New rule: only the crazy people get to complain about psych meds

OK, it’s not really a rule (except in my personal fantasy world). But I am tired of sane, neurotypical people talking about how terrible psychiatric medications are. Really tired of it.

Now, if I want to talk about how terrible psychiatric meds are, I can do that, because I take them. I actually experience the side effects. Same goes for other people who take or have taken them. It’s kind of like, I can complain about my parents, but if some random person comes and says something bad about my parents OH HELL NO.

So I might say, in a certain mood, “I hate that I’m on all these meds.” Another person who’s weaned off their meds might say, “I think it’s ridiculous that they had me on 5 medications,” and I might commiserate about the imprecision of current psychopharmaceuticals. But if a sane person who’s never taken psychiatric drugs comes and says “The medication cocktails people take for mental health problems are ridiculous,” OH HELL NO.

Because you don’t get to decide if it’s ridiculous. You don’t live with my brain. You don’t get to decide if it’s worth it for me, any more than I get to decide if it’s worth it for somebody else. The only person who can decide if the meds are worth it is the person taking them.

Let me say that again: The only person who can decide if the meds are worth it, is the person taking them.

That’s true whether the person decides it IS or ISN’T worth it. Telling somebody “The side effects can’t be that bad, maybe you’re imagining them,” or even “This medication can’t cause that side effect!” (thanks ignorant psychiatrist) is ableist. Telling somebody that “these medications are serious and have serious side effects!” (duh) and therefore I shouldn’t be taking them (thus assuming that the problem I’m taking them for isn’t serious) is also ableist.

Why do people have such strong feelings about medications they’ve never taken, anyway? How often do you hear people who don’t take blood pressure medications complaining about blood pressure medications? People who don’t take seizure medications complaining about seizure medications? (Some of which are the same medications!) Do people who don’t take asthma medications post memes saying that instead of risking oral thrush from steroids, everybody should just breathe clean air?

Dear sane people: stop telling me how to feel about my medications. My decade+ of experience with them is much more complicated and nuanced than your whitewashed view of this matter will ever be.

Yes, even if your whitewashed view is based on a family member’s experience.

Thanks.

 

 

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I’m paranoid, how are you?

As the title of the post suggests, I’ve been dealing with some paranoia on and off for the last couple of months, which means med changes a.k.a. being a pharmaceutical guinea pig. The paranoia flared up again last week so I’ve been thinking and reading a lot about psychosis, and it’s something I feel should be talked about much more openly. We can’t humanize or destigmatize something if we don’t talk about it. Of course, this is an anonymous blog – but hey, it’s a start. I promise I’m a real person.

First let me clarify what I mean by paranoia. For me, at this time, it ranges from “that person hates me and wants to harm me somehow” to “the government is watching me every time I leave my apartment.” The first could potentially be true. The second is less likely to be true, although let’s face it, the government does have the capacity to watch us, so it’s more a matter of whether the government actually cares about me in particular, which it probably doesn’t. A lot of my paranoia centers around law enforcement, which was triggered by an actual (recent) bad experience with a police officer, and is also grounded in the reality that mentally ill and/or autistic people are more likely to be harmed in encounters with police than the average person because their behavior seems “suspicious” even when all they’re doing is talking fast or stimming with a piece of string (does that make the police paranoid?).

And that’s what I really want to talk about: how these delusions can be grounded in real and legitimate fears. The popular view of psychosis is something totally irrational and arbitrary. Well, it is irrational, but I don’t believe it is arbitrary. I just recently read Elyn Saks’ memoir The Center Cannot Hold (which I highly recommend). Elyn Saks is a professor of mental health law who also has schizophrenia. She has benefited from medication, but also from psychoanalysis that was not afraid to address the content of her delusions. Traditionally, psychiatry has treated the content as irrelevant.

There is definitely a distortion that goes on in my paranoid thinking – what are the chances that my husband is accessing a secret database of information about me for nefarious purposes? not great – but the underlying psychological impulse can be rooted in reality. I mean, in this example, the internet does have a scary amount of information about us, which can be misused. It’s just unlikely that my husband will be the one to misuse it.

