"It's nothing like a broken leg"
July 1, 2018 11:51 AM Subscribe
"In the last few years I have lost count of the times mental illness has been compared to a broken leg. Mental illness is nothing like a broken leg." [SL Guardian] [TW: Suicidality]
In recent years the discussion around mental health has hit the mainstream. I call it the Conversation. The Conversation is dominated by positivity and the memeification of a battle won. It isn’t a bad thing that we are all talking more about mental health; it would be silly to argue otherwise. But this does not mean it is not infuriating to come home from a secure hospital, suicidal, to a bunch of celebrity awareness-raising selfies and thousands of people saying that all you need to do is ask for help – when you’ve been asking for help and not getting it. There is a poster in my local pharmacy that exclaims, “Mental health can be complex – getting help doesn’t have to be!” Each time I see it, I want to scream.Hannah Jane Parkinson (previously) on the mental health "conversation."
Very interesting and valuable perspective.
I think part of the trouble is that mental illness, like other forms of illness, is not a single phenomenon, and the experience of different illnesses can be very different, or are experienced differently by different people. Sometimes, some mental illnesses can be like a broken leg, in that they are a normal response to certain kinds of trauma, with a relatively well-defined timeline for recovery. Extreme grief can manifest in this way, and if it temporarily incapacitates the sufferer, I think it is reasonable to consider it an illness. Other mental illnesses may manifest as chronically reduced resilience to normal trauma, resulting in pathological mental states in response to events that healthy individuals would not have as much trouble dealing with. These could be thought of as more akin to osteoporosis than to a broken leg. Some anxiety disorders may fall into this category. Other disorders, like bipolar, are chronic diseases with periodic flare-ups of symptoms. And still others are persistent pathologies that last for the lifetime of the individual.
Treating all of this spectrum of mental illness with the same language and framing certainly does alienate those whose experiences are not well described by what Parkinson refers to as "the Conversation." But it's also true that there's a lot of people whose experiences have informed this cultural shift. Hopefully as our cultural narratives around mental illness evolve and become more sophisticated, we can get better at making these distinctions and not alienating those who are already suffering.
posted by biogeo at 1:23 PM on July 1, 2018 [26 favorites]
I think part of the trouble is that mental illness, like other forms of illness, is not a single phenomenon, and the experience of different illnesses can be very different, or are experienced differently by different people. Sometimes, some mental illnesses can be like a broken leg, in that they are a normal response to certain kinds of trauma, with a relatively well-defined timeline for recovery. Extreme grief can manifest in this way, and if it temporarily incapacitates the sufferer, I think it is reasonable to consider it an illness. Other mental illnesses may manifest as chronically reduced resilience to normal trauma, resulting in pathological mental states in response to events that healthy individuals would not have as much trouble dealing with. These could be thought of as more akin to osteoporosis than to a broken leg. Some anxiety disorders may fall into this category. Other disorders, like bipolar, are chronic diseases with periodic flare-ups of symptoms. And still others are persistent pathologies that last for the lifetime of the individual.
Treating all of this spectrum of mental illness with the same language and framing certainly does alienate those whose experiences are not well described by what Parkinson refers to as "the Conversation." But it's also true that there's a lot of people whose experiences have informed this cultural shift. Hopefully as our cultural narratives around mental illness evolve and become more sophisticated, we can get better at making these distinctions and not alienating those who are already suffering.
posted by biogeo at 1:23 PM on July 1, 2018 [26 favorites]
This was cathartic as hell to read. Thanks for posting it.
posted by colorblock sock at 1:27 PM on July 1, 2018 [2 favorites]
posted by colorblock sock at 1:27 PM on July 1, 2018 [2 favorites]
My mom struggled with depression for years until, about a decade ago, we embarked on a thrilling ride of full-on hallucinations, delusionality, and hospitalizations, including a suicide attempt. I’ve now had the pleasure of experiencing the medical system in four different American states. And my mom—who is wonderful, and at the moment stable, has struggled hard with the resulting sense of shame. She’s had a wide variety of care, most of it terrible, some, luckily, decent. We were talking about her feeling so ashamed the other day and I broke out the broken leg metaphor, which she’s managed not to hear (or more likely forgot about) and she found it useful. No, asking for help isnt the end of it. And experience has taught us that she has to keep asking—even pushing—before the help she asks for is actually helpful. Doctors know about broken bones, but even the experts seem to mostly be guessing w/r/t mental stability. But experience has also taught her/us that there’s just no way we can fix it on our own. And I would LOVE for her to stop seeing the illness as her fault. So though the metaphor (like the medical help) is of limited use, I’ll keep with it until something better comes along, thanks.
posted by heyitsgogi at 1:44 PM on July 1, 2018 [11 favorites]
posted by heyitsgogi at 1:44 PM on July 1, 2018 [11 favorites]
have I tried just shutting the door on the past and moving on?
Try these optimistic platitudes!
posted by thelonius at 1:46 PM on July 1, 2018 [30 favorites]
Try these optimistic platitudes!
posted by thelonius at 1:46 PM on July 1, 2018 [30 favorites]
The system is fucked.
A person I know is on medicaid and is bipolar. He claims in the county there are only 4 'shrinks' and are backloged on medicaid. Thus the time with the one is for getting the sign off on the drugs he rotates through. The 12 year old I know who was subject to being sexually assulted by her dad's new wife's son less than a week into the marriage can't seem to find someone who's willing to take her on due to medicaid per 2 of post-turndown talks.
