No One Will Know Why You Were Out; Or, Secret and Stigma

August 1, 2010 at 5:22 pm | Posted in Fighting Prejudice, Work Life | Leave a comment

So. I went inpatient for 10 days. After my release, I took 30 days of medical leave from work on the advice of my attending psychiatrist. I start work again tomorrow, and, being a rational creature, I’m as anxious as hell. I feel guilty for having let the program down, and, yeah, crusader against stigma that I am, I’m tormented with self-consciousness about having had a bout with a mental illness.

I know, I know, it’s a perfectly legitimate affliction, just as real as diabetes or cancer, blah-blah-blah. I have nothing to be ashamed of. Decent people will feel sympathy, and anyone who doesn’t isn’t worth my contempt. And so forth. I know this advice because I’ve been here before. In graduate school and while teaching I created my share of scandal. I lived it down then, and I can live it down now.

Also, I know this advice well from having ladled it out to others. I remember once in group therapy scolding a woman who had been a prominent leader in the community before she became addicted to opiates and attempted suicide. She was mortified at the idea that people would laugh and sneer, and that she might never regain her previous professional standing. I listened to her concerns, acknowledged that her case was special, and especially difficult. Then I told her what I believe to be the hard truth:

People will laugh. People will sneer. You will lose friendships and professional opportunities. On the whole, people will feel less sympathy for you than if you’d had a stroke or been in a car accident. No one wants to be a living illustration of the principle that mental illness strikes people of all class backgrounds and levels of education. You have two choices, and they both suck. You can either tell your story calmly and boldly, or you can creep around and let rumor do its work. In the end, the results may be the same. Some people who you trusted will disappoint you; others who you feared or disliked will amaze you. Mostly, it won’t come up. You’ll come back without fanfare, and most people will confine their comments to moments when you’re out of the room. You will survive, and it will be both easier and harder than you thought it would be.

I’ve lived this again and again, but the usual gap between what I know and what I feel remains. And some people’s well-intended efforts to cover for me still infuriate me beyond measure. After grad school I cut off a friend of 12 years when I found out that he had lied to my dissertation director during one major hospitalization, telling her that I’d collapsed from hunger. Apparently in his mind it was less shameful to have an eating disorder than to be bipolar.

In the end, the truth is easiest. In my ideal workplace, the program admin would send out a one-line email saying that I’d been hospitalized for depression. If I’d been in a car accident or had lost a parent, management would notify everyone briefly and ask for their understanding. Since it’s shameful to be mentally ill — right? — my absence will go unexplained, and unless I send out that email myself, I’ll return to the weird silence that tends to surround a mystery. Rumor will fill the vacuum.

No wonder I’m dismayed, then, when people try to reassure me by saying, “No one will know why you were out.” Actually, I’d rather people knew the truth. As it is, secrecy will tend to spread stigma, and I’m not such a raging activist that I’ll spend my first two weeks back at work launching preemptive strikes against prejudice. In the end, it’s another social puzzle that I feel ill-equipped to solve. It’s one of life’s more irritating ironies that when anything horrible happens to you — when you’re raped, bereaved, crippled, whatever — you will have to devote tremendous energy to helping other people feel comfortable about it.

I do feel better now.

Love to all.

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On the Necessity of Following One’s Still, Small Voice

July 30, 2010 at 1:03 pm | Posted in Philosophical Problems, Spirituality and Religion | 1 Comment

Changing one’s life — addressing the most thorny issues of a given existence — would be a lot easier if you could just follow a handful of strict rules unwaveringly. Or, better yet, if others would enforce good behavior. Sometimes change does work this way, of course: Kicking a chemical addiction is the most obvious example, since you cannot use at all when you’re in recovery.

So often, though, our problems stem from relationships — whether to things or to people — that we need to modify, but can’t eliminate. People who have problems with overeating do eventually have to learn to eat responsibly, for example. Even radical gastric surgery leaves most people with enough latitude to fail. For many people, sex, too, must be controlled. If you’re in a poisonous sexual relationship, you can cut off a given lover. Most of us aren’t called to chastity, though, and eventually we must learn to moderate this most primal urge without denying it entirely.

We know in our hearts what we need to do. To put it in Christian terms (which I prefer to the language of psychotherapy), we know where our sin lies. In his Mere Christianity, a brilliant explication of fundamental Christian beliefs, C.S. Lewis points out that living a blameless life is not a matter of following clear-cut rules. Even the Ten Commandments require a surprising amount of interpretation. (That interpretation remains abstract to me, since I have never had any potentially legitimate occasion to kill anyone.) How much more difficult, then, is the fundamental Christian requirement that we love God and our neighbors as ourselves. I am sure I’m not the only person who has little idea what loving God entails, and the difficulty of figuring out who counts as our neighbor provides the subject of many a sermon in my parish church. The law, religion, and ethics will always disappoint when we try to apply these blunt tools to our muddy, intricate lives.

