An Unorthodox Proposition

With the New Year barely one week old and the snowflakes flying outside, I bet you can barely remember the gaiety and the relaxation of the holidays. Distant memories. Now, we face the long, hard winter with but one short holiday in Ontario to break the monotony and cold. Family Day on February 16.

I want to ask to you to consider a rather unorthodox proposition. Chances are you read "Coming Out Crazy" because you have personal experience with mental and emotional issues. Chances are, this is a place where, I hope, you feel comfortable and welcomed.

Perhaps this is the only place where you feel that. Perhaps your mental health issue is your secret.

What I propose – and I do not want you to do anything that makes you feel uncomfortable or threatened – is simply to tell someone about it. Confide. Share. Open up. Speak out.

Here's why. Mental illnesses, disorders, problems, concerns, whatever euphemism you wish to use, would be far less problematic if more people simply accepted them as part of life. Like any other physical illness. The only difference is that with mental health issues, we may behave a little or sometimes a lot differently.

What if they were demythologized?

What if we could prick the bubble of secrecy that surrounds mental health issues and that creates such enormous problems? Mainly, people are so frightened they won't even seek help. And help doesn't necessarily mean taking medication or seeing a psychiatrist. Help can mean many things. But that help demands talking about how you're feeling.

So, back to my unorthodox proposition. Let's say you are getting help. Perhaps you have a diagnosis. Maybe you don't. You're getting help with some of your problems of living anyway. You may talk to your family doctor. You may see a psychiatrist. You may take medication. You may belong to a peer support group. You may be attending a WRAP group or a Pathways to Recovery group. You may be involved in art therapy or music therapy or any kind of endeavour that you find healing.

Tell someone about it. Someone who doesn't know. Someone who appears to be ignorant about these issues or problems. 

I'm not, for an instant, suggesting you tell your boss at work, unless you have a very solid and secure working relationship. But I am suggesting that perhaps you know someone who makes demeaning or offensive remarks about people perceived to have mental or emotional health issues, clearly out of ignorance. Instead of swallowing this codswallop, stand up and say something. 

This person may be a member of your family. Or a friend. Or the spouse of a friend. And every time he or she says something, you cringe or break into a sweat. You want to disappear. Why not say to this person, "You know, every time you make a comment like that, it upsets me because it's not really accurate. It's not the truth. And I know, because you're talking about me."

Or, in the course of conversation, you could mention that you're dealing with depression or anxiety or whatever issue you have. 

This is why I'm asking you to make this rather unorthodox admission. It will help to educate people. It will make mental and emotional health issues more familiar and commonplace. If everyone told one person, soon, it would appear that these issues are as ordinary as any physical health issue – which they are. But no one talks about it.

Perhaps people wouldn't hesitate it seek some sort of help, without fear or hesitation. 

This is something everyone can do. Soon, words like "crazy" and "nuts" and "mental" won't have the bite they now do. Soon, perhaps, people will demand that an emotional or mental health issue be rightly considered part of our everyday life experience instead of exotic, odd and even, in some cases, scary.

It's one small, but unorthodox thing you can do to begin an open dialogue about mental health and wellness that is long overdue in our society, where too many people suffer in silence.

Here's another perspective. Just something to think about, while considering my unorthodox proposition.  

An unorthodox point of view.

Not all psychiatrists agree that mental illnesses have a basis in medicine. The most notorious, Thomas Szasz, in an article The Myth of Mental Illness, published in the journal American Psychologist in 1959, followed the following year by the publication of his book of the same name, argues that "psychiatry is conventionally defined as a medical speciality concerned with the diagnosis and treatment of mental disorders. I submit that this definition, which is still widely accepted, places psychiatry in the company with alchemy and astrology and commits it to the category of pseudoscience. Why so? The reason is plain. There is no such thing as 'mental illness.'"

