August 26th, 2003 |
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From http://www.darkecho.com/JohnShirley/mental.html
Mental State of the Union
by John Shirley
1. I'm Okay, If You Say So
I'm sane, no, really, I am.
I'm not insane. No, really, I'm not.
Except…I've struggled with clinical depression and drug addiction, and
these are both diseases of the brain. For a long time I made the same mistakes
in life over and over, knowing better each time — but doing it anyway. I was
married and divorced four times before I figured out that I was giving in to
relationship-wrecking compulsive behavior.
But since I don't rave on the street, I don't stalk people or have delusions
of grandeur or hallucinate or hear voices, let's pretend I'm not crazy.
When I was young, I was in a mental hospital because of an overdose of a
powerful street drug.
The drug that put me there made me temporarily psychotic. I chased my mother
around and smashed windows and I bit a cop on the leg as he cuffed me and I
writhed vomiting and hallucinating in the back of his police car. I was strapped
on my back on a table staring at a naked light bulb for two days, while the same
movies played over and over in my head. Shattered glass flying in slow motion as
I break the windows, over and over again like those mistakes in my later life,
smashing every window in the house. It was the same Security Ward in Oregon in
which Ken Kesey set One Flew Over the Cuckoo's Nest. One guy screamed at
his penis, "Stop it, stop it, leave me alone!" (I know the feeling, actually.)
Thanks to that horrible street drug, I was temporarily able to experience
full psychosis, artificially induced-hence I know what one form of psychosis is
like, and have a sense of what the psychotic endure: the sense of being strapped
to an evil carnival ride going ten times too fast, everything nauseating,
everything terrifying, and it never seems to stop. The feeling of being utterly
subjected to forces outside of your control. All that you have left is the part
of you that experiences the nightmare.
But it was all over in 48 hours or so, and I was able to wake up from the
nightmare. Some people are born into it; some people never wake up from it. It's
so easy for the "sane" to shrug off the suffering of a psychotic. If only they
knew…
I was luckier than a relative of mine, who's bipolar — or schizophrenic,
depending on which doctor you ask — and whose life has been hellishly
undermined by it from the time he was a young man. The road of his life
capriciously turns to quick sand under him, all of a sudden, as the voices and
the paranoia and the hallucinations begin. He once spent all night talking to
"Bob Dylan" in an alley in Sacramento. Perhaps there was no one with him in that
alley, or perhaps it was some street alcoholic amusing himself babbling to a
handy schizophrenic.
I used to sometimes take care of that relative when he was a baby: a sweet,
affectionate, bright toddler. Twenty years later that baby was waving a knife at
cops on the street and warning them that he knew exactly who they were really
working for.
We deal with mental illness in different ways in our society. One way is, we
make it a joke — "They're coming to take me away ha ha they're coming to take
me away ha ha to the funny farm where life is beautiful all the time and I'll be
happy to see those nice young men in their clean white coats…"
But we also romanticize madness. By calling it madness instead of
sickness-the word madness has a melodramatic, Roderick Usher sort of sound to
it. Usher, in the Poe's "The Fall of the House of Usher," spoke of being
hypersensitive to sounds and impressions, his consciousness constantly under
bombardment until he was driven to madness — he was Poe's Poster Boy for the
overwhelmed, the anxiety-raddled, and even now he could symbolize our
dysfunctional relationship with our media, our technology and frantic lifestyle
addictions; our ravening hunger for input that'll keep us one step ahead of
having to live with ourselves…until we overload from it like modern Roderick
Ushers.
Sometimes kids can't deal with all the input — and maybe with the toxins
we've let them ingest, and the low-attention settings we've given them through
our media conditioning — and they are perceived to have Attention Deficient
Disorder. Some of them really have something of the sort. But do the enormous
numbers of kids who get a powerful amphetamine-related medication really have
the disorder? Are those vast numbers of kids genuinely, definitely, truly in
need of drugs like Ritalin, which permanently alter their neurological makeup?
And is it a coincidence that Ritalin vastly enriches the pharmaceutical
industry, an industry which makes, no exaggeration, twice the profits of other
Fortune 500 companies?
