Bipolar 2 From Inside and Out

Posts tagged ‘public perception’

The Rights of Mental Patients: An Early Crusader

In 1887, investigative journalist Nellie Bly pretended to be insane so that she could report on the conditions in a New York asylum. The results of her sojourn there were the subject of her book Ten Days in a Madhouse and became the catalyst of increased funding for mental institutions. (I wrote about her in https://bipolarme.blog/2016/03/20/what-is-sanity/.)

Now there is a book that recounts an even earlier example of a woman who publicized the conditions in an insane asylum. It has a bearing on the rights of mental patients and involuntary commitment.

The legal rights of mental patients have been much discussed of late. Involuntary commitment is a particularly thorny subject. Some people decry it as a violation of civil rights. Others point to its usefulness in cases of extreme danger to self and others, but also in cases of anosognosia that do not quite meet that standard. “Assisted outpatient therapy” is one version of involuntary commitment that has many supporters. (See my post https://bipolarme.blog/2020/03/08/systemic-breakdown-and-involuntary-commitment/.)

Long before this became a matter of debate, and a couple of decades before Nellie Bly’s exposé, a woman crusaded for the rights of mental patients and against the practice of involuntary commitment. Of course, the involuntary commitment she decried was of married women by their husbands, and in 1860s Illinois, husbands were perfectly able to do that. The causes cited could be as varied as novel reading and masturbation (two separate categories). For Elizabeth Packard, the reason her husband gave was that she was insane because she disagreed with his religious opinions and dared to teach her opinions to others.

Karen Moore’s book The Woman They Could Not Silence recounts Packard’s story, in detail. Meticulously researched (as was Moore’s previous book, The Radium Girls), the nonfiction work is based on many primary sources, including Packard’s own writings (from when she was in the asylum and hid her papers, in one case inside her hat, as well as the book and pamphlets she published) and newspaper accounts of her crusade and her trial.

Packard’s trial was a result of a law she had promoted requiring a civil jury trial before a married woman could be committed, instead of on her husband’s word and the recommendation of an asylum doctor. Interestingly, immediately before the jury trials were mandated to begin, hundreds of married women were miraculously “cured” and released from the asylum where Packard had been held.

Once released from the asylum, three years after being committed, Packard became a tireless campaigner for the rights of the involuntarily committed and of married women (who at the time were not entitled to their own money or property, or even their own children). Packard also exposed the abuses that mental patients suffered at the hands of asylum staff, including isolation, beatings, and cold water baths (near-drowning) used as punishment. Another policy that she sought to have changed was withholding mail from mental patients. Packard had been prevented from reading supportive letters that her relatives had written.

Women dabbling in politics was not common, or approved of, at the time. Packard was able to influence lawmakers and other officials with a combination of her compelling speaking style, her eloquent presentation of her cause, and her remarkable tenacity. To say that she had an agenda is putting it mildly.

The prologue to The Woman They Could Not Silence begins, “If she screamed, she sealed her fate. She had to keep her rage locked up inside her, her feelings as tightly buttoned as her blouse,” and the book ends, “There was a world out there that needed reforming. And she was determined to do it.”

The Woman They Could Not Silence (subtitled One Woman, Her Incredible Fight for Freedom, and the Men Who Tried to Make Her Disappear) was selected by A Mighty Girl (http://www.amightygirl.com/), which serves as a clearinghouse for books, toys, and other products for adults and children, as one of their “Pick of the Day” recommended books for adults.

I highly recommend it too.

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COVID News and Mental Health

Many people have been blaming COVID for depression and other mental health problems. They have said that quarantining and uncertainty have raised the level of anxiety in the general population, and quarantining has caused depression. These increased levels may be – probably are – accurately reported, but I don’t think they necessarily indicate an increase in the incidence of mental illness in our society.

The depression and anxiety that people are feeling are, I believe, natural and expected reactions to the pandemic conditions that prevail. I’m not trying to minimize these experiences, but most people have never experienced clinical depression or anxiety and so don’t understand the nature of the actual illnesses. What depression and anxiety the pandemic has caused is likely to clear up when (if) the pandemic does. This is situational depression and anxiety.

