by Barry Drogin
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I am being indoctrinated. I have come into contact with the relatives of people "at the extremes of symptomology," people who are a danger to themselves or to others. I have learned there are two realities, what might be called rational reality and what might be called emotional reality. They co-exist in all of us (I have described it in my Law of Hypocrisy in an unpublished book manuscript). As we seek truth, we struggle with the difference between rational and rationalization, and as we seek happiness, we struggle with the difference between our personal emotional reality and the emotional realities of others and of society as a whole.
I still cling to this passage from Kate Millet:
Let sanity be understood to be a spectrum that runs the full course between balancing one’s checkbook on the one hand and fantasy on the other hand. Possibly higher mathematics as well. At one end the humdrum but exacting work of the mind, at the other, surrealism, imagination, speculation. In the center there is occasionally a balance between logic and the creative forces, which generally tend to fall upon the wilder side: metaphor, simile, parallelism, abstraction, all along a median range. To one side reasoning, equations, expository prose. To the other, theater, painting, déjà vu, recollection. A spectrum. A rainbow. All human. All good or at least morally indifferent. Places within the great, still-unexplored country of the mind. None to be forbidden. None to be punished. None to be feared.Society cannot simply allow people who are violent or homicidal to roam freely, they must be imprisoned, and a difficult line must be drawn between possibly temporary imprisonment as a means of punishment and deterrence and possibly permanent imprisonment due to what has legally been termed "not guilty by reason of mental disease or defect," the insanity plea.
Suicidal ideation is at the other extreme, and this is where the issue of freedom of the individual becomes most troublesome. With suicide, the difficult line does not exist - those who attempt to kill themselves are not punished but they are imprisoned in a locked ward, denied access to any objects that could be used to kill themselves until the ideation subsides. This asymmetricality warrants further consideration.
There are moral and religious arguments against suicide, and there is emerging consensus over assisted suicide, and these tend to dissuade most people from suicidal ideation. But here Kate Millet is correct - we don't want to admit to ourselves that we all have contemplated suicide, just as we all have contemplated violence. Similarly, we all hear voices (when we think), we all have hallucinated (when we imagine), and we all have delusions (when we misinterpret). The line between "normal" and not is an artificial line that is modified with each edition of the DSM, but denying the existence of the extremes is not useful to society and to culture. Again, I have come into contact with relatives of people at the extremes, I have heard their stories, and I am simultaneously humbled and astonished that they can live with that knowledge.
There are, of course, other mental illnesses, and the ones I have just referenced do not always manifest themselves in homicidal or suicidal ideation. Perhaps here the asymmetricality becomes clear, because the family of a murderer can be moved to express solidarity with the family of the murdered, but the family of one who kills themself is left isolated, bereft, devastated. That is a primitive simplification and generalization of a multitude of circumstances and situations, but I write it anyway. The family of the murderer, or rather the individual with homicidal ideation, expresses solidarity because that family has been aware of the ideation for a long time. Remember that the Unibomber was identified by his brother.
So there is the question about what the family, and society, can do about it, and here all language devolves into metaphor, which is at the root of the problem itself. What is treatment, what is cure, what benefits the individual, what benefits society?
The subject is so vast, there are so many points of entry. For example, many animals kill (or, rather, some animals kill animals, some animals kill plants, both are living organisms), animals kill for food, for protection (self-preservation), for dominance within a tribe. Animals may not have language the way we do (although we know that animals can learn our language, or, rather, we can invent a language so that we can communicate with them), but it is clear that they think, they plan, they plot, they react, they strategize, they remember. Animals can be trained, animals can sacrifice themselves for their young (and animals can eat their young and each other), animals can grieve. Caged animals can exhibit abnormal behaviors, animals separated from their young can exhibit abnormal behaviors, and the persistence of these behaviors means that animals have memory and thought. So animals think, they have thought, and some have some form of language which we may or may not be able to interpret, translate, and understand. Perhaps some animals can approach metaphor, who knows if animals dream?
So perhaps it is useless to postulate that many of the various behaviors we identify as "mental illness" are unique to humans and can be blamed on human language, thought, and culture. Perhaps it is best to just analyze our current culture, thought, and language, for at least we have access to that and can analyze it.
Some thoughts, those that involve visual imagery or sonic combinations, do not involve language at all, or, rather, use a visual language and a sonic language. I have written elsewhere that words are the most abstract, because a visual is a visual, a sound is a sound, but a word is a pointer towards another thing, a visual thing (when written) or a sonic thing (when spoken or heard) that is not the visual or sonic thing itself, but which represents something else, and is made up of visual or sonic elements that have no direct relationship to the visual or sonic elements, although the words can have visual or sonic elements that are similar to the visual or sonic elements of other words.