It seems the system is fine, if you have money.
posted by rough ashlar at 1:52 PM on July 1, 2018 [3 favorites]
A person I know is on medicaid and is bipolar. He claims in the county there are only 4 'shrinks' and are backloged on medicaid. Thus the time with the one is for getting the sign off on the drugs he rotates through. The 12 year old I know who was subject to being sexually assulted by her dad's new wife's son less than a week into the marriage can't seem to find someone who's willing to take her on due to medicaid per 2 of post-turndown talks.
It seems the system is fine, if you have money.
posted by rough ashlar at 1:52 PM on July 1, 2018 [3 favorites]
The system is broken for everyone.
Saying the system is broken implies that it once worked. Did it ever? Was there ever a time when people with mental illness were able to seek and find rapid, effective, compassionate and affordable treatment to their satisfaction?
posted by Modest House at 3:23 PM on July 1, 2018 [6 favorites]
Saying the system is broken implies that it once worked. Did it ever? Was there ever a time when people with mental illness were able to seek and find rapid, effective, compassionate and affordable treatment to their satisfaction?
posted by Modest House at 3:23 PM on July 1, 2018 [6 favorites]
I think it’s saying the system works for certain kinds of treatments (broken legs) and broken for treating mental illness.
posted by nikaspark at 3:27 PM on July 1, 2018
posted by nikaspark at 3:27 PM on July 1, 2018
I relate so hard to the part about feeling old and playing catch up. Between mental illness and years of alcoholism and personal circumstances, I had zero sense of self, so I feel both ancient and half my age. I get along better with teenagers because that's when I last had a strong identity of my own. (I'm quite enjoying sobriety and the process of figuring of figuring out who I am.)
And no, the system is not fine even if you have money. Although I will say that, as an upper middle class white woman, I was horrified at the preferential way I was treated when I unexpectedly found myself admitted to inpatient rehab last year. The minimum stay is supposed to five days. I was out in two and a half, with an unspoken assumption from the hospital staff that I'd go to a private (expensive) rehab facility away from those other people who were clearly not like me. It was really gross, but I really wasn't in the mental state to call it out. I was also treated like a delicate little flower while others... weren't.
For as much as people hate the company I work for, they treat mental illness as a legit illness and I'm grateful for that. Before my surprise hysterectomy, I was actually on a reduced schedule as a disability accommodation for mental health.
posted by Ruki at 3:33 PM on July 1, 2018 [18 favorites]
And no, the system is not fine even if you have money. Although I will say that, as an upper middle class white woman, I was horrified at the preferential way I was treated when I unexpectedly found myself admitted to inpatient rehab last year. The minimum stay is supposed to five days. I was out in two and a half, with an unspoken assumption from the hospital staff that I'd go to a private (expensive) rehab facility away from those other people who were clearly not like me. It was really gross, but I really wasn't in the mental state to call it out. I was also treated like a delicate little flower while others... weren't.
For as much as people hate the company I work for, they treat mental illness as a legit illness and I'm grateful for that. Before my surprise hysterectomy, I was actually on a reduced schedule as a disability accommodation for mental health.
posted by Ruki at 3:33 PM on July 1, 2018 [18 favorites]
I’ve never broken a bone, but I can see the two things being similar if the people around you react to a broken bone by saying “god, this is so typical, your leg would be fine by now if you’d have gone to physical therapy like I told you to!” Or if you get a cast on the wrong leg and spend a couple years hobbling around while people talk about how it’s all part of the process and if it feels like the cast is on the wrong leg, that means you’re making progress.
posted by shapes that haunt the dusk at 4:00 PM on July 1, 2018 [25 favorites]
posted by shapes that haunt the dusk at 4:00 PM on July 1, 2018 [25 favorites]
Also, was mental health care in the UK always this underfunded? I’m not familiar with how the NHS usually works, but even with free mental health care here in the US (Medicaid or free clinics) it’s been a six month wait, not two years. At least in my experience in two large cities.
posted by shapes that haunt the dusk at 4:15 PM on July 1, 2018
posted by shapes that haunt the dusk at 4:15 PM on July 1, 2018
The truth is: enough awareness has been raised. We – the public, the health professionals, the politicians – need to make our words and actions count for more.
What does the government need to do? Hire more staff, and then more. Enough staff to provide a service that meets individual needs. That means better working conditions and pay, and not piling all funding into a single type of therapy or care path. Clinical commissioning groups need to spend money earmarked for mental health on mental health. Prescription charges for long-term conditions should be reviewed. Funding and research must be increased.
This is probably a bias in how I view the world, but the problem always seems to be that everything is so damn businessified now. Everything is efficiency, austerity, checklists, paperwork, and step up, move along, next. This stuff is highly individualized and that just does not jibe with the way all of the decision makers want everything to be tick the boxes until the approved cost-effective amount of progress has been made and get out.
This is why awareness campaigns are so popular. They are so measurable. Get the impressions online, get on some TV shows and then everybody pat themselves on the back and move on.
posted by Regal Ox Inigo at 4:33 PM on July 1, 2018 [6 favorites]
What does the government need to do? Hire more staff, and then more. Enough staff to provide a service that meets individual needs. That means better working conditions and pay, and not piling all funding into a single type of therapy or care path. Clinical commissioning groups need to spend money earmarked for mental health on mental health. Prescription charges for long-term conditions should be reviewed. Funding and research must be increased.