This is not to say that people experiencing pandemic-related depression and anxiety don’t need help. Of course they do. “Talk therapy” may do them a lot of good, and there has been an upswing in the number of online and virtual counseling services available. Whether these people need antidepressants and anti-anxiety meds is a question I’m not able to answer. My best guess is that they don’t, at least not long-term courses of drug treatment, as their symptoms are probably not indicative of mental illness. Short-term anti-anxiety meds may do some good.

I do think that the pandemic and the reactions to it have been triggering for many people who do have mental health conditions. People with OCD who are germophobic saw their most extreme fears become reality. People who have Seasonal Affective Disorder may have suffered more from lack of sunlight during the stay-at-home orders and quarantines.

Many people are in extreme denial, believing that the pandemic is a hoax and refusing to take any steps to prevent its spread. Is this a symptom of mental illness? I don’t see how threatening officials and doctors who promote pandemic precautions is a sign of mental health, but are the people who do this delusional or are they merely at one extreme end of the anxiety spectrum?

I understand that people’s perceptions of reality differ, but it annoys me when people deny mine, which currently is made up of snot and phlegm, as well as depression and anxiety. We can have these academic debates, but for my husband and me, at least, the pandemic has pushed us from believing that it is “out there” to realizing that it’s in here, in the most literal and alarming sense.

My husband has tested positive for COVID, and I have a terrible sore throat and cough, so I likely have it too. We’re resting and taking Coricidin until we hear from our doctors what to do. A dear friend has sent us a pulse oximeter, with instructions to get more help if our O-sats fall below 90.

All this is messing with my head. I was entering a depressive phase anyway. Now I’m not sure if it was due to my bipolar disorder or my immune system crapping out. (Just FYI, my husband and I are both triple-vaxxed. He probably got the virus at work and undoubtedly passed it on to me. I can’t imagine I would test negative now.)

I don’t think our illness is life-threatening, though honestly, it could be. You never know with COVID. And now, that’s part of my reality.

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Sharing About Bipolar

Sometimes I despair. I have realized that part of the meaning in my life is to share with other people the realities of bipolar disorder. At times, I think I have failed. I know I shouldn’t let the fact that others, such as Gabe Howard, Pete Earley, and Laura Pogliano, to name but a few, do it better than I do discourage me. This is not a contest. Everything any of us does to spread the word about bipolar and other mental disorders is a positive thing.

Here are some things I have tried.

Books. I wrote two books based on my blog posts. Neither of them sold very many copies. The first one was published by what I’d call a seat-of-the-pants indie company, and the other one half by them and half by myself, so quasi-self-published. I had a book reading/signing at the local Barnes & Noble. Two people came. We did have an interesting question-and-answer session, even drawing in a couple more people from the cafe where we set up.

I promoted my books, but not very well. There were a couple of podcasts. On one, for first-time authors, it was evident that the host had never read my book, though I sent him one. He asked me questions like, “Are there any other creative people in your family?” My interview on Bipolar Girl went better, but I had no way to gauge the response. I got a write-up in the local paper, but it was clear they wanted me to buy an ad, which I was unable to afford and my publishing company was unwilling to fund. The publishing company did send out form letters to various outlets, but I completely misjudged who should receive them. There were no reviews.

Tattoos. The idea behind the Semicolon Project was that people concerned with suicide awareness and prevention would get tattoos of semicolons. (The idea was that a semicolon is a place in a sentence where a writer could have put a period and stopped, but chose to go on.) When people asked about the peculiar punctuation tattoo, one was supposed to open a dialogue with them about suicide, suicide helplines, and the like. I got the semicolon tattoo and also a bipolar tattoo (a colon, half a parentheses, and another colon to make both a smiley and frowny face). Like this : ) : Gabe Howard has used this symbol on his merchandise, such as t-shirts, mugs, and stickers, and I hope he has achieved a great response. But no one has asked about either of my tattoos, so I have never had to explain them.

Blog. This blog is the most successful of my methods of reaching out to others to get across my message about bipolar disorder and mental health. It reaches a few dozen readers every week, unlike the thousands of viewers that many sites get. I cross-post my blogs to other sites like The Mighty, Medium, and Thought Catalog, when appropriate. I had somewhat of a better following on Medium, but then their Invisible Illness section decided they wanted posts with more research than I was able to provide, and from writers with higher academic degrees than I have.

The Mighty has been the most consistent in featuring my posts and the most successful in garnering responses. They also sent me a The Mighty t-shirt and hoodie, which, again, no one asks about.

