Psychiatric survivors, labels and me

If any organism fails to fulfill its potentialities, it becomes sick. William James


The deleterious effect of evil, pernicious, stigmatizing labels is at the core of psychiatric survivor discourse™, so of course it makes me wonder why I don’t care about mine so much, like — what am I missing here, am I insufficiently outraged about a civil rights injustice?!
Borderline, Bi-polar, Schizophrenia, these official stamps of psychiatry will lead to life of ruin, they say, while saying not so much about the label that actually got them committed. Puzzling, but later for all that. The thread on BPD at the only blog that matters has me head in a spin.

I identify with borderlines, my life’s been filled with them, I have it in me, it’s a hellish disorder. I’ve only seen doctors in offices. In the room, every diagnosis came at a snail’s pace by reluctant treaters who always provided the caveat that what they do are “diagnostic IMPRESSIONS” — their best opinion, that others might not agree with, including me. Fair enough. Over many years 3 different diagnosticians gave me a Cluster B (Dramatic) Personality Disorder Not Otherwise Specified, all of them working independently without reading each others notes, and all of them placing an AXIS I diagnoses as the primary concern, whether major depression, bi-polar, PTSD, hysteria (conversion disorder) or some kind of schizophrenia. The docs I saw regularly who presumably knew me best were adamant that I do not have BPD, and I wanted that diagnosis, to feel closer to the people I love, and the musicians I relate to, all the luminous, sullen and delicate cutters.

I just last week sat down for the first time to read the opinion of the psychiatrist who evaluated me for the Social Security Administration. It’s been sitting here seven years and I’m aware that I have feelings about it before even reading it, the language is very sobering. I saw this SSA psychiatrist for 90 minutes and turns out he settled on “a long-standing and well-documented history of borderline personality disorder” with the following attached:

Dr. Aitcheson’s testimony is well-supported by the objective medical evidence, which establishes a deeply ingrained and maladaptive pattern of behavior associated with oddities of thought, perception, speech and behavior, … extreme difficulty getting along with others…panic attacks, psychotic features, vegetative states, hypersomnia… emotional lability as well as intense and unstable interpersonal relationships and impulsive and damaging behavior. This symptomatology has resulted in marked difficulties in maintaining social functioning, marked difficulties in maintaining concentration, persistence, pace, and repeated episodes of decompensation, each of extended duration.

I’m supposed to be offended by that? It’s the truth. I guess I could be offended, but appears I have a rather full plate to be upset by something so removed. I mean, it seems removed; I have my life and I have these labels. Now I finally have one that makes me chestpuff, I’m in with the out crowd.

I don’t care. That’s the problem, I am perceived as falling short in the victim identity. But listen, schizoaffective disorder was real tough on me, due to all the research it requires, but okay fuckit, overall I have no personal issues with labeling, I’m not outraged by the iffy nosology in psychiatry because the iffiness has been established for me by psychiatrists throughout my treatment course. Now I’m getting shit at Furious Seasons because what happened to me just don’t sound right. It’s a competition, this shit right here.

I feel protective and territorial about my newfound BPD label and don’t like how things are going over there. I am nobody’s victim and am sorry to say have always felt supported by my treaters, but do hang on to anger for the lobotomy and expect I always will. My gramma was the only one in that house who loved me, I saw what it did to her. Saw what psychiatrists did to my whole family, who, hang on a sec, unlike me were all involuntary patients. I guess today they’d be psychiatric survivors, since they were forced into asylums and treated against their will.

The difference between voluntary and involuntary patients is something. Seriously, cartoon king Szasz got one thing right.

Still, I am against the BPD dx for all the right reasons. People are negatively effected by that specific label in all kinds of specific ways and they don’t like it, and that should be reason enough to say it’s got to go. Period. But none of these DSM labels, invoked like mantras are what I look for when psychiatric survivors say they are sharing their feelings about what society thinks about them. The label they avoid is the one I’m most interested in hearing about  and what they do with it.

Yeah. What’s it like to be considered dangerous by the powers that be, and is it too late for me to get some of that juju?

The sole justification for involuntary commitment. You must be found to be a danger to self and or others. You might think that would make some impact on a person, an activist, a truthteller, but damned if I’m onto that discourse, in fact I’m seeing more like a taboo around meaningful discussion in the psychiatric survivors, but hey I’m borderline now, I get to stir shit up.