In a short online biography of Szasz, I should add, who is a medical doctor and a psychoanalyst with a long and remarkable career of practice in many aspects of psychiatry and psychoanalysis, he is credited with starting the "anti-psychiatry" movement. He believes that "both our uses of the term 'mental illness' and the activities of the psychiatric profession are often scientifically untenable and morally and socially indefensible." He considers mental illnesses as opposed to organic illnesses to be "problems of living."

Roy Porter, in his book Madness, A Brief History, writes that for Szasz, a Professor Emeritus of Psychiatry at the Statue University of New York in Syracuse, "mental illness is not a disease, whose nature is being elucidated by science; it is rather a myth, fabricated by psychiatrists for reasons of professional advancement and endorsed by society because it sanctions easy solutions for problem people."

Mental Illness is a social construction created by doctors, a metaphor, Szasz has said. "Mental illness is a myth whose function is to disguise and thus render more palatable the bitter ill of moral conflicts in human relations. In asserting that there is no such thing as mental illness, I do not deny that people have problems coping with life and each other... Classifying thoughts, feelings, and behaviours as diseases is a logical and semantic error like classifying the whale as a fish." 

So for 2009, I throw out these ideas to you. I am not suggesting that if you are under a doctor's care and on medication, you flush those pills down the toilet and stop seeing your therapist. Just that you begin to believe that whatever your "problems of living," you're also OK! You have every reason to feel a sense of dignity and pride in the human being that you are.

How do you react to this perspective? Do you agree? Disagree? What do you think? Let me know with your comments.

And in the meantime, feel free to question your doctors. Feel free to be skeptical. Feel free to trust in yourself.

After all, you are all you've got. You! 

And speak out!

Comments

[Melodie Burkett]

Hi Sandy, Is this emailed comment of mine getting through? I have spent hours writing to you two times, that when I clicked "post" my letter vanished, could not be retrieved and left me knowing that you did not get it. You did respond once to me when I signed Mrs Onion. I was thrilled. The next time I wrote in, I bravely used my own name BUT wimped out when a I was asked by a gentleman at the (Star?)if you could print my name. Sorry, thank you in advance for forgiving me. The letter that did not make it through was basically cheering for you to keep on keeping on. I made the analogy of the success that A.A.has had world wide. It took 3 Alcoholics to begin the enlightenment. It makes perfect sense that your insight and complete honesty has the power to revolutionize the way people think and feel about mental illness. The time is certainly right. The whole world seems to have gone mad! North America seems to be self medicating deep mental unhappiness. Yet we think 3rd world countries stay lost in fanatic religions and opiates. They are coping with poverty and we are coping with wealth! Actually a twisted concept of wealth. I urge you to read "Payback" by Margaret Atwood. Well, let's hope this clicks through. I liked listening to you very much on the radio program with Nellie Jacobs. I promote "Coming Out Crazy" to anyone who will listen,especially my whole family. I was gutsy enough to ask the Chief of Shrinks in Barrie to do a seminar at my house with about 15 family members. He was gutsy enough to do it. No Charge! Nice guy but, who wants to believe that genes
or bad seeds lock you into an incurable disease? I agree with you that Believing is Seeing. By for now, Melodie Burkett

[Sandy Naiman]

Hi Melodie,

Great to hear from you at last. Sorry for the communications glitches. How wonderful that you're advocating so strongly and with such passion. I'm thrilled to hear from you and I hope that the dialogue continues. I'm glad you heard that radio interview, too. No one else did, or at least, no one has mentioned it to me.

Keep speaking out. You're so right. Now is the time. I believe that "Now" is always the time. I wish you and yours a very happy and healthy 2009. Did your beautiful dream house ever sell? I hope a happy family is living there now.

All the best,
Sandy

[Tara]

With regards to the references to Szasz:

There are three dimensions that a person needs to deal with when overcoming any health problem, no matter where this problem affects the body: The medical aspects, the personal aspects, and the social aspects. Where "problems of living" occur, is when medical and personal aspects of a condition have been resolved, but the social conditions remain unresolved. (Likely due to the reciprocal relationship between we people and our societies... It is here where discrimination, mythology, and political neglect begin to interfere with the ability to "heal fully.")