I don’t mean to whine (though I suppose I am), but I sincerely wish I could reach more people. There are many in this world who need to hear the messages about mental health in general and bipolar disorder in particular. Of course, I’m not a celebrity, so I’m not likely to be featured in news stories or TV ads. But, since I am out of other ideas, I will keep on with this blog and any way I can think of to spread the message.

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What God Gives You

There are two expressions, common in “inspirational” memes, posters, and the like, that rub me the wrong way.

One is “What doesn’t kill me makes me stronger.” I addressed that one in a post (https://bipolarme.blog/2014/11/10/suffering-and-train-wrecks/) roughly seven years ago, and now I’m ready to tackle the other.

“God doesn’t give you more than you can handle.”

Let’s take a look at the premise. It implies that God gives us all our trials and troubles. Already, I have problems with that. Perhaps God is love and the devil gives us trials and troubles. Perhaps neither God nor the devil is involved, and life gives us trials and troubles. Perhaps even we give ourselves trials and troubles. It strikes me that these are equally valid propositions, though many people favor one or another.

At the heart of it, though, is the fact that there are trials and troubles in our lives, whoever or whatever gives them to us, and we must handle them. Wherever they come from, they will not be more than we can handle, the saying states.

The evidence of our eyes, and perhaps our own lives, says that this simply isn’t true. Plenty of people encounter (or have given to them) more than they can handle. Think of the homeless mentally ill. Are they able to handle what they’ve been given? The woman with her third miscarriage? The veteran with catastrophic injuries? Sure, some of them face their conditions bravely, but others don’t, and they’ll never make the news as “inspiration porn,” the uplifting stories of people who can and have overcome their afflictions, which is predominantly what we hear about in the media.

The fact remains that some people do receive more troubles than they can handle. There are serious mental illnesses that have no treatment. There are injuries and horrors that leave a person scarred inside and out. There are troubles that are so bad they contribute to death by suicide. In these and other cases, someone or something (or simply life itself) has given certain people more than they can handle.

The premise behind the saying, however, is that God never gives YOU more than YOU can handle. What I’ve said doesn’t mean there is no hope – only that it might come from a source you don’t expect. That might be the same God who ostensibly gave you those trials. It might mean another person, or a group of people, or a society can help you with what you need to make it through.

It’s not necessary to leave it all up to God to solve these problems. And it may be that we cannot rescue ourselves. But perhaps we can be that person, or one of those people, who can help someone whose troubles are more than they can handle by themselves.

I won’t argue whether it is because of the grace of God that other people help. But the original saying, in all its simplicity, is too simplistic. I believe that troubles and trials come to us from somewhere in the world, not from God, and people in the world are ultimately the ones who can help us handle them.

I’m not trying to deny the actions of God in the world. I’m saying that we must do our part to solve these problems too. Donate to a good cause. Volunteer to help. Listen to someone who’s hurting. Even just buy a box of cookies from a Girl Scout. Let’s make that “you” an “us.” God (or life) never gives us more than we can handle – together. (Note: Don’t even get me started on “God helps those who help themselves.” That’s not even in the Bible. Go ahead and look. I’ll wait.)

And why is this post in a blog on mental illness? Because that’s one of the things that some people can handle and others can’t, whether it was God or genetics or brain chemicals or trauma that gave it to them.

Simone Biles: Mental Health Is Health Too

There’s been a lot of media interest lately in Simone Biles. The gymnast described by many as the Greatest of All Time withdrew from the Olympics, citing mental health reasons. Many news outlets and commenters have been understanding, but some have not. A Texas Deputy Attorney General, for example, called Biles a “selfish, childish national embarrassment,” which he apologized for six hours later. A podcaster called her “weak,” and said that her performance showed that “when things get tough, you shatter into a million pieces.” After Biles pulled out, the team won a silver medal, with the Russians getting the gold.

Many have compared Biles with Kerri Strug, who performed the vault in the 1996 Olympics, despite having an injured leg. At the time she was praised for her courage and strength, although it turned out that the American Women’s Gymnastic Team would have won the gold even without Strug’s dramatic vault.

Biles’s situation and its comparison with Kerri Struggs serves to reinforce the idea that only physical injuries are “real” and that talking about and acting on mental health matters is not acceptable. Yes, Olympic swimmer Michael Phelps has talked about his struggle with depression, but only after the Games were over. It was brave of him to talk about it, but he received little to no backlash after deciding to talk openly about depression and suicidal ideation.

