One thing I have absolutely been through the wringer over is mental health.
I half wonder if it would somehow be interesting to collect my comments on this very site, because I have been here long enough that for most of the time – everything but the last two years, in honesty – my issues were uncontrolled. They were uncontrolled because they were unidentified; and they were unidentified because, by and large, nobody bothered to look beyond the first ideas. It’s one thing to go by “if you hear hoofbeats, assume horses, not zebras” but to keep saying ‘horse’ when you’re staring at a stripy black and white walking barcode is taking it much too far.
To be clear: I disagree heavily with Marcus (whose blog I follow assiduously) on this one topic. I believe that psychology and psychiatry very much are scientific disciplines. Empirically, there are hordes of people out there whose lives have been improved immeasurably by psychological techniques and psychoactive medication, so something must be working. But there are also hordes of people (smaller ones I hope and believe, albeit an anecdotal opinion) who aren’t helped.
I do believe psychiatry and psychology are a very young science, and in many respects actually a good solid 50 years younger than they are generally taken to be. We’ve only in the last little while arrived at a definition of ‘mental disorder’ that seems to be practically useful, one which depends on whether the issue at hand causes discomfort or distress to the patient. For most of their history these disciplines have been massively and inappropriately normative in a very Victorian way, trying to define any deviation from the privileged class’s ideas of “normal” as a disorder to be solved. It’s washing that stain off only very slowly and really only in proportion to how quickly marginalized folks enter the field, people carrying the message that “normal” is nowhere near a fixed target…
‘Normal’ is not a place I have ever lived. When I was little, teacher-types called me ‘gifted’. They were also confused by some of the ‘alien-ness’ in my behavior but didn’t think to make anything of it. I was, am, autistic. This went undiagnosed until 2017: professionals did wonder about me and did tests, but this was long before even (now-defunct) Asperger’s was part of the common literature. For reasons mostly to do with societal pressures, autism presents differently in boys and girls. When I was a child, this fact was either not widely known or not widely accepted, and besides, everyone thought I was a boy. Being trans complicates everything, I tell you h’what…
For most of my teen years and adult life, I was monstrously depressed. That isn’t an exaggeration. It was intense, constant, and ruined an awful lot of my life. People would get to know me, then try to help, then discover they couldn’t, then get frustrated and throw me away. I’ve been on a whole palette of SSRIs, and even lamotrigine for a while because I had a doctor who thought I might be Bipolar II. That same guy later complained that he was trying to diagnose me with borderline personality disorder, but couldn’t make it fit. The litany of therapists I went through is a story for another day but I encountered some epic Wrong during that, but the main thing was trying to fit me up for wrong diagnoses over and over, because they know about Major Depression and Bipolar Disorder and so forth, so much spaghetti flung at the wall and none of it stuck.
The most extreme instance of this was in October 2017, when I went to the local municipal mental health provider, told them everything I knew and begged for help. They offered me some group sessions for depression, then just before the first one called and cancelled that. The told me me my ‘case is too unique’, and in its place offered… nothing. Bupkes.
Think about that. An organization whose entire raison d’être is to improve the mental health of the citizens of this municipality, turned away one of those citizens for being too weird. For fuck’s sake, you’re a psychiatric institution, exactly how normal do you expect your clients to be?
This, ludicrous as it was, wasn’t the grift. It was pretty much the opposite of a grift, in fact; this was the work of an underfunded and lowest-common-denominator-serving public institution. Some of those therapists you could argue were a sort of grift, putting in just the needed amount of care and association-approved prepackaged wisdom to keep the client coming back every week at $100+ a pop. The BIG grift, though, is what happens when you’re alone: the self-help industry.
It would be unfair to call it all a grift. Self-help and consumer psychology is a very varied field. But it’s an unregulated very varied field, and one in which the more palatable and magical you make your content, the better it does. I remember my psychiatrist insisting I should read Eckhart Tolle’s ‘The Power of Now’; he told me I would find it useful despite being a bit woo, but less so than the other books he was thinking of.
Folks, have you heard of Eckhart Tolle? He is definitely a grifter. His work is not ‘a bit woo’, it is SOLID woo from stem to stern. It is completely and unremittingly bullshit, of a spiritual new-agey flavor. I found an audiobook version of ‘The Power of Now’ and had the fascinating experience of traveling to work on public transit, huddled inside my coat, becoming angrier and angrier that this nonsense was not just for sale, not just contaminating my eardrums, but was there because my goddamned DOCTOR recommended it!
I stopped when Tolle told me the universe had a plan for me, because otherwise I would have ripped down the next station we came to out of pure indignant fury. I hadn’t even made it out of the introduction.
Psychiatry/psychology is a science. But at this stage it’s a young one, and a pretty stupid one. It’s swallowed an awful lot of nonsense from different quarters, from its origins in “of course white men are best, old bean” to the kinds of sprituality that can actually interfere with healing clamoring for attention because suffering people will pay to stop suffering.
Fact is… I don’t have any of the above. I have c-PTSD: complex post-traumatic stress disorder. You know who finally figured that out? Me. I figured out the autism too, because when I found a list of ways it presents in women, boom, huge match. I brought the literature for all of this to the psychiatrist, who read it all, agreed with everything, made the diagnoses official and… thereby ceased to be of any use whatsoever, because neither of these things has a component that can be treated with pills.
My case ultimately is a success story, but not because of the mental health industry; it’s in spite of it. When the whole thing is this much of a mess and fails so often, what is the point of it? It needs to be better, massively better, so that people like (and unlike) me don’t fall through the cracks so often, because when we do, there’s only a couple of places to wind up: on the streets, in isolation, or in the predatory clutches of the grifters.