I Told Them I Was Sick - DSM Revisited

Have you heard about the man whose tombstone read, "I told them I was sick"?

A New Diagnosis Or Two

So, the docs earned their big fee and the Pension Fund got its money's worth out of this three-day psychiatric evaluation.  I have a couple new diagnoses.

That is really not so remarkable.  If you attend a Peer to Peer course, NAMI's signature ten-week self-help program for loonies, you know this.  One week, the participants go round the circle and tell their diagnoses, or rather, their history of diagnoses.  Most trace a whole tour through the DSM, the Diagnostic and Statistical Manual.

Where Diagnoses Come From

Support the Troops - Stop Shopping

So I am back from getting my head examined, that three day intensive evaluation.  I had my doubts about this enterprise.  At my most anxious, my therapist reminded me I would get air miles.  That would be something, at least.  To my surprise, I also received some surprises.  And the experience was worth a couple of blogposts.  This one will be about PTSD, or make reference to it.  Next week we will play with the DSM.

I start at the Hilton.  Well, before that, my pension plan, which is how I ended up at the Hilton, not to mention how I ended up getting a three day psychiatric evaluation at the Gabbard Center, which does not usually happen for loonies in my tax bracket. 

Decent Benefits For People With Mental Illness? 

The Episcopal Church Pension Fund was established by one of the biggest robber barons of the 19th century, J.P. Morgan, doing penance for his sins.  Like how Charles and David Koch aren't.  Since then, clergy have put the equivalent of a whopping 15% of our salaries into the fund.

Unlike United Airlines or General Motors, this retirement fund is not run by people who have the option of stealing it by threatening to close up shop unless the pensioners just hand over their hard-earned savings to increase the compensation of the CEOs.  The shop being the Episcopal Church.  Plus for some reason, in defiance of the way managed mutual funds work in the real world, the Pension Fund beats its performance indexes year after year after decade after decade.  Maybe this has something to do with karma.  Maybe the angels.  Choose your metaphysical system.  Whichever, for me, this is good.

As a consequence, my disability pension comes from one of the last defined benefit plans in America.  And it regularly has to come up with ways to spend its excess revenues, like by providing good benefits for its disabled beneficiaries, even those whose disability is of the loony variety.

And since the people who manage that much money are used to staying in places like the Houston Hilton, then that is where they put up their loony beneficiaries when we are getting our heads examined.

Which is how I came to spend four days there, two blocks north of the Galleria. 

Galleria As A Tourist Attraction 

Malls called Galleria don't have stores with names like Old Navy.  They have stores with names like Giorgio Armani, Christian Dior, Chanel, Louis Vuitton, Saks, Baccarat, Tiffany's, Cartier, De Beers.  A whole store called De Beers, for God's sake.

Galleria is where the restaurants are, where we went when we were tired of sitting next to tables at the Hilton where we had to overhear earnest mentors training earnest mentees for their presentations to their big clients.  The oil companies were meeting at the Hilton.  Down the street, Bechtel was meeting at the Westin.  Bechtel is the construction company to the Saudi monarchy.  So it may be the timing was not a coincidence.

We walked to the Galleria.  The neighborhood isn't really designed for walking.  Houston is more of an internal combustion engine kind of place.  So as we picked our way through parking lots, we overheard a father and young son comparing their Beemer to the Beemer they parked next to.  We dodged  Maseratis and Mercedes while crossing streets.  Well, you get the idea.  There was a closer restaurant.  But the doorman appeared to be wearing Kevlar under his vest.  Well, you get the idea.

One of my docs, making small talk as we entered her office, asked if I was getting to look around Houston in the off hours when I wasn't getting my head examined.  I said, No I am too tired.  Except, we went to the Galleria.  She responded, Well, THAT's something! 

It was something alright. 

Galleria As A Mental Health Hazard 

One evening on our way toward sushi, a young man held out soap samples.  I said, No thanks, I don't do scents.  Then he grabbed my hand.  Okay, he asked permission.  I see your nails are clean.  You don't paint your nails?  No I don't.  Let me show you something.  So he explained about ridges and natural oils while he did his flirty little small talk and buffed one of my nails.  Now don't scream when you see the results.  Indeed, the nail was beautifully shined, and made the notion of painting nails seem cheap.  I agreed it was beautiful and said I was not going to buy the buffer anyway.  Why not?

