The giving, offering, and forcing of selves

Not another post about nuance! Yes and it all started when I heard benevolent superstar Jon Swift is offering exposure to his blogroll writers with another year-end round up of Best Posts Chosen by the Bloggers Themselves. Last year was a great success, providing hours of enjoyable reading and oodles of new visitors to the entrants’ blogs. This is not a contest, but an invitation for writers of all kinds who want a little more attention. I’m posting about it in the enduring hope of seeing psychiatric bloggers do more crossing-over into the wider progressive blogosphere. Of course you have to be on his blogroll, but since his blogroll is famous for being open to anyone I can’t imagine why anyone wouldn’t be on it.

I had little trouble choosing my own favorite post from this year’s slim pickens because I’m still pissed about that blogger from last year’s round-up who decided the most important post she wrote in 2007 was an injunction to readers to take their psychiatric meds. I don’t easily let go that sort of bullshit and it’s not because I’m against people taking psychotropic drugs. It was the compulsion to thrust her garbage onto the faceless reader as if the reader was any of her damn business, it’s that sort of foolishness gets stuck in my craw.

It looks like we’ve come full circle in one year’s time. These days the big drag in the psychosphere is seen in the browbeating of bloggers who actually do take their medication, to the consternation of antipsychiatry bullies who know for a fact that using meds does nothing but support corrupt big phRma. The DSM’s a bastard, mental illness a social construct, everybody hurts, but if you need a crutch there’s always B-Vitamins and Omega 3 fatty acid, looser! You may think this a caricature and sadly, so do I. But it’s for our own good, the twisted stigmatizing by double-talking activists who seem to think unvarnished contempt of their own (imagined) constituency is lost on anyone who believes other people’s choices are deserving of respect.

What are we to make of it? Unsolicited warnings about disabling side effects, but ZOMFG stopping drugs cold turkey without “tapering” will make you a school shooter, calling out fellow bloggers in a keyboard-pounding frenzy to justify their failure to denounce the modern tools of psychiatry, and without a single self-deprecating nod to their own fixation over this grave and pressing life and death matter.

One popular no-med blogger did just that to your shy and retiring flawedplan this year and thankfully I was able to maintain sufficient wit to persuade her to swiftly remove the nonsensical post but these displays of nerve can leave a chilling effect. And they’re accumulating, some phase, the pendulum swinging, whatever the reason, antipsychiatry abounds. Yes I know, google antipsychiatry and you’ll end up here, isn’t that ironic. Something’s gotta give.

Just this October while cleaning out my medicine cabinet I found a two year old bottle of un-opened Effexor and decided I’d take one a day to see what it did to my mind. First time I try psych drugs in over three years but can’t bring myself to share this experiment on my own damn blog because who wants to fight with competitive antipsychiatry ass berets? That’s fucked up . And more fool me, being so wilting lily sensitive but
when
I
can
I
will
so let the record show, Effexor kicked ass in the third week, got me talking to people, telling jokes, on the phone and off my computer, playing with kids, looking up at the sky above, cornbread moon and twinkly stars, take that, assholes! all very banal and run-of-the-mill, a mood elevator doing what it was designed to do, someone better call Ripley. But I dreaded the outcry — Placebo effect!— Uh huh, and it only took 32 trials with prior “placebos” til Effexor hit the sweet spot, what a mystery these dadgum sugar pills, 31 fakes til the real placebo kicks in.

Now, wait just a dadblasted minute. Did I not just say I’ve been off psych meds for three full years and now I’m going on about undergoing 32 drug trials? Which is it, what gives? I get these triumphant gotcha emails and don’t know what to make of them that seem to be saying “Come Clean!”

Because nothing says you’re filling a necessary void like an excruciatingly detailed exposition of your journey with psychotropic medications, therefore a blogger is beholden to describe her course in its entirety, stops and starts, gains and losses, why I changed my mind, then changed my mind again, til I came upon the final wisdom, whether from compliance to non-compliance or non-compliance to compliance and the road back to where I was before the meds destroyed my fill-in-the-blank, the fact of the matter is every veil that falls from my eyes will be validated by matching veils falling from your own. Or else.