One day a few years ago we were suddenly confronted with mechanical voices on
the telephone, menus and automated responses, press one if you want a recording
to explain about this, press two if you want a recording to explain about that,
and having pressed three, press four if you want an explanation of the
explanation. You literally had to go through a maze to talk to the phone company
about a problem with the phone — and it's that way with most businesses now.
Suddenly there was a new technology that was part of our lives and nobody asked
us if we wanted it there. It was another maze to go through besides the mazes of
streets and personal conflicts.
Maybe there are too many tons of Just Too Much loaded on people. More and
more people are flipping out and killing their wives and children — a rash of
people killing their children lately — or blowing people away at work, or
getting addicted to Oxycontin or Xanax or learning to lean on the panoply of
antidepressants advertised on television as if they were skin creams or hair
products. Everyone is Roderick Usher sometimes.
We love the drama, the romance of madness-as opposed to mental illness. We
love to imagine tortured artists wrenching the pearl of their genius from the
tortured oyster of their suffering: Van Gogh half mad and all genius, never
understood or appreciated. We all feel inadequately understood and under
appreciated.
We romanticize insanity or we ridicule it — or we put it in the room where
we keep the objects of our pity, a chamber we rarely enter, we toss some coinage
through the door and dutifully look through the window at times, at the raving
icon of human isolation on the street, the homeless and insane. Sure, it's
understandable: we can only carry so much burden. So we compartmentalize life
and people and ourselves to make it easier. And in that compartmentalization we
methodically build mazes and then we complain we're lost in a maze.
This is the society that thinks Celebrity Boxing is normal
and…funny.
2. Sicker-Than-Ever Society?
Now hear this, an estimated 22.1 percent of Americans ages 18 or older suffer
from diagnosable mental disorder in a given year — and that's not just someone
who's a little troubled and neurotic and goes to a therapist. I'm not counting
myself. In 1998 that was 44.3 million Americans. Four of the ten leading causes
of disabilities in the United States are mental disorders — major depression,
bipolar disorder, schizophrenia, and obsessive-compulsive disorder. Many people
suffer from more than one of those at a time. For the multiply-stricken, life
can truly be a bitch-a hag, a harridan riding your shoulders and tearing at your
skull with a serrated beak.
About 18.8 million Americans have a depressive disorder. That's almost ten
per cent of the adult population. Nearly twice as many women as men are affected
by a depressive order each year. Why, because they have to live with American
men? That's 12.4 million American women.
Depressive disorders seem to be appearing earlier in life in people born in
recent decades. Clinical depression often co-occurs with anxiety disorders and
substance abuse — and with substance abuse, clinical depression only gets
worse, since narcotics damage the brain's ability to make mood regulators,
endorphins, and serotonin.
Whatever the cause, "Major depressive disorder" is the leading cause of
disability in the USA and established market economies, worldwide.
Bipolar disorder affects approximately 2 point three million American adults
or about one point two per cent of the us population age 18 and older in a given
year. Men and women are equally likely to develop bipolar disorder.
In 1997 30,535 people — that we're sure of — died of suicide in the USA.
It's probably more than that. More than 90 percent of people who kill themselves
have a mental disorder or a substance abuse disorder. The suicide rate in young
people increased dramatically over the last few decades. In 1997 suicide was the
third leading cause of death among 15 to 24 year olds. Four times as many men
than women commit suicide — but women attempt suicide two to three times as
often as men. (Ladies — was it drama all along or was it inefficiency? Cut to
the chase and see a therapist.)
Approximately two point two million American adults — apparently a lot of
them attracted to San Francisco — are schizophrenic.
Anxiety disorders include panic disorder, obsessive-compulsive disorder,
post-traumatic stress disorder, generalized anxiety disorder and phobias. About
19 million Americans (13%) have diagnosable anxiety disorder. Many people have
more than one anxiety disorder.
Not all of them know it — they just think they really need to drink a case
of beer and watch six hours of television a night.