The solution is simple, but it isn’t easy. It’s our duty to discern in our hearts what is right, and to act accordingly. As Kierkegaard was fond of pointing out, right behavior may look radically different in different people — for one man, it might mean marrying a woman he loves, while another might be called to abstain from marrying. Social norms are not a reliable measure of what each of us needs to do (though, of course, any decision to violate laws — or, to a lesser extent, conventions — requires the highest possible level of self-scrutiny combined with willingness to accept the consequences).

It is incredibly hard to behave well even 60 percent of the time, I think. Every day we make hundreds of tiny decisions — to put off a boring task or a potentially uncomfortable confrontation, to refrain from eating nasty food, to maintain even the most minimal spiritual discipline — and, sad to say, I’m often not conscious I’m making a decision. When I am aware of what I’m doing — procrastinating, say — I still often talk my gullible self into all sorts of self-indulgent behavior. I do have some ingrained good habits — I am unfailingly prompt, and am disciplined about emptying out my email in-box regularly — but those good habits live under a deep, cold drift of accumulated tendencies to laxness.

More later.

Love to all.

Excellent Suggestions from The Happiness Project and Illuminated Mind

July 30, 2010 at 6:47 am | Posted in Links | 1 Comment

I don’t know about you, but I’m often overwhelmed by my blog feeds. Every morning I’m confronted with more good advice and information than I could implement in a lifetime. Today, though, I found two entries that justified slogging through the happy tips and lists.

The Happiness Project is still one of my hands-down favorite blogs — Gretchen Rubin gives excellent advice made palatable by a charming tone. Here, she gives a list of actions that may tempt you in the moment, but that will actually intensify your unhappiness in the end. Like all excellent advice, it’s simple but it’s not easy. Learning to avoid just the first two — treating yourself and letting yourself off the hook — is a life’s work.

This guest post from The Illuminated Mind gives a quick list of ways to jolt yourself out of complacency and pay more attention to your life.

I would add a fifth item: Take care of a task that you know will suck, but that will be life-improving in the end. For example, almost daily I regret that my iTunes collection is too large for my iPod, and that mediocre songs have crowded out some of my coolest play lists. Sadly, this is not one of those things that I’m putting off for no rational reason, that will prove gratifyingly easy in the end. I’m pretty certain that I’ll hate every minute of it the hour or two of frustration and tedium. How nice it will be in the end, though! (Of course, the real challenge is to do something hideous when there’s no particular reward — I think of wading through endless voice mail menus to straighten out the unjust hospital bill I got last week. That takes true dedication.)

More later, and love to all.

Free Will Moment

July 23, 2010 at 1:02 pm | Posted in Uncategorized | Leave a comment

I found this New York Times blog post interesting, and I submitted the following comment:

I don’t see why (iv) above must be true — that is, that we must have chosen how we are in order to be held responsible for the actions that follow from that being. In fact, it’s commonplace and probably morally necessary to hold ourselves responsible for actions and states that we did not explicitly choose.

This concerns me because I am manic-depressive, and though I didn’t choose to be that way, I have remarkable latitude >and< responsibility with regard to my actions (though perhaps not to the extent that a person with no mental illness has). No one would seriously argue that, since I haven't chosen my mental state at any point in my adult life, I can't be held responsible for anything that I do. Or, to look at a more specific instance: If I suspect that my medication is making me dangerously ill — perhaps even exacerbating my illness — I may go off my medication. If, as a result, I have a manic episode and, say, steal your car or seduce your husband, it seems to me that I could (and should) be held responsible for my actions, even though I didn't choose to be manic, or to experience side effects from my medication. I acted according to my best judgment; as it turns out, I still hurt people. Did I have free will? Even the most minute examination of the circumstances will not prove that I did or didn't. Am I responsible? Following David Jones above, I would say that, yes, I am.

My point is this: It's fruitless to try to reason out free will and responsibility without considering the specific circumstances in which we find ourselves, and acknowledging that we cannot predict the results of our actions.

Love to all.

Check Out This PRI Forum with Ethan Watters

May 18, 2010 at 5:06 am | Posted in Book Reviews, Links, Philosophical Problems | Leave a comment

I’ve been so obsessed with Robert Whittaker’s work that I’ve lost track of how Ethan Watters’ excellent book, Crazy Like Us, has fared recently. I got a very flattering invitation to participate in this PRI forum on America’s most profitable non-defense export: mental illness. I’ve already posted once, and I’ll probably return before the forum closes on May 31.