Else what?

You can face the pathetic need to have complete strangers put their stamp on your own life choices or you can assume the identity of a pharmaceutical fetishist, choose to troll blogs, shut down discussion, expect everyone to be similarly obsessed with pharmaceuticals in a vain attempt to normalize batshit insanity by projecting your issues into the environment, which no one in the history of the world has ever tried before.

They’re out there. Trolls are meant to be smacked down, though I wouldn’t call them concern trolls, because they’re incapable of misrepresenting the concern part of the concern troll protocol. It seems more like a minority of angry antipsychiatry usurpers have united in an effort to seize the mental health discourse, make discussion ugly for any mental health blogger inclined to post about a casual relationship with said drugs and prescriber, who gives the topic due proportion, as an aside, one detail in a multi-faceted narrative. Not to mention any blogger who feels conflicted about using pharmaceuticals, you will watch your mouth or rue the day you turned off comment moderation.

Antidepressants aren’t that interesting, they are just the device in a battle of wills. It’s about control, over-powering the blight of personal sovereignty by those who feel personal sovereignty was stolen from them, and by the looks of things it was. But there has to be a way of reclaiming what’s yours without destroying the self-esteem of psychiatry’s willing guinea pigs as if their peace of mind is what’s wrong with this picture.

Perhaps I’ve gone far afield of the original subject, but it seemed some preamble was in order. I’ve come to realize that anticipating a jump to conclusions has become necessary in blogging and guess there’s nothing to be done for that but learn to address it in fewer words. I’ll aim high, meanwhile my favorite 2008 post at Writhe Safely remains this one, but I won’t submit that since it’s pure link love, I didn’t write anything. My own best typing in 2008 combines social criticism with personal confession (and if you think I exaggerate the violence of online antipsychiatry read that thread) but will submit this instead with a thought for public service. If you come away from that convinced of what I stand for you are privy to a truth that is not even in my own possession. Why would you want that responsibility? Just think about the post, not a bunch of interesting ideas about the person who wrote it.

Right now I am thinking of various mental health bloggers who deserve a wider audience. Here’s hoping half my blogroll makes an appearance in Jon Swift’s self-selected personal bests for Election Year 2008! I’ll be clicking along with my Christmas toddy, in solidarity, basking in the plenitude of complimentary hits.

Busy, busy busy

Our sensitive overlords at the National Center for Trauma-Informed Care are holding a conference this weekend; their 3rd in a series spanning two decades. I must be in pretty bad shape to consider this good news, but beneath the layers of shmooze and self-congratulation must lie some potential toward changing hearts and minds in the bureaucracies they toy with. That’s what I tell myself, looking over the program schedule (PDF), which kicks off July 10 with a private all-day Consumer/Survivor/ Peer/Expert Meeting to develop a National Consensus Statement on Trauma-Informed Care. Heaven knows it is time for that or something like it.

From the pink flower-embossed, healing brochure:

The Center for Mental Health Services (CMHS) has been sponsoring conferences that have defined the agenda of what needs to be done to recognize, understand, spark, and speed the healing and recovery process from violence and trauma.

From Dare to Vision in 1994, to Dare to Act in 2004, and now Dare to Transform in 2008 we are moving closer to real action for positive and lasting change. Our Goal: Revolutionizing Human Services with Trauma-Informed Care.

Trauma-informed programs and services represent the revolutionary transformation as the “new generation” of mental health and allied human services organizations and programs that serve people with histories of violence and trauma. Trauma survivors and consumers in these programs and services are likely to have histories of physical and sexual abuse as well as other types of trauma-inducing experiences.

These adverse experiences often lead to mental health and other types of co-occurring disorders such as health issues, substance abuse, eating disorders, HIV/AIDS, and contact with the criminal justice system. Unrecognized trauma also may lead to misdiagnosis or mistreatment of consumers and survivors.