As in so many other situations, mental health and mental disorders are considered less “real” than physical disorders. And the pressure put on athletes and Olympic athletes in particular can be a factor in damaging their mental health. Athletes have long been encouraged to “play through the pain,” even when that results in severe physical injury. Few have considered how playing through psychological pain affects athletes.

Added to the stress of competition and the pressures of fans, parents, and coaches to succeed, many athletes have suffered through physical and sexual abuse. Simone Biles has commented that she is part of the #MeToo movement that has brought attention to previously unrecognized instances of sexual harassment and exploitation. In a lengthy tweet, Biles revealed that she was one of the victims of team physician Larry Nasser, who is now in jail following over 100 counts of such behavior. “As I continue to work through the pain,” Biles tweeted, “I kindly ask everyone to respect my privacy. This is a process, and one that I need more time to work through.” She could have tweeted the same thing regarding her recent mental health problems.

Another factor in the language surrounding Biles’s decision to remove herself from the Olympic competition is how many people talk about how she personally denied “us” a gold medal (as if all Americans were in contention for the medal) or ceded the victory to the Russians. Ideological matters ought not to be a point of discussion regarding an athlete’s mental health. But they are. People forget that the Olympic Games are just that – games. Too much patriotic fervor is whipped up based on the outcome and the international goodwill of the Games has been lost.

Along with the fact that an amazing athlete was strong enough not to let the pressures of competition further affect her mental health. Simone should be praised for her decision, not called weak and childish.

Words Matter

“Sticks and stones may break my bones, but words will never hurt me” is one of the worst lies that grownups tell to children. Children threw stones at me when I was a child (though they fortunately never broke my bones). But the many, many words they hurled hurt me deeply internally, rather than externally. I was bleeding inside from them, as much as I bled externally from the rocks.

Plenty of children feel the pain of words. We say, “Children are cruel” and leave it at that, or tell children to simply ignore cruel remarks. We have anti-bullying campaigns that are notably ineffective, especially in the face of cyberbullying. Children who hear demeaning words from their parents, teachers, or other adults are likely the most damaged.

People with mental disorders feel the pain of words, too. There are many ways this happens.

One of the most common taunts, often used in popular media, is “psycho.” One may possibly excuse Robert Bloch, who wrote the book Psycho in 1959, and Alfred Hitchcock, who made the movie in 1960, because they were products of their time, when microaggressions and the concept of nonracial slurs did not exist. American Psycho (2000), has much less of an excuse. In movies such as these, “psycho” is shorthand for “serial killer.”

But now “psycho” is in common usage in phrases such as “psycho bitch from hell” (which is anti-woman as well as offensive to persons with mental illness). Songs such as “Sweet But Psycho,” “I Might Just Go Psycho,” and “Am I Psycho?” are recorded.

“Craziness” is also taken lightly in words and phrases such as “cray-cray,” “cuckoo,” “maniac,” “lunatic,” and “cracked,” not to mention “bonkers,” “bananas,” and the more offensive “batshit crazy,” “bug-fuck crazy,” and dozens of other words. There’s even the stereotype of “crazy cat lady.” It may seem cute or silly to call a friend one of these words in a joking manner, but the person who does have a mental illness hears such a word as an insult. Even if it is just overheard, it tells a lot about how the speaker regards the seriousness – or unseriousness – of mental disorders.

There are lots of other examples. “Off their meds” is one. It, along with plain “crazy” or “psycho,” is quite often applied to mass shooters, suicide bombers, and other offenders. While it is true that some of such people have mental disorders, the terms are thrown around long before anyone finds out whether the person is diagnosed with a mental illness or is on psychotropic medication. It is the default explanation. Julie Beck, in an article in the Atlantic, called the easy leap from mass killing to mental illness “a consistent and dangerous narrative.”

Other usages seem innocent enough, but really aren’t. “The weather is bipolar,” meaning it changes quickly, is common. It isn’t accurate, however. Only a person can have bipolar disorder, a serious illness. Applying it to oneself when you change your mind or have a momentary mood swing, is also inaccurate. Likewise, “schizophrenic” is used to describe something or someone that has two sides, or that seems incomprehensible to the viewer. “Multiple personality” (more correctly called Dissociative Identity Disorder, or DID) is shorthand for someone who exhibits different sides of his or her personality on different occasions. People who disagree with you politically are not “insane” or “crazy” either, unless they have been diagnosed with a psychiatric disorder by a professional.