This is probably a bias in how I view the world, but the problem always seems to be that everything is so damn businessified now. Everything is efficiency, austerity, checklists, paperwork, and step up, move along, next. This stuff is highly individualized and that just does not jibe with the way all of the decision makers want everything to be tick the boxes until the approved cost-effective amount of progress has been made and get out.
This is why awareness campaigns are so popular. They are so measurable. Get the impressions online, get on some TV shows and then everybody pat themselves on the back and move on.
posted by Regal Ox Inigo at 4:33 PM on July 1, 2018 [6 favorites]
I think it’s saying the system works for certain kinds of treatments (broken legs) and broken for treating mental illness.
I can only say, having now had a broken leg (ankle), that the metaphor doesn't really hold up from the other end, either. Because sure, there's no stigma to saying you've broken a leg, but when it makes it difficult to wash regularly and you look different, or when the pain medication makes you spacey and you have serious trouble focusing, friends and colleagues will tell each other you look rough and wonder how long this will all take and whether we have time for it (or if it will happen again). And if they've never had the experience before, they may judge you for not being more together a month after surgery, when in fact you're doing the best you can and are exhausted every day from just the growing bones part, not to mention anything else you might try to do. A lot of people will be outwardly supportive, not to discount that, but may have no idea how healing broken bones actually works, and most won't bother to read up on it if they haven't experienced it.
And some friends may just disappear from your life, out of fear somehow that perhaps you are contagiously clumsy (you're not), or you're just not fun anymore (look, you're just tired and not really able to maintain your usual level of hygiene despite best efforts, but you're trying not to just talk about your ankle all the time, despite the fact that it's what occupies your thoughts the most as of late), or you'll never be able to keep up with their outdoorsy exploits or other sports things (maybe not again for a while, but that doesn't mean you don't want to or don't value the same things they do), or that you're on an unstoppable downhill trajectory to being, yes, one of those jumpsuit-wearing people who never got it together (I think that really scares them). It's hard to even self-identify as someone who enjoys certain things if you're not going to be able to do them for a while, so it makes you doubt your own commitment to them, or what you are even interested in anymore, when you have no energy or ability to do it, even though you know it's only temporary.
The mental health aspect of breaking a leg is largely invisible, unfortunately, so sure, I suppose that the experiences are similar in that respect, but not in the positive respect that the metaphor intends. All those things are pretty similar, really, to my experiences dealing with mental health issues that took away my will to practice self-care, to imagine a better future for myself, or to do anything, really, besides sleep for long periods and drop all my commitments. The idea of self-care sounds great until you're too worn out mentally and physically to do much. So I guess like aurora borealis, some things do indeed have to be experienced to be understood, and a broken leg might be one of them. I certainly feel like I get the psychology of the Isadora Wing character in Erica Jong's Fear of Flying (who broke her leg skiing) a bit better now.
On just a level speaking about medication, obviously the difficulties with regard to that are a bit different in the U.S. and U.K., but there are certainly difficulties either way. In the U.S., the difficulty I had the joy of experiencing is that once you've had ankle surgery and you're discharged, from a hospital you ended up in on vacation, 3 hours away from home, and you actually take your pain meds when you have pain, as well as have an orthopedist back home who's on vacation in the time frame they want you to follow up, and thus have to wait longer to see someone, you may start to run low on medication. When that happens, in my experience, the fear of prescribing opioids is so great now that you can end up getting shuffled between 4 doctors' offices over the course of a week and a half and still get no relief, as no one wants to be responsible for prescribing you pain meds and you're in no shape to leave the house until your follow-up ortho appointment. You started following up early because you knew this could be a thing, but all that initiative didn't help, and you end up on your last dose on the morning of your appointment, and that's after taking less than would be recommended for your pain level and stretching what you had as far as it would go between doses every day.
Yeah, OK, maybe the experience of dealing with mental health issues and the experience of having a broken leg are similar (and one can be comorbid with the other, certainly!)—but again, not in any of the good, positive ways. The system and the conversation both repeatedly fail people with physical and mental illnesses alike.
posted by limeonaire at 4:52 PM on July 1, 2018 [18 favorites]
I can only say, having now had a broken leg (ankle), that the metaphor doesn't really hold up from the other end, either. Because sure, there's no stigma to saying you've broken a leg, but when it makes it difficult to wash regularly and you look different, or when the pain medication makes you spacey and you have serious trouble focusing, friends and colleagues will tell each other you look rough and wonder how long this will all take and whether we have time for it (or if it will happen again). And if they've never had the experience before, they may judge you for not being more together a month after surgery, when in fact you're doing the best you can and are exhausted every day from just the growing bones part, not to mention anything else you might try to do. A lot of people will be outwardly supportive, not to discount that, but may have no idea how healing broken bones actually works, and most won't bother to read up on it if they haven't experienced it.