When a human service program becomes trauma-informed, every part of its organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma impacts the life of the individual seeking services. Trauma-informed organizations, programs, and services are based on an understanding of the trauma survivor’s vulnerabilities, which traditional service delivery approaches may inadvertently exacerbate and, as a result, cause re-traumatization.

This shift marks the change from a place that merely
carries out services to one that becomes a safe place of healing for the people it aims to serve. It is from this place of understanding that we have come together at Dare to Transform – a starting point for revolutionizing our systems of care.

Program highlights:

What’s that supposed to mean?

You should know after reading this post, which has nothing to do with the song. I sang along with it daily for a thousand years before taking in the narrative intention. Sometimes we need an essay to get there.

So here’s an all-time favorite, from the psychologist Richard Grossman’s website, Voicelessness and Emotional Survival.  Nice use of art as a tool to embiggen understanding:

Many students from around the world have e-mailed me about becoming a therapist.  “What do I need to learn?” they ask. One of the most important tasks of “insight” therapists is to understand and appreciate subtext.   What is subtext?  It is between-the-lines communication that convey powerful messages indirectly.   Subtext affects all relationships, and is especially critical in child-rearing.  Do you have an aptitude for subtext?  Does the concept interest you?  Here’s a simple exercise. Consider the well-known and beloved Robert Frost poem, “Stopping by Woods on a Snowy Evening”

Whose woods these are I think I know.
His house is in the village though;
He will not see me stopping here
To watch his woods fill up with snow.

My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.

He gives his harness bells a shake
To ask if there is some mistake.
The only other sound’s the sweep
Of easy wind and downy flake.

The woods are lovely, dark and deep.
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.

Now, take a minute and re-read the poem, this time looking for subtext (between-the-lines meaning).

What did you find?

On the surface the story is simple: a man stops by the woods, is enticed by the beauty and peace of his environs, and then moves on. A therapist, however, hears something entirely different.  In subtext, the poem is much darker: a man stops by the woods, thinks about whether to commit suicide, but ultimately decides to move on.

What are the subtextual clues?  There are many:

1) The man knows he is not being watched.

2) The horse is confused why the man would stop in such a out of the way place.

3) The “darkest” evening of the year has a double meaning:  lack of light and blackest mood.

4) The woods are “lovely, dark, and deep”  suggesting the thought of ending his life is enticing.

5) “And miles to go before I sleep” is repeated twice.  A poet of Frost’s skill would not simply repeat a line to fill space and maintain rhythm.  The lines have two different meanings:  he is a long way from home, and, he has decided his life’s journey is not yet over.

Any one clue, by itself, would not justify an interpretation, but together they form compelling subtext.  Once understood, the poem literally snaps into focus.  Indeed, Frost suffered from serious depression his whole adult life, so it is not surprising that he would write poetry about suicidal feelings.   Of course, unlike Frost, clients are often unaware of the subtext of their own stories; therapists have to help them discover it.

Does this kind of reading (listening) intrigue you?  People often present the same kind of puzzle as Frost’s poem. Their words tell one story, but underneath, another tale, often darker and more compelling, lies in wait. 

Russert in the gray

I’ve been reading thoughtful blogging in the wake of Tim Russert’s death, and lean toward the ambivalent writing, as I’ve been growing more exasperated with him as the election cycle progresses, but yes I cried Friday the way you do when anyone who’s loved or not loved dies unexpectedly, and he was both.

I understand the “what do we do now?” lament in losing our trusted election night guide, and have been enjoying the lead up to November, anticipating the wee hours he explains it all for me, contagious and disheveled big wonky teddy bear doing access politics at 3:00 AM, extracting clarity from chaos like no one else can. This is disorienting. Because he was a fixture his sudden death is a breach in continuity, like waking up one day to find all the McDonald’s restaurants are gone.