My experiences with other people have not been overwhelmingly positive. Thanks to my social awkwardness, misleading body language, and emotional instability, I have the distinction of turning lots of people off. I look angry when I’m not. I say the wrong thing, or neglect to say the right one. As a child, I was a magnet for bullying from peers and psychological abuse from adults who didn’t like me. Sometimes the peers and the adults collaborated.

So when someone passes me in the hall at my son’s school and I think they are giving me strange, hostile looks – how much of that is real, how much is me misinterpreting their facial expression, and how much is mild paranoia? It’s tough to say.

I crave friendship, human connection. I want to believe the best of people. But over and over, they hurt and disappoint me. That is not conducive to trust.

There are a few awesome people in my life who get me, who have stuck with me through thick and thin. They are the reason I’m not homeless or continually in and out of mental hospitals. They are a very small and vital minority.

I guess I’ll stop there, since it’s a semi-positive note. I don’t want to give too much away, in case someone from the government is reading.

(Just kidding! Or am I? *cue suspenseful music*)

Straddling the Autistic/parent divide

The division in the autism community between autistic adults and parents of autistic children is one that I find particularly frustrating, because I belong to both groups and feel allegiance to both.

On the internet, I have encountered some intense hostility from autistic advocates who know that I’m a mother, but don’t know that I’m autistic myself. This hostility was not provoked by anything other than me being an “autism mom”. I support and identify with the neurodiversity movement, I don’t want to eradicate my son’s autism, and I am not seeking accolades for being an “ally.” Incidentally, in these conversations, I do not feel the need to identify myself as autistic or mentally ill or otherwise neurodivergent. I shouldn’t have to disclose my neurology in order to defend myself as a mother.

I have also encountered hostility from other “autism moms” when I objected to attempts to make murders (and sometimes torture) of autistic children somehow about the child instead of about the parent. Fortunately, most of the moms I know both in person and online, are as horrified by these stories as I am; but there are certainly some out there who will try to make it about how hard parenting an autistic child is, instead of the parent being a sadistic person who preys on the vulnerable.

There are things that are worth being angry about – the example I just gave is one. But most of the arguments I see online between parents and adult autistics are not about things like this. I see people from both groups starting out from a place of defensiveness and/or hostility, resulting in conversations where they are talking past each other, with very little attempt to come to a mutual understanding. Example:

Parent: “My son wears a harness that I can grab onto when he bolts during a meltdown.”

Autistic: “That’s horrible and degrading. Your child is a PERSON, not a dog.”

Parent: “Not everyone is as high-functioning as you.”

Autistic: “Functioning labels are ableist!”

The parent comes away from this conversation thinking that adult autistic advocates completely don’t understand what it’s like to parent their child, and therefore their perspectives are not worth listening to. The autistic comes away from the conversation thinking that autism parents believe their children are essentially animals. But from the beginning, both are making assumptions about the other: the parent is assuming that the autistic person is mildly affected and cannot understand their situation, and the autistic person is assuming the worst about the parent’s motivations.

Here’s an alternative version of the same conversation:

Parent: “My son wears a harness that I can grab onto when he bolts during a meltdown.”

Autistic: “Is that really necessary? It seems degrading to me, like you are treating him like a dog.”

Parent: “Yes, unfortunately, it is necessary right now. He’s been almost hit by cars so many times, and I’m not willing to take that risk. Also, he tells me that he finds the harness comforting, like a hug.”

Autistic: “Huh. OK. I still don’t like the idea.”

Parent: “I’m not crazy about it either, but I like it better than the idea of my son being dead.”

Notice how, in the second conversation, the autistic person’s severity level and the issue of functioning labels didn’t come up – because they are, actually, not relevant to the issue being discussed. Shocking! At the end of the conversation, these two individuals may not be in complete agreement, but they each understand where the other is coming from. They don’t come away believing the worst about each other.