I realized something the other day, how the same thing happens when visiting a General Practitioner for the first time. The Physicians Assistant does the standard intake on medical history; surgeries, cancers, allergies, heart disease, mental health issues? “Yes,” I reply breezily, I’ve been treated for psychiatric conditions. “Any hospitalizations?” Why do they always look up and ask that? They do it every time, ask and look up, make eye contact and hold it.

Any hospitalizations for mental illness?

They are trying to gauge how much they need to be on guard in my presence. I guess we’re all doing that to some extent, but this makes it rather stark. I’ll remember next time to say “Nope, you’re safe!”

As am I, so far at least. I imagine that things could be different for me.

Obama to McCain: CBT is shit-fer-brains

Welp, I’m back from my break. Feast your eyes to the right of this blog, after 3 months over-thinking how to set it up we now have a world of VODPOD, and I think it’s going to help. I’m just building the library now but once it holds a hundred or so clips will find a way to order the narrative so we can get lost for a day or two in there.

So what’s new? I took off a few weeks because I’ve been animated by a real serious project that I didn’t want to jinx by blogging about and since this project is uppermost in my mind found I couldn’t blog about anything until I feel secure it’s going to work out. I feel secure it’s going to work out and will explain everything tomorrow but as a tease will just share that due to this new and mysterious activity I am barred from employment at the United States Department of Justice. Of course since I live on Social Security and won’t be seeking fulltime employment any time soon, it’s only a symbolic gesture, but I am very flattered, Mr. Inspector General and will do my utmost to earn the distinction on your federal no-hire shit list. La!

I have to run now, iron my hat and polish my shoes so I can look victorious tomorrow during my special secret activity mission serving Amerikkka, but this Obama video making the news sure tickled me and I wanted to highlight the psychological two cents of his snarkiliciously broad and populist message. La la!

His top economic advisor

said the other day that

Americans should stop complaining; they’ve become a nation of whiners.

That all these


problems everybody’s talkin about is just a



And if you would just change your mind

everything’d be okay!

Somebody’s been laid off

Their plant’s closed or gone to

Mexico or China?

Change your mind!

It’s all good!

…True quote!!!

This is what cognitive behavioral therapy fixes & that is why it must be stopped

Bukowski: the shoelace

a woman, a
tire that’s flat, a
disease, a
desire: fears in front of you,
fears that hold so still
you can study them
like pieces on a
it’s not the large things that
send a man to the
madhouse. death he’s ready for, or
murder, incest, robbery, fire, flood…
no, it’s the continuing series of small tragedies
that send a man to the
not the death of his love
but a shoelace that snaps
with no time left …
The dread of life
is that swarm of trivialities
that can kill quicker than cancer
and which are always there –
licence plates or taxes
or expired driver’s license,
or hiring or firing,
doing it or having it done to you, or
roaches or flies or a
broken hook on a
screen, or out of gas
or too much gas,
the sink’s stopped-up, the landlord’s drunk,
the president doesn’t care and the governor’s
lightswitch broken, mattress like a
$105 for a tune-up, carburetor and fuel pump at
sears roebuck;
and the phone bill’s up and the market’s
and the toilet chain is
and the light has burned out –
the hall light, the front light, the back light,
the inner light; it’s
darker than hell
and twice as
then there’s always crabs and ingrown toenails
and people who insist they’re
your friends;
there’s always that and worse;
leaky faucet, christ and christmas;
blue salami, 9 day rains,
50 cent avocados
and purple liverwurst.

or making it
as a waitress at norm’s on the split shift,
or as an emptier of
or as a carwash or a busboy
or a stealer of old lady’s purses
leaving them screaming on the sidewalks
with broken arms at the age of 80.

2 red lights in your rear view mirror
and blood in your
toothache, and $979 for a bridge
$300 for a gold
and china and russia and america, and
long hair and short hair and no
hair, and beards and no
faces, and plenty of zigzag but no
pot, except maybe one to piss in
and the other one around your

with each broken shoelace
out of one hundred broken shoelaces,
one man, one woman, one
enters a

so be careful
when you
bend over.