Many of the people writing in have not read Watters’ book, and as a result he’s been answering some of the most obvious questions and objections, which may be more valuable to the average reader than a detailed engagement with the nuts and bold of his argument. In any case, check it out.

I’ve had all sort of wacky symptoms since I cut out the meds a month or so ago. It’s a cheaper and less time-consuming madness than what I’ve had for the last several years, though, so I’m trying to ride it out.

Love to all.

Not Now — I am Hypnotizing the Chickens

April 27, 2010 at 3:44 am | Posted in Uncategorized | Leave a comment

Chickens.  Lots of chickens.

The poor things don't even have their own cubicles!

I kept cracking up as I read this New York Times piece on the use of PowerPoint in the military. Who knew that there was such an apt phrase for the act of dazzling and boring a credulous audience into submission?

On a slightly more serious note, if you’d like to start your day with the lash of indignation, you have only to read this exercise in arrogance by psychiatrist Daniel Carlat, who is proud that he now spends a few moments talking to his patients before whipping out his prescription pad even though doing so reduces his profits slightly. Be still my heart. I’m fascinated by how he pairs an unquestioning faith in the psychiatric Diagnostic and Statistical Manual with a cheerful willingness to slap a patient with fiercely addictive uppers and downers without apparently mentioning the substantial long-term risks. Even more interesting — and, frankly, discouraging — is how many of the comments praise him for for his insight. If this is an example of refreshing modesty, then our standards for psychiatrists must be very low indeed.

I have been considering what the heck to do with this blog now that I am apparently not bipolar. I don’t really see closing up shop, and he idea of launching a campaign against the psychiatric establishment makes me more weary than an hour of PowerPoint. I have a lot — a lot — to say about the evils of the 21st Century, so don’t be surprised if I hare off in that direction.

I’m Not the Only Mental Chick Off Her Meds

April 25, 2010 at 6:01 pm | Posted in Philosophical Problems | 1 Comment

I’m intrigued to note that the author of The Secret Life of a Manic Depressive has gone off of her meds, and is questioning a diagnosis for which she’d been treated since age 12. Hm. I sense a movement starting.

I must note with regret that I’ve lost five of the 10 pounds that I gained on Zyprexa and Remeron. I felt mighty cute at 109, and was almost giddy at the prospect of being able to buy clothes off the rack. Alas, I’m back to regarding food with mingled indifference and suspicion, and my uncannily tiny clothes are growing baggy once more.

In Which I Rise Like Lazarus

April 23, 2010 at 4:50 am | Posted in My Fascinating Mood, Philosophical Problems | Leave a comment

I’ve been off all medication for two weeks now, and I have the strange sensation of turning back into the mercurial 19-year-old that I’ve missed so. It’s as if I’ve come back to life and the burial cloth shrouding my senses is falling away. When you combine this with the evidence from Robert Whitaker’s Anatomy of an Epidemic, it looks very much like the past 20 years of crushing mental illness may have been iatrogenic.

You would think I’d be vibrating with horror at that possibility, and, indeed, a part of me feels very angry indeed. However, I’m mostly grateful to have escaped. I’m not entirely recovered, and it’s not realistic to expect to undo two decades of damage in weeks or months, or perhaps ever. I’m hardly perfect now — I do have this alarming temper, for example — but I’m so much better than I ever hoped to be. It really does take my breath away, and I feel profound and unforced gratitude.

There is a moral here, however: It rarely pays to be a good patient. The more conscientiously I followed medical advice, the worse my situation became. A more rebellious or skeptical soul might have stepped off the merry-go-round years ago. Until six months ago, with each downward turn I actually redoubled my commitment to the medical model. If I can just get the meds right, I can whip this, I would think. And the worse I got, the more I doubted my own perceptions. I knew I was getting the best possible treatment, so I blamed my slow disintegration on imagined deficiencies of character. I felt that I must be lazy, sloppy and downright ungrateful. The meds are so good, I thought, and I’ve certainly tried them all. I must be the weak link here. The truth, though, is a textbook example of irony (Dad take note): The more faithfully I followed orders, the worse I became. I felt so horrible precisely because I was so very, very accomplished at being “good.”

I’ve run out of writing time — I’m finding all of this very difficult to imagine and express — so I’ll close now and return later to what is, after all, the key question: Why was I so desperately obedient? And what drove me to this lifesaving rebellion?

Most profound love to all.

I Hate the 20th Century: Email Hack Edition

April 22, 2010 at 1:48 am | Posted in I Hate the 21st Century | Leave a comment

Here's the Archbishop Cranmer being burned at the stake in 1556. He seems to be taking it pretty well, all told.