Because I don't buy things. 

That took some explaining, both to him and to myself, since I had never said those words before.  He decided I had made a life style choice.  Well, okay.  That would be one way to look at it.

But it was more like a commitment than a choice, made then and there.  I would no longer buy things.

Don't get me wrong.  I am as fem as they come -- short of destroying my feet in those instruments of torture that women willingly put on their feet nowadays.  Evidently, all that work we did in the 1970s to get women to love ourselves was a waste.  In other cultures, women are forced to deform their feet.  Having stopped in the 70s, now we do it again.  In the US, we call that freedom.

Where was I?  Oh yes -- I found those beaded dresses in the Gucci windows quite lovely.  And I have some beaded things in the back of my closet from pre-loony days.  Maybe not pre-loony, maybe just not-yet-identified hypomanic days, who knows.

But tripping past them, dodging the Lexus SUVs, all of that, I felt this growing sense of doom about the American way of life.

What The American Way Of Life Costs 

I couldn't shake the images of three young men.  One is a friend of my son's, who came home from Iraq with a TBI and PTSD.  Another is a relative with a couple tours of duty in Afghanistan and a troubled marriage.  The third is a young man I counseled, who signed up, hoping to come home a hero in a box. 

Support the troops, people say.  Support the ones who are protecting our freedom.  Freedom to shop at Galleria.

There I was, surrounded by the way of life they were protecting at the cost of their brains and their families and their lives.

It is too high a cost.

It is too high a cost.

These thoughts, coming in the midst of getting my head examined, make me think we need to get America's head examined.

Money, Military and Mental Health

This isn't a political blog.  I do advocacy about mental health issues.  I am not here to plug political opinion.

This is not an opinion.  This is a photograph.


 

This is another photograph.

And here is another.





 
And now we return to the shoes.

As I look at one picture, then another, as I listen to those young men, and then to the people in that restaurant next to me, I do have an opinion.  Here it is.

These shoes cost too much.

They cost too much.

Actually, I don't think this is about mental health, after all.  It is a sickness of the soul. 

What Is The American Way Of Life? 

I did meet some very nice people at the Houston Hilton.  One man was from Ethiopia.  He drove the shuttle, and we got to know each other in twenty-minute conversations each day on the way to the Gabbard Center.  He came to this country because he wanted opportunity.  And he found it.  He drives a shuttle bus.  His eldest is a policeman.  His daughter is about to graduate from college, and his youngest about to enter.  He doesn't need a Maserati to have the American way of life.

The other shuttle driver came to the US during the war in El Salvador.  We talked about Archbishop Romero, and the strength we still get from his witness.  If I remember right, somebody gave Archbishop Romero a pair of shoes for his consecration.  People gave him lots of things, but his friend asked him what he wanted, and he said shoes.  This former refugee, now shuttle driver, also found the American way of life.  Emphasis on life.  He doesn't need a Lexus. 

Freedom And Addiction 

People say our young men and women are sacrificing their minds and their bodies to protect our freedom.

We need to protect our freedom ourselves.  We are not free.  We are addicted.  Addiction is a disease of the soul.  And it is progressive.  The more you feed it, the worse it gets.

Our freedom begins when we acknowledge our addiction for what it is. 

Step One -- We admitted we were powerless over our addiction - that our lives had become unmanageable.

I don't want those shoes.  But I do want that beaded dress.  And having resisted it, having told that young man I don't buy things, the very next day I still almost bought an Eileen Fisher sweater at Nordstrom's across the street.  Because it was on sale.

Just in time I remembered those three young men.  That sweater cost too much. 

My Bit For The War Effort 

PTSD, Post-Traumatic-Stress-Disorder is bankrupting the defense budget.  Researchers are trying to figure out how to prevent it.  Does it take a neuro-scientist to figure out that you prevent Post Traumatic Stress Disorder by preventing the trauma?

I have decided to support the troops the way the troops do, by caring about what happens to their buddies and acting to prevent harm from coming to them.  I will not wrap a flag around my shoulders nor post one on my facebook page for Veterans' Day.  I will hold before me the faces of those three young men, and wrap myself in my love for them.

I will work the Steps, always remembering that I am just as addicted to things as any of you.

