Category Archives: mental health

Recommended Reading for August 10, 2010

Wheelchair Dancer at Feministe: On the Cover [trigger warning for discussion of violence]

Regardless of how disability plays out in Aisha’s world, the vast majority of readers of TIME live in a culture that understands disability as tragedy. As shocking. As among the worst things that can happen to you (bar death). Mainstream American culture thinks it knows disability and knows how to read it. Ms. Bieber has a history of photographing disabled bodies[. . .]But the work she does in the Real Beauty series does not come through in this photograph — perhaps because of the context and placement of the image. Here she (and or the editor) uses Aisha’s disability to trade upon the readership’s sympathies and their horror: this and other unknown kinds of disability are a direct result of the US departure from Afghanistan. This is not about Aisha; it’s about the message of the article.

Cripchick at Cripchick’s blog: tell me who i have to be to get some reciprocity?

don’t feel the way white supremacy creeps into your life and plops itself in the center?

in the last wk, white ppl have:

  • told me how to rearrange my words as to be more approachable.
  • made my need to have ppl of color time about them.
  • asked me invasive medical questions about my body.
  • thanked me over and over for teaching them about oppression.

Cara at The Curvature: Disabled Student Assaulted on School Bus; Bus Driver Watches and Doesn’t Respond [trigger warning for description and discussion of severe bullying]

Most readers here who have ever ridden a school bus will have at some point been on at least one end of bullying and harassment. Many will have at different points throughout their childhoods and adolescences acted as both bullies and victims — myself included among them. Big news stories since I stopped riding a school bus have left me with the impression that little has changed. School buses are places where bullies, harassment, and violence thrive. And as all current or past school bus passengers know, students with disabilities, particularly cognitive or intellectual disabilities, are especially vulnerable.

Daphne Merkin at the New York Times Magazine: My Life in Therapy

This imaginative position would eventually destabilize me, kicking off feelings of rage and despair that would in turn spiral down into a debilitating depression, in which I couldn’t seem to retrieve the pieces of my contemporary life. I don’t know whether this was because of the therapist’s lack of skill, some essential flaw in the psychoanalytic method or some irreparable injury done to me long ago, but the last time I engaged in this style of therapy for an extended period of time with an analyst who kept coaxing me to dredge up more and more painful, ever earlier memories, I ended up in a hospital.

William Davies King at PopMatters: In Defense of Hoarding

To be sure, a special label like compulsive hoarding seems required by many of the heart-rending cases they recount, people neck-deep in the slough of their despond, overwhelmed by more whelm than can be weighed. But sadness and dysfunction are hardly rare or new. What is new is the social imperative to ram open that front door. Bring in the wheelbarrows, the commanding case worker, and the camera—especially the camera, which enlists us all in the drive to evacuate these cloacal dwellings. Reality TV rolls up its sleeves, puts on the rubber gloves, and hoards the evidence while [authors] Frost and Steketee stand alongside the labyrinth, notepad in hand, giving that Skinnerian nod.

Vulnerability Indexes, Homelessness, and Disability

(Note: this originally appeared in a modified form on my tumblr.)

Vulnerability indexing is a new trend in homelessness services. It started in LA and NYC but is now being used a bunch of cities and localities of all sizes around the country. Instead of traditional outreach services, these projects use a “vulnerability index” survey to collect data from street-based homeless folks (rather than people in shelters, living in cars, doubled up on couches, etc). The data is then used to rank the homeless people, in order, by their “vulnerability,” or likelihood of dying within the next 12 months if they remain on the street.
That ranked vulnerability list is then used as a priority list to provide the people with services, starting with housing.

In providing housing and services, these programs use a “housing first” model, which means that unlike the vast majority of homeless housing services, individuals are NOT required to be clean of drugs/alcohol or engaged in mental health services prior to moving in. Once they move in, they’re provided with all the supportive services they want, including substance abuse treatment, mental health treatment, education and job training and placement assistance, etc.

I strongly support these programs and have been very excited to see them gaining traction in LA. (we have project 50 in downtown LA, project 30 in the San Fernando Valley, and others pending right now.) I also think these programs are of special interest from a disability perspective because of the extremely high prevalence rates of mental and physical disabilities among the long-term chronic homeless, and the way these disabilities make it difficult, if not impossible, for this group of homeless people to move towards stable permanent housing.

Here are some of the reasons I think this approach makes a lot of sense:

1. It targets the population that needs it the most, re-opens discussions about serving the chronically homeless
These projects target a subset of the homeless population – the chronically homeless. This group is defined as people who have been continuously homeless for at least a year. This is a minority of the overall homeless community (about 23% of all homeless), as most people cycle in and out of homelessness in periods of 3 months or so. The