Psychodynamic Psychotherapy

I likes it.

Via, an old wiki entry that’s been replaced by a more clinical definition, alas:

“The goal of psychodynamic therapy is the experience of truth. This truth must be encountered through the breakdown of psychological defenses. Simply stated:

[psychodynamic] psychotherapy teaches the client to be honest.

Individuals suffering from “psychological disorders” or deep-rooted “personality disorders,” often come from confusing, manipulative, dishonest, or even violent families in childhood. Being honest with ones feelings is a difficult, even terrifying process for these people.

But there is a silver lining. If the patient client is willing to face up to their hidden secrets they will discover the unconscious reason for many of their feelings, and therefore obtain self-understanding and relief. In essence

the more honest and direct one is with his/her life,

the more “symptoms” will


and the more one’s childhood and defenses are understood.”

Read a decent exploration of how all that comes together at Mental Health Net: The HBO TV show In Treatment: Understanding how patients ‘lie’ to themselves and others is at the heart of dynamic psychotherapy.

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?

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?

Continue reading

WaPo good, Huffpo bad

It’s enough to make your head spin, these two posts I read one after the other with my morning swear words. Liberal bastion Thorn in my side Huffington is screaming for forced drugging and involuntary commitment (Britney, et alia) —

It’s outrageous that she was released from the hospital …all the experts say she needed to have been held for a minimum of 30 days!

while the wingnutty Washington Post says flat out that the medical model has got to go.

Here’s the problem: The WaPo piece says nothing about forced commitment and the HuffPo piece says nothing about the medical model; but I can say with assurance that these 2 posts are general critiques of the other, that in mental illness discourse we shake out on partisan lines and this has got to get more explicit or it’s just circular wankery and talking past each other.

There is a disconnect underlying most of what passes for learned opinion regarding mental illness in the blogosphere. The disconnect is on writers who don’t know what they’re talking about because they haven’t done their homework. Pundits should be conversant with the various models of mental illness and the body of scholarship that underpins each, at the very least they should recognize when they are promoting the medical model, and what that means, because when you don’t understand something you can make it mean anything. Is that too much to ask? So of course when a knowledgeable commenter like the following comes along and offers a recognizable critique he is shot down for being a pedant, complicator, and delusional ex-patient with an ax to grind:

No other medical condition is the basis for incarceration. Those of us with mental illness are denied rights that everyone else enjoys. Thanks to people like you who have no concern for our rights and have no understanding of our illness, we are singled out, stigmatized, imprisoned, ridiculed and ostracized.

…Were it not for you and those who are likeminded singling us out in the ways just described, we might be more accepting of ‘help.’

That comment in the Huff post is an implicit smackdown of the medical model. The same model explicitly identified and shitcanned over at the Washington Post today:

Larry Davidson, a Yale researcher on recovery from severe mental illness, has examined the data and found that this model is flawed, at least in the field of mental health. “In the medical model, you take a person with a mental illness, you provide treatment in the hopes of reducing symptoms, and then they’re supposed to approximate some notion of normality,” he told me. “Our research shows the opposite. You take a person with a mental illness, you then reduce the discrimination and stigma against them, increase their social roles and participation, which provides them a reason to get better in the first place, and then you provide treatment and support. The issue is not so much making them normal but helping them get their lives back.”

These are fighting words. They sound so benign that it’s easy to overlook that fact, that when we hear someone talk about social support, engagement, participation and community roles they are not speaking in a vacuum, and they are not talking about a subordinate adjunct to the medical approach, but invoking an alternative, social model of distress and recovery, which has all but been silenced by the dominant paradigm whose signifiers are doctor, hospital, medication, stabilization, biology, genetic, heredity, bloodlines, as in tainted, etc. These are the dogwhistles that point to a belief system known as the medical or biological model of mental illness. So it’s about language, and learning the words that the bad people use.

