Freedom’s just another word for nothing left to lose

14 08 2014

There was another death, of course, one I didn’t so much skip over as decide to mull.

Robin Williams’s suicide, I mean.

I was a fan, I guess. His flights away from ordinary conversation at first made laugh, later made me uneasy, and thought some of his acting schticky, but when he was focused his characters could be, as with Parry in The Fisher King, almost unbearably human.

But as my fandom was mild, I didn’t have much to say.

And then I heard this:

BOB MONDELLO, BYLINE: Those struggles now ended. He is, as his Genie character in “Aladdin” would have it, finally free.

BLOCK: Well, that idea – that suicide is freeing – has prompted a lot of concern in the mental health community. We heard from a number of our listeners about that. Among them Elizabeth Minne, she’s a licensed psychologist in Austin, Texas, and she joins me now. Thanks so much for being with us.

ELIZABETH MINNE: Thank you for having me.

BLOCK: And you wrote in to express your concern. You said, comments like this make my job difficult. Explain what you mean by that. How is it more difficult?

MINNE: I have found that comments like this can be interpreted by families and by individuals as a sign that they too can attain something positive by committing suicide.

BLOCK: Something positive meaning some sort of liberation from the pain that they’re in?

MINNE: Right. Some sense of freedom or view it as a positive way to find – or an appropriate way to find some sense of relief.

Minnie goes on to note that she tells her patients that “suicide is never an option for working through distress – that there is always a way for us to get to a better place.”

Most of the commenters were, shall we say, unimpressed, calling out Minnie’s credentials, expertise, and even motivation—one accused her of wanting to keep her patients alive just to make a buck off of them—and generally decrying her inability to see how awful depression could be.

Her words pricked my ears, certainly, and had I heard something similar when I was in the midst of my own self-destructiveness, I would have lit my own torch against her: Of course I have the right to kill myself! Of course I can free myself of all of this terribleness!

But I’ll give Minnie half a break: she is a psychotherapist who works with greatly distressed people, so if she’s going to be of any help to them she has to carry the hope that they lost. She has to believe they can get through until they can believe it themselves.

I’ve spoken enough about this before to say simply that that mattered to me, even if I wasn’t at the time wholly conscious that and how it mattered.

But it also helps to acknowledge that suicide is, in fact, an option, and that suffering in life can be so great that wanting to shed that suffering by shedding life makes sense.

It’s about recognition: just as telling someone that they can get through is a way to see that person when she, perhaps, can’t see herself, noting that suicide is on the table is a way to see, to allow one to see, her suffering.

You don’t have to agree with it or like it or encourage it, but if you know you can’t save someone else—and therapists damned well better know they can’t save someone—then maybe you have to accept that he can’t save himself. If his life is in his hands, then his life is in his hands.

Depression morphs one’s mind—I look back to old journal entries and think Who was the person?—but it’s not as if one is a less authentic self when depressed when not, that somehow all one has to do is to scrape off the weight of despair and one’s real life will pop back up.

I don’t know, maybe some patients want to hear that, want to hear of the elasticity of the self, and who knows, maybe for some it’s true.

But for some it’s not, for some the suffering has seeped in so deep that the only way to get rid of the suffering is to get rid of the self.

I don’t know how a therapist deals with a situation like that. I mean, I know that the two who worked hard with me kept working, but I don’t doubt that they knew the limits of that work. Do they see mental illness like other potentially fatal illness? that sometimes the surgery and the chemo and the therapy don’t take? Or is that fact that there’s no hospice care for depression mean that the limits themselves aren’t understood?

In any case, my life was in my hands, and only when I finally, finally, figured that out for myself—only when I knew that death and life were both options—was I able to sigh, Okay.

It could have gone the other way, of course, and that sighed Okay could have been my last word. But I don’t know that I could have closed my fist over life had I not also held death in my hands. I had to hold them both before I could let one of them go.

I am sorry for Robin Williams’s family that he let go of life, and I’m sorry for him for the suffering that led to that letting go.

Okay.





Devil was my angel

7 07 2013

Twenty five years ago today I was vacationing in lovely Chez Bedlam, watching Wimbledon, enjoying the respite from the Madison heat.

