Nick Kristof, NYTimes columnist who grew up in the Portland area (as did I -- he’s younger) has asked for feedback for one of those New Year’s idea prompt lists: http://www.nytimes.com/2014/01/05/opinion/sunday/kristof-first-up-mental-illness-next-topic-is-up-to-you.html?_r=0 To quote: “So here’s your chance to tell us what we’re missing. I invite readers to suggest issues that deserve more attention in 2014. Make your suggestions on my blog, nytimes.com/ontheground. I hope to quote from some of your ideas in a future column.
“My own suggestion for a systematically neglected issue: mental health. One-quarter of American adults suffer from a diagnosable mental disorder, including depression, anorexia, post-traumatic stress disorder and more, according to the National Institutes of Health. Such disorders are the leading cause of disability in the United States and Canada, the N.I.H. says.”
I have no suggestions for neglected issues that would be new to anyone who reads this blog regularly, but I have some real objections to making a big deal out of mental illness without some careful pre-thinking. It too easily becomes a weapon. Nonconformity too easily becomes insanity.
Russian mental hospital
One person’s mental disorder (as defined by someone else -- which it often is) is the next person’s character flaw or maybe just bad behavior or possibly even criminal acts and maybe an activist’s different culture. There’s also simple immorality or, as we used to recognize in Russia, political difference prompting incarceration. The boundaries among these are so situational, so interpretable, that anything outside organic dysfunction that can be detected by some objective means or that does clear damage to self or others (the most common current legal definition), that they are impossible to define. I mean, why isn't Dick Cheney formally defined as insane? He's certainly outside my reality.
What I’m saying is that interpreting someone as “crazy” is a good way to discredit and control them. On the other end, refusing to define someone as irrational enough to justify intervention, can cause deaths and suffering. I speak from experience: my brother, had prefrontal cortex trauma from falling. After months of living with him and my mother, with whom he lived because he couldn’t work, I could finally see that there was something wrong with what they call “executive function,” which is to say, good judgment. He had been a Marine MP and often stepped back into those mannerisms. After my mother was gone and he had outworn his welcome with other relatives, he disappeared. He was in his sixties, penniless, and his applications for welfare ended up in quarrels with the intake staff, usually female. He refused to accept the idea that he had a disability.
I called the sheriff in Oregon and put in a “request for a welfare check.” They found my brother and questioned him, which he and my other brother deeply resented as an unwelcome intervention and a malignant attempt to discredit him. Neither that brother nor I knew at that point that he’d spent the summer holed up in a basement, paranoid, in a fort made of boxes. In today’s climate, we would worry about him going on a shooting spree. Living on the street, he had a series of heart attacks and for a short time was in a Veteran’s Hospital where they did not detect nor treat his brain dysfunction though the scar on his forehead was obvious. This was just before a wave of brain damage stories about football and military concussions.
Do you remember Martha Mitchell? The "Martha Mitchell effect", in which a psychiatrist mistakenly or purposely identifies a patient's extraordinary claims as delusions, despite their veracity, was later named after her. She was mouthy, defiant, a leaker of information about Watergate among other things. One night at her hotel men threw her on a bed, knocked her out with a sedative hypo in the butt, and took her to a mental hospital where she was treated for “alcoholism.” At the time my marriage was in about the same state: I was mouthy, defiant, but not alcoholic. There was a certain amount of “gas-lighting” going on. Other women in my situation in the same community were being committed to mental hospitals and given electroshock (this was 1970 when EST was harsh and they were NA) until they stopped making trouble. It just then happened to the wife of a Montana museum official who had been fired for stealing. I was terrified that would happen to me. It didn’t.
Bob Scriver himself was considered more than a little crazy, which the locals thought was the natural state for any artist, and but was a suggestion actively promoted by the more carnivorous art dealers when he indignantly opposed them. He used to say, you can get away with anything if it’s totally outside what people expect, from the Jewish Holocaust to Bar Jonah, cannibal of boys.
Ten years ago when I briefly taught in a nearby small white town, each teacher was given a list of students on which medications. Two pages. Probably a quarter of the student body. One boy had fits of destructive rage; I suggested steroid use, which was quickly denied. They said the whole family was that way. Besides, he was an outstanding athlete. How much is mental health compromised by pharma prescriptions and how much by illegal drugs? We “know” which one is supposed to be the solution and which is supposed to be the problem, but not why, so we sort by family reputation.
Kristof quotes figures of mental illness showing that “mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.” That’s easy to fix: just change the definition of mental disorder -- we do that with poverty. In fact, the psychiatric establishment changes the definition of mental illness all the time, which is very interesting to the insurance establishment, the pharma industry, and those who sell the annual issue of the Diagnostic and Statistical Manual of Mental Disorders. DSM | psych.org Also the people who "code" the descriptions into billable units. "Crazy" is a commodity.
In the meantime, we are busy making people crazier by withdrawing the social safety nets, arresting people according to their ethnic or racial background, and putting antisocial people in solitary confinement so complete that, if they weren’t crazy already, they soon become that way. We’re great at creating the social double-binds that cause brains to go in tiny circles. If a fourth of the population of a country is definable as crazy, isn’t it logical to ask whether it’s the nation itself that’s crazy? In a world that is painful, blaming, and excluding, can a victim of those forces be called crazy for being suicidal?
And here’s another question: thinking and feeling are exquisitely calibrated molecular functions of the brain. The molecules used are those ingested, breathed or absorbed through the skin. We have invented so many new molecules and put them into our bodies so many different ways, how do we know they aren’t what's interfering with brain function? How can adding more unnatural molecules (meds) be helpful?
What about people who are simply born missing brain parts? Or have too much of other parts? So much of defining them as “diseased” is just difference, wrong expectations, lack of some context that can accommodate them. Seems to me that the trend towards charter schools, drop-out schools, alternative schools, is at least a gesture towards the sort of thing that could be done in the larger society. Maybe we need secular monasteries. Communes?
Living in the streets, which is the fate of too many people, could make anyone crazy. Why shouldn’t basic shelter be Kristof's top concern? Simple shelters with a little privacy and storage; accessible toilets designed to resist damage; public showers kept stocked with soap; laundry facilities with dryers in northern climates, clotheslines elsewhere. Safe parking for people living in their cars.
Here’s my top priority: someone who could listen. No particular training, just an aptitude for empathy and paying attention. Could be a kid as easily as a grandmother. Could be online. Those who do it know it works. Good on Kristoff for doing it. Of course, judging from the “we” he uses, it will be staff. and you’ll need internet access. I'd post the comment access code but I'm denied -- I've already used up my limit of ten free stories and Kristof's blog has gone behind the pay wall.