While I can respect that certain people feel that environmental or relational factors affect their mental health, and it is certainly the case that these do, (in fact, some conditions of mental health have a fairly direct relationship with environment and relationships) I tend to think that there are other factors involved in this process, and that we cannot apply the logic of Szasz to every condition in the spectrum of those conditions that would affect the mind or brain.

And yes, it is true, psychiatry, and much of medicine for that matter, still does reside in the domain of alchemy. Afterall, alchemy is primarily concerned with how a few mere chemicals and molecules can make up something as grand and seemingly mysterious as ourselves and the world around us. I think it is a natural curiosity that people would be interested in exploring those minute blocks that build the material and less material life around us.

And so if one is interested in using clever word coinage to turn a respected field (of chemistry), into a mystical endevour, then that is up to the writer. But the writer needs to understand that at one time in our history, all scientists were considered sorcerers and heretics by persons who believed that humans and our frailties belonged to the domain of G-d, and not to that of man. Notably, if we need reminding, the the Church also suppressed the fact that the earth was round. And so it is to the credit of the conjurers and magicians that we know as much as we do about the world that surrounds us today. And it is to their credit that we began an exploration of the human condition that gave birth to some of the modern technology that we find helpful (and even life-saving) in our every day lives.

Have our explorations always been ethical? Absolutely not. Fortunately, we live in a very different day and age. Although, again, we are still vulnerable to failure of judgment and ethic. We are, afterall, human.

By conjuring mythological historical archetypes (speaking of stigma and stereotypes in science and health), we simply wind up looking as foolish as some of our forefathers who wanted us to live in a world where we believed that if we strayed to far, we may have fallen off its very edge!

Science, for the record, isn't fearsome. However, ignorance, the perpetuation of ignorance and an at-all-costs approach to ideology is.

I do agree, however, that the further we partition the body and break down its components into separate and ever distinctive chemical signatures, the more we come to lose sight of the person within. In dividing our efforts we may come to understand the chemicals but we will fail to understand how these work together to ensure the healthiest human being.

For those of us with a wholistic approach to healing, synthesis of information is most important. And rather than examining only chemicals, we examine other factors as well. It is simply a matter of treating the person, and if possible, treating the community. And for the most part, "treatment" of people and communities simply involves a healthy measure of education. This education about our health is something that our leaders are not currently interesting in doing. That is not the fault of psychiatry. The is the fault of our politicians.

Until medicine understands that we as humans rarely, if ever, stand alone either in health, or in illness, we will never fully be able to heal. To note, this is not to say that communities "create" disease so to speak. Poor health is merely a product of human vulnerability and should be expected, to some degree, as part and parcel of our human condition. To think otherwise, is simply delusional.

In the face of illness, however, communities *do* play an important role in ensuring that the member of the community who experiences an accident of health can rely upon the community to provide them with the means to regain their health. In the event that an illness has become debilitating, it is the responsibility of the community to ensure that the member still has a meaningful place. Here I am speaking of all conditions affecting our health inclusively. Do we do the aforementioned at present? No. And this is why illness tends to become more serious than it needs to be.

It takes a healthy community to have healthy people. But even in the healthiest of communities, people will still become victims of the condition of human vulnerability.

And are we seriously so naive, in this day and age, to believe that the mind is any more "resilient" than the body, with respect to disease? Really? In this day and age, can we logically even divide the mind from the body? For me, that would be a serious act of faith: assuming that my brain is invulnerable to the assaults that occur regularly to my body.

In all honesty, I'm a little disappointed to see buried references to Szasz in this blog. I don't care where you sit ideologically, but the ideas of Szasz are very political, and readers deserve the benefit of seeing a little explanation of the word "notorious." Too many times the media presents tidbits of ideas as facts, or they are interpreted as facts because of their presence in a trusted media source.