Of course no one *likes* McDonald’s, the most popular restaurant in the American universe. Just like Meet the Press is Sunday morning yelling time for the average political junkie, “FOR CHRISTSAKES TIMMY WHAT A TOOL YOU ARE, CAN’T YOU SEE HE’S LYING TO YOUR FACE! “ And now you’ve put me on the spot, reckoning with these conflicting emotions.

I spent the weekend reading archives and transcripts and seeing Tom Brokaw break down on Father’s Day was hard to take. We are now, rightly inundated in eulogy, the legacy will take shape in the time that takes. I’m still all over the map, but this sounds promising:

Based on what we saw first-hand, we would guess that Brother Russert really was the nicest guy in the world.

Sometimes, though, “nicest guys in the world” are the last to challenge conventional wisdom—even when it desperately needs to be challenged, examined, hollered about. In Tim’s case, we think he showed poor judgment in various instances over the years, as we’re all inclined to do. Chris Matthews touched on one possible error in judgment in his comments from Paris on Friday’s Countdown (text below). For once, we think Chris’ lack of impulse control served the public understanding—although he’s getting beaten up for his comment at various spots on the web.

Over the weekend, other members of the mainstream press corps did the thing that comes natural inside their group; they went on the air and told Group Tales, tales which reflected quite wondrously on Tim’s journalistic work—and, of course, by extension, most importantly, on them. Telling the truth is pretty much the last thing that enters these people’s heads. And so, they handed out novelized tales about Tim’s always brilliant work—failing to make the slightest attempt to be balanced, objective or truthful.

For the record, we’re talking about the way they described Tim’s work—not the way they described his decency as a person, a person they loved.

This isn’t really the week for such topics, though Tim’s death—more precisely, the torrent of industry propaganda it unleashed—demands that such topics be discussed. We’ll plan to look at some of those issues next week. In the meantime, we’ll suggest that you ponder a real possibility: The possibility that a guy who showed a fair amount of bad judgment—as we all do—may also have been the nicest guy in the world, just as you’ve seen him described.

Cognitive dissonance is the reason that’s so hard. People will tell themselves anything to avoid the discomfort of holding thoughts and feelings that cancel each other out. If his death can make us grapple with the gray area, that itself is quite a gift. Godspeed Mr. Russert, may angels sing thee to thy rest.

Can I count on you if I fall apart

I have been consumed with feline diabetes the last few days, as I should, it’s complex as it gets and the knowledge base as demanding as that of informed mental health patients. Angelbait will need me to test her glucose 4 times a day, before and after I give her the shots, that means pricking her ear and getting the reading on a monitor. She will need prescription food and I have to figure out how to do things like get the insulin from the vet to my house in 100 degree heat without a car, the insulin has to be kept refrigerated. This home-based disease management will cost about 150 a month, the only way that will work is if I quit smoking. And I have to figure out how to do all this when the legislature is in session, and bills are passed at 2 AM, when I’m at the Capitol 18 hours a day.

Sometimes the glass is half empty. I just found an Austin blogger who accuses my vet of killing 2 pets.

He killed my cat.

I don’t know if she’s right or wrong and based on her post, neither can you. All I know is Angelbait is in this same man’s hands, at that clinic still, right now, and I feel powerless. Am I? What would you do? I don’t know where to go from here. I talk to the vet, he says all the same stuff to me he said to this blogger, I went and saw X play last night and stopped crying for the first time since Sunday, thinking it’s going to be a long hard road, but if I keep my shit together Angel will make it. I can’t sleep from the hundreds of rules to learn and remember, and I stayed up to research the vet and found that post and this 2006 reprimand by the Licensing Board for violating the “PROFESSIONAL STANDARD OF HUMANE TREATMENT, by failing to begin treatment for Sarcoptic mites, even with an initial negative skin scrape when confronted with symptoms of crusty ears, generalized itching, non-responsive treatment protocols, and a human rash. Disciplinary Action: Informal Reprimand.”