Well, okay, it might be a stretch to call a just-barely-voluntary (as in: do it or else) stint in a locked psychiatric ward a “vacation”, but I did watch Wimbledon and the ward climate, like everything else, was controlled.

I’d first ended up in B6/5, as the unit was known, in June, and not voluntarily. I still have my “patient’s subject’s right” sheet for those detained against their wishes:

UW detained

I was first interviewed by the some/all of the staff (what fun!) the day after the cops deposited me in the ER. I don’t remember much about the interview—and, really, even in calling up the event I’m almost certainly altering it—but I do recall someone asking me (after I must have mentioned I’d been accepted to grad school in political science) if I thought I’d be or wanted to be president.

I’d snorted and said “No”. My therapist was the only one who laughed.

Everyone else was dead serious. I wonder if they were trying to figure out whether my distorted thoughts had extended all the way into delusion.

I did get the hearing, was represented by a competent attorney, and ended up staying, mmm, a week, maybe?

A coupla’ weeks later I was back, not in cuffs this time, but under the impression that had I not returned voluntarily the cops would know where to find me.

My rights as a voluntary admit were a bit more expansive:

UW voluntary

Friends did visit, bringing food and quite possibly a beer, and over the course of my two stays I made friends with J. who, unlike me, was not at all conflicted about wanting to get better. She wanted to be healthy more than anything, but it seemed like every time she managed to get a grip on the ledge, something would come smashing down on her fingers.

We stayed in touch for a few years afterward, but eventually fell away from one another. I have no idea if she’s still alive.

Anyway, no great scandal on the ward. ECT was suggested, but the suggestion was dropped at my vehement opposition. I was given an experimental drug, fluoxetine (brand: Prozac), but it made my legs shake and not much else, so that ended. I spent a few nights in the open containment rooms, got a few day passes, had a few good conversations with some of the nurses, and then I left.

And about a month or so after I left I was in Minneapolis, starting grad school.

Strange time, that.





Devil was my angel

14 01 2013

Is it an aha moment if it drags you down and hollows you out?

Kurt Anderson at Studio 360 has been running an occasional series on “Aha Moments”—those encounters with books or movies or music which have changed one’s life.

Most of the stories are enlightening or funny or just sideways; I wonder if he’d want to hear about dark epiphanies?

I may have discussed this before, but what the hell: I was around 15 when I had mine. Two years earlier I had first started trying to kill myself, and after one brief ER visit and overnight psych ward stay at 14, I was trying to come to terms with my inability to end myself.

It was also around this time that I read The Thorn Birds, by Colleen McCullough. There’s a scene late in the book when the priest Dane, Maggie’s son (by the priest Richard Chamberlain Ralph) goes for a swim, saves two women from drowning, then feels his heart bunch up. He begins to struggle to get back to shore, then says, in effect, Isn’t this what I want? To be with God? He stops struggling, spreads his arms, and drowns.

(That’s how I and Ms. Wikipedia remember it, at any rate.)

Well. That made quite an impression: Is this what I really want? To die? I could only answer, Yes. Am I ready to open my arms and let go? Not yet. Ah. This means I should wait until I’m ready, and only then kill myself.

Now, you might think this is pretty fucked up because. . . it’s pretty fucked up. Why did I have to answer Yes to the want-to-die question? I had no other answer. I had so humiliated myself by my failure that it seemed to me the only way to overcome that humiliation was to succeed.

Oddly, then, the Dane-epiphany kept me alive. I couldn’t stand another failure, and I couldn’t stand to live: thinking that I could stay alive long enough to prepare myself for death gave me some breathing space (albeit of rather toxic quality). I’d think about it periodically, check if I were ready, say nope, then keep living.

Of course, the pressure built. I tried and failed again in college, then again my first year of grad school. At this point I just said Fuck it, and stopped dealing with anything having to do with depression and suicide. I avoided books and movies on the theme, and did my damnedest to shut it all down.

And that worked, for years, that worked. And then the cracks, the frays, the quake, the buckling—whatever metaphor you prefer—and there I was, much older, and still not dead.

Which was a problem.

I was at least able to figure out that if I still hadn’t killed myself, well, y’know, there was something I could do about it. Back into therapy, back into the fight should-I-stay-or-should-I-go, blah blah. I did the work, I excavated myself, exposed the structures of my fucked-up living-to-die being, and by the end,  could neither stay nor go.