Can’t we have more conversations like that?

Supermom

I have an alter-ego. Her name is Supermom.

Supermom wears makeup, which she compulsively checks in the car mirror because any imperfections in her mask might let her real self show. She dresses nicely. Maybe a little bit too nicely for such mundane occasions as grocery shopping and driving her child to therapy. The clothes are from thrift stores and from relatives who didn’t want them anymore, but you’d have to look closely to see the holes.

Supermom might be tired from getting up at 2:30 AM, but she has her shit together. She keeps detailed medical records and educational records. She makes to-do lists. She’s on time to IEP meetings and parent conferences. Usually. She schedules appointments and keeps them.

Supermom is comfortable with social interaction. Mostly. If she’s not, it’s just because she got up at 2:30 AM and she’s really tired …. It’s definitely not because she’s autistic or struggling with paranoia.

Supermom is mentally stable and does not need medication in order to function in day-to-day life.

Supermom does not have any weird political opinions.

Supermom is an advocate. She argues with doctors. She fires therapists. She files formal complaints. She keeps records and paper trails.

Supermom is involved in all of her kid’s therapies. She also implements the therapies at home on a daily basis, due to her endless amounts of energy and patience and lack of personal needs. She makes visual supports and uses them consistently.

When Supermom comes home, she wipes off her war paint, and there’s just me.

I laugh, I cry, I make terrible jokes, I feel overwhelmed, I struggle to keep my eyes open, I get mad, I yell, I apologize, I hug my son, I make silly faces, I stomp like a dinosaur. I put on a TV show and let him eat 3 boxes of yogurt raisins so that I can sit on the couch playing word games online. I rock back and forth and flap my hands. I take my meds. I grapple with self-doubt. I get worked up about politics. I slack off on therapy strategies. And I really do get up at 2:30 AM to give breathing medications and comfort and love.

I’m not sure how many people my Supermom persona actually fools – maybe no one. But I’m aware that I’m expected to try. At least try to pretend to be superhuman. And how my son is treated, the services and supports and medical care he gets, depends on my trying.

So I do. You’re welcome.

Neurodiversity’s gatekeepers

I read this yesterday, and I want to link it here because it’s so good and so important: Dr. Simon Baron-Cohen Does Not Understand the Neurodiversity Paradigm

Here’s a quote from the article:

“The Neurodiversity Paradigm says that all brains are good brains and no one is disordered or in need of a cure or treatments that work to the detriment of their personhood.” – Max Sparrow

I passionately agree with this interpretation of the neurodiversity paradigm. Unfortunately, Dr. Baron-Cohen is not the only one who espouses the view that if a condition affects one’s functioning beyond a certain point (defined by whom?), it is no longer a “difference” or part of the person’s identity, but a “disorder” to be cured by any means. I hope that the people who see it this way are in a minority, but I don’t know that they are.

Here’s another example of this type of thinking:

“Autism is a natural form of human neurodiversity. Labeling it as a “mental disorder” or a “disease” has no scientific basis, has no benefit for Autistic people or their families, and leads inevitably to stigmatization, shame, and marginalization. Blind people, Deaf people, and many other disabled people get the services and accommodations they need without being labeled as having mental disorders. We don’t have to call autism a disorder or a disease to acknowledge that Autistic people are disabled and can require accommodations. Stop worrying about the latest changes to the DSM’s diagnostic criteria, and just remove autism from the DSM entirely, just like homosexuality was rightly removed years ago.” – Nick Walker (emphasis added)

Ohhh, OK, I get it. Having autism is fine, because it’s not a mental disorder. Better take it out of the DSM so that the stigma from all those mentally disordered people doesn’t rub off on us! And if an autistic person has a comorbid mental illness, we’ll just stigmatize them for that, not for the autism.

To sum it up another way:

Blind = “Hey can you teach me to read Braille?”

Deaf = “I really admire your culture!”