During the Elizabethan era, the state executed unfortunates who were convicted of treason as follows:

1. Half-hanging (which I believe is an erotic practice in these degenerate times);

2. Disembowlment while conscious (not, to my knowledge, an erotic practice);

3. Burning at the stake.

If your friends felt sorry for you, they would pay to have a bag of gunpowder hung around your neck for the last step; it would decapitate you relatively painlessly as soon as the flames reached it.

An inventive bunch, the Elizabethans. But nothing they could dream up is too harsh for the jerk-off who hacked my email yesterday, thereby inconveniencing me at the end of an exhausting day of PowerPoint-driven meetings.

Speaking of the death penalty, when I am named dictator, I must dream up and enforce a grisly punishment for people who utter any variant of the following during a PowerPoint presentation: “I’m not going to read this whole chart to you….” To which I say, “No? Well bless you, since the wretched thing is written in single-spaced six-point type.”

Final note on the history of capital punishment: For the Elizabethans, murdering your husband was punished as treason, since, after all, your husband was your lord and master for legal purposes. I believe that murdering your wife drew a fleeting frown of disapproval from the bench before the court moved on to more serious matters, like sheep-rustling.

Final note generally: I’ll be cutting back to two sessions a week for my intensive outpatient program, so I should be able to creep back into this space.

Book Review: Robert Whitaker’s Anatomy of an Epidemic

April 21, 2010 at 5:31 am | Posted in Book Reviews | 2 Comments

If you’re taking psych meds or care about anyone who is, click here and order Robert Whitaker’s Anatomy of an Epidemic right this minute. Better yet, hie thee to your local big box bookstore, buy it today, and start it tonight. You’ll want an emergency appointment with your shrink the next day.

I am prone to exaggeration, I suspect, but I’m not indulging that sin when I tell you that this is the most important book I’ve read about psych meds. Whitaker argues that, far from fixing “broken brains” or relieving symptoms, psych meds — antipsychotics, antianxiolytics, antidepressants, and mood stabilizers — cause the very illnesses that they purport to cure.

I don’t want to believe Whitaker. I want to plug my ears and hum, put out my eyes rather than read the words on the page. The evidence is irrefutable, though, and it’s pulled from a staggering variety of unimpeachable sources.

A crude summary:

1. Clinical studies have shown again and again that antidepressants, for example, are no more effective than placebos in relieving depression. This is well-established, and has even been discussed in the general press, including my beloved New York Times. The few studies that do show efficacy do so because they were crudely manipulated by the sponsoring drug companies.

2. It’s also long been accepted that psych drugs do not work the way that conventional wisdom says that they do (I read about this debate most recently in The New York Review of Books, but if you’re interested in these things, again, this will not be news). That is, they do not supplement a serotonin deficiency. Whitaker takes this debate to its logical conclusion, demonstrating that powerful evidence exists that psych drugs actually damage the brain’s ability use the neurotransmitters available. The science is not based on speculation, and this is not a hypothesis. The mechanism of action of antidepressants is old news, and Whitaker’s argument simply presents long-available information in a lucid, step-by-step fashion.

3. But what about those hordes of crazy people who got their lives back when psych meds were introduced? Um, that didn’t happen. Depression, anxiety disorders, and manic-depression were all vanishingly rare in the centuries before the 1970s and 1980s. Systematic examination of the studies available shows that all three have reached epidemic levels in the last 30 years.

4. More horrifying still: Large-scale outcomes have deteriorated significantly significantly for all of the mental illnesses for which drug treatments are available. In the 1950s, about half of the few people who suffered a manic, psychotic or depressive episode remitted spontaneously. When patients did experience repeated episodes, they enjoyed long interim periods of stability and high functioning — they married, had children, held jobs, and lived largely normal lives. People who are diagnosed with a mental illness today are much more likely to be permanently disabled, and much less likely to function well enough to get an education, hold a job, marry, or care for any children they may have. By objective and subjective measures, their lives are a misery.

Have I mentioned that I am one of them, and that my life has sucked?

5. It’s always been acknowledged by enlightened practitioners that psych drugs are, at best, a bargain with the devil. When doctors weren’t just telling you to shut up and take your meds already — do you want to be a burden on society? — they were apologetically explaining that side effects ranging from humiliating to life-threatening are a small price to pay for the privilege of living a normal life. Psych drugs can kill you quickly, through, say, a serotonergic reaction or a fatal spike in blood pressure. They can kill you slowly by causing dangerous weight gain, diabetes, and metabolic syndrome. And, of course, they can render your life pointless by making you impotent, for example, or robbing you of your intellectual and artistic gifts.

That’s the quick-and-dirty version. There’s a lot more, including cogent responses to all of the objections that are bubbling up on your lips right now. Read it. I dare you.

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