With God as my higher power, the next time I buy something, it will be a bicycle.  So I can leave my Civic in the garage.

photo of J.P. Morgan by Edward N. Jackson and in the public domain

photo of Bacarrat Chrystal Sculpture used under the terms of the GNU Free Documentation License 

photo of Maserati, Gran Turismo by Rudolf Stricker and usedunder the terms of the GNU Free Documentation License

photo of Louis Vuitton shoes used under the Creative Commons Attribution-Share Alike 2.5 Generic license

photos of medical evacuation and coffins in public domain 

Getting Shrunk

I'm off this week to get my head examined, so am taking a break from using it.  This would be your opportunity to examine the many features of Prozac Monologues.  Here is a brief tour of the site and some tips for cyber-dinosaurs.

The basic breakdown: on the left are mental health and medication resources.  To your right are helps to navigate around the site, plus some fun stuff.

Text that appears in tan is a link to somewhere else.  The links on the left are to sites outside Prozac Monologues.  Most on the right go somewhere on the blog itself.  Notice in particular the feature called Labels.  If you click on a word in that list, several past posts on the same subject will appear.  The bigger the word, the more often I have written on it.  The right side also includes videos that change occasionally and sometimes coordinate with the current post, and sometimes not.  Ditto the Word of the Week.

The text in the middle is the new stuff I try to write once a week, weather and brain waves permitting.  Again, the tan text links to something else.  It could be a research article, an Amazon.com review, another blog, or an earlier Prozac Monologues post.

Below each post are some icons.  Click on comments to read other peoples' comments or add one of your own.  Click on the envelope to email the post to somebody else.  Click on one of the letters to share the post with whatever social media you use.  Click on the number to bring the post to the attention of the cyber world.  I don't actually know how that feature works.  Can somebody tell me?  Then there are more labels, links to other posts that deal with similar matters.  At least, I think they are similar matters.

That's enough to keep you busy while I spend the week filling out bubbles on instruments of torture devised by psychologists, and telling my tale of woe to psychiatrists who have heard worse, even if I can't imagine it, and who think they can come up with a new idea that my own doctor hasn't come up with, though I can't imagine that either.

Catch you later...

flair from facebook.com

Mental Health Day -- The Funner Version of Advocacy

Last week it was Mental Illness Awareness Week, according to NAMI.  So today it's World Mental Health Day, according to WHO.  The World Health Organization, that's WHO.

That's a week for mental illness, a day for mental health.  Whoever organizes these things must be reading my mood chart.

I cycle within cycles.  In the larger circle, I have been able to maintain a stable state for a while now -- the state of jaded, that is.  So I take up this week where I left off last week, continuing the repost of a series on the sorry state of mental health advocacy.  This second post takes a glass-half-full approach.

Not exactly mental health, but at least the upside of mentally interesting.  I mean, we got these diseases for life.  We might as well learn to make them work for us.

Mental Illness Awareness Week - Because We Are Really Good at Delusional

Imagine this -- Somebody from NAMI attends one of those campaign events and gets to the microphone.  Intending to ask about the candidate's views on funding for community mental health, this poor parent begins with a statement: 

People with severe mental illness die on average twenty-five years before everybody else.  They have the expected lifespan of Somalia. 

Nowadays the crowd will cheer.  But that particular youtube wouldn't go viral.

I am jaded about this Mental Illness Awareness thing.  It will not be subjected to any Best Practices evaluation.  NAMI and the pharmaceutical industry have been making us more aware of mental illness for decades now.  The numbers on prejudice have not budged.  They have not budged.

That negativity -- does it mean I am currently displaying symptoms or that I have done my research?  Both, actually.

I'll cop to the irony here.  I myself was a speaker at one of those Mental Illness Awareness Week events once, held on a Sunday night in a not-much-traveled portion of a university campus.

It was very moving, the candles and all that.  And it did raise awareness, in the sense that it made those of us who were there, people with mental illness and those who love us aware that we are not alone.  But did it increase funding for research and treatment?  Did it reduce prejudice?  I don't think so.

Let me answer that another way.  Did it increase funding for research and treatment?  Did it reduce prejudice?

Nope.

So symptoms, research, irony and all, my contribution to Mental Illness Awareness Week is a repost of what I think we ought to be doing this week.  And next.  And next. 