And some friends may just disappear from your life, out of fear somehow that perhaps you are contagiously clumsy (you're not), or you're just not fun anymore (look, you're just tired and not really able to maintain your usual level of hygiene despite best efforts, but you're trying not to just talk about your ankle all the time, despite the fact that it's what occupies your thoughts the most as of late), or you'll never be able to keep up with their outdoorsy exploits or other sports things (maybe not again for a while, but that doesn't mean you don't want to or don't value the same things they do), or that you're on an unstoppable downhill trajectory to being, yes, one of those jumpsuit-wearing people who never got it together (I think that really scares them). It's hard to even self-identify as someone who enjoys certain things if you're not going to be able to do them for a while, so it makes you doubt your own commitment to them, or what you are even interested in anymore, when you have no energy or ability to do it, even though you know it's only temporary.
The mental health aspect of breaking a leg is largely invisible, unfortunately, so sure, I suppose that the experiences are similar in that respect, but not in the positive respect that the metaphor intends. All those things are pretty similar, really, to my experiences dealing with mental health issues that took away my will to practice self-care, to imagine a better future for myself, or to do anything, really, besides sleep for long periods and drop all my commitments. The idea of self-care sounds great until you're too worn out mentally and physically to do much. So I guess like aurora borealis, some things do indeed have to be experienced to be understood, and a broken leg might be one of them. I certainly feel like I get the psychology of the Isadora Wing character in Erica Jong's Fear of Flying (who broke her leg skiing) a bit better now.
On just a level speaking about medication, obviously the difficulties with regard to that are a bit different in the U.S. and U.K., but there are certainly difficulties either way. In the U.S., the difficulty I had the joy of experiencing is that once you've had ankle surgery and you're discharged, from a hospital you ended up in on vacation, 3 hours away from home, and you actually take your pain meds when you have pain, as well as have an orthopedist back home who's on vacation in the time frame they want you to follow up, and thus have to wait longer to see someone, you may start to run low on medication. When that happens, in my experience, the fear of prescribing opioids is so great now that you can end up getting shuffled between 4 doctors' offices over the course of a week and a half and still get no relief, as no one wants to be responsible for prescribing you pain meds and you're in no shape to leave the house until your follow-up ortho appointment. You started following up early because you knew this could be a thing, but all that initiative didn't help, and you end up on your last dose on the morning of your appointment, and that's after taking less than would be recommended for your pain level and stretching what you had as far as it would go between doses every day.
Yeah, OK, maybe the experience of dealing with mental health issues and the experience of having a broken leg are similar (and one can be comorbid with the other, certainly!)—but again, not in any of the good, positive ways. The system and the conversation both repeatedly fail people with physical and mental illnesses alike.
posted by limeonaire at 4:52 PM on July 1, 2018 [18 favorites]
Mental Illness is vastly more like a broken leg than demonic possession.
My impression on any commentary that makes that metaphor is that it's an attempt by the writer to move mental issues into the physical real world and reduce the stigma. Not that it's like Ebola or a broken toe or brain tumor or lung cancer but it is so much more like any illness or injury (or should be for insurance qualification) than many of the historical and unfortunately still current myths.
posted by sammyo at 5:31 PM on July 1, 2018 [4 favorites]
My impression on any commentary that makes that metaphor is that it's an attempt by the writer to move mental issues into the physical real world and reduce the stigma. Not that it's like Ebola or a broken toe or brain tumor or lung cancer but it is so much more like any illness or injury (or should be for insurance qualification) than many of the historical and unfortunately still current myths.
posted by sammyo at 5:31 PM on July 1, 2018 [4 favorites]
I had GRS, I’m pretty familiar with recovering after surgery and how people’s mental health is affected by recovering from surgeries. If you’ve already got a history of inpatient care and mental health issues surgery can exacerbate mental health issues considerably (and are in fact, in my case)
posted by nikaspark at 5:58 PM on July 1, 2018 [1 favorite]
posted by nikaspark at 5:58 PM on July 1, 2018 [1 favorite]
but also there's this bit about "normal" which... I'm not sure what point she's trying to make there?
I thought she was very clear so maybe my paraphrase will be no clearer. but: depression and anxiety are normal. so normal that many people get annoyed by how easy they are to understand, and defensively try to retroactively un-normalize them (by declaring that depression isn't the same as being very sad; anxiety isn't the same as being nervous. though the difference between "just" sadness and "real" depression is no greater than the differences between one depressed person's internal experience and another's.)
but, as she says, bipolar disorder, schizophrenia, and other conditions with a dissociative or psychotic or involuntary behavioral component are not like that. are not things that "we all struggle with" in anyone's opinion, however glib they are. on the bright side, nobody will say "oh, well, doesn't the modern world make us all schizophrenic, really?" as people will say to the mood-disordered. or relatively few will. on the dark side, the spontaneous (if superficial) empathy and understanding that anxious depressed people get does not pour out in the same way or in the same quantities. Sympathy, sometimes. I go through life sort of assuming that "everyone" is anxious and depressed to some degree, and I am right as far as my own social circles go. but other conditions, I don't expect in that way. they feel more like news when people tell me about them.
this is not about level of suffering, or to suggest that anxiety and depression, alone or in combination, can't cause as much suffering (and death) as any more stigmatized illness. but I think she's right that the "normal" mood disorders are the public face of mental illness because everyone thinks they can relate, even if they're wrong. certain other ones are both harder to conceal and harder to talk about, which is very unfair.