These ways of speaking hurt the persons they are spoken about, but also the mental health community. Fear of being called “psycho” or “crazy” is one reason that some people don’t seek treatment for a disorder or conceal it if they do.

And that’s a sin and a shame.

Fake It Till You…Can’t

I used to have a couple of suits hanging in my closet. One was oatmeal-colored. One was blue tweed. One was rust-colored. I had a couple of silk blouses and a jacket or two that I could wear over a dress.

I called them my “Respectable Business Lady” disguises.

At the time I was working at a 9-to-5 job where the dress code was pretty casual. Fridays were jeans days, not casual days. But every so often I had to go to meetings or business conventions, and for them, I needed the disguises. I was dressing to “fit in” and to give an impression that I was competent and stable.

I don’t honestly know if the suits worked as a disguise, but I made it through meetings and conventions fairly successfully (I think), if I was allowed to collapse afterward, at home or in a hotel room. I think the disguises were as much to remind me how to behave as they were to convince people that I was indeed respectable and a business lady.

Nevertheless, I can’t really buy into the “fake it till you make it” philosophy that has been so popular in self-help books, including those promoting business and entrepreneurship help. I had no notion of becoming a respectable business lady by wearing those suits. I was always going to be awkward and out of my league. I was only trying to pretend by using protective coloration.

The essence of “fake it till you make it” is practice. As the saying goes, you get good at what you practice. Unfortunately, you can’t practice not having bipolar or another disorder. You can practice assorted coping mechanisms and get better at doing them, but they’re a solution to some of the symptoms, not the disease.

I don’t think that “fake it till you make it” really applies to people with mental health problems. No matter how much or how long you fake it, your mental disorders are not going to disappear, though they may ease up at times. I certainly don’t think the business lady disguises made me go into remission for a week or a weekend. They were merely a coping mechanism and nothing I practiced enough to get really good at.

One danger of trying to fake your way through mental illness is that you can fall into the trap of what’s called “smiling depression.” When this happens, people don’t notice that you’re miserable because your smile makes it seem you are happy. It’s another disguise, but not a permanently successful one.

Once I was teaching a class, and several women gathered around another woman and asked her what was wrong. “I didn’t think it showed,” she said. “No, honey,” I said, “it leaks out around the eyes.” She wasn’t crying or anything like that, but we could all tell something was wrong, despite her smile. We offered her conversation and sympathy until she pulled herself together a bit.

I’ve never been able to school my face into any kind of smiling depression anyway. If some people have “resting bitch face,” I have “resting sad face.” I can’t count the number of times when I didn’t feel particularly sad, but someone asked me what I was sad about. Of course, I was probably suffering from low-grade depression, like a low-grade fever, but at the time I was undiagnosed and had no idea that I had a mental problem that caused me to look that way.

Basically, what I’m saying is that when you have a mental illness like bipolar disorder, you can fake being psychologically together for a while, but you can’t sustain it forever. Certainly not until you “make it.” After I took off my Respectable Business Lady disguise, I would revert to my original self, as far from a respectable business lady as ever. Sometimes it would take me days to recover enough to feel that I was functioning again on any sort of level.

I think it’s better, ultimately, to admit who you are and what you need rather than to try to disguise or fake it. Even if your authentic self is depressed and miserable, getting help for it is still better than trying to cover it up.

My Triggers

By shane / adobe stock.com

Bipolar disorder is a funny thing. It can come on with no warning. One moment you’re fine, and the next you’re in the infinite doldrums or jagging on a spike of enthusiasm. Most of the time, it’s like that. The moods come on unexpectedly and stay as long as they want.

Sometimes, however, there are things in your life that seem to trigger a bout of depression or mania.  This isn’t quite the same as what’s commonly called a trigger. In the usual sense, a trigger is something in your past, like a traumatic memory, that comes bursting through when you read, see, or otherwise encounter a reminder of that memory. Suddenly, you are thrown back into the situation that triggered you, reliving the trauma, feeling as if you were still there, re-experiencing it. Triggers are most commonly associated with PTSD (or Post Traumatic Stress Disorder). Many people associate PTSD and its flashbacks with veterans and war, but other traumas, such as rape, assault, and natural disasters can also cause PTSD.