From Friday, March 11, 2011:

Ignore/Laugh/Fight/ -- Mental Health Advocacy That Wins

If they don't want to employ you, if they are afraid of you, if there are four times as many of you in jail as in the hospital, then it's not just stigma.  It is prejudice and it is oppression.

The twentieth century offered a whole degree program in prejudice and oppression.  Others have made progress against what beat them down.  Though we are now stalled and falling behind, we can move forward when we adopt their methods.

The Map to Liberation

Mahatma Gandhi was not the first freedom fighter.  But he is the great theoretician.  He gave us the map.

First they ignore you.
Then they laugh at you.
Then they fight you. 
Then you win. 

Four simple steps.  The good news -- we have already taken the first.  Got that one down pat.

Liberation 101: 

We are in charge of the map.  The oppressor doesn't decide that oppression will end.  It endures until the oppressed decide that it will end.

What we have to do is provoke the next step.

Then they laugh at you.

Well, that's where we are stuck, because we are unwilling to be laughed at.  Last month's NAMI meeting was about Iowa's upcoming budget cuts.  Somebody said, When we complain, they say we are crazy.  I think she is a therapist.  She has that therapist look, if you know what I mean.

Therapists say the funniest things.  When we complain about how we are treated, they say we are crazy.

But we are crazy!  We start off ahead of all the other liberation movements that had to get crazy to take it to Gandhi's next step.

Think Martin Luther King.  Think Nelson Mandela.  Freedom?  People called them communists.  Either that or just plain nuts. 

Like these other movements, we have to find a spiritual taproot deep enough that we can endure being laughed at.  Just like the tree, standing by the water... 

The spiritual work will be impossible if we expect our care providers to lead.  They get twitchy if we talk spirituality.  I will address that work another time.  Right now I will sketch out how we break beyond First they ignore you, and move to Then they laugh at you.

What that means more precisely is, we have to do things to make people think we are nuts.  Like, DEMAND that we receive funding for research and treatment, DEMAND that we have the same access to health care as anybody else, DEMAND that we receive our health care in health care facilities, not in jails.

It's all about budget cuts right now.  Corporate tax cuts -- that's a given.  Corporations spent good money for our current crop of legislators, and they expect a return on investment.

So who will pay for these tax cuts, the people with mental retardation or the people with mental illness?  The Iowa State legislature has a committee that has asked us to decide.  Well, isn't that special.

We have to DEMAND that they change the rules of this game.  We have to REFUSE to play Survivor.  We have to refuse LOUDLY.

How?  African Americans sat down.  That is when they moved off Step One, when they REFUSED to be ignored any more.

So how about we lie down?


Lie In/Die In

Picture this.  The next Loonie Lobby Day at the state legislature, we don't get all showered and neatly normaled up and go have sincere conversations with our legislators who are really sympathetic (their brother has depression, so they know what we are up against, but their hands are tied by that pesky deficit...)

Instead, we stand in the rotunda and read off the names of their constituents who have committed suicide.  Each time a name is read, somebody falls down.  They have to step over our bodies to get out of the building.

Mental Health "Parity"
 
The Mental Health Parity and Addiction Equity Act would be better called the Swiss Cheese Mental Health Act.

1) Only large employers are affected.

2) If they can demonstrate it causes them financial hardship, they can get an exemption.

3) Parity is a laugh anyhow, if reimbursement rates are so low you can't find a provider who accepts your insurance.

4) The provisions of even this piss poor legislation that address reimbursement rates are now the top of the list on Congress's chopping block.

So off we head to Washington.  There are 13,000,000 million of us with serious mental illnesses in the US, including 5.7 million with bipolar, 2.4 million with schizophrenia and 7.7 million with PTSD.  The numbers add up to more than 13,000,000, because some of us get to double dip.  Piece of cake to pull together 34,000 to do a die-in around the steps of Congress, representing one year's worth of the deaths by suicide in the US.  We will drape American flags over the bodies of the vets.

Yes, we are dying out here.  Let them step over us.

How nuts are we to think we can turn around this systemic discrimination?  In this political climate?

Progress Report

Remember, When we complain about how we are treated, they say we are crazy?  By now some of my readers seriously want me to reconsider Seroquel.  Others -- if you are still reading, your doc wants you to up your dose.  This means we are making progress.

At some point, laughter becomes a cover for scared.  Then it's time for the next step.