posted by queenofbithynia at 6:12 PM on July 1, 2018 [7 favorites]
I thought she was very clear so maybe my paraphrase will be no clearer. but: depression and anxiety are normal. so normal that many people get annoyed by how easy they are to understand, and defensively try to retroactively un-normalize them (by declaring that depression isn't the same as being very sad; anxiety isn't the same as being nervous. though the difference between "just" sadness and "real" depression is no greater than the differences between one depressed person's internal experience and another's.)
but, as she says, bipolar disorder, schizophrenia, and other conditions with a dissociative or psychotic or involuntary behavioral component are not like that. are not things that "we all struggle with" in anyone's opinion, however glib they are. on the bright side, nobody will say "oh, well, doesn't the modern world make us all schizophrenic, really?" as people will say to the mood-disordered. or relatively few will. on the dark side, the spontaneous (if superficial) empathy and understanding that anxious depressed people get does not pour out in the same way or in the same quantities. Sympathy, sometimes. I go through life sort of assuming that "everyone" is anxious and depressed to some degree, and I am right as far as my own social circles go. but other conditions, I don't expect in that way. they feel more like news when people tell me about them.
this is not about level of suffering, or to suggest that anxiety and depression, alone or in combination, can't cause as much suffering (and death) as any more stigmatized illness. but I think she's right that the "normal" mood disorders are the public face of mental illness because everyone thinks they can relate, even if they're wrong. certain other ones are both harder to conceal and harder to talk about, which is very unfair.
posted by queenofbithynia at 6:12 PM on July 1, 2018 [7 favorites]
I definitely did not get that from the way it was written, so no, your comment was clearer. I was very tripped up by the bit about how things like randomly sending your friends hostile texts isn't "normal", as if the issue in such situations was the normality or lack thereof; I figured that it had to be some kind of discussion of the concept of normality but couldn't find a thesis.
posted by inconstant at 6:57 PM on July 1, 2018
posted by inconstant at 6:57 PM on July 1, 2018
Saying the system is broken implies that it once worked.
Maybe it would be helpful to say that the system is still a half-done project of our civilization, and that it's dangerous to see a tall facade and think, "Hey, that's a building built for those guys, we can forget about it while we work on some golf courses for a while."
posted by amtho at 7:29 PM on July 1, 2018 [1 favorite]
Maybe it would be helpful to say that the system is still a half-done project of our civilization, and that it's dangerous to see a tall facade and think, "Hey, that's a building built for those guys, we can forget about it while we work on some golf courses for a while."
posted by amtho at 7:29 PM on July 1, 2018 [1 favorite]
No doctor takes you seriously and then sees you broke your leg once and then come back and say you are making up your current real broken arm.
Oh my god, yeah. I have literally stopped going to the doctor because I got tired of the conversation never progressing past treatment for depression and anxiety. “Oh you’re exhausted all the time? Are you still in therapy?” If you say yes, then it’s assumed that you’re currently working through something difficult. If you say no, it’s assumed you’re refusing to accept treatment.
posted by shapes that haunt the dusk at 8:37 PM on July 1, 2018 [4 favorites]
Oh my god, yeah. I have literally stopped going to the doctor because I got tired of the conversation never progressing past treatment for depression and anxiety. “Oh you’re exhausted all the time? Are you still in therapy?” If you say yes, then it’s assumed that you’re currently working through something difficult. If you say no, it’s assumed you’re refusing to accept treatment.
posted by shapes that haunt the dusk at 8:37 PM on July 1, 2018 [4 favorites]
Also, was mental health care in the UK always this underfunded?
No, it was not. NHS funding relative to demand has suffered across the board under the Tories. It was never great, mind, and hugely variable based on which PCT you were in (the Primary Care Trust organisation system no longer exists, but you still see its echoes in sometimes stark variance across arbitrary old PCT borders) but it wasn't stretched as thin as it is now.
posted by Dysk at 2:58 AM on July 2, 2018 [1 favorite]
No, it was not. NHS funding relative to demand has suffered across the board under the Tories. It was never great, mind, and hugely variable based on which PCT you were in (the Primary Care Trust organisation system no longer exists, but you still see its echoes in sometimes stark variance across arbitrary old PCT borders) but it wasn't stretched as thin as it is now.
posted by Dysk at 2:58 AM on July 2, 2018 [1 favorite]
It is strange to compare a chronic and mostly invisible condition like mental illness to an acute and visible condition like a broken bone. Asthma seems a little better as an analogy for chronic depression: there are treatments that often help somewhat, and there are specific things that you may do that make your condition flare up. I have the beginnings of an analogy rattling around my head between chronic schizophrenia and kidney failure, in that a patient in kidney failure who devotes an enormous amount of time and money to dialysis can trade a miserable death for an exhausting life. I'm not ready to commit to that analogy, yet.
posted by fantabulous timewaster at 5:05 AM on July 2, 2018 [1 favorite]
posted by fantabulous timewaster at 5:05 AM on July 2, 2018 [1 favorite]
The Conversation tends to focus on depression and anxiety, or post-traumatic stress disorder. It is less comfortable with the mental illnesses deemed more unpalatable – people who act erratically, hallucinate, have violent episodes or interpersonal instability. I don’t want to pretend that this stigma is merely a hurdle to be overcome. Stigma exists from a place of real fear, and a lack of understanding of the behavioural changes that can accompany mental illness.