Trigger warnings are controversial. Some people need a warning that the content – especially books, blog posts, or films – may trigger a suppressed or otherwise traumatic memory and leave the person caught up in the sensations during a public moment, such as in a classroom. Obviously, people with traumatic memories would prefer to avoid this, so a trigger warning is placed at the beginning of a story, novel, or even a song that deals with rape, domestic abuse, or other traumas, especially ones depicted in a particularly graphic manner.

To other people, reacting to a trigger is an admission of fragility, at best, or at worst, an excuse for avoiding content that most people can easily handle. This is part of the mindset that leads to calling the severely traumatized “snowflakes” for their perceived inability to deal with stimuli that “normal” people take for granted. They do not understand the power of traumatic memories or the power they have over people who have been through trauma. They consider such people weak. They consider themselves strong, even if – or especially if – they have been through traumas themselves.

In general, my life has been less traumatic than some, more traumatic than others. There are memories that invade my dreams, situations that cause me panic, and stimuli that rev me up. I am not in control of these stimuli, or what they do to me.

Most of the stimuli trigger depression in me, as my bipolar disorder is heavily weighted towards depression. (In fact, I was diagnosed with unipolar depression before a psychiatrist finally recognized my condition as bipolar 2 with anxiety.) When I encounter one of these “personal” triggers, I am panicked, unable to communicate, and immobilized, or nearly so, and must rely on the help of others, especially my husband, to get me through. There’s no telling how long that depression will last.

Primary among my triggers is what I call “the rotten ex-boyfriend who almost ruined my life.” It was a toxic, gaslighting relationship that left my soul sucked dry and my emotions shattered. Fortunately, I do not often encounter anything that reminds me of those days. A friend I met during that time, in fact, has helped me heal both then and for many years thereafter.

Still, I have dreams – ones where I am traveling to the man’s house, ones where I am in the house but he is not present, and ones in which he is. I wake feeling vaguely seasick and nervous. The feeling persists like a hangover through most of the next day. It interferes with my ability to do work and to interact with people. My reactions used to be much worse, with specific words even able to throw me into panic and depression.

Another thing that triggers me is disastrous financial matters, or at least ones that I perceive that way. IRS dealings are by far the worst. A letter with that return address throws me into a panic. Once I even collapsed on the street after an IRS engagement and was unable to get up without assistance. Overdue bills and dealing with personal finances are triggers, exacerbated by the fact that I pay most of the bills, despite the fact that I make less than half the money. This is one of my contributions to the household since there are many things I am unable to do. Such situations leave me with my head in my hands, shaking and catastrophizing, unable to do what must be done until I calm down. (My husband is by now adept at helping me do this.)

And I have one of the more “traditional” trauma triggers – a natural disaster. A year and a half ago, our house was destroyed by a tornado. At the time it hit, I was upstairs in the bedroom. I remember the roof coming off. I remember putting a pillow over my head and hoping for the best. For many months I suppressed the trauma. But now it has come out. When the wind blows very hard or the rain blows sideways, I panic. Despite the fact that upstairs is the very place I shouldn’t go, that’s where I end up – in bed with a pillow over my head. (I also avoid movies like Twister. I’m not even sure I should try The Wizard of Oz.)

As for hypomanic triggers, I have few. Most of my hypomanic flights are unexpected, lifting me up with no warning. Although they can be exhilarating, they are also dangerous. One of the hazards is unwise spending, which of course can lead to the aforementioned financial depression triggers.

One trigger that takes me as near as I ever get to hypomanic sexuality, though, is a sensory, rather than a situational, trigger. For some reason, the smell of Irish Spring soap brings up the heat in me. I distinctly remember the first occasion on which I noticed this. A coworker walked past me and I smelled the distinctive scent. It started my juices flowing. Later, we became lovers. My reaction to Irish Spring is less extreme these days, but it still triggers a memory of the feeling. I seldom encounter the scent anymore, as my husband prefers Zest.

At any rate, it is my experience that triggers can arise from sensory memories, from dreams, from upsetting situations. I have few triggers related to textual representations, though I am not immune to those in films (I left the movie “What Dreams May Come” before it was over and waited in the lobby until it was over).

