[psych/pshrinkery] May is Mental Health Awareness Month
May is Mental Health Awareness Month, and unlike most other Awareness Month topics, this is one that I think there is insufficient awareness about, so I figure I should write something.
There are about mental health two things, I suppose, before all others I would like my readership to be more aware:
0) Mental health is about more than mental illness. Please don't hear "mental health" and just think "crazy people", or even, more enlightenedly, "people with mental illnesses". Health isn't only a topic for sick people, and that's just as true in the psychological as the somatic.
I don't really have it in me to work up a full discussion of that topic, but just kinda be aware that it's there. Contemplate it, if you will.
1) Nevertheless, ironically, my second point is in fact about mental illness: you know more people with mental illnesses than you know have mental illnesses; and when you try to think about or generalize about mental illness, unless you have the kind of access only mental health professionals usually have, you are doing so in a profound vacuum of examples. This is true even if you, yourself, have a major mental illness.
Let us ignore for the moment the population of people who have mental illnesses and don't know it, or don't know which one, which is a not inconsiderable number of folks. The vast majority of people with mental illnesses, who know it, who have diagnoses, are deeply in the closet about it -- for damn good reason. The more severe or frightening the disorder, the less they want you to know they have it, because the more prejudicial that information is about them.
Sure, there are people who do come out more broadly. The population that does skews hard towards comparatively less severe illnesses, and ones with more social acceptability, like depression. Yes, depression is the "more socially acceptable" example: take it as edifying that there are lots of things even harder and less socially acceptable to out oneself as having than depression.
Consequently, the public sphere is largely absent the voices of people with major mental illnesses, and what few voices there are take on disproportionate weight and authority.
I want you to hear that silence. I want you to become aware that it's there. There's a great slogan in the Autism self-advocacy movement: "Nothing about us without us". But because many people with many disorders can't come out of the closet, discussion about them -- clinical discussion, policy discussion, casual discussion -- will happen without them.
For those of you who are such people, listening to others talk about your fate, your rights, your liberties, your nature, in front of you, like you weren't there, wishing you could erupt, "Oy, that's my life you're talking about!" but not daring to, please remember this: you are not the only one so listening. That lack of voices can leave one feeling enormously alone. It can leave you feeling small and helpless in the face of a great unsympathetic ignorance. But you are not alone. There are far more others out there than dare admit it, for the same reason you dare not admit it. Free advice: to whatever extent you can, seek those others out and make allies of them. It helps.
For those of you who aren't, and are wondering what an ally's work in this entails: you can't fix this, yourself, but you can help. Here are some things you can do, to make yourself less part of the problem and more part of the solution:
0) Work to become cognizant of how discussion about a people without them tend to go off the rails, in general.
For instance, remember the pattern of "you weren't at the meeting so we decided it was your fault": when people aren't at the table, both problems and solutions tend to get situated in them. For example, the poorer general medical countcomes for people with major mental illnesses is usually addressed in terms of how the mental illness interferes with the patient's ability to manage the illness -- a very important problem to be sure -- to the exclusion of looking at how medical professionals discount the complaints of people with major mental illnesses. Think to ask yourself and others, "Are we focusing on the role of the person with the illness to fix this problem, to the exclusion of looking at what the systems they're having problems with could be doing to help?"
Similarly, remember the pattern of "you weren't at the meeting so we made you secretary": when people aren't at the table, those who are often manufacture work for the people who aren't, inventing new laborious procedures that they have to go through and burdensome practices they have to adopt. Example: Abilify is an antipsychotic medication with AFAIK no street value to speak of; if you're on a certain insurer for the indigent in this state, your psychiatrist can prescribe it to you up to a certain dose, but if you need more than that, it requires pre-authorization. That is to say, if you're ill enough to need a higher dose, your doctor has to fax an additional form to the insurer saying, "Yes, I think, in my medical opinion, this patient needs this dose of this medication. May I prescribe it?", and the insurer basically always rubber stamps it -- what are they going to do, micromanage the doctor? -- and then the prescription can get written. This serves no actual earthly purpose -- it certainly doesn't cut down on fraud -- except to penalize patients who need a higher dose of the medication with a longer wait for their medication. But no doubt some bean counter thought it a lovely idea. Think to ask, "Is this really the 'no big deal' people make it out to be? Will it be a 'no big deal' for people without cars? For people with a busy schedule of medical appointments? For the blind? For people with memory problems? For people with chronic exhaustion? For people who can't assert themselves appropriately or at all with authority figures?"