Is this necessary? Why not just say, gosh, with so many conflicting and complex models to choose from, why not have the consumer do the homework and direct their own personal care and treatment, whether medical or alternative or an eclectic mix of both, or decline all of it and que sera. But to make this assertion is itself a partisan stand, because any alternative to the medical model will, by definition deviate from the medical model, and that’s the mortal sin. It’s not the particular treatment choice under fire, but choice, period. And so every alternative falls under the single rubric of “filthy hippy healthcare” coined by medical model monster E. Fuller Torrey, who wants you to believe irresponsible advocates would force bipolars off their evil meds, when what we actually demand is that bipolars be empowered to make fully-informed decisions ourselves, without penalty, and with the understanding and expectation that we will make mistakes and change our minds just like everybody does, with the same right to learn the hard way, while do-gooders suck it up and wrench their garments in dread, too bad, so sad.

I’m pretty sure the WaPo author would agree with me; his piece indicates we share the same politics, the HuffPo author not so much, because oddly enough we don’t. Once again it looks like I dared to take the true blue liberal stand on a mental health matter at a liberal blog. Or thought I had. I don’t even know anymore.

As long as I’m free to complain and orient myself like this I’m happy that people are talking more openly about mental illness in the blogosphere. I can’t say why anyone would deny their own bias, but I know one way to shut down the opposition is to pretend there is no opposition, and some people do operate in total bad faith like that, but maybe others just don’t understand enough about the terrain they’re on, and deserve to be given benefit of the doubt while they navigate the learning curve, yes, with feet held firmly to the fire, on notice that teh willful stoopid will not be tolerated without one minute of surcease, seriously, it’s embarrassing. An opening salvo? Yes, I’d be delighted:
Mental illness is a political issue.
Will political liberals kindly step up and take THE goddamn LIBERAL POSITION?

Housing. First.

Apologies to regular readers about the light posting, I spent the week running down opportunities for real life volunteer work and I have to learn about homelessness, so am back to the Internet for the goal-direction and learning tools.

I remember when getting off the streets meant you can walk into a 24 hour drop in center at 2 AM, upset, hysterical, crying, and a nice social worker would take you in and make you a sandwich. Sit next to you on the couch and listen to your problems, then give you a blanket and squeeze your shoulder and tell you it will be all right. And when you wake up on your own schedule, the social worker pours you a cup of fresh coffee, offers you a cigarette and asks how you slept. The two of you sit at the kitchen table with a telephone and rolodex, which the social worker matter-of-factly refers to as “resources”, and starts dialing numbers, flipping through the cards. Food stamps, clothing, housing, transportation, employment. There is a sense of purpose and a real clear focus. None of it on a broken brain, all of it on essential needs, a walk up Maslow’s ladder, step-by-step, nothing more and nothing less. Reality based. Problem solving. At the end of the day you have 3 appointments, you’re still sad, but you believe in the things you have to believe if you’re going to go on. People will help, problems can be solved, I don’t have to fall off the radar, I can get attention and still be safe.

Thirty years ago this was how it went for me the 3 times I had no place to go, because dignity, boundaries and empathy were built into the model. What the hell happened? There was no psychiatric assessment, no “behavioral health” component, no substance abuse checklist, no prefabricated codes of conduct. There were offerings that relate to mental health, yes, presented without emphasis, because they must have rightly understood that to go beyond offering resources, with a punitive, coercive and paternal process would add to my degradation, which has to lessen if a person is going to tap into their will, which doesn’t just pop up automatically once it’s defeated. Homelessness is defeating. The helper’s role is to inspire hope, so you can stand up, square your shoulders and go forward.

I just don’t get it. This week I’ve been talking to homeless people, because it’s cold and they’re just standing around. It’s not that they’d rather go it alone, it’s that they are meant to go it alone, to die. I know this because a few years ago you could hand your food stamps out to a homeless woman and she could walk into the store and get something to eat for herself and her child for the first time all day. Human Services went to debit cards in order to stop that practice. The message is clear, play by our rules or they can die.

The one thing that keeps me from being homeless is my house. Tis a gift to be simple, folks.

I’ve lived in my own mobile home for ten years, and the most stabilizing thing in my life is my mortgage. I’ve had one episode of major depression in the last five years, didn’t leave the house for 2 months, til the threat of losing my roof sent me to the psych clinic for the Effexor. Which I took until I got better, and discontinued after 3 months because I was allowed to, because I no longer needed to, because I am not in the system, where an un-medicated brain is seen as better off dead, according to all the latest scientific research genocidal maniacs.