For me, this is the closest she comes to defining the problem. We're not very good at making the distinction between what could be thought of as "mental injury" such as the consequences of traumatic experiences, or conditions associated with physical health problems (such as chemical imbalance or damage) and vulnerabilities associated with schizophrenia, bipolar or autistic conditions, or even addictions.
There's certainly truth to the adage that we're all potential basket-cases in this modern world, but the fact is that a lot of the stigma comes from far older notions of morality which are still embedded in our society. It's far easier to deal with the cause-and-effect of PTSD or bereavement than erratic or otherwise out-of-control behaviour associated with predisposition. On the other hand, in the ongoing process of accepting and dealing with my own condition (which certain friends and family would prefer to think doesn't actually exist) I'm increasingly of the opinion that we're all living on some or other spectrum, and some of us are blessed/cursed to live on the extremes of them.
Amy Winehouse, voice of a goddamn goddess. We’ll allow. Kathy, 54, works at Morrisons. Not so much.
Fuck knows, this sounds incredibly glib, but Amy Winehouse was arguably the worse off for having to deal with the pressure cooker of fame and the people around her leaching off her. She only reached half Kathy's age. Whatever. Improving things for either of them depends on understanding different kinds of minds, why successful human societies display so much variety, and how we can make space for them in our culture. I can understand why she rails against the "crazy genius" narrative, but isn't a key step in this is acknowledging the role of minds prone to ASD/BPD in the arts and sciences, and building societies which support our wellbeing rather than force us into dysfunction?
I have to be optimistic about the fact that we can even have these conversations, and pride seems to me like a good place to start. We're usually the only people mad enough to try and change things, and when we're well we can be very good at it. We should be talking much more about what drives us and why. While we're about it, we could maybe deal with the fact that most of our leaders seem to be psychopaths and narcissists.
posted by Elizabeth the Thirteenth at 5:42 AM on July 2, 2018 [2 favorites]
For me, this is the closest she comes to defining the problem. We're not very good at making the distinction between what could be thought of as "mental injury" such as the consequences of traumatic experiences, or conditions associated with physical health problems (such as chemical imbalance or damage) and vulnerabilities associated with schizophrenia, bipolar or autistic conditions, or even addictions.
There's certainly truth to the adage that we're all potential basket-cases in this modern world, but the fact is that a lot of the stigma comes from far older notions of morality which are still embedded in our society. It's far easier to deal with the cause-and-effect of PTSD or bereavement than erratic or otherwise out-of-control behaviour associated with predisposition. On the other hand, in the ongoing process of accepting and dealing with my own condition (which certain friends and family would prefer to think doesn't actually exist) I'm increasingly of the opinion that we're all living on some or other spectrum, and some of us are blessed/cursed to live on the extremes of them.
Amy Winehouse, voice of a goddamn goddess. We’ll allow. Kathy, 54, works at Morrisons. Not so much.
Fuck knows, this sounds incredibly glib, but Amy Winehouse was arguably the worse off for having to deal with the pressure cooker of fame and the people around her leaching off her. She only reached half Kathy's age. Whatever. Improving things for either of them depends on understanding different kinds of minds, why successful human societies display so much variety, and how we can make space for them in our culture. I can understand why she rails against the "crazy genius" narrative, but isn't a key step in this is acknowledging the role of minds prone to ASD/BPD in the arts and sciences, and building societies which support our wellbeing rather than force us into dysfunction?
I have to be optimistic about the fact that we can even have these conversations, and pride seems to me like a good place to start. We're usually the only people mad enough to try and change things, and when we're well we can be very good at it. We should be talking much more about what drives us and why. While we're about it, we could maybe deal with the fact that most of our leaders seem to be psychopaths and narcissists.
posted by Elizabeth the Thirteenth at 5:42 AM on July 2, 2018 [2 favorites]
There is a poster in my local pharmacy that exclaims, “Mental health can be complex – getting help doesn’t have to be!” Each time I see it, I want to scream.
All of the messaging around Oh hey, stop being ashamed of your mental health issues, stop being afraid that people will treat you badly if they know what you're going through, just ask for help!, which is happening in Canada too, it frustrates me to no end. Sure, ask for help, but be prepared to wait (for months, or maybe for years), especially if you want/need anything more than an uncomplicated prescription for antidepressants. Asking for help is one thing, getting help is a whole different ballgame.
There's so much Conversation too about not self-stigmatizing (with significant social pressure to get people to talk about their health problems - see Bell Let's Talk Day), but not nearly enough focus on teaching the general public not to stigmatize, mistreat, and discriminate against people with mental health issues (so people will have less reason to be afraid of other people knowing they have mental health problems).
A Canadian Medical Association survey found that:
posted by Secret Sparrow at 7:41 AM on July 2, 2018 [9 favorites]
All of the messaging around Oh hey, stop being ashamed of your mental health issues, stop being afraid that people will treat you badly if they know what you're going through, just ask for help!, which is happening in Canada too, it frustrates me to no end. Sure, ask for help, but be prepared to wait (for months, or maybe for years), especially if you want/need anything more than an uncomplicated prescription for antidepressants. Asking for help is one thing, getting help is a whole different ballgame.
There's so much Conversation too about not self-stigmatizing (with significant social pressure to get people to talk about their health problems - see Bell Let's Talk Day), but not nearly enough focus on teaching the general public not to stigmatize, mistreat, and discriminate against people with mental health issues (so people will have less reason to be afraid of other people knowing they have mental health problems).