Then they fight you.

Remember, this is our map.  We are the ones who push it forward.  Nobody else will.  And if I am scaring you, look at it this way.  If we aren't scared already, we'd have to be crazy.

Until we change our advocacy, we will continue to lose psychiatrists.  We currently have less than half the psychiatrists we need to provide a even a shoddy level of token med checks.  In Iowa, we have one fourth.  While demand is going up (think Iraq, think Afghanistan), supply is going down, as retiring psychiatrists are not replaced by new doctors.  Why go that far in debt to get through med school and then choose a specialty with the lowest pay scale on the block?

Until we change our advocacy, we will continue to lose community mental health centers.  Remember community mental health centers?  The places we were supposed to go when they kicked us out of the hospital?  They are disappearing already.  Here are the Kansas numbers.  You can find the same story for any state you google.

Until we change our advocacy, we will lose what parity was promised.  Again, all employers have to do to avoid it is demonstrate that it costs them money to provide it.

Until we change our advocacy, we will lose even the programs that jails now provide.  Why should criminals be coddled?

Desperate Times Call For Futile Gestures

What were we thinking?  That public demonstrations would make a difference to cold hard facts?  Were we nuts?  (By the way, what have we been thinking, that talking would make a difference?)

After the strategies designed for Then they laugh at you prove futile, we up the ante.  In place of our bodies, we substitute urns full of ashes and dump them on the floor of the assembly halls.

In 1987 AIDS activists entered the New York Stock Exchange.  Seven people unobtrusively chained themselves and a banner to the rail overlooking the trading floor.  At the opening bell they unfurled their banner and blew fog horns.  They drowned out the opening bell, and prevented traders from trading, while they brought national attention to their demand that pharmaceutical companies stop profiteering at the cost of their lives.

Wall Street is our audience, too -- all the businesses that insure some of their employees but not us, all the health care companies that pay reasonable reimbursement to some doctors but not ours.  How about we bring ambulance sirens? 

A Day Without Mental Health Care 

Next we head to Main Street.

The 2004 film A Day Without A Mexican imagined what would happen if one day everybody in the US from Mexico, Guatemala, Honduras, Nicaragua, et al disappeared.  Economic havoc, that's what.  A few years later, the movie inspired a political demonstration.  Workers stayed home for a day.  In some places, restaurants simply closed for the day, unable to serve their customers.

So last week the Wall Street Journal reported a survey by Workplace Options.  The survey discovered that 41% of workers polled had taken 4-9 days off work in the previous year to care for their own, their friends', their coworkers' or family members' mental health issue.  Half work in offices with no benefits, support or services to deal with mental health issues.

They think they can't afford to provide services?  They haven't a clue how much it already costs them not to. 

There you have it, a National Day Without Mental Health Care.  Everybody who has a mental illness or loves somebody who does -- stay home.  I'm thinking Monday -- to make that moon connection, and maybe even disrupt Monday Night Football?

Going To Jail

At this point, we are littering, destroying property and generally disturbing the peace.  We are going to jail.

Everybody on a three-month wait list for an intake interview,

Everybody on a two-year wait list for the judicial review of an SSDI application,

Everybody on a four-year wait list for sheltered housing,

Everybody who had been doing okay, but stopped taking meds when the day program closed,

Everybody who can't afford the copay for that third tier prescription anyway,

Everybody who doesn't have health insurance at all,

Everybody who is homeless,

Go downtown and set a trash can on fire.

We Need Some Coordination Here

No, not everybody.  Jail is not a good place for people with OCD, PTSD, nor Borderline.  You all, your part is to run right down to the courthouse, legal brief in hand, to make sure the police department fulfills its obligation to get the rest of us our meds.

Prejudice And Oppression -- Some Observations

This post has been about fighting oppression, the institutional arrangements that support an unjust system.  Oppression is weighty.  It is fierce.  It does not respond to reason.  Power yields only to power.  The strategies and actions I have described are the power of anger that has been organized.

Our families and our care providers are just as scared as everybody else of our anger.  So they will not help us here.  They want to address prejudice, not oppression. 

Prejudice is the irrational thoughts and feelings of individuals.  Well, prejudice also needs to be addressed.  There is work enough for everybody.  Think of differential diagnoses as differential skill sets for the differential tasks of freedom-fighting.