And then I had another moment. This wasn’t an Aha Moment the way the Dane thing was, but was a recognition, nonetheless. I had been listening to a lot of Beth Orton, and there was one song, Devil Song, which stayed with me, stretched out and empty and barely there.

But looking back in retrospect
Did you ever really get what you’d expect?
Trying to rectify
Got lost a little further
You’ve been trying to justify
Find out how and where it came

Devil was your angel, but it’s not no more
The devil was your angel, when you weren’t sure

Yep, pretty much.  And then there’s this:

Gonna take you back down
I won’t feel no shame
Till my dreams
Are my own again
Gonna take you right down, and I’ll take the blame
Till my dreams are my own again

Here I am again

Those lyrics didn’t save me. In some ways, I didn’t even save me: as I’ve mentioned previously, there was no decision, just a leaf turning this way rather than that.

But I think there was something in this song that said, in effect, you can go with this. Just because you were that before doesn’t mean you have to stay that way.  It’s okay not to die. It’s okay to be alive.

It’s coming up on 12 years since that night, and I’ve remained here. And that’s all right.

Here I am again.

Not yet, but getting there, getting there.





Never seen this picture before

1 02 2012

It’s Philip Glass’s birthday today.

I went through a period in grad school where I listened to this cd every day. It was not a good period. Did the music make it better, or worse? Or did I just ride it through?

Anyway, I like Glass, but wouldn’t mention his birthday were it not also my birthday. I’m not as old as the composer, but I almost certainly have more days behind me than in front of me.

It’s odd: to think of one’s life as more than half over but also simultaneously to realize I’ve lived a long time and I’ve got a long stretch in front of me.

I turn around and look at my life and say sing-shout My god, what have I done? but I don’t ever think, wow, that was quick. It’s been a trek, a slog, a marathon, a sojourn—anything but a lark.

Perhaps that’s the one upside to living so much of my life down: I’ve felt so damned many jolts and jangles on my wayfaring through the days that looking ahead the end does not seem near; a bumpy path is a long one.

No guarantees, of course—Mayan apocalypse 2012!—but absent the end of the world or a Newt presidency (do I repeat myself?), well, as Emmylou sang, I’ve still got a ways to go.





I put this moment here

2 11 2011

This.

No, this is not me and not particularly what I went through or what I’m going through—except for the parts that are exactly like what I went through or what I’m going through.

And my penultimate-ish panel involved a small green stone instead of horror movies and Skittles.

But I did have my Eskimo vagrant moments. Still do. Probably always will.

There are worse things.





When I break down just a little and lose my head

11 01 2011

Deep breath.

I don’t know if this is the first but I do plan for it to be the last time I talk about this.

This is about Jared Loughner. And me. And the one thing that might connect us: neither of us were committed for mental illness.

As mentioned previously, I do not know if Loughner is mentally ill, and I really wish so-called experts would quit diagnosing him over the airwaves. But mentally ill or not, his actions prior to the shooting have led to a fair amount of discussion as to whether he should have or could have been committed.

Here’s where I come in: A half a lifetime ago, I had a commitment hearing. It was not a pleasant experience.

The judge was fine, the court-appointed attorney was fine, even the room in the locked ward of the psychiatric wing of the hospital was fine. And I wasn’t even committed, tho’ I do think I had to agree to stay on the ward and do x, y, and z.

I was deeply angered at having been incarcerated in the psych ward in the first place, and for years afterward felt that the incarceration was both unjustified and unjust.

Hey, I just wanted to kill myself, that’s all, no one else. No big deal.

The details are, pfft, details. There were cops and handcuffs and then at the hospital, restraints (which I managed to pull off*)—all of which sounds ghastly and it was, but it was ordinary, too.

Ordinary in that the cops were decent, as were the hospital staff, and the ward was clean and everyone had their own semi-private rooms and it was probably as good as these truly shitty things get.

It sucked, yes, and it sucked because I needed to be there.

It took me awhile—years—to realize that corralling me into a psych unit was both just and justified.

So, zoom back out: Does this mean I believe that everyone with an untreated or refractory mental illness should be consigned to a psych ward?