Should I see red flags? Are reprimands common with vets who have been practicing long? All I know is he examined the older cat Kamikaze twice and agreed to let me administer the shots at home and he gives me a break on the price. I asked him 2 years ago if the cortisone would shorten Kami’s lifespan and he said “probably, yes, it’s likely. But it’s either that or letting her suffer like this.” His candor appealed to me, the Animal Trustees non-profit recommends him for low-income pet owners, he is a nice man, and with Angelbait he will allow me to do home-based glucose monitoring. That is a big plus in his favor, according to the progressive feline diabetes community.

I would be remiss to leave out the impact these readings are having on me. I read that post and disciplinary action and went into conversion disorder for the first time since I wrote about standing up and falling down on troublewaits. I would like people who don’t believe in mental illness to see what conversion disorder looks like, you fucks, and deal with the fact that it was a certified psychiatrist what taught me how to deal with it. (“Talk to people, express yourself; hysteria is caused by over-control and stoicism, which is contraindicated due to your trauma history”.)

Contraindicated: he was recommending I let myself fall apart, validating my craziness as the way things are supposed to be, bless you Dr. Oppressor. I’m calling him up inside my heart and going over the protocols for these times. He said you will probably have falling down spells for the rest of your life when overwhelmed by emotion and you will get through them because you have so far. I asked how I can *share* like a human being when my speech goes garbly and I drop for no apparent reason, how can I talk when I can’t form words. He put his thumb and forefinger together with a fraction of space between them and said “This is how much understanding you’ll find out there. But it’s either try or suffer in silence, and silence is why it’s happening.” He said at first the speech and falling down will be TEH SUCK, but “once you start talking everything smooths out.” I’m not telling you this to stick up for him, but to share my disdain with the antipsychiatry dickstains who feel welcomed here for some incomprehensible reason.

I have not followed my old shrink’s advice, am reclusive, have no one I am close to, the only person I talked to about Angelbait said I should prepare myself to put her down. Well-meaning betrayal stings less, but that friend is off my helplist. That’s how he escaped his certain fate, as luck would have it. I need help, some support or perspective.

UPDATE: I called the licensing board. My vet has 2 reprimands, one informal the other formal, only 2% of vets get reprimands of any kind. 98% do not get one. Angelbait is undergoing intensive regulation treatment, I asked the licensing board rep if moving her in the middle of the process would kill her. He couldn’t say. All my questions are unanswerable, I guess but they are warranted aren’t they. Should I call a philosopher?

About Sunday’s NY Times piece on MAD PRIDE

Does anyone think that was a decent shot of journalism? Then damn your eyes. Oh I can imagine an earlier me who would come away from that complete piece of shit grateful for the exposure and yay for recognition! But that column pissed off a lot of people in a number of ways I can relate to, beginning with its placement. I ask you, does this social stigma make my butt look too big? Because Gabrielle Glaser’s ‘Mad Pride’ Fights a Stigma is in the Fashion & Style Section, it must be tres chic, don’tchaknow, the fight against prejudice and discrimination, just one more set of kooks aboard the pop cult bandwagon with their self-important, trendy and disposable cause. Sigh.

First she pokes a stick at some prominent crazies in the blogosphere – Liz Spikol, Scatter at The Icarus Project, Mindfreedom’s David Oaks- then puts it all in perspective by quoting reigning tower of babel Fuller Torrey, as if he was just some random psychiatrist chiming in with all we need to know about Mad Pride (nudge nudge, wink wink). Bloody Christ on a catshit cupcake, if this quack has any place in a story about MAD PRIDE he should be correctly rendered as its ideological opponent, his views presented as subordinate to those of the subjects, rather than, you know, the authority on their movement.

Sara, commenting at furious seasons puts it well:

I think the article has all sorts of insidious undercurrents myself. Like I don’t think the author is really glorifying Liz or even Saks — in fact I think she’s almost denigrating them, especially Liz. I mean she sure is harping on the way Liz likes to revel in some of the more off putting aspects of her treatment — incontinence from ECT and drooling from meds — please — is this being respectful to Liz — are these the things that we remember about Liz when we read her blog? Ach — no. I wonder if Liz is angry about this. I think I would be. And David Oaks — well to me she’s kind of making fun of how he is controlling his purported madness as if it’s naive. She quotes Torrey because he’s of the school that thinks “mad pride” is bloody dangerous and maybe Gabrielle Glaser does too.

