Kiss5Tigers

The 5 Tigers represent the big things in life. This blog is about facing them.


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Is Mental Illness Real?

I was browsing a Facebook group where I’m a member and one of the other members stated that there is no such thing as mental illness.

Huh.

In a forum of people who have psychological distress, you have stated that mental illness isn’t real.

Not sure where I stand on that.

Well, no, I’m pretty sure where I stand on that: It’s a bit dismissive. It’s more than a bit dismissive. It’s downright belittling.

But also, I get it. I mean, we talk about mental illness as opposed to “being normal” only normal isn’t real. It’s a statistical construct based on the average way people act. It isn’t even based on feelings most of the time because we don’t know what people feel, we can observe how they act.

I suppose that’s why Abraham Low, who might be the first CBT practitioner back in the 40’s and 50’s, talked so much about seeking to be average. I feel like, it’s not about what you really experience, it’s about your ability to pass for typical.

The person’s perspective on the forum, if I understand correctly, is that extreme mental states are part of being human. They are normal and natural, and shouldn’t be pathologized.

Also, there is remarkably little data about brains with mental illness. Or the functionality of brains without mental illness, for that matter. We have some really good ideas about how the brain works, but when it comes to mental illness, it’s a black box. We don’t really know what goes wrong when people lose touch. We think it has to do with chemicals and neurons, and theories have led to some effective medications.

But medication is not 100%. Things like Cognitive Behavioral Therapy are reported to be as effective in shifting mood as many drugs. Does that mean drugs aren’t effective?

Not all drugs work for the same condition in different people. I mean, you can pretty sure that if you and I both have an infection, the same antibiotic will help. But with my bipolar? I take one cocktail of medications and my friend with the same diagnosis takes a different one. Does that mean we have different disorders?

And there is no biological test for mental illness. We can test for high blood pressure or diabetes. We can see a physical injury like a cut or a broken bone. We can detect appendicitis or cancer. But mental illness is invisible in this sense, there is no way to detect it in the body. It only appears in behavior and reported feelings.

So here I am, dealing with bipolar. And I know the big thing is not that there is something wrong with me, but that my moods and feelings stray outside the realm of average and interfere with my ability to manage life.

Does that make me sick? Or maladapted? Or sensitive to mood?

I take drugs that help me with my mood. Mood under control means life is manageable, which is good. Manageable means I pay bills on time, take a shower, sleep daily, have a job. Manageable means I pass for normal, even though my moods are often outside the bell curve. Manageable means you don’t point and stare at me. I can pass.

Who do I take the drugs for? Me or you? Because some days, most days, I feel pretty average and that was true before my diagnosis. Am I making my life more manageable for my own benefit, or because you (whoever you is) are uncomfortable with my difference?

I have been called eccentric for most of my adult life. Eccentric is okay, not as creepy as being weird, not as out of control as crazy. I’m a little odd. You think I’m normal until you find out I’m not. I make you slightly uncomfortable from time to time, but you can pass it off.

For example, I seem to observe people closely, maybe a little too closely. It makes my friend feel scrutinized. I am not aware of doing it. I watch motion. If you happen to be moving, I’m watching you. It’s a habit. I’m not consciously doing it. In fact, my attention may be turned inward and I’m not paying enough attention to actually see you at all. But I’m tracking what you’re doing. I try to be conscious of this because it makes folks uncomfortable and gets me labelled weird. It’s rude. Is it a sign of illness? Or a poorly managed evolutionary adaptation? After all, in the wild, there are advantages to being visually attentive.

But I digress.

Suppose I am not ill. Suppose I am just at one end of the bell curve of emotional sensitivity. Why do I medicate? Wouldn’t it make much more sense to change my behavior? I mean, there’s nothing wrong with being 6’5″ tall or 4’9″. They are just opposite ends of the bell curve. Maybe I am just more sensitive and somewhere there is someone who is less sensitive. Maybe I don’t need medication but understanding.

Yet medication works, so isn’t that an indication that I’m sick? Medicine changes things for me in a way that is an improvement. Doesn’t that mean I’m unwell in some way?

Is mental illness real? I certainly have real troubles and real mood extremes and real cognitive distortions. What I don’t have is a physical diagnostic that shows where bipolar exists in my brain. I can’t have my bipolar removed or point to the area where my bipolar is. I can’t even say for sure what happens when I have an episode. Why am I sometimes depressed and other times manic? It seems like there must be 2 different things going on here, to get two such different mental states.