That's coming next week...

banner from nami.org

image of prison bars from microsoft

photo of Mahatma Gandhi in public domain 

flair from facebook

forest photo by Maylene Thyssen used under the GNU Free Documentation license

sit in at Walgreen's in Nashville, Tennesee, March 25, 1960, in public domain

photo of die in casualties by Brendan Themes and used under the Creative Commons Attribution 2.0 Generic license

fist graphic in public domain

Manifesto: The Mad Farmer, Consumer, Blogger, Whatever

As in the days of Amos, John of Patmos, John of the Cross, it's the poets who will save us, those of us who have ears to hear.  For the rest, it's the poets who will preserve the evidence, in hope that there will yet be ears to hear.

So today, Wendell Berry's Manifesto: The Mad Farmer Liberation Front.

First, one liner note: Your mind will be punched in a card and shut away in a drawer.  In the early days of computers, data was recorded by punching holes into cards, literally, card stock, roughly 3"x7".  This was before web crawlers could find the word bread in a Facebook comment and then put up ads for kitchenware on your page.  The line in the poem, first published in 1970, is truer than ever.  The technology has simply got more efficient.

Manifesto: The Mad Farmer Liberation Front

Love the quick profit, the annual raise,
vacation with pay.  Want more
of everything ready-made.  Be afraid
to know your neighbors and to die.
And you will have a window in your head.
Not even your future will be a mystery
any more.  Your mind will be punched in a card
and shut away in a little drawer.
When they want you to buy something
they will call you.  When they want you
to die for profit they will let you know.

 

So, friends, every day do something
that won't compute.  Love the Lord.
Love the world.  Work for nothing.
Take all that you have and be poor.
Love somebody who does not deserve it.
Denounce the government and embrace
the flag.  Hope to live in that free
republic for which it stands.
Give your approval to all you cannot
understand.  Praise ignorance, for what man
has not encountered he has not destroyed.

Ask the questions that have no answers.
Invest in the millennium.  Plant sequoias.
Say that your main crop is the forest
that you did not plant,
that you will not live to harvest.
Say that the leaves are harvested
when they have rotted into the mold.
Call that profit.  Prophesy such returns.

 

Put your faith in the two inches of humus
that will build under the trees every thousand years.
Listen to carrion - put your ear
close, and hear the faint chattering
of the songs that are to come.
Expect the end of the world.  Laugh.
Laughter is immeasurable.  Be joyful
though you have considered all the facts.
So long as women do not go cheap
for power, please women more than men.
Ask yourself: Will this satisfy
a woman satisfied to bear a child?
Will this disturb the sleep of a woman near to giving birth?

Go with your love to the fields.
Lie down in the shade.  Rest your head
in her lap.  Swear allegiance
to what is nighest your thoughts.
As soon as the generals and the politicos
can predict the motions of your mind,
lose it.  Leave it as a sign
to mark the false trail, the way
you didn't go.  Be like the fox
who makes more tracks than necessary,
some in the wrong direction.
Practice resurrection.

from The Selected Poems of Wendell Berry

And your homework for this week, gentle reader --

What does it mean to Practice resurrection?  What tuition will you pay?

Johannes der Evangelist in Patmos from a triptych by Hans Memling, 1479

photo of punched computer card by Litrefs used under the Creative CommonsAttribution-Share Alike 3.0 Unported license

photo of Immortal Tree, Humboldt Redwood State Park by Jan Kronsell, public domain

photo of fox from US Department of Interior, public domain
book cover from amazon.com

Differently Abled - More, Please

It's like he is in a world of his own. The first grade teacher, old school, same worksheets for the last thirty years, did not mean it as a complement.

The mom was confused. She asked her son's Montessori preschool teachers for their take on it. They, too were confused. Then the light dawned. The way they put it was, He has immense powers of concentration. They thought he was marvelous.

The problem was, he was still absorbed by the story he was writing, when the first grade teacher had moved on from writing to math. The world he was in was not her world.

His second grade teacher recommended him for the Talented and Gifted program.

His fifth grade teacher thought he had ADHD.

People who are different get diagnosed. The Diagnostic and Statistical Manual (DSM) is all about describing the various ways we don't fit. But if you can pass for normal, you don't have a disability. If they can pick you out in that One of These Things is Not Like the Others game, then you do.