The psychologist John Grohol at Psych Central:

She also apparently believes that mental disorders can only be treated by drugs (which is mentioned a few times in the article; psychotherapy is mentioned zero times) …Really now? Having regular exercise, a good diet, and engaging in self-help support groups is “outside the mainstream thinking of psychiatrists” when it comes to maintaining good mental health and wellness? How does she know that? Did she survey them?

Of course not — this is the writer’s opinion creeping into the writing, and getting it 100% wrong. Most mental health professionals recognize the importance of maintaining a good diet, exercising, and self-help support groups in helping a person in their recovery efforts. None of these ideas are outside of the mainstream thinking

But I can think of no greater crime in a cultural study than ignoring its historical context. Mad Pride was founded by the tragic-comic powerhouse campaigner Pete Shaughnessy, who was linked to the English punk rock/DIY scene, the roots of which can be seen in the confessional poetry made famous by Sexton, Bukowski and Lowell. Mad Pride was about passion, policy and performance. There is history here. The writer should know it.

Let us pause to make an argument for history, for knowing where we are, how we got here, and how to move forward. I swear we could reduce the infighting by half if we’d do this kind of homework. It’s that lack of context driving the comments I’ve seen by some stakeholders who say they don’t “get” Mad Pride, that it’s bizarre to glorify what can be truly destructive and debilitating severe and persistent blahblahblah, which leads to the counter retort that hey man, mad pride makes me feel good about myself, yes, I know, but Mad Pride isn’t as much about how we’re feeling as what we’re doing, out there.

I realize the glib and stylish do invoke the term as a way to be groovy and I have nothing to offer them but a pox on their houses. How does “Glad To Be Mad” even begin to make sense? If I admonish a toothless schizophrenic living in a dumpster to take pride in her mad self what would that make me if not clueless and cruel? And yet, that is what some people are taking away from this discussion; that Mad Pride is a misguided attempt in building self-esteem. That it encourages navel-gazing in people who think too much. I believe Mad Pride was originally more ambitious than simple therapeutics, broader than the internal and solitary landscape. I think the focus was taken pointedly off the internal and made external, from the self to the group, uniting the twin and rival disciplines of psychology and sociology, which is revolutionary in itself, by pioneers who recognized that doing mental illness takes both disciplines.

So, Mad Pride as a frame. Who needs a frame? Wiki says “A frame defines the packaging of an element of rhetoric in such a way as to encourage certain interpretations and to discourage others. When done by political or social organizations, it is likely to advance their causes or views.” The point of framing is preparation for action, the groundwork in getting an agenda on the table. Vaughan shows how in his Mindhacks review:

Mad Pride is often rather clumsily related to ‘antipsychiatry’ but they are are often at the forefront of campaigns when essential services are threatened.

In London, the campaign against the shutting of the Maudsley Hospital psychiatric emergency clinic was spearheaded by several ‘mad pride’ organisations – who had a mischievous and witty banner at one demo saying “We must be mad! We want the emergency clinic kept open!”.

For the sake of pragmatism I endorse the actions taken in the name of Mad Pride, but that’s where I draw my own line. I juggle too many social identities (feminist, existentialist, liberal, punk) to over-identify with any of them, but I can think of nothing I want to define me less than the state of mental illness. And frankly, that’s where the message falls apart, when it’s patterned on the discourse of the civil rights movement. It’s one thing to make common cause with similar social justice groups (and the case can be made that we win the Oppression Olympics™ handsdown), but the identity politics in mental illness veers toward nonsense. In civil rights terms, Identity is not just about what I am, but what you’re not and can never be. You don’t understand what it is to be black/female/queer/outside the dominant white male patriarchy. I am the authority on what it means to be so situated, and it’s your boot on my neck that makes me your moral superior.