A Canadian Medical Association survey found that:
- Just 50% of Canadians would tell friends or co-workers that they have a family member with a mental illness, compared to 72% who would discuss a diagnosis of cancer and 68% who would talk about a family member having diabetes.
- 42% of Canadians were unsure whether they would socialize with a friend who has a mental illness.
- 55% of Canadians said they would be unlikely to enter a spousal relationship with someone who has a mental illness.
- 46% of Canadians thought people use the term mental illness as an excuse for bad behaviour
- 27% said they would be fearful of being around someone who suffers from serious mental illness.
posted by Secret Sparrow at 7:41 AM on July 2, 2018 [9 favorites]
Asking for help in and of itself is incredibly complicated. The last couple of weeks have been really traumatic for me. I am not sure if it's situational or a recurrence of major depression. I am privileged enough to actually have a psychiatrist, but I'm not entirely sure what to tell her. Also, because of one of my past psychiatric conditions (bulimia - in remission for 7 years) I am not allowed to even try certain medications. How much consequence am I going to face by being honest? What if those medications were the right ones for me? Will I ever be able to try them and is the PTSD ever going to be dealt with? These questions and more...
posted by Sophie1 at 8:03 AM on July 2, 2018 [1 favorite]
posted by Sophie1 at 8:03 AM on July 2, 2018 [1 favorite]
Sorry for thread sitting, and for what might read as relentless positivity. The fact is that I'm having a day of piss-poor brain chemistry, and when I'm like this I've no choice but to admit that I'm ill. Despair is my enemy. The best I can do today is be kind to myself.
This is why I feel so very strongly about self-advocacy. I've found it helps me to understand what makes me like this, and how to look after myself. I flew this quirky brain quite successfully for many years before I got sick and I know that if I'm going to stay healthy in future, I have to be willing at least to claim autonomy, even if I can't necessarily control it any more.
I definitely share the author's frustration with the Conversation, but there's only so far Western medicine is going to take any of us. There's a point at which you've got to be willing to challenge that narrative and look for better options. For instance, there's plenty of experience to draw on from other cultures' successful use of psychedelics as an aid to mental wellbeing, but I don't see us adopting them anytime soon. This is all further complicated by the need to seek help, as Sophie1 points out. The help might not work out, assuming you get it.
The question that's always at the back of my mind is the relative sanity of the people deciding what is or isn't a disorder? We have diagnostic criteria for anything remotely out of the ordinary, but does anyone even know what it means to be sane? I certainly don't have the spoons to engage in these debates all the time, but neither am I having any self-confessed sane people telling me how to be. I've been there and I'm not going back. Thanks, but no thanks.
posted by Elizabeth the Thirteenth at 10:02 AM on July 2, 2018 [1 favorite]
This is why I feel so very strongly about self-advocacy. I've found it helps me to understand what makes me like this, and how to look after myself. I flew this quirky brain quite successfully for many years before I got sick and I know that if I'm going to stay healthy in future, I have to be willing at least to claim autonomy, even if I can't necessarily control it any more.
I definitely share the author's frustration with the Conversation, but there's only so far Western medicine is going to take any of us. There's a point at which you've got to be willing to challenge that narrative and look for better options. For instance, there's plenty of experience to draw on from other cultures' successful use of psychedelics as an aid to mental wellbeing, but I don't see us adopting them anytime soon. This is all further complicated by the need to seek help, as Sophie1 points out. The help might not work out, assuming you get it.
The question that's always at the back of my mind is the relative sanity of the people deciding what is or isn't a disorder? We have diagnostic criteria for anything remotely out of the ordinary, but does anyone even know what it means to be sane? I certainly don't have the spoons to engage in these debates all the time, but neither am I having any self-confessed sane people telling me how to be. I've been there and I'm not going back. Thanks, but no thanks.
posted by Elizabeth the Thirteenth at 10:02 AM on July 2, 2018 [1 favorite]
As someone who suffers from Severe Depressive Disorder and General Anxiety with particularly strong social triggers, this article fascinates me. I haven't finished reading, but I had to pause when I got to the part where her former guard tries adding her on Facebook. That's shockingly disgusting.
Anyway, with the CDC reporting some pretty alarming statistics (like suicides being up by more than 30% in more than half of U.S. states since 1999 and 54% of those who commit suicide do not have a known mental health condition), getting the Conversation right is evermore important.
What I believe needs to enter into the discussion is the economic reasons why we're having such a mental health crisis, especially in the U.S.
It is no wonder that the Conversation becomes louder when 'successful' and wealthy celebrities commit suicide. They are famous, their deaths are high-profile. But when it comes to the state of their mental health, it usually begins with the apparent contradiction of their remaining depressed despite having "made it". "See, depression is real! It effects everyone!" Then it devolves into semi-related, though typically polarizing subjects like "No more guns!" and debates about addiction and the war on drugs, among other things.
Then the normalization Hannah warns against kicks in and things fall further off the rails.
Instead, what about considering why the Conversation is happening? People are suffering under late-stage Capitalism, exacerbated by a corrupt government and a divided populace, and it is leading to mass mental deterioration. Hopes and aspirations are dashed. Disparity is pronounced.