[Sandy Naiman]

Dear Tara,

Thank you for your thoughtful, thorough and honest response to my post, and especially my not giving enough background on my “buried” mention of Thomas Szasz. You are absolutely right to be disappointed. Sometimes, when I’m writing, I quickly grab from my idea bank and throw something in to provoke thought. Here, perhaps I wasn’t as careful as I should have been. I should have given more background and explained my use of the word “notorious.” I’m most grateful that you’ve chosen to comment and question this and other issues. In another post, I will discuss Thomas Szasz more thoroughly.

At the end of your comment about Szasz, you say: “Too many times the media presents tidbits of ideas as facts, or they are interpreted as facts because of their presence in a trusted media source.” In all honesty, I must add that I have linked to Szasz’s original “The Myth of Mental Illness” essay and other sources about him, should people wish to explore them on their own. That is why the links are there. I hope, in so doing, I can open up other areas of learning and information for the readers of my blog to consider.

Also, I cannot control the way my writing is interpreted by my readers. However, I will say this about “facts” – they are pieces of information, but they are not necessarily “truths.” There is no such thing as one absolute truth, except, perhaps, that one. There are many truths. We all have our own “perspectives” and for us, those are our truths.

Many mental health problems, illnesses, disorders, conditions, etc., do not fit into the Szasz “problems of living” logic. Obviously. Some are well served by psychiatric treatments – in the short term or for a long time. I know. I take a drug every day and have done so for many years.

I agree entirely with your discussion of the “three dimensions we need to heal” and although the analogy isn’t entirely parallel, it resonates with the Clubhouse motto that we all need “a home, a friend and a job” to begin to build healthy lives. The Clubhouse model arising, of course, from another pre-Szaszian anti-psychiatry, patient-driven model, although that model has mellowed in recent years.

Where I have a bit of a problem is with your assertion, I believe, that political neglect interferes with the ability to fully heal. We are all potentially part of the political process, are we not? All our interactions with others are both social and political, aren’t they? As individuals, we can begin the process of educating, by educating ourselves and then speaking out about our concerns, in this case, our mental health, to help to enlighten members of our community as a whole. As well, we should be speaking out to our medical professionals.

We are members of our communities. We have to take responsibility, don’t you think? Not just pass social change off to the politicians. I think that’s too easy. Become social entrepreneurs, change-makers. We’re part of the political process, too.

My understanding of the conditions affecting mental health, especially today, with the powerful influences of the pharmaceutical industry and a group of doctors who are right now rewriting the DSM-V in secret, no less, plus a tendency for far too many to feel they need “a quick fix” -- a psychiatric diagnosis and medication to feel they’re “being healed” deeply concerns me.

Psychiatric treatment in isolation won’t work. We all need all kinds of supports. Principally, hope. Without the support of other environmental influences -- family, school, friends, job, doctors, employers, teachers, the media, the community as a whole.

Psychiatrists have always been on the bottom rung of medical science and know it. That’s why the pharmaceutical paradigm is so exciting for them. It’s scientific, even if the drugs prescribed in most cases treat symptoms, not what causes those symptoms. Chemical Imbalances in the brain do not necessarily cause mental illnesses. This is still a theory. (See http://chemicalimbalance.org)

It’s extraordinarily distressing to me, as more “disorders” are being “created” for the DSM-V and a larger arsenal of new drugs are going to be created to treat people who may be diagnosed with these disorders. I always wonder what comes first. The drug? Or the disorder?

Either way, I don’t buy it. I, like you, believe in the mind/body connection. That’s why in other posts, and here, I suggest that when an emotional or mental problem is a concern, one should first see a family physician, who has a holistic approach to one’s health. Not go into denial. And that happens, too. A family doctor can see the connections between mind and body. They tend to treat “the person” as a whole. They’re more open to your questioning a quick referral to a psychiatrist or a quick prescription of a drug.