Except madness is not fixed and immutable, not even in the same person, much less categorically, as in some people have it and some others don’t. All humans have what it takes, anyone who denies their spark of madness this second remains eligible, if you have a mind you can lose your mind, there’s nothing to it really. We’re not exceptional. The language of diversity doesn’t fit. Crazies are not cast out of society because we are different from the rest, but because we are so similar.

Setting ourselves apart from a belief that we are the chosen few who are “mentally interesting” feeds a false dichotomy and endorses the fiction that we’re Other when crazy is more likely roiling under the surface of everyone you meet.

Setting ourselves apart as the world’s ruling victim class entails a preening sanctimony impossible to stomach.

But setting ourselves apart from an intent to get shit done makes practical sense, and for me that’s where it stops.

Inclusion by most out-groups is a demand for society to include them. I think our paradigm calls for the mad to include society. Mad Pride has this sensibility. Good god this post is over 1600 words and I am still muddling through what was said much better by the aching Anne Sexton:

For John, Who Begs Me Not to Enquire Further

Not that it was beautiful,
but that, in the end, there was
a certain sense of order there;
something worth learning
in that narrow diary of my mind,
in the commonplaces of the asylum
where the cracked mirror
or my own selfish death
outstared me.
And if I tried
to give you something else,
something outside of myself,
you would not know
that the worst of anyone
can be, finally,
an accident of hope.
I tapped my own head;
it was a glass, an inverted bowl.
It is a small thing
to rage in your own bowl.
At first it was private.
Then it was more than myself;
it was you, or your house
or your kitchen.
And if you turn away
because there is no lesson here
I will hold my awkward bowl,
with all its cracked stars shining
like a complicated lie,
and fasten a new skin around it
as if I were dressing an orange
or a strange sun.
Not that it was beautiful,
but that I found some order there.
There ought to be something special
for someone
in this kind of hope.
This is something I would never find
in a lovelier place, my dear,
although your fear is anyone's fear,
like an invisible veil between us all...
and sometimes in private,
my kitchen, your kitchen,
my face, your face.

Faith healers

Over the last 4 years I’ve heard the term Evidence-Based Medicine™ invoked 20 times a day at the Capitol and named it gobbledygook from day one. Evidence-Based Medicine™ refers to interventions based on established criteria in the medical literature, involving steaming piles of horseshit from the academic domain that just happen to call for the most expensive procedures. But not til 2 weeks ago did I hear the first professional talk it down, in a committee on domestic violence, where “stop the bleeding” has become “drug the victim” since we live in an era that has medicalized what any reasonably empathic person should recognize as predictable aftermath. Meetings where victimization is the theme — battery, rape, child sodomy — this is domestic violence, while invited testimony is dominated by medical professionals. Fucking obscene.

After some six hours listening to her peers wank glowingly of Evidence-Based Medicine™ the representative from Texas Network of Abuse Prevention Services warned the senate to be wary of EBM terminology, said it is not a black and white seal of approval, that evidence-based appraisals are contested in the academy, due largely to bias in research, conflict of interest and the inherent difficulty of quantitative data-collection in human service research experiments. Evidence based services cost more, she said, agencies that make these investments need to know what an evidence based product is and how it is so denoted, and make sure that it is evidence based in substance and not in name only.

Speaking truth to power is always unexpected from that quarter, I’d say it’s a fluke but for what hit my inbox this week:

Why Evidence-Based Medicine Cannot Be Applied to Psychiatry

Co-written by Robert Levine, MD, associate professor of clinical psychiatry at New York University School of Medicine and Max Fink, MD, professor emeritus of psychiatry and neurology at Stony Brook NY, founding editor of The Journal of ECT and author of Electroshock: Restoring the Mind. Worthy opinion by the likes of dirty rotten scoundrels bears some looking into, and it goes without saying they’re going to get smacked down by their colleagues for publishing this in Psychiatric Times. Oh yes, it’s hard going, but anyone interested in EBM, this is the shit. (Sorry no linky, subscription only):

Evidence-based medicine (EBM) is rapidly becoming the norm. It is taught in medical schools and is encouraged by both government agencies and insurance plan providers. Yet, there is little proof that this model can be adapted to fit psychiatry.