For another instance, remember how discussion about a people without them tend to be more enthusiastic about curtailing their liberty than they would ever be. Think to ask, "Is this necessary, or just convenient for the people in favor of the status quo? How would I feel if it were me?"
For another instance, remember how what voice the people not at the table do have in the discussion tends to be discounted. In this case, that goes times ten. When the opinions and preferences of real, actual people with major mental illnesses are being ignored, disputed, or invalidated, stand up and say, "This isn't right. That's someone in a position to know. They're the authority here, not us. They're invested in how this turns out, not us. We should be deferring to them, not insisting they defer to us".
I bet there are other examples; feel free to brainstorm more of them in the comments.
1) Whenever you are discussing issues that pertain to people with mental illnesses, and that discussion is happening in a group of more than four people, remind yourself that one of the people in this discussion is one of the people under discussion. You just don't know which one. And if it's more than four people, there's more than one who has a major mental illness.
This is a head-game you can play on yourself to keep yourself honest. It deters your making any rhetorical maneuvers that position all your audience as "us" and the mentally ill as "them". It deters your making any really embarrassingly bigoted remarks. (Prejudices about the mentally ill are a huge topic which warrants its own post.)
2) Point out the silence to others, when you see discussions happening without the people who are the topic of discussion. Do some consciousness raising. "Hey, this article about the state reducing funding for supportive living facilities for the mentally ill, it didn't ask any of the people affected what they thought or how they would experience the cuts." "Hey, this op-ed about how psych meds are evil is by someone who isn't even diagnosed with any of the disorders these meds are meant to address. I wonder what they would have had to say about it."
So, there, now you're a bit more aware of mental health.
There are about mental health two things, I suppose, before all others I would like my readership to be more aware:
0) Mental health is about more than mental illness. Please don't hear "mental health" and just think "crazy people", or even, more enlightenedly, "people with mental illnesses". Health isn't only a topic for sick people, and that's just as true in the psychological as the somatic.
I don't really have it in me to work up a full discussion of that topic, but just kinda be aware that it's there. Contemplate it, if you will.
1) Nevertheless, ironically, my second point is in fact about mental illness: you know more people with mental illnesses than you know have mental illnesses; and when you try to think about or generalize about mental illness, unless you have the kind of access only mental health professionals usually have, you are doing so in a profound vacuum of examples. This is true even if you, yourself, have a major mental illness.
Let us ignore for the moment the population of people who have mental illnesses and don't know it, or don't know which one, which is a not inconsiderable number of folks. The vast majority of people with mental illnesses, who know it, who have diagnoses, are deeply in the closet about it -- for damn good reason. The more severe or frightening the disorder, the less they want you to know they have it, because the more prejudicial that information is about them.
Sure, there are people who do come out more broadly. The population that does skews hard towards comparatively less severe illnesses, and ones with more social acceptability, like depression. Yes, depression is the "more socially acceptable" example: take it as edifying that there are lots of things even harder and less socially acceptable to out oneself as having than depression.
Consequently, the public sphere is largely absent the voices of people with major mental illnesses, and what few voices there are take on disproportionate weight and authority.
I want you to hear that silence. I want you to become aware that it's there. There's a great slogan in the Autism self-advocacy movement: "Nothing about us without us". But because many people with many disorders can't come out of the closet, discussion about them -- clinical discussion, policy discussion, casual discussion -- will happen without them.
