Psychiatric survivors, labels and me

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

Ω

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

economic

problems everybody’s talkin about is just a

mental

recession.

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
chessboard…
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
madhouse…
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
crazy.
lightswitch broken, mattress like a
porcupine;
$105 for a tune-up, carburetor and fuel pump at
sears roebuck;
and the phone bill’s up and the market’s
down
and the toilet chain is
broken,
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
expensive.
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
bedpans,
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.

suddenly
2 red lights in your rear view mirror
and blood in your
underwear;
toothache, and $979 for a bridge
$300 for a gold
tooth,
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
gut.

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

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

dissolve,

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?

How to kill empathy

This was especially useful tonight, but his speeches are often a thing of beauty, both intellectually and emotionally, and there are a ton of them at youtube.

I’ll save my own impressions for later so as not to mar the experience of the viewer, but just offer thanks for Dr. John Breeding, who has taken his place on the side of the angels.

Because enduring ennobles we won’t be discussing that

I’m still having a hard time recovering from mental illness awareness week, migraines, can’t sleep and nightmares when I can, plus waking up crying. I woke up and hollered “Molly!” a few hours ago, and I’ve been drinking a bit to take the edge off, which is nothing to me but a clue. Molly Ivins lived in this city, and this week I’m going to walk the streets she walked, the streets she urged us, in her final proclamation, to run into with glee, banging pots and pans, shouting “We are the deciders.”

No, we’re not. Over a hundred google alerts in my inbox last week promoting awareness of mental illness, and not one word about child abuse, because, do I have this right — because NAMI — a family organization — is in charge — do I have that right — in charge of mental illness awareness — NAMI, is that right? Wait, ok, so the ghosts are in my house, my people, my blood, thicker than water, kinship, my loyal perpetrators, no escape, she’s dead and I’m buried, mom without end. This is how it was, invisibility in the family, this is how it is, invisibility in the mental health system, it feels like I’m in the wrong time frame, I don’t even know where I am, it’s all seamless, positively fourth street. I read the pdf files and feel like I’m losing my mind, they use our language, capital “R” recovery — recovery is possible, expect recovery! Recovery from what? With what? Drugs and denial, symptom suppression, fuck you, my symptoms need expression, space, recognition, discharge, that takes skill, competence, — Expect Recovery — I expect Mark Eitzel is on the stereo saving me “Why do you say everything as if you were a thief? Like what you stole has no value, and what you preach is far from belief?”

That’s what they do, steal a thing of beauty and turn it into shit, “It only takes one person to change the world!” Yes and tomorrow we’ll change it back, because we write, another behavior you’ll never begin to understand.

I have to type more about me and the first thing to appreciate is that I don’t want to. This is one reason we remain invisible in mental health policy and even to our own ignorant CBT “solution focused” treatment providers, we avoid the material, and all the fixers in the system collude with us, by failing to educate themselves about traumatized personality development, because they don’t want to look at it either. It’s a human tendency to avoid the dark and depraved, it’s unsettling to sit with, and take it in day after day, it screws people up to listen. It’s about helplessness, people have a problem with being helpless, they can’t change or undo anything, they can only be witnesses, and that’s enough!

The only therapists who are of any use are not available to most of us anymore, the old school, expensive, time-intensive treatment associated with psychoanalysis is what we need, and that is not an option today.

Therapists can’t just ask outright “were you abused as a child?” Because we’ll say no, dummy, we were indoctrinated to conceal, minimize and forget what was happening. We have no language. I didn’t say a word my first year, I drew pictures, gave my therapist collages made from magazines, took her by the hand and walked her outside and pointed at a tree. It takes a year in therapy to prepare to do the work of trauma, to build trust and go at it at a very slow angle. You need an intentional therapist sitting across from you that whole year, who knows what they’re doing, consciously working to prepare you for doing the work you dread.

I have been scared for a long time, I have been thinking about it all last week, remembering troublewaits, when I didn’t even know what I was talking about, just wailing that some undefined they were taking trauma out of existence. Erasing the concept. Now I am seeing it happening. I think. Who is doing this? Is it NAMI? Am I invisible to my allies too? Do others working as activists in mh liberation who know I insist on inclusion of the trauma model know or care why I say that? Tell me, what are my Suicide Survivor Notes about? When I talk about “my hospital records” do you assume I mean psych ward, and not the general emergency room where I went to get my ribs taped up after my NAMI did what they always did? I won’t spell that out every time you know, that was my mother.

Fighting biopsychiatry is not just about getting to the truth, it’s about the specific needs and challenges facing traumatized persons in the realm of mental health, and about making general sense out of personalities that are a real foreign land, which is useful for everyone, but of paramount relevance for people in the provider system. There are maps, this has all been studied and paid for, research and books and movies and songs, and 1200 scars on my best friends arms, programmed to self-destruct, still here, heroically in the way. We are in the system, we don’t always know why we end up in a mental health facility, but I am one who does know what happened to me, and what it did to me, and that there is no cure, and that there doesn’t need to be.