EBM supposedly allows the clinician to offer the most effective treatment for each patient.^1,2 This goal is laudable, but the model is not appropriate for psychiatry because precise and stable diagnostic criteria are lacking in our specialty. Treatment outcomes in psychiatry are not defined by remission or cure. Instead, fractional reductions in the number and severity of symptoms are accepted, as measured by rating scale scores. Evidence-based psychiatry (EBP) is an untested hypothesis; for this theory to be either useful or valid, 3 basic assumptions must be examined.

• Is the diagnostic system valid?
• Are the data from clinical trials assessing efficacy and safety sound?
• Are the conclusions in a form that can be applied in clinical practice?

Bloggy juxtapositions that made my head explode

I can’t believe I got sucked into a thread with a child abuse denier but it looks like I stepped in it. Sally caught the stink of evil for what it was off the bat in Why are so many kids mentally ill? while I was doing my “multi-perspective, tease out the complexities” liberal tolerant fence-sitting claptrap like a lamb jumping for the knife. The post brought out the “You’ll have to pry this troublesome child’s pharmaceuticals from my cold, dead hands” grandstanding by a mother who’s first post was an incoherent mess of spelling and grammatical errors; who’s style became remarkably more intelligent and articulate as she was challenged step by step, until she revealed that oh my stars and garters she happens to work in an official capacity with impaired children. It’s all very creepy and gotcha, the way this mindfuck game is played: present yourself initially as an inferior adversary, then gradually demonstrate your ability to think and speak like educated people, make jaws drop by alluding to some vague expertise of your own in these matters and you win, flounce away, savoring your devastating impact. I remember as a DV counselor encountering this type, it was the child rapists who above all felt entitled to be seen as good people, superior to their judges, and would call the child abuse hotline and attempt to paint a picture of reality that the counselor would validate as acceptable parenting, but the more you tease out those complexities the more the truly horrifying picture emerges. It’s very manipulative, almost seductive, and deliberately bewildering, once you realize what you’re dealing with the world drops out from beneath your feet. You will physically age for every call you get like that. Not to say I know what this woman’s deal is, but given she devotes 400 words to disputing the prevalence of child abuse and follows that with a disingenuous handling of the question of environment in assessing what makes a child run riot I’ve got the old chills up my spine today. I think she is amused by her own deft avoidance of the issue of environmental impact on behavior, as if that can only mean we are talking about this:

flawed plan, thank you for caring about my child’s environment. It’s been an interesting adventure, often to the surprising benefit of everyone, to make the environment more comfortable for him.

We were lucky to find a gifted OT who could help give us insight into the kind of activities that were calming to him, and those that helped to strengthen and organize his activity level and concentration, and raise his level of physical balance and bodily awareness. Brava!

Fail. “Environment” is code for what is going on in that house and I’m sure she knows it.

So I dropped by the more enlightened comforts of Pandagon, and see they’re trying to figure out how to make a DV victim testify against her abuser, since it is a frustration for law enforcement (to say nothing of the Cause) that so often women who have been abused recant their testimony and the beater goes free. A helpful commenter gained traction with this idea:

One could argue that beaten and brainwashed women are in mental health crisis, and should be treated the same way as anybody who is considered a danger to themselves.

In other words, they could be committed for a short time to receive the mental health services they require to fully restore their agency.

Fail fail, headdesk, emergency, smelling salts, seriously, Amanda says there are no right answers; I think there are, but that’s not it. After leaving my own typically inscrutable, hysterical 500 word comment I turn from that thread to todays paper and find
AP Exclusive: More than 800 employees have been suspended or fired for abusing mentally and developmentally disabled patients since fiscal year 2004, state officials said Tuesday.

Abuse, where? Mental health facilities! Which means? Governor Goodhair:

The state is doing its job.

I have no words.