Personal experience says mental illness is real. Just like chronic fatigue syndrome is real. That’s something that was believed to be made up until enough people reported it. Pain is real. Psychological pain is real.

For me, I just keep on doing what works. Medication helps. Support groups help. Making art helps. Seeking wellness helps. Working helps. Learning about my disorder helps. Because at the end of the day, it doesn’t matter if I need medication to cope or if I can learn resiliency skills. What matters is that I figure out what I need to thrive.


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The Right to Fail

I’m thinking about this in terms of parenting, but I think it’s bigger than that.

My daughter is 21. When I was 21, I had been on my own for 2 years, having been orphaned when I was 19. I knew a lot more than when I was 19 but I still knew almost nothing. My daughter, well, she’s had a hard life and she knows a lot, but she seems to make bad decisions. It’s okay, she’s young and has time to recover from an stupidity she may commit.

I have to keep reminding myself of that. She is an adult. She has the right to make her own decisions, good or bad. She also has the right to bear the consequences. I keep wanting to save her, to make her life easy, to rescue her. She, of course, does not want this from me. So I have to remind myself, she is an autonomous being, she has the opportunity to succeed, and also the right to fail.

We don’t think of failure as a right, but if you want to make your own decisions, failure is simply going to happen from time to time. Some decisions are bad from the get go, others are reasonable at the time but turn sour, some are positively brilliant. If I rescue her from negative consequences, she never learns. She is never fully autonomous, she is simply a human avatar for my ego. And at the end of the day, I want her to be a functional adult. After all, she will outlive me, she has to be able to get along without me.

I got to thinking of this with regards to mental health. So often we who have a diagnosis are treated like children. We have decisions made for us, supposedly in our best interest, but without our input. We lose agency by admitting to our difference. We are seen as so impaired that we cannot decide whether to take medications that have such dangerous and unpleasant side effects.

Now I take meds and I am happy with them, but there was a time when the dose was too high and it flattened me. I had long pauses in conversations before I responded, and I was so slow that I didn’t even know it. Freaked out my friends. I felt fine, but they were worried. Then I had a family member die and I couldn’t cry about it. I told the doctor and he tweaked my dosage. I have the right to cry when things are sad. I have the right to be miserable, actually, though I don’t choose it.

I, however, have never been suicidal or psychotic. Both of those are potential states I could experience with bipolar. So I have been up and I have been down, but I haven’t been truly out of my head. I have mild symptoms. I’m lucky.

But even if I had intense symptoms, I don’t know that someone should be able to take agency away from me. If I am dangerous to other people, sure, but we do that with anyone who becomes dangerous, like the guy who robs a convenience store with a gun, or a mugger with a knife. If I am simply not in consensual reality, well, does that require forced medication? I mean, we as a society assume it’s a sign of health to acknowledge the same reality as everyone else, but maybe it’s not a necessity.

Because for us with a diagnosis, success is seen as partaking in society as it is, as the constituents agree it is and opting out is failure. The person has failed to adapt, to present as typical. There is no suggestion that there is a failure of society to accommodate the other experience. Or that adaptation to an unwell society is not a sign of mental health. And make no mistake, there are aspects of our culture that are not healthy. Which is true of any culture.

So the standard of success is how much I can pass for neurotypical. If I can’t pass, I must be medicated, even though many of the medicines used are no more effective than placebo. I must be medicated until I comply, then I am a success.

What if I don’t comply? What if I am happy with my ups and downs, my creativity and deep thoughts, my highs and lows? Then I would fail to pass. And I have that right. I have the right to fail. I have the right to make my own choices about my health. I have agency over what happens to my body. Or I should.

Except that I am mentally ill, so I must pass as “sane” or “normal”.

We call them “average people”. I am not insane. I am not abnormal. I am not typical. But I might be average. I might have higher highs and lower lows, but you have ups and downs and nobody feels the need to medicate you out of a range of emotions. Average people have the right to fail. I want the right to fail.

I fail miserably at 40 hour a week jobs. I simply don’t have the stamina to keep it up beyond a certain length of time. I want the opportunity to make other choices. I want the right to choose other paths even if it means I fail. I don’t want to be medicated into compliance. I don’t want a job that I need to take happy pills and valium to go into an office every day. It doesn’t sound like a life, even though it would look successful. I want the right to fail.

So here is my daughter, with all the drive of a young person, all the fire, all the dreams. And the best I can do is let her go, and hope she fails gloriously.

Don’t conform, daughter, unless it’s a game you enjoy playing. Do your best. Make different choices. I hope you succeed, but you have the right to fail.