Physically disabled = “Thanks for the curb cuts!”

Autism = “Natural form of human neurodiversity.”

Mentally ill = “AHHHHH HELP THERE’S A CRAZY PERSON SHARING A DIAGNOSTIC MANUAL WITH ME GET ME OUT OF HERE!!!!!!”

I think of people who think this way as Neurodiversity Snobs. They are the self-appointed gatekeepers of the neurodiversity movement. They stand at the gate, checking everyone’s credentials:

“Ah, I see you have a job and you’re married? Quirky but brilliant? Go right in.”

“Wait a minute, wait … this says you’re psychotic and frequently homeless? I’m sorry but you can’t go in. You make a bad impression and … you’re just not really our type.”

“Hi there. Looks like those accommodations in college really worked for you! Well, go in, they’re just serving the cocktails.”

“You’re intellectually disabled? Um … I’m not sure what happened but they shouldn’t have sent you here. That was a mistake. Yeah, just head over there to the Eugenics Division, they should help you out.”

Fuck that. Seriously, fuck it.

I reject any articulation of the neurodiversity paradigm that excludes certain people because they don’t have the “right kind” of neurodivergence.

Sanesplaining

I got into an argument with a stranger the other day on a mutual friend’s Facebook page. It started as a debate over the role of mental illness in the Las Vegas shooting and very quickly became a discussion of whether I was qualified to have an opinion on the matter. My opponent, a white male psychology student, told me “You don’t understand mental health.”

Well, maybe that’s true. Maybe I don’t understand mental health. But I think I have a decent understanding of mental illness – primarily the depressive-bipolar-schizophrenic variety and PTSD – from having lived with it for most of my life and having lots of contact with people who live with it, treated and untreated. Of course I am always learning more and there is much that scientists don’t understand either; and my knowledge and understanding of things like substance abuse, personality disorders (including antisocial personality disorder), is more limited.

There is no evidence that Stephen Paddock was mentally ill or that “counseling” would have prevented what he did, had he been motivated to seek it out (certainly money was not a barrier for him). He carefully and deliberately planned the massacre over a long period of time in a way that somebody with the cognitive impairments often accompanying psychiatric illness would be unable to do. His preparations included modifying legally purchased rifles to function as automatic weapons and installing surveillance cameras outside his hotel room.

I hold the unpopular opinion that some people simply enjoy hurting others and are basically bad people. You can label that a mental illness if you want, but these people are often very clever, very manipulative, good at hiding at their crimes and appearing charming. They have no functional impairment or apparent distress due to their actions. Very sadly, I have some personal experience with this, too. What do we call these people? What do we call the child pornographers and the serial killers?

That’s the discussion we could have had – the psychology major and I. But the discussion we ended up having, centered on me and how ignorant I am. He picked at my use of words; he was passive-aggressive and condescending. As it happens, I have not been terribly stable lately, and I snapped.

No doubt, the strong and colorful language that I ended up using, completely discredited everything I’d said. But I was discredited in his mind long before then. Why? Probably because I’m female and not a psych student and I disagreed with him. Disclosing that I’m crazy (and using the word “crazy”) didn’t help my case.

What upset me, and left me in a fragile and agitated state for the rest of the day, was not that someone disagreed with me. I actually enjoy debate. It was the way he picked apart everything I said. It was the implicit sneer in his comments. I hate to think that this person may become a therapist. I hate to think that people will go to him for help and that he will impose his preconceived ideas on their realities, then pick at them and condescend to them when they object. We don’t need any more therapists like that. That’s the last thing we need.

Navigating the world with a brain that filters and connects things unpredictably, that turns on you at odd moments, is scary. Depending on how much insight we have into our condition, it can make for a lot of self-doubt and self-questioning. “Are my perceptions here correct? Is this real? Will I look back on this later and realize my thinking was totally distorted? Or am I right this time? I’ve turned out to be right before.” Having a couple of trusted individuals whom one can consult in these instances of doubt is very helpful. But this dependence on others to confirm or dispute our interpretations of our own experiences makes us very susceptible to gaslighting, and to what I’m going to call sanesplaining.