Women are twice as likely to have an anxiety disorder, post-traumatic stress,
generalized anxiety, agoraphobia and specific phobias. Of course those specific
statistics don't point out that at least some of that — especially
post-traumatic stress — probably does come to women after they've been abused
by men: raped, beaten, or psychologically raped and beaten.
Others are just neurologically prone to anxiety — and there are imponderable
causes having to do with the fact that, generalize as we might, every person is
exquisitely individualized, having their own individual experiences from the
moment of birth. It stuns me to look at a big crowd anywhere and think that each
person– if you could turn time backward for them and follow along — would
follow an individual path through millions of experiences in millions of places,
each one with their unique joy and suffering and misunderstanding and
understanding; each person in a kind of winding tunnel of personal experience.
Try psychoanalyzing that vast accumulation of experience; try finding clear
psychological causation in thousands of miles of experiential tunnel.
About two point four million people have panic disorder… which often leads
to agoraphobia. About three point three million Americans have OCD:
Obsessive-compulsive disorder. Five point two million Americans have some form
of serious post-traumatic stress disorder, usually after personal assaults such
as rape, vicious muggings, parental abuse, or encounters with terrorism — as in
Oklahoma City, as in the 9/11 attacks — or due to natural disasters, car
accidents, and so forth. And the above statistics don't even venture into the
terrifying world of Alzheimer's patients.
So besides all the depressives grazing on Prozac (I used to be one), and all
the children getting their attention spans chemically tweaked, we have this huge
population of people with mental disorders. We raise money and we get help for
all kinds of charities and sufferers — but when did anyone last do a "walk for
the mentally ill"? It might happen, but not very often.
Maybe because we can't bear to imagine all that unjust suffering, we somehow
cling to the idea that in someway mentally ill people have brought it on
themselves. Not all mentally ill people are always just victims — many of them
may indeed collaborate with their own diseases, or succumb when they could
fight.
But that's easy for us to say. Those of us who don't hear voices in the
electric toothbrush, don't go for days without sleeping because of fear of
what'll get them when they sleep. For the most part the mentally ill, and not
just the ones on the street, are the abandoned-and it's easier for us to assume
that there's nothing we can do to help and in some obscure way it's all their
karma.
Notoriously — most readers will know this — this is the one major
industrialized nation with laughably inadequate socially-provided health care
and that goes big-time for mental health care. If little is done for the
uninsured poor with physical problems even less is done for the uninsured poor
with mental problems. And what is done is under funded, hackneyed, saddled with
uneducated health care workers who don't care because they're not paid enough to
care — I don't mean the doctors and nurses; I mean, for example, the generic
"mental health workers" now found in mental hospitals.
It used to be that assistants to doctors and nurses in mental hospital,
so-called Psychological Technicians, or "psych techs", had to be well trained —
but they're being replaced by the untrained. To save money, asylums and hospices
for the elderly stricken with Alzheimer's are now allowed to use people employed
at minimum wage, workers who are untrained or barely trained. These sullen
drudges resent what they're paid — or what they're not paid — and act out on
their resentment by doing as little as possible.
You get what you pay for in health care too, and at that rate of pay you tend
to get people who can't get another job for a reason. That might be partly why
at least one of San Francisco's mental hospitals for the uninsured has a high
incidence of mental health care workers making deals with patients for sex —
usually the currency is cigarettes. And why that same hospital has a high
incidence of mental health workers raping patients, and mental health workers
stealing jewelry from patients. (Alzheimer's patients, by the way, routinely
have jewelry stolen from them by minimum wage workers in nursing homes). Yes and
this policy may be a large part of the reason that mental patients and
Alzheimer's patients are often left in restraints unnecessarily so that they
soil themselves and develop bedsores. Unsupervised, they hurt one another or
commit suicide.
3. Racism, Poverty and Mental Health
Racial and religious-minority groups are egregiously under-served by the
mental health care system. A constellation of barriers deters minorities from
seeking treatment. Language and cultural barriers make them unlikely to get
treatment that meets their needs. Because the system is shaped by research on
white middle class populations, mentally ill minority groups experience the
mental health system as the product of white, European culture. Hispanic and
Vietnamese and Cambodian people have problems complicated by their history. How
many white mental patients had to escape the Killing Fields or napalm — or life
in the inner city ghetto?