What I can say is that people’s triggers do not make them “snowflakes.” Triggers elicit visceral reactions that are no less real for not being visible to outsiders. While I don’t advise purging any possible triggering material from, say, academic curricula, I do think a trigger warning on syllabi or blog posts is only polite, and possibly psychologically necessary.

 

Mental Illness and Homelessness

By Halfpoint / Adobestock

There are a lot of assumptions made about mental illness. One is that all of the homeless population are – or at least predominantly are – mentally ill. That’s far from the truth.

Homeless people get that way for a variety of reasons. Some lose their jobs or are evicted from their housing. Some have no friends who can put them up when that happens to them, so they have time to pull themselves together and find a new job or living situation. Some live on the streets because of alcohol or drug addiction.

And yes, some people are homeless because they are mentally ill. Disorders such as depression and bipolar disorder, schizophrenia, anxiety disorders, and substance abuse disorders are frequently seen in the homeless population. According to the Harvard Medical School, “about a quarter to a third of the homeless have a serious mental illness — usually schizophrenia, bipolar disorder, or severe depression — and the proportion is growing.” 

Psychiatric Times states, “There is clearly a link between psychiatric disorders and homelessness; disentangling the nature of this relationship is complicated….Mental illness had preceded homelessness in about two-thirds of the cases. Homelessness in turn has been associated with poorer mental health outcomes and may trigger or exacerbate certain types of disorders.” 

PTSD is also a factor among homeless veterans and others with traumatic pasts. Many military veterans suffer from it as a result of their experiences in combat situations. A traumatic event such as witnessing or being victim of an attack, sexual assault, and so forth experienced during homelessness can itself cause PTSD. And homelessness itself can be the traumatic event that leads to PTSD.

The system is rigged against homeless people. With no address, phone, no reliable transportation, no place to bathe, it is hard to get and keep a job. Many times homeless people are taken advantage of when they can get day labor such as mopping a store, cleaning toilets, or sweeping a parking lot. The job “broker” for casual labor can easily demand a kickback from the homeless person in exchange for finding the person a job.

Some homeless people have been kicked out of their houses because of their alcoholism, drug addiction, or disturbances caused by mental illness – or because of “tough love” philosophies.

And let’s not forget people who have been released from jail or a mental health facility. It can be almost impossible to find a job and an affordable rental. Thanks to a broken system of both prisons and psychiatric facilities, the recently released have no place to go but the streets. When Reagan closed down and defunded “asylums,” he took away the most common way for the mentally ill to get help. Where did these people end up? Either in prison or a homeless camp.

In fact, being in jail is a luxury for some homeless people. They may commit petty crimes in order to be arrested and put where they know they will receive “three hots and a cot” for at least a couple of months. But there is little to no psychiatric care for homeless people in jails or prisons. Despite this, the prison system is clogged with mentally ill people who have no way to get better and nowhere to go when they are released.

With a few exceptions, people do not choose to be homeless. Many people look down at the homeless, sure that they know what would be best for them or clinging to the outdated notion that a homeless person can “pull themselves up by their bootstraps” and conquer both mental illness and homelessness. People who experience schizophrenia or psychosis are particularly hard to place, even in shelters.

What about those shelters? To begin with, they are overcrowded. Not everyone who needs one is able to get a place. Many are horrible, crowded places, where theft, assault, and rape occur. Many make the residents leave at 7:00 a.m., whether they have a place to go or not. Many others make residents adhere to codes of conduct little better than jail, or insist that a resident profess the preferred religion of those who run the shelter. And don’t forget bedbugs, lice, and infections linked to too many people being in an enclosed space. COVID restrictions make it even harder to find a place in a shelter. There are more shelters for women – and especially women with children – than can accommodate the women who make up 29% of the homeless

And what about the violence associated with both the homeless and the mentally ill?

Lynn Nanos, in her book Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, makes an excellent case that schizophrenic and psychotic patients, especially those with anosognosia, are the most likely of all psychiatric patients to commit violence and be victims of violence. 

But murderous violence is not the only kind. An NCBI study reported that “mental illnesses only moderately increased the relative risk of any violence, that is, assaultive behaviors ranging from slapping or shoving someone to using a weapon in a fight.” In addition, they said, “the absolute risk was very low; the vast majority of people with diagnosable serious psychiatric disorders, unless they also had a substance use disorder, did not engage in violent behavior.”