No.

But while it might have once been too easy to commit people for too long (for-ever. . .), the problem now is that too many people—both those who want help and those who don’t—have difficulty getting that help.

That’s where the focus should be: on access to good treatment for mental illness. Any discussion about making involuntary commitment end must begin with that concern.

William Galston goes about this the exact wrong way:

The story repeats itself, over and over. A single narrative connects the Unabomber, George Wallace shooter Arthur Bremmer, Reagan shooter John Hinckley, the Virginia Tech shooter—all mentally disturbed loners who needed to be committed and treated against their will. But the law would not permit it.

Starting in the 1970s, civil libertarians worked to eliminate involuntary commitment or, that failing, to raise the standards and burden of proof so high that few individuals would meet it. Important decisions by the Supreme Court and subordinate courts gave individuals new protections, including a constitutional right to refuse psychotropic medication. A few states have tried to push back in constitutionally acceptable ways, but efforts such as California’s Laura’s Law, designed to make it easier to force patients to take medication, have been stymied by civil rights concerns and lack of funding.

We need legal reform to shift the balance in favor of protecting the community, especially against those who are armed and deranged.

Yes, the point of treatment is not the unwell, it’s the rest of us.

Think I’m misreading Galston? Well after arguing for an expanded list of people who should be held legally responsible if they have “credible evidence” of someone’s “mental disturbance” and don’t report it to “both law enforcement and the courts”—not emergency rooms, not health officials—he argues that “A delusional loss of contact with reality” (whatever that is) should be enough to begin the process of commitment.

To be fair, he does say this process should include “multiple starts with multiple offers of voluntary assistance”, which, if one doesn’t volunteer, could end with “involuntary treatment, including commitment if necessary.”

That actually would sound reasonable as a way to try to get help for people, except, of course, that’s not Galston’s real concern:

How many more mass murders and assassinations do we need before we understand that the rights-based hyper-individualism of our laws governing mental illness is endangering the security of our community and the functioning of our democracy?

That’s right: people sleeping on heating grates or hiding out in rooms or basements and unable to care for themselves or anyone else is not the threat to democracy, it’s that “mentally disturbed loners” might take a shot at a president or pop star or member of Congress.

I have absolutely no truck with murder and assassination, and believe that if better care for the mentally ill would lead to fewer violent crimes, that would be wonderful.

We’re not going to get that better care, however, if all that matters is the fear of the well and the punishment of the unwell.

Right now, punishment is the driving approach to mental illness. According to a 2006 Human Rights Watch report,

More than half of all prison and state inmates now report mental health problems, including symptoms of major depression, mania and psychotic disorders, according to a just-released federal Bureau of Justice Statistics (BJS) report, Mental Health Problems of Prison and Jail Inmates.

In 1998, the BJS reported there were an estimated 283,000 prison and jail inmates who suffered from mental health problems. That number is now estimated to be 1.25 million. The rate of reported mental health disorders in the state prison population is five times greater (56.2 percent) than in the general adult population (11 percent).

Women prisoners have an even higher rate of mental health problems than men: almost three quarters (73 percent) of all women in state prison have mental health problems, compared to 55 percent of men.

Galston should be pleased: we’re already locking up a lotta crazy folk! Too bad that they’re not getting treated once they’re in jail.

Prison staff often punish mentally ill offenders for symptoms of their illness, such as being noisy, refusing orders, self mutilating or even attempting suicide. Mentally ill prisoners are thus more likely than others to end up housed in especially harsh conditions, including isolation, that can push them over the edge into acute psychosis.

Would involuntary commitment have helped these prisoners? Again, if one follows Galston, the deranged should be reported to “law enforcement officials and the courts”, not to anyone actually in a position to help them.

And where would all of these people go, if not to jail?

According to Human Rights Watch, the staggering rate or incarceration of the mentally ill is a consequence of under-funded, disorganized and fragmented community mental health services. Many people with mental illness, particularly those who are poor, homeless, or struggling with substance abuse – cannot get mental health treatment. If they commit a crime, even low-level nonviolent offenses, punitive sentencing laws mandate imprisonment.