In some traditional societies mental health problems are viewed as spiritual
concerns. Traditional religious authorities are not heard to say, "You don't
need me as much as you need to see a psychiatrist." Sometimes having religion
helps with stress, makes you less prone to breaking down, gives you a free
support system — but if you have a major mental illness, there's not a hell of
a lot your religion can do for you. It might even add to your delusions with
talk of demonic spirits.
African-Americans are statistically less likely to voluntarily seek
outpatient therapy. Besides cost issues and the stigmas associated with the
mentally ill, the short reason is they just don't trust us. No more explanation
is necessary — except for why we don't do more to do outreach to provide
reassurance and outpatient help in the black community.
The overall mental health of Native Americans has barely been studied. What
is apparent is that psychological illness is generally higher among Indians than
the rest of the population — alcohol abuse, which, of course, is
self-medication, is especially prevalent and suicide occurs at alarmingly high
levels.
Lower economic status has been strongly linked to mental illness — the poor
are two-and-a-half times more likely to suffer from serious psychological
problems. Poor women experience more physical danger from men. And of course the
poor have less access to health care so they have less access to therapy and
medication — so things are more likely to get more seriously out of control.
Meanwhile a wealthy matron in Beverly Hills pops another Xanax and wonders how
some little woman in Texas can go mad and kill her five children.
The poor are also more likely to be exposed to major environmental toxins.
The refineries that keep breaking down and leaking are, many of them, snuggled
right up against low-income communities. I stayed at a cheap motel once, in the
San Fernando Valley, a block from the Budweiser brewing factory. This place put
out some major fumes, sulfur dioxide probably among them, that burned the eyes
and hurt my lungs — and I was there only overnight. The factory is right smack
in the middle of housing for the poor. They live with those burning eyes and
aching lungs, and whatever neurological effects the pollution from the place may
generate.
Last time the EPA worked it out, almost two billion pounds of randomly mixed
chemicals were dumped into our nation's water systems. In that same year
two-and-a-half-billion pounds of chemicals were released into the atmosphere;
with the total chemical attack on the environment estimated at almost six
billion pounds. This is only in one year.
Seventy thousand — that's 70,000 — chemicals in commercial use today
have not been tested for neurotoxic effects.
Known neurotoxins that we are most commonly exposed to — these are not from
that 70,000 group — are lead, mercury, cadmium, and pesticides. Most of these
toxins are colorless and odorless, making sensory detection impossible. Round Up
and other herbicides are being quietly phased out after years of vast public use
because we're just now finding they cause serious brain damage in children. The
symptoms of those kinds of poisoning may come on slowly due to a gradual build
up. The kid gets weirder and weirder and weirder and then one day…
Here is just a partial list of common early subclinical symptoms of toxicity
from toxins we routinely allow in our air and water: fatigue, lethargy,
depression, headaches, allergies, chronic infection, nervousness, sudden anger,
memory loss, and paralysis. Notice how many of these symptoms involve behavior.
Mental illness is more prevalent than ever — how much of it is because we're
routinely poisoning ourselves?
4. Are Paranoids Right?
If you know any seriously paranoid or bipolar people, you know that they may
often fear that they are being poisoned. The irony is of course that they are
being poisoned, though usually not as much as they think-
And yet sometimes they are being poisoned almost as badly as they fear. Look
at the Erin Brockovich case — whole neighborhoods were genuinely being poisoned
by smiling friendly people from Pacific Gas & Electric. The PG & E people were
oozingly sweet when they dealt with that community and they knew they were
exposing them to toxins and some of the PG & E employees knew they were doing
real damage — and they just covered it up. Same goes with the Monsanto case in
Aniston.
In both cases, the paranoid were right.
Paranoids are afraid of medication — because they think it's poison.