Sanesplaining is when someone who does NOT have a major psychiatric condition themselves, tells someone who does what their condition is “really” like, what they experience or should experience, how they feel or should feel. It also involves discrediting and disputing the person’s thoughts and opinions. I’m going to use an example here from one of my favorite movies, Benny and Joon.

Joon is a highly intelligent young woman with an unspecified mental illness (mostly resembling schizophrenia). She is cared for by her older brother Benny. After Benny finds out that Joon has begun a sexual relationship with their roommate, Sam (who’s also neurodivergent, with a learning disability and some autistic traits), Benny goes into a rage and throws Sam out of the house. At this point, Joon tells Benny, with strong feeling and conviction, “I love him!”

“Yeah?” says Benny. “Well you are crazy.”

There you have it. Sanesplaining in a nutshell.

Our feelings and thoughts are constantly in question. It’s not always that overt. It might be a family member asking “Did you take your meds?” when we’re trying to explain why we’re upset about something they’ve done. It might be a psychiatrist saying “No, that’s not a side effect of this medication”. (Hint: if your psychiatrist says this, FIND A NEW ONE.) Or it might be some douchey psychology major on the internet, saying “You used a clinically imprecise term, therefore your opinion is worthless. Your lived experience doesn’t matter.”

Functioning labels for mental illness?

I don’t know if this is a recent development or if I’ve only recently noticed it, but for the past year or so I’ve been seeing lots of articles using the terms “high-functioning” and “low-functioning” to talk about psychiatric conditions like depression. Apparently, using them for autism wasn’t bad enough. The autistic community has addressed, many times, the problems with these terms in the context of autism; I want to discuss them in the context of mental illness.

Many of the points to be made are the same as for autism. We all function differently at different times and in different circumstances. The resources available to us – which include money, supportive family, good quality therapists – can make a tremendous difference. A person can have multiple mild comorbids that, together, severely impact functioning, which makes terms like “high functioning depression/autism” linguistically imprecise and misleading. (I don’t have a problem with severity labels. While functioning labels describe the person, severity labels describe the condition. Important difference.) Finally, dividing people into “high” and “low” diminishes the challenges faced by one group and the autonomy of the other, and tends to create division rather than alliance.

There is one big difference from the discussion surrounding autism: mental illness can be medicated. Not always successfully – and medications bring their own problems. But it introduces yet another variable.

One person might be “high-functioning” on medication and “low-functioning” without it. Someone else might be “low-functioning” on medication because of treatment-resistant symptoms. Another person might be “low-functioning” without medication but unable to take medication because they previously developed Neuroleptic Malignant Syndrome, or unwilling to take it for various reasons. And yet another person may be “high-functioning” without medication and choose not to take it, even though it could potentially resolve their symptoms, either because of previous side effects or they just don’t like the idea, etc.

Personally, I function pretty well ON medication … when it’s working. By functioning pretty well I mean I get the necessary things done. My son gets his medicines and his food and his diapers changed, and he gets to school and therapy and medical appointments. Those are the most important things, so I make sure they happen. I make myself acceptable-looking in public even if I haven’t showered in a couple of days. Things like cooking, cleaning, talking to people, those often take a back seat when my mood dips. I don’t always have the energy to brush my teeth, or to walk across the room for something that isn’t an emergency. I do my best though and I have enough good days to make up for what I’ve let slide on the bad days.

Again, this is ON medication. I am also aware that my current medication regimen won’t work indefinitely.

I’ve read too many articles where people who identify themselves as “high-functioning” anxious/depressives don’t even address whether or not they take medication, or why/why not. But if we’re going to talk about functioning, medication matters, because one of the primary purposes of medication is to restore/increase a person’s ability to function in society. It matters, regardless of how you feel about medication. It has profound implications for society, for how we think and talk about human value, work, autonomy, responsibility.