Desperate times

I just read this paper by Shery Mead, describing what’s become of alternative support systems in the age of accreditation. It resonates totally with my own experience, for which I’m grateful, as I’m still trying to get my bearings in understanding how mental health took such a bad turn, and why the old models, which do exist and to put it mildly, have not been officially discredited, are, nevertheless ignored in making policy.

In the past 25 years I’ve been a client, paraprofessional, support group member, paid direct care staffer and worked in all types of mental health agencies and settings. The difference in how things were 20 years ago compared to today are stupifying, more so because the blatant devolution is touted as progress.

The origins of peer support is humanistic theory. I was treated by humanists and made them my model. I was taught that peers help one another mentally by entering their narrative, by assimilating their “field of representation” and going with it in empathy, a willingness to be uncomfortable, and suspension of judgment. This was bottom line qualification, what you start with and build on, or you really have no business dealing with people in distress.

Once trust is established you can begin to share your own experience with psychosis and extreme mental states, delusions, cutting, self-destructive and suicide urges, and if the person is scaring you, you tell them what you need them to do to make you feel safe with them. The point of mutuality is genuine connection, and the sharing is to de-intensify the so-called “bizarre,” and make it part of the conversation, which is between two open and honest equals, and out of that conversation you create new meaning, acceptance and strategies for coping with the cards you’ve been dealt. Neither person is considered defective, neither one is acted on by the other, both of us come out of it with more than we had going in. What happened to this model?

We now live in an age of accreditation, peer support is devalued if not outright suspect. DBT groups have replaced the old way, though DBT is lauded as peer support, making it more evil than the usual authoritarian horseshit because it pretends to be something it’s not.

I lasted 2 months at the group I joined, and night after night the indignity of the power dynamics left me speechless. I didn’t want to leave the others in the DBT group, my peers, and they liked me too, but I hated the paid facilitators and the harm they did to people in pain. As if how they treated people was okay because they were following the manual and the manual was the thing.

After the DBT group ended the headcases would hang out in the parking lot, helping each other recover from the disrespect we’d just paid 35 dollars to subject ourselves to, at the urging of our psychiatrists. I couldn’t stand it anymore, and years later I still wonder how this became the norm, about the waste of our human resources, and what could have been had the members not been in subordinated social positions. DBT is not an act of god or inevitability, it is however marketed as a treatment of choice and lobbied to “people in the know” who casually direct us to these invalidating environments because the evidence base shows misfits come out of them conforming and well-behaved.

It’s easy and obvious to lambaste programs like DBT, what’s not so easy is to recognize the influence of the paradigmatic shift in a person’s own way of thinking and relating. The shift from entering the other’s narrative to diagnosing them is complete. It is now seen as perfectly normal and unproblematic for an alternative, uncredentialed supportive peer to inwardly make a diagnosis and proceed from that, without realizing the completely fucked up dynamic s/he’s creating. If you have any doubts about that, call a peer-run psychiatric warm-line next time you’re in crises and see what happens.

Every model they shove at us is de-politicized, as if there is no context anywhere in the whole wide world and *you* are the problem. Trauma-informed peer support has been confiscated. We have a long way to go to begin taking it back, what we can do is live our lives as if we should. And that we do, whether in recovery or screaming batshit through the streets.

Mead, on Peer Support and a Socio-Political Response to Trauma and Abuse (pdf.)

The trauma agenda (or our attempt to build more trauma- informed mental health services), once again has been put on the back burner.

Treatment outcomes are based on acceptance of psychiatric diagnoses/labels given by others, on compliance to what others think is “good for us,” and adherence to medication regimes that once again require our bodies to be in the power of others. Even if we are given a “trauma” diagnosis (PTSD, Borderline Personality Disorder, Dissociative Identity Disorder) we are considered manipulative, hard to work with and needy. We are mandated to rigid and controlling therapy programs such as DBT and lose treatment resources if we don’t go. We are considered inappropriately angry and unsuccessful at relationships, and we are banned from calling hotlines. Further, as managed behavioral healthcare has developed a stronger voice across all mental health treatment, we are losing many resources that might help us to work through the abuse, to build healing relationships and to move through the anger that has kept us bound to our cycles of pain.

In fact, rather than helping people truly to heal from the effects of past abuses and
offering them the opportunity to break the cycle of violence, we are creating lifelong “mental patients” – people who are firmly embedded in the notion that they have something permanently and organically wrong with them.

Peer support programs must challenge the current system’s approach to how people with histories of abuse are treated. The devastating impact of abuse must be recognized for what it is and not viewed as psychiatric pathology or biological brain disorders. Through peer support services we can offer each other relationships that are respectful of our experiences, our ways of communicating, and how we have learned to tell our story. We can challenge each other to both face and to move beyond these stories and patterns. We
can build new community norms that replace the illness environments that have kept us trapped. Finally, we can conscientiously name and expose the cultural violence that caused us to end up in these institutions. If we can learn to tell our stories in new ways, we can create communities where the sanctioned outcomes include non-compliance to “mental patient” identities or expectations, rejection of unhelpful treatment regimens, the questioning of overuse of medication, and speaking out about the prevalence of trauma and abuse.

Finally, we can to call into question whose “problem” it really is.