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Friday, October 24, 2014

So You're Crazy? A Quick Guide to Understanding Mental Illness

So you've just been told you're crazy. And by a professional this time and not just the receptionist in the office who has no interest in going hot air ballooning with you this or any other weekend. There are some important things you should know on your road back to health and normalcy, things that not even your psychiatrist is going to tell you.

7. Psychiatry is not an exact science
We put a lot of trust in our doctors. And it's easy to see why. Not only do they undergo years and years of specialized education and constant re-certification, but they also have millions of dollars of high-tech, state of the art equipment at their disposal.

Psychiatrists, however, sit in small rooms with lots and lots of old books.

Don't get me wrong, shrinks spend endless hours reading journals, attending conferences, and working with patients, but the field is less science and more boozy guy in a bar standing in front of a dart board, praying his next shot sticks.
What does it mean if it lands on the guy leaning against the wall?

There's a lot of guess-work involved in diagnosing mental illness is what I'm saying and how you're treated usually has less to do with your symptoms and more to do with:

  1. Your doctor's particular field of study
  2. What drug/disease is currently trending (more on this later)
  3. Which drug rep just left the office (more on this too)

The human brain is complex. Think of an early map of the earth with a large blank space marked out with the phrase 'Here there be dragons'. That's essentially what we're still doing with the human brain--trying to map out a mysterious land without the proper tools or technology required to accomplish the task. Only in this case, the dragons are real and they're everywhere.
Property values are shockingly low.

Knowing what effects which part of the brain and why is a complete mystery. So all psychiatrists have to go on are symptoms and those symptoms are usually filtered through patients' descriptions and (occassionally) observed behaviors.

I'm not telling you this so you can fake an illness and score some fantastic anti-psychotic drugs (though you definitely could). I'm telling you this because, as a crazy person, it's important that you don't go into your doctor's office expecting an easy solution to your very complicated brain's problems. It doesn't exist. And it's important that you not put all your trust in your shrink to find the answers on your own. A good shrink-shrinkee relationship involves both of you working your ass off to understand the issues at hand and what might be causing them. If it helps, think of yourself as Short-Round and the doctor as Indiana Jones. Sure, one guy gets the bad ass fedora and whip, but where would he be without his little Asian buddy with the cool gadgets? Dead. That's where. Maybe the metaphor doesn't completely work here, but still, Indiana Jones. Amirite?

6. Psychiatry goes through more trends than the fashion industry.
As I mentioned above, psychiatry involves a helluva lot of guess work so when shrinks do make a break-through, they get very, very excited about it. Even if that guess later turns out completely wrong (and it often is). For example, the guy who came up with lobotomies was once awarded a Nobel prize. I'll say that again, the man who decided that what a broken brain needed most was just an appropriately applied ice pick, received a reward for humanitarianism.

Pictured: Someone whose work with ice picks was far more deserving of a Nobel.

And how long did it take psychiatry to figure out that maybe therapy and medication were a better alternative than stab-hating brain matter? 20 fucking years.

Nowadays, break-throughs tend to involve less making brain soup and more the naming of illnesses that already exist. Like Aspergers. And Autism. And before that Schizophrenia, clinical depression, ADHD, ADD, etc. etc. etc.

And like a kid with a new label-maker, when psychiatry comes up with one of these new illnesses, they go around sticking it on everyone. The same happens when a new medication makes it to market. For a while, damn near everybody was on Prozac. Today, it's Ritalin. I swear if I so much as nod off in a meeting, four people are shoving an ADHD pill in my face.

Psychiatry's answer to this is quite brilliant--they're not getting caught up in the heat of the moment and over-diagnosing (or over-prescribing) the latest crazy flavor of the month, they're just correctly recognizing people who had these issues all along. Which does nothing to explain why the same people with depression twenty years ago who were nom-nomming on Prozac like Tic Tacs are now depression free and in treatment for ADHD.

The point is that you have to be able to separate yourself from the headlines and look at your symptoms in a vaccum. And you're going to have to help your shrink do it, too because he's more immersed in that sort of thing than anybody.