Semantics, metaphors and grammars are very important, not only new words that we assign to things, but how we use those words, and whether those words are used elsewhere in reference to other things. In "The Medical Model of Mental Illness," Goffman writes extensively about the difference between repairing an object and repairing the body, and then the further problem when that model is extended to repairing (or treating) the brain. And so we don't say that someone "is cancer" but that they "have cancer," but we do say that someone "is mentally ill" although we could say that someone "has a mental illness." Yes, any person is not his or her illness, but we do say someone "is sick," "is blind," "is disabled," etc. (or "has an illness," "has visual impairment," "has a disability"), but it is extremely important to continually remind ourselves that the illness does not define the person, although I have equally stressed elsewhere that, holistically, it is improper to not consider that any and all of these conditions has an impact that is far beyond the symptoms themselves, that they exist in a context both within the individual and his or her life as well as within society.
As to society, that is where issues of parity in financing are a major concern (especially within an industry that doesn't want to pay for anything), where stigma is a concern, and where merely figuring out how to speak about something is a concern. Are we talking about an illness, a disorder, or a disability? Depending upon the compensation mechanism, the same thing could be all three.
Illnesses can be cured, disorders can be treated, and disabilities can be accommodated, and so the language used can also effect the expectations. A chronic illness cannot be cured, that's why we call it chronic, the reasoning is circular.
Goffman, taking the sociological perspective, goes deeply into how behaviors in one context can be accepted by society and in another context can be rejected. Adding Millet to the mix, which is psychological, the behavior becomes common of all humans, so then it is only that the behavior is occurring within the wrong context, which really isn't a problem of the culture. When an emotion is persistent despite the appropriate cultural impetus, or when the emotion is the opposite of the cultural impetus, this is not a cultural problem, it is an individual problem, although it poses a problem for society in deciding whether to allow the behavior or how to respond to it. Culture tends not to accommodate, it tends to stigmatize, shun, flee, or ignore, and this is not to society's benefit if, morally, it has ambitions to be inclusive, to engage, to be democratic, to be compassionate, etc.
Leaving the broader topic of society's choice of language, efforts to end stigma, moral obligations to the individual, and need to protect itself, there remains the primary issue for the individual, that of "treatment" (not in the society sense of how the individual is treated, but in the medical model sense of what resources can be provided to the individual). Millet, of course, was writing at a time of treatment at its most primitive, but I think that treatment in 2015 is still very primitive, although it may be the best that we have.
Confinement (institutionalization), but within a structured environment that forces a schedule upon the individual. Memory erasure through electrical shock. Drug cocktails using different drugs at different dosages customized to each individual ("If you've met one person with [blank], you've met one person with [blank]") with associated side effects. Talk therapy (face-to-face interaction) within an entire framework of financial and cultural assumptions. Behavioral therapy (recreating "triggers" in a controlled fashion) as a form of conditioning. Group therapy to provide self-help and the opportunity to help yourself by helping others. And then we extend to a multitude of cultural assistance, not as therapy, but to help an individual remember to show up for the other treatments, help an individual see to their material needs (food, shelter, employment).
Here is where my statement about how primitive treatment is today comes into play. When I first wrote "The Psychoterrorists," it was a FACT - four medical professionals were treating two people, and none of them were in contact with each other. It is much more expensive, but now it is certainly understood that it is better to not separate the psychoterrorist from the pill pusher and to not separate others from both of them. And yet, even in the most extreme cases, the family members are not provided with connections to family resources by the medical professionals, which is why family members (and friends) have to form their own organizations, to self-help, and why I am hearing stories of family members who have been dealing with medical professionals for DECADES and are, randomly, discovering that these resources exist, including resources that they can provide to their relative, not to themselves.
I have to continue to agree with Millet that the brain is a "great, still unexplored country" and that society is afraid of "its astonishing functions and fandangos, its complications and simplifications, the wonderful operation of its machinery - more wonderful because it is not machinery at all or predictable." Nor is it a computer, although our understanding of computers has not yet led many to the realization that we cannot and should not fix a software problem by treating it as a hardware problem (for medications, I use the metaphor of presuming that one can fix a software bug by pouring molasses into the interior of the computer (a metaphor that worked better when computers weren't as thin as a piece of cardboard) or by slowing down its clock speed or just deleting its memory (although we know that a reboot, although it doesn't solve a software problem, might at least return a computer to functioning until the software bug is encountered again)). And so, these treatments are all we have, the metaphor of a "chemical imbalance" is absurd, rarely are any treatments customized to the individual, let alone customized by time and day and circumstance in a reliable way, and none of them are 100% effective, so that, at the extremes, if a drug prevents 99 out of a 100 suicide attempts, if it prevents 99 out of a 100 homicidal rages, we know that it only takes that one failure of the medication to result in a permanent death, either of the individual or of some other individual. And so, in writing this, I push for society to provide better accommodations, for individuals and their families to join together and demand a better system, and for no individual to take this essay as implying that because a medication is not 100% effective, that therefore it is completely ineffective and to stop taking the medication, but to demand better doctors, better medications, better ways to deliver the medications, better (and alternative) treatment options, to demand that society will listen. #IWILLLISTEN.
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