citizens" of the Psychiatry empire.

It's sort of like this - Psychiatry allows you a form of social currency. Consider a hypothetical Polis and neighboring Colony that have different forms of currency. The Polis invades the Colony and takes away their form of currency, substituting their own. Eventually, the strictness of the Polis' presence declines, and the Colony is allowed to use its own form of currency again, but it has been without said currency for so long that it is difficult to find any, difficult to understand how to use it; moreover, citizens of the Polis have moved to the Colony to help "civilize" it, and they don't accept non-Polis coin. So even though you are technically "allowed" to have your own money, it is difficult to use even among your fellows, and citizens of the Polis will not do business with you.

The only way to use Polis money is to become a citizen of Polis and be ruled by all of its laws for citizenship.

The only way to be accepted by the Psychiatric empire is to accept the language of "mental illness" and be ruled by those laws.

I submit that the Mad would have a much stronger currency if we weren't fighting with Psychiatry for the right to even have one. I think that there would be many new and valid ways of discussing distress, deviance and madness, ways that are invigorating, not invalidating, ways that inspire change, rather than enforce the status quo - if we could just have a chance to establish a culture for ourselves.

But the one unique thing about the Mad colony is that we have never been allowed to have a public culture. Like many marginalized social groups, science and medicine have been working diligently to never allow us to coalesce into a working community. GLBT individuals have begun to remove themselves from the Mad category through hard work and advocacy, but the category still exists. It has existed for all time. And for a very, VERY long time, it has been the subject of imperial authority: if not from psychiatry, then from its predecessors; the asylum of Charenton, and Bethlehem. (Pronounced in a cockneyed accent, "Bethlehem" sounds like "Bedlam," which is where the term comes from).

We have never been given a chance to make a culture on our own terms. I hope to live to see the day when we are given that chance properly.

Sincerely,
R