The irony is double edged. Anti-psychotic medication is somewhat toxic — there
are no medications for schizophrenia or related diseases that aren't rife with
nasty side effects. At the same time, most seriously affected schizophrenics and
bipolars are even sicker without the medication. Despite its bad side effects,
it does make it possible for them to live somewhat rationally in the bizarre
civilization we've created. Yet they can see it's giving them permanent tremors
and difficulty thinking; they find it makes them drool or lose control of their
limbs at times. People have died from not-so-very-large doses of the
anti-psychotic drug Haldol.
So the paranoids are trapped — they're trapped between their own fantasy and
the reality of the necessity of taking the stuff that in turn feeds their
fantasy by poisoning them for real. This is a nightmarish dilemma to be stuck
in.
Medication is sometimes badly selected — people vary neurologically, but the
same group of medications are given for most mental patients. Doctors don't want
to take the time to be specific. If the patient feels the medication is making
her sicker than it is helping him, and is resistant, the doctor or nurse or
psych tech assumes the patient is just being paranoid. And they might be — and
yet they might be right! That is their real dilemma, the cognitive dissonance
they live every day.
Paranoids are afraid they're being spied on. Sometimes people are
being spied on — I get e-mail and phone calls from people who seem to know what
my consumer patterns are, what I've bought recently, what insurance I don't
already have, because marketing groups routinely sell information that should be
private.
Of course reality is notoriously subjective. And notoriously there were many
powerful, effective people, like Abraham Lincoln, who suffered from
"melancholia," or mental illnesses of various kinds. Louis Ferdinand Celine was
compulsively anti-Semitic — it was a sickness, not an ideology — and he was
one of the best writers of the early 20th century. Some of Coleridge's best
writing emitted from states that are almost undistinguishable from schizophrenic
hallucination.
People talk about how this or that public policy is crazy, is insane. Surely
it is insane, indeed, to knowingly dump 6 billion pounds of toxins into our food
chain. To allow the destruction of forestland and the ocean life that creates
the very oxygen we breathe. We still put arsenic and mercury and lead in the
air. We take insane risks with nuclear power plants — risks so notoriously high
that no insurance company will insure the plants. And these things seem like
madness.
At the end of Bridge On The River Kwai the British commander kills t o
protect the bridge he worked so hard to build and then deliberately blows up the
bridge he killed to protect — and as he does this the doctor says,
"Madness…madness…madness…"
When I was watching the Gulf War on television, just like an action-based
television show about aerial combat, I was caught up in it — I am opposed to
any but the most absolutely necessary wars, but found myself really digging it
when those smart bombs zipped from my country — by extension from me — to blow
people up in that cross-hair marked building. I enjoyed it — and I was opposed
to it, both at once.
I was insanely self contradictory — but then I was just taking part in the
collective mass hypnosis. We as a species are far more prone to mass unified
behavior than we know. How else to explain what made the Khmer Rouge do what it
did? How else to explain the Holocaust and whole towns in the American south
partying around lynchings? How else to explain the lunacy of the McCarthy era?
How else to explain Jonestown? We have a gift for dehumanizing human beings in
our minds and making a sort of mass ritual of it — and that is a form of
insanity.
What is insanity? Among other things, it's the idea that we're immune to
consequences. A madman thinks he's invulnerable — at times when he's not being
paranoid, as our Sane Leaders were in the McCarthy era. We think we can dump
billions of pounds of toxins into ourselves — and not have one in three people
come down with cancer and one in five with a psychiatric disorder. We are insane
as a society. We are far more asleep, more automatic, more mechanistic in our
reactions, our behavior than we know — and that is something psychiatry
diagnoses as disassociation.
What if, as a society, we're far crazier than we realize? What if — and that
includes this magazine's hipster readership, each with his or her own set of
conditioned psychological reflexes and insanely overblown vanities — what if
we're all truly — not figuratively, but truly — insane? We happen to be insane
in a way that's functional, like a heroin addict who gets enough dope so he
doesn't start screaming and manages to get through his day. But he knows his
addiction in insanity. We're functional — but insane.
Maybe we really should have more sympathy for the guy who talks to the air in
the subway station.
Maybe we should commit more resources to help ourselves.
* * *
(First published in The Thresher, Issue 2, 2002)
I went to a sangha meeting for 