In terms of the myths about the mentally ill homeless, much of that is related to the stigma surrounding the seriously mentally ill. When we look at the facts we find that, while mental illness may be one cause of homelessness, it’s wrong to say that all the homeless are mentally ill – just as wrong as it is to say that all of the seriously mentally ill are homeless.

It’s often said that most of the U.S. population is one paycheck, spouse, illness, job loss away from homelessness. Let’s add mental illness to that list of potential causes. As the sign in the accompanying picture says: Once I was like you. We need better programs to serve the homeless, the mentally ill, and the homeless mentally ill.

 

 

 

 

 

 

 

Are Lobotomies Gone for Good?

By alexlmx/adobestock

If I were a few decades older, I might have undergone a lobotomy. Treatment-resistant bipolar disorder (or manic depression, as it was called then) and schizophrenia are some of the disorders lobotomies were recommended for. It was thought that such mental illnesses were caused by faulty connections in the brain and that the cure was to sever those connections. Lobotomy pioneer Antonio Egas Moniz received a Nobel prize for inventing the operation.

The main problem was it didn’t always work as planned. There were other problems as well, such as the flattening of affect and severe brain damage (what a surprise). The most noted person to have a lobotomy (also called leucotomy) was Rosemary Kennedy, the developmentally delayed sister of John and Robert.

There were two kinds of lobotomies, though only the method differed. The prefrontal lobotomy involved drilling holes in the patient’s skull in order to get to the frontal lobes, where the trouble was thought to lie. The other, and to me more alarming, version was called the transorbital lobotomy. The “orbit” in transorbital refers to the eye socket. An instrument was introduced into the brain by going through the eye socket (without disturbing the eye) and used to sever the connections between the frontal lobe and the rest of the brain. Around 50,000 lobotomies were performed in the U.S., most between 1949 and 1952

Doctor Walter Freeman was the champion of the transorbital lobotomy, often called “icepick surgery” for the slender instrument that was inserted and then swooped about, in hopes of severing the faulty brain wiring. Dr. Freeman was so adept at this that he could perform many of these surgeries in a day, and indeed performed around 3,500 during his career, including 2,500 icepick lobotomies. He once performed 228 of the procedures in a two-week period and taught the technique to countless other doctors. Some of his patients underwent more than one lobotomy.

Eventually, the lobotomy came into disrepute for A) being the horrible invasion that it was, B) reducing many patients to an emotionless or brain-damaged state, and C) being depicted in Ken Kesey’s 1962 novel One Flew Over the Cuckoo’s Nest as a punitive, brutal, and unnecessary procedure. The lobotomy all but disappeared from the psychiatric and surgical landscape.

But wait! Lobotomies may be out of fashion, but psychosurgery (or “functional neurosurgery”) is still performed for treatment-resistant mental illnesses. In these operations, however, rather than randomly severing neural connections, the surgeon removes the areas of the brain thought to be the cause of the psychiatric problem. Modern versions of psychosurgery include “amygdalotomy, limbic leucotomy, and anterior capsulotomy,” none of which I know enough about to comment on. Suffice it to say that the days of drilling burr holes in patients’ skulls or taking an icepick to their brains are, as far as I can determine, gone. 

Psychosurgeries are now performed rarely, deep brain stimulation being the preferred form of treatment, especially for non-psychiatric conditions like Parkinson’s or treatment-resistant seizures. And they’re always performed under anesthesia. The patient’s consent is required.

Electroshock therapy is much less invasive and is still used today, although in a lower-key and safer manner than the original procedure – under sedation and with lower amounts of electricity. It still has side effects, such as the loss of short-term memory for the period surrounding the treatment.

Electroshock therapy was considered in my case because of my long-term, treatment-resistant case of bipolar 2, which involved years-long depressive episodes. At first I was terrified, but after doing some research and talking to knowledgeable people, I was just about ready to agree to it. At that point my psychiatrist suggested we try one more drug first – which worked, alleviating (though not curing) my condition like turning on a switch.

(Side note: When I began researching lobotomies, I found that the book My Lobotomy, by Howard Dully, was particularly interesting. The story didn’t follow the usual pattern. Instead, it seems, Dully’s hospitalization and operation (in 1960, when the boy was 12) were largely instigated by his stepmother, who wanted him out of the way, though schizophrenia was diagnosed by Dr. Freeman (see above) before the transorbital procedure.)

 

 

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