For those of you who are such people, listening to others talk about your fate, your rights, your liberties, your nature, in front of you, like you weren't there, wishing you could erupt, "Oy, that's my life you're talking about!" but not daring to, please remember this: you are not the only one so listening. That lack of voices can leave one feeling enormously alone. It can leave you feeling small and helpless in the face of a great unsympathetic ignorance. But you are not alone. There are far more others out there than dare admit it, for the same reason you dare not admit it. Free advice: to whatever extent you can, seek those others out and make allies of them. It helps.
For those of you who aren't, and are wondering what an ally's work in this entails: you can't fix this, yourself, but you can help. Here are some things you can do, to make yourself less part of the problem and more part of the solution:
0) Work to become cognizant of how discussion about a people without them tend to go off the rails, in general.
For instance, remember the pattern of "you weren't at the meeting so we decided it was your fault": when people aren't at the table, both problems and solutions tend to get situated in them. For example, the poorer general medical countcomes for people with major mental illnesses is usually addressed in terms of how the mental illness interferes with the patient's ability to manage the illness -- a very important problem to be sure -- to the exclusion of looking at how medical professionals discount the complaints of people with major mental illnesses. Think to ask yourself and others, "Are we focusing on the role of the person with the illness to fix this problem, to the exclusion of looking at what the systems they're having problems with could be doing to help?"
Similarly, remember the pattern of "you weren't at the meeting so we made you secretary": when people aren't at the table, those who are often manufacture work for the people who aren't, inventing new laborious procedures that they have to go through and burdensome practices they have to adopt. Example: Abilify is an antipsychotic medication with AFAIK no street value to speak of; if you're on a certain insurer for the indigent in this state, your psychiatrist can prescribe it to you up to a certain dose, but if you need more than that, it requires pre-authorization. That is to say, if you're ill enough to need a higher dose, your doctor has to fax an additional form to the insurer saying, "Yes, I think, in my medical opinion, this patient needs this dose of this medication. May I prescribe it?", and the insurer basically always rubber stamps it -- what are they going to do, micromanage the doctor? -- and then the prescription can get written. This serves no actual earthly purpose -- it certainly doesn't cut down on fraud -- except to penalize patients who need a higher dose of the medication with a longer wait for their medication. But no doubt some bean counter thought it a lovely idea. Think to ask, "Is this really the 'no big deal' people make it out to be? Will it be a 'no big deal' for people without cars? For people with a busy schedule of medical appointments? For the blind? For people with memory problems? For people with chronic exhaustion? For people who can't assert themselves appropriately or at all with authority figures?"
For another instance, remember how discussion about a people without them tend to be more enthusiastic about curtailing their liberty than they would ever be. Think to ask, "Is this necessary, or just convenient for the people in favor of the status quo? How would I feel if it were me?"
For another instance, remember how what voice the people not at the table do have in the discussion tends to be discounted. In this case, that goes times ten. When the opinions and preferences of real, actual people with major mental illnesses are being ignored, disputed, or invalidated, stand up and say, "This isn't right. That's someone in a position to know. They're the authority here, not us. They're invested in how this turns out, not us. We should be deferring to them, not insisting they defer to us".
I bet there are other examples; feel free to brainstorm more of them in the comments.
1) Whenever you are discussing issues that pertain to people with mental illnesses, and that discussion is happening in a group of more than four people, remind yourself that one of the people in this discussion is one of the people under discussion. You just don't know which one. And if it's more than four people, there's more than one who has a major mental illness.
This is a head-game you can play on yourself to keep yourself honest. It deters your making any rhetorical maneuvers that position all your audience as "us" and the mentally ill as "them". It deters your making any really embarrassingly bigoted remarks. (Prejudices about the mentally ill are a huge topic which warrants its own post.)
2) Point out the silence to others, when you see discussions happening without the people who are the topic of discussion. Do some consciousness raising. "Hey, this article about the state reducing funding for supportive living facilities for the mentally ill, it didn't ask any of the people affected what they thought or how they would experience the cuts." "Hey, this op-ed about how psych meds are evil is by someone who isn't even diagnosed with any of the disorders these meds are meant to address. I wonder what they would have had to say about it."
So, there, now you're a bit more aware of mental health.