Explore other means of therapy, if possible. Other means, period. As for the whole area of health education and a "holistic approach" to health, you must know from reading here, that I am all for it. That's the whole point of this blog. I am passionate about education as a way to fight ignorance, fear, prejudice and discrimination, especially around mental and emotional illnesses, health and wellness.

The point is that we are all human beings, all unique. Different. We must be treated as special, not square pegs jammed into round holes. When it comes to helping people with emotional or mental health care issues, there’s no one size fits all.

At the same time, is it our fault that this ignorance persists? Is it political? Is it the educational institutions? Or is it all of us?

The point is, we are desperately in need of a new approach, a new way of thinking about health – where mental and physical health intersects and how to educate our communities about it. I think it must begin with us. We must demand change.

A community. Not only a health community, but a community as a whole must endeavour to be responsible for each of its members. I don't see that happening, yet. Do you?

Finally, thank you, Tara, for your insight and passionate comment. All your comments. You inspire me and I am enormously grateful to you.

I will post more about Szasz soon. Promise.

Cheers and I wish you a healthy, gentle and happy 2009.

[Tammy]

Sandy, I want to thank you for what you are doing, and especially for this article and your proposal to speak out. You are so right on this!
I had a very rough year 2007 due to PTSD, anxiety and depression, resulting from addressing childhood sexual abuse as well as issues with life circumstances. It was a crisis period for me. I had been through a group, crisis counselling, writing group, talked to friends and family, but still "crashed and burned", partly due to summer break with my support groups, a lot of physical symptons that I could not get relief from and that my doctor was approaching as isolated physical issues, and withdrawl of close friends. I never saw a psychiatrist as I didn't have the cash, and never got a referral, plus general lack of availability as I live in the country. I did not want to consider medication, except as a last resort, but then it is only in hindsight that I realized I was suffering from clinical depression and anxiety.
Fortunately, I was able to improve considerably with a combination of chiropractic for pain, certain vitamins and changes to my diet, some family help with life stressors, and sheer bull-headedness on my part.

In dealing with my past I have come to believe that it is vital to speak up and educate people, only then can there be real understanding, support and healing, for all concerned. It is the same with issues of mental/emotional health. I have made a commitment to be more involved in speaking out on child abuse and poverty, you have helped me to see that mental/emotional illness is something else that I can be speaking out on. One way I do this is through spoken word poetry, and so I think I shall sit down and get to work on a piece about mental illness for a local open mic at the end of this month!
Thank you again for what you are doing, I am sure you are giving encouragemnt, inspiration and hope to many others out there!

[Sandy Naiman]

Dear Tammy,

You have no idea how much your comment above means to me. Buoys me up. Sometimes, I feel so alone here, trying to respond to comments and to keep a sensitive and valid dialogue going. Sometimes, I don't know whether I'm coming or going; whether what I'm writing makes any sense at all; whether it will help.

I am no expert. Just a fellow traveller. My heart breaks when I read about how hard a year 2008 was for you, despite the fact that everything you were doing was so healthy and positive. I am heartened to hear that things are beginning to brighten up for you, that you are healing and making new connections, doing new and very exciting things. Reinstating your recovery on your own terms. Bravo!

Your spoken word poetry must be so moving. I wish I could replicate it hear. If it were possible to YouTube yourself, I would love to share your vision here at "Coming Out Crazy," because so many people seem to share the experiences from which you are recovering.

I want to thank you for writing and speaking up here. You give me strength and I'm sure your resilience and insight are contagious. Perhaps others will find their own unique ways to "speak out." Like you have.

All the best of luck at your open mic at the end of the month. I'll be thinking about you. Sending good thoughts to you. Please let us know how it goes for you. How it feels for you. And how your audience reacts to your words of spirit and bravery.