The new BJS report reveals that state prisoners with mental health problems were twice as likely to have been homeless and twice as likely to have lived in a foster home, agency or institution while growing up as those without mental health problems. Prisoners with mental health problems were also significantly more likely to have reported being physically or sexually abused in the past, to have had family members who had substance abuse problems, and to have a family member who had been incarcerated in the past. An estimated 42 percent of state inmates had both a mental health problem and substance dependence or abuse.

(See also: here, here, and here, or just run a search on “mentally ill prisoners”.)

I don’t think this is working. It’s just possible, in fact, that if there were better patient-centered options—options which could include involuntary treatment—that fewer mentally ill people would end up in jail. Good for them, good for us.

We can’t just jump ahead to involuntary treatment and commitment, however, before building up the infrastructure for all treatment, voluntary and not. It wasn’t until 2008 that the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was signed into law, and even with that law, treatment for mental illness may legally go uncovered.

So let’s make treatment possible. Let’s make sure the vulnerable have a place to go where they can actually get help before we call on cops and judges. Only after we make sure treatment is actually available does it make sense to talk about laws to draft the resistant into that treatment.

There’s nothing easy about any of this, not least because some mental illness are just damned hard to treat, but if commitment is to be both justified and just, then it makes sense that in our rights-based hyper-individualist society that we actually pay attention to the individual at the center of the debate.

*This is why you should always wear a watch: if anyone tries to tie your wrists together or to something (like, say, the rail of a hospital bed), you can use the extra space provided by the watch to wrench and wriggle your wrist free.

~~~

Coda: I got lucky—although it sure as hell didn’t feel like it at the time—because I got care.

A person shouldn’t need luck to get care.

h/t The Daily Dish





Writing prose, anything goes (pt I)

21 06 2010

I’m very hard-working for one so lazy.

And analytical, for one so emotional. Ditto excitable and nonplussed, enthusiastic and apathetic, ambitious and resigned, arrogant and doubtful, ignorant and well-read, watchful and impatient, attentive and brusque, orderly and chaotic, disciplined and scattered, impetuous and thoughtful, collegial and contrary, motivated and inertial.

It’s not that I’m unique in my dichotomies, but I am certainly of the type that veers toward one end or another. Some of us are naturally moderate; some of us are. . . not.

Temperament has popped up fairly regularly on this blog, and against all expectation: I don’t know how much I thought about it before I began blogging (or before I passed the midpoint of my life).  And I’m not sure what to make of it.

I think it’s a real phenomenon, but I’m uncomfortable giving the concept (completely) over to psychology. I’m not anti-psychology, especially in the psychotherapeutic realm, but my eyes thin at some of the grander, i.e., more reductionist, claims of the field. To the extent that psychology has modeled itself on the physical sciences, it has, like all non-physical sciences, lost sight of its subject.

(I think this is even a problem with the biological sciences, although much less; that’s another post.)

I used to joke with my grad school therapist that she spoke psychology to me and I, philosophy to her, and most of the time we managed to make ourselves understood to one another. So I guess that as much as I recognize the psychological aspect of temperament, I’d like to preserve, perhaps even privilege,  its practical-philosophical dimension.

What is it to be one way rather than another? How adaptable are we? What is temperament’s relationship to character?

How I am now is not how I always was—no surprise, given that I’ve aged—but I’ve also wondered how durable is my who-ness. Circumstances matter—it’s highly doubtful a woman from the lower-middle classes could have earned a PhD even a hundred years ago—but would I have been as driven by ideas? Would an 18th or 19th century version of me be recognizable to me, or would I have gotten married and had kids and been more like my contemporaries than is the 20-21st century version?

Or what if I hadn’t fallen off a cliff in my early teens? I had been a happy, hopeful, outgoing, and optimistic child; those traits shriveled in darkness of my depression. I broke, and broke with who I had been.

What emerged was not unknown to me—I think those characteristics had been running through me, submerged, before—but did they cause that break? Did they only emerge afterward?

Could it all—could I—have been different?

Of course—so much is dependent upon circumstances.

And of course not, because I can recognize in the memory of that sunny child traits which I see today: the dichotomies, the conflicts and contradictions, the poles to which I was always drawn.

I’m an adult now, past the sunshine and no longer living so obstinately in the dim, living in that middle space which was never my natural home.

I am unmoored; I need new poles.