Catch a fire

It’s not everyday reading something on the Internet can move me to tears, but I’ve given up hope on seeing something like this post (and commentary) at Whiskey Fire. The study is not yet published and I know it only begins to scratch the surface but for the first time since the tests were done on me I have hope, if not for myself I can imagine glad tidings for tomorrow’s little Dickens.

When the neuropsychologist laid it out for me 10 years ago I was crying and he was almost crying, because he couldn’t answer my very pointed questions and account for the disparities in my mental examination. An evaluation spanning eight hours over two days, as comprehensive as it gets, followed by a 25 page report and two hour debriefing and still something missing hangs in the air. In the end I knew that he knew and we both knew what I needed to hear that he couldn’t say. What I didn’t know was that he couldn’t say it because there was no supporting cognitive science to make our unspoken hypothesis official in a formal setting. Correlation is not enough to move the world off its ass, but I have had enough correlation to last a lifetime, and that time is running out. Catch up with me.

He tried to make me feel better like Jake the Snake talks at Whiskey Fire — it’s not a life sentence, keep building up strengths, focus on your incredible resilience and amazing inner resources. Oh please. Show me the science.
Now we’re talking. It’s a start.

“This is a wake-up call…these kids have no neurological damage… yet, the prefrontal cortex is not functioning as efficiently as it should be….researchers suspect that stressful environments and cognitive impoverishment are to blame…The study is suggestive and a little bit frightening that environmental conditions have such a strong impact on brain development…”

Suggestive and a little bit frightening indeed.

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Via, an old wiki entry that’s been replaced by a more clinical definition, alas: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

Tomorrow’s fish and chip paper

You remember that lady who fell down and died in front of everybody in a New York hospital? What are you, living in the past, that was 8 whole days ago! But here’s a footnote lest you were to think something relevant was about to happen — that video didn’t hit the airwaves as the result of an investigation into the deplorable conditions of our nation’s yadda yadda, it was a fluke stumbled on while investigating some other unrelated everyday civil rights violation. See that puff of smoke going up, that would be the change in the air, an allowance that what happened in Kings County Psychiatric Hospital happens all the time in those places, in your neighborhood and mine, standard and unremarkable. Putting eyes on it is what’s remarkable, which leads to necessary outrage which leads to — oh look, something shiny!

“WHY?” asked NBC. Why in the name of all that’s sacred did this poor, black, aging, psychiatric, involuntarily committed woman slump to the floor and die in the space of one hour to the callous indifference of everyone around her?  If only there were some dots to connect, we might begin to understand.

Shit, Piss, Fuck, Cunt, Cocksucker, Motherfucker, Tits.

Seven words you can never say on television. I was 19 years old when the Supreme Court affirmed the FCC’s authority to censor George Carlin on the public airwaves and being in radio school then, the case was used to hammer home all the phony, hypocritical “ethics” I’d be expected to uphold during my illustrious broadcast career. His suit woke me up to the inviolability of self-expression, the attendant danger in civility and the lengths authoritarians will take to make their own senseless fear yours and mine. George Carlin was the first living figure to show me he gets it, that the forces telling us there is a correct way to perceive and speak are trying to shape reality, and of course the correct way just happens to be theirs. I read in a comment thread today that whenever people invoke the overused cliche about truth to power what they mean is George Carlin. For that he will be missed. From his bit on soft words:

I don’t like words that hide the truth. I don’t like words that conceal reality. I don’t like euphemisms, or euphemistic language. And American English is loaded with euphemisms. Cause Americans have a lot of trouble dealing with reality. Americans have trouble facing the truth, so they invent the kind of a soft language to protect themselves from it, and it gets worse with every generation.

For some reason, it just keeps getting worse. I’ll give you an example of that. There’s a condition in combat. Most people know about it. It’s when a fighting person’s nervous system has been stressed to its absolute peak and maximum. Can’t take anymore input. The nervous system has either (click) snapped or is about to snap.

In the first world war, that condition was called shell shock. Simple, honest, direct language. Two syllables, shell shock. Almost sounds like the guns themselves. That was seventy years ago. Then a whole generation went by and the second world war came along and very same combat condition was called battle fatigue. Four syllables now. Takes a little longer to say. Doesn’t seem to hurt as much. Fatigue is a nicer word than shock. Shell shock!

Battle fatigue. Then we had the war in Korea, 1950. Madison avenue was riding high by that time, and the very same combat condition was called operational exhaustion. Hey, we’re up to eight syllables now! And the humanity has been squeezed completely out of the phrase. It’s totally sterile now. Operational exhaustion. Sounds like something that might happen to your car. Then of course, came the war in Viet Nam, which has only been over for about sixteen or seventeen years, and thanks to the lies and deceits surrounding that war, I guess it’s no surprise that the very same condition was called post-traumatic stress disorder. Still eight syllables, but we’ve added a hyphen! And the pain is completely buried under jargon. Post-traumatic stress disorder. I’ll bet you if we’d of still been calling it shell shock, some of those Viet Nam veterans might have gotten the attention they needed at the time. I’ll betcha. I’ll betcha.

He continues here, and will forever on youtube:

I miss him already. George Carlin: American Radical, RIP and thanks for the memories ~

Religion is bullshit.

You have no rights.

This country is finished.

White people.

We like war.

Fuck hope. The public sucks.

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?

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?

Intersections, what intersections?

At Psych Central Dr. Grohol makes a much needed point about the very fucking idea of relationship. He begins with the recent Lancet Journal study that shows the use of anti-psychotics as a useless option for subduing aggressive behaviors:

Medicating People Because It’s Easier Than Talking To Them.

Of course, this works too:

Officer Claudia Wright said she used her weapon on [Elizabeth] Beeland because the woman was “verbally profane, abusive, loud and irate.” Beeland pointed her finger “towards my face” and was waving her arms, the officer wrote.

And that, my lovelies is about relationship.

How do they get away with ignoring that? First we de-legitimize the relational, as in, this un-desirous behavior has no relation to anything or anyone, least of all me. From then on it’s just a matter of technique. Taser or neuroleptics, it’s quite the puzzler.

I am aware of the gooey, fuzzy, pussified and loaded overtones in the word relationship. Anyone who think that’s what I’m on about is encouraged to click the handy link under Santa Philosopher on my blogroll. Those who believe relational dynamics have nothing to do with psychiatric oppression are basically NAMI’s useful idiots. NAMI rules because of these analytical disinclinations.

Video via Pandagon, another very good post: Out of Control Tasing Continues.