Take care,
Sandy

[Tammy MacKenzie]

Thank you for your encouragement Sandy!
The YouTube is a great idea, thank you.
I am determined to write something meaningful, there was a bit on the news last week about a local woman who sought help at the hospital as she was suicidal, and ended up being sent home - the doc at the local hospital tried, but we have no psych facilities out here, and ROH in Ottawa wouldn't take her as she "did not live in Ottawa"! They couldn't admit her at the local hospital as she wasn't physically ill or injured. This is such a sad comment on, and underscoring of, the general attitude regarding mental/emotional illness in our society, the need for resources, facilities and support for those needing and wanting help. I've heard quite a few sad and even shocking stories of experiences people have had in seeking help, coming away with an impression that you are either not going to be taken seriously or you are going to be drugged and locked up without regard for the impact on your life - one woman was held at a mental health office with her children due to get off the bus in less than an hour, and was not allowed to leave or even call anyone, because she told an intake worker (a clerk, no medical training!) she needed assistance because she was having thoughts of suicide. These are some of the things that prevent people from seeking help in the first place, these are the kind of attitudes that need to change, so that people can seek help and be treated with respect and dignity and have their situtaion given as much consideration as someone seeking help for diabetes, a heart attack or a broken leg!
Unfortunately, that means, in large part, public pressure on politicians.
For that, people need to be educated and understand that everyone is as susceptible to an illness or injury of the mind/emotional body as the physical body, and be accorded the same level of compassion and assistance.
It is indeed time to speak up.
It is time that we "crazy people" helped others to understand that we are not flawed, defective, broken or contagious, anymore than a person who has epilepsy, diabetes, or a leg in a cast, is!
Hopefully we, in our healing journeys, discover just how strong and wise we are as a result of them.
Tammy

[Sonia]

Hello Sandy,

I have been quiet for a while as life took place, and all in some way related to this post. Here are parts of what's happened.

One of my sisters was a bully for all of 18 years during which we resided in our parents' house. Once adult, our separate life paths kept us distant and not in contact with each other; not for birthday, Christmas, New Year or Easter. Then, this last week of 2008, I receive from her an invitation to join her on Facebook. Her email in my inbox was enough to call back horrible memories of events I had left "back there" in the foggy and undefined past under "abuse of power". Even though her intent seems honourable, the scars and fears became more than real. The impact of sleepless nights, flashbacks, repressed feelings is so great that she and I will probably never sit in the same room, have a conversation, or exchange letters. The trauma is too deep.

This Christmas my father-in-law had his book of short stories published in time to be wrapped, shipped, and placed under a number of Christmas trees around the world. These stories are about his life (1920-2009) that he has written in the last 15-20 years. His wife and daughter helped with collecting photos for the stories, and we three women helped prepare the stories for publication. "Droppings" by R.S.I. tells about his childhood, his time in WWII and his life in retirement. The humour he infuses in each story conveys the human aspect of three difficult times in the 20th century. The first takes place in the depression in Ontario when most people had little enough to live by. The second covers parts of WWII in which he took an active part or was a direct witness. The third covers the transition from employment to retirement and the activities he embraced. His gentle spirit lives on through these loving stories of every day life made special through his telling. He died January 5, 2009 in sunshine, comfort, and surrounded with loved ones. I have come to realise that he is an embodiment of "father" such as I had not known in my life.

I was raised with siblings, and want very little to do with them. There was so much abuse of power that together we are not healthy. This means that I appreciate the role that siblings play in the lives of each other, while never being able to enjoy their company.

My father was abusive in so many ways, and for such a long time, that the father-figure he should have been never surfaced. He was a biological predecessor and legal parent. My father-in-law was not perfect, and he understood the importance of dignity, self-respect, boundaries of socially acceptable behaviour. His code of ethics permeated like the smell of freshly brewed coffee. I will remember him for teaching me that some fathers are worthy of the title.

Sonia