5. There is never a cure
One of the most difficult things about being mentally ill is accepting that this is a lifetime diagnosis. You don't ever stop being sick. All you get is different degrees of manageable. You don't even get the luxury of finding one pill that works and living out a happy, medicated life. Because the body's chemistry changes--it builds up tolerances or changes and your pills no longer work. Or they get recalled because it grows a third nipple. Or the manufacturer stops making it because it's not profitable enough. Or your insurance won't cover it because it's too expensive.  You will spend the rest of your life mixing medications like Tom Cruise in cocktail. 

Like this if the depression hadn't crippled you into complete inactivity. 

And for that reason you shouldn't ever let yourself feel too comfortable with any one medication. But it doesn't matter, because even if you did, you'll probably quit them on your own at some point because...

4. Beware the vicious circle
When you do find a drug that works (inasmuch as drugs work), it's easy to get caught up in a state of normalcy. You may find that you no longer cry everytime you burn a piece of bread or see that goddamned long distance commercial about the kid calling his grandmother.
No, not that commercial. Sickie.

You may even begin to think that your normalcy has nothing to do with the obscene amount of pills you take everyday. Or maybe you're an artist type who has discovered it's much more difficult to come up with rhymes for 'abyss' when your head is delightfully clouded with anti-suicidal medication.

At any rate, at some point in your newly doped up career, you will come to the unfortunate decision that 'I no longer need these meds' and you will stop taking them. I call this stage, "You are a fucking idiot." That normlacy you've got is solely because of the meds. They'v given you a window to real life. A little space to breath in and practice acting like a normal person. But never forget what opened that window in the first place. And for God's sake, never stop taking your meds. Which brings me to the next point.

3. You can never stop taking medication. 
The pills can and will alter your brain's chemistry, but the brain does not fix itself. Once broken, it's always broken. Think of your head as the Hoover Dam and your crazy is a tiny leak at the base. Everyday that you don't plug that hole, the leak gets larger and larger until one day you are naked in your apartment disconnecting all your phones so the government can't bug your calls. Those pills are the only thing stopping the leak. And the moment you stop taking them, the crazy starts dripping out all over again. It's slow and gradual so you may not notice it at first. But listen to your friends and family when they tell you that the cat is not trying to communicate hidden messages from the television to you. They have your best interests at heart.

Or maybe they've never met your cat.

2. Sometimes the cure is worse than the disease
Sleeplessness, anger, irritability, suicidal thoughts, sexual, I'm not reciting symptoms from the DSM, I'm listing some of the side-effects from the hosts of medication you will try. No medication is side-effect free. And depending on the severity of your crazy and the dose of your medicine, you may be faced with a choice between say never having sex again or having to listen to the voice of Gilbert Godfrey chanting 'Kill' all day. And you know what? Whether you want to deal with those side-effects for a chance at normalcy is a private decision, but just know that the end result of a person with a mental illness who goes unmedicated long enough, and I'm talking just about any mental illness, is often suicide. Which leads me to the last item...

1. Suicide is always option.
That's an awful statement, just hanging out there. But let me clarify. The thing about mental illness is that people who have it suffer in silence. You've probably heard that cliche a million times. But it's true. And you know what sucks about suffering in silence? Nobody believes you. So aside from the crippling depression and physical effects, you will also have the added bonus of everyone thinking it's all in your head. And when that happens, it's easy to stop talking about your issues, which in turn only makes things worse. It's a terrible cycle.

Now I'm not advocating you throw yourself off a bridge the moment you find out you're OCD. You should try every option available to you to get back a normal and healthy life. You should fight every day. And when you can't fight for yourself anymore, fight for the people who love you. Because suicide is a terribly selfish option. It leaves nothing but blame and guilt and unanswered questions in its wake.
Just like a visit from my mother-in-law

What I'm saying is that if things ever get too terrible to manage, you have that option. Should you ever take it? No. But sometimes, when the fire is closing in, just knowing where the exit is can be comforting. And there's nothing wrong with thinking about leaving. It's actually normal. Don't hate yourself for it. Don't be ashamed of it and don't try to ignore it. And for God's sake, don't ever stop talking about it. 

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