This is not normal. Mental health is a challenging subject, and grappling with its anomalies and complexities will always be a part of human nature and society as a whole. But supporting an economic system that greatly benefits the few while it significantly contributes to the misery and suffering of the masses is straight up fuckin' cray cray.
posted by pedmands at 12:48 PM on July 2, 2018 [1 favorite]
Anyway, with the CDC reporting some pretty alarming statistics (like suicides being up by more than 30% in more than half of U.S. states since 1999 and 54% of those who commit suicide do not have a known mental health condition), getting the Conversation right is evermore important.
What I believe needs to enter into the discussion is the economic reasons why we're having such a mental health crisis, especially in the U.S.
It is no wonder that the Conversation becomes louder when 'successful' and wealthy celebrities commit suicide. They are famous, their deaths are high-profile. But when it comes to the state of their mental health, it usually begins with the apparent contradiction of their remaining depressed despite having "made it". "See, depression is real! It effects everyone!" Then it devolves into semi-related, though typically polarizing subjects like "No more guns!" and debates about addiction and the war on drugs, among other things.
Then the normalization Hannah warns against kicks in and things fall further off the rails.
Instead, what about considering why the Conversation is happening? People are suffering under late-stage Capitalism, exacerbated by a corrupt government and a divided populace, and it is leading to mass mental deterioration. Hopes and aspirations are dashed. Disparity is pronounced.
This is not normal. Mental health is a challenging subject, and grappling with its anomalies and complexities will always be a part of human nature and society as a whole. But supporting an economic system that greatly benefits the few while it significantly contributes to the misery and suffering of the masses is straight up fuckin' cray cray.
posted by pedmands at 12:48 PM on July 2, 2018 [1 favorite]
I'm seeing my GP tomorrow for an issue unrelated to mental health (well, inasmuch as anything is unrelated to mental health) and have to figure out whether to also disclose that I stopped seeing my psychologist because I felt like I wasn't getting anything out of our sessions anymore. I have not had the spoons to start the process of trying to find an alternative psychologist or counsellor, and because it is such a frighteningly intimate experience don't feel like I can see just anyone.
So I am limping along on my antidepressants which (some days it feels like) do bugger-all to actually make anything better (how bad would I be if I didn't take them? Would I be screaming in the corner bad?) and telling myself that it won't always feel like this is ringing increasingly hollow. I am terrified of asking for more help because of what that help might involve - what the author describes at the beginning of her article is one of my worst nightmares. As bad as I feel, I am aware that being wrenched away from my normal and chosen environments, deprived of social contact and all the many, many tools I have mustered over the years that do help, just not quite enough - well, that would be far worse.
There are absolutely aspects that are similar to having a broken leg, but (as others have pointed out) having your very agency questioned, disregarded or taken away from you is generally not something that happens with a broken leg, or measles, or asthma.
posted by Athanassiel at 7:34 PM on July 2, 2018 [2 favorites]
So I am limping along on my antidepressants which (some days it feels like) do bugger-all to actually make anything better (how bad would I be if I didn't take them? Would I be screaming in the corner bad?) and telling myself that it won't always feel like this is ringing increasingly hollow. I am terrified of asking for more help because of what that help might involve - what the author describes at the beginning of her article is one of my worst nightmares. As bad as I feel, I am aware that being wrenched away from my normal and chosen environments, deprived of social contact and all the many, many tools I have mustered over the years that do help, just not quite enough - well, that would be far worse.
There are absolutely aspects that are similar to having a broken leg, but (as others have pointed out) having your very agency questioned, disregarded or taken away from you is generally not something that happens with a broken leg, or measles, or asthma.
posted by Athanassiel at 7:34 PM on July 2, 2018 [2 favorites]
I like using medical analogies to describe mental health issues. I've got anxiety right now and I've had depression, and it's been a useful way of talking about it for me. I use more than just 'broken leg' though. I talk about how my brother's got a congenital ankle issue. It causes him pain to walk, it's an everyday thing. He's got things that can help, but it's a constant issue that won't be easily fixed. I talk about how being unemployed was like a sprain, and how I needed help and treatment to get it better, but that I'm more sensitive than I was. It can happen again, so I have to be a little more careful. People don't get ashamed of having physical issues, so I try to explain things in a physical way as much as I can.
posted by stoneegg21 at 8:03 PM on July 2, 2018
posted by stoneegg21 at 8:03 PM on July 2, 2018
This is fantastic, and I'm going to add it to my list of resources when trying to explain to people about the shit. Even though I read the Guardian regularly, I'd missed this, so thank you for posting it.
posted by Errant at 9:44 PM on July 2, 2018
posted by Errant at 9:44 PM on July 2, 2018
When people start talking about the mental health care system in the US, I always like to point out how great it was that President Jimmy Carter created a landmark legislation policy Mental Health Systems Act of 1980. Of course it didn’t last very long because Ronald “The Saint” Reagan rolled it back as soon as he could. Sure is unfortunate that people got a real good taste of ObamaCare before they could roll that back. Hasn’t stopped them from essentially doing just that.
History rhymes.
posted by P.o.B. at 11:52 AM on July 3, 2018
History rhymes.
posted by P.o.B. at 11:52 AM on July 3, 2018
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posted by inconstant at 1:22 PM on July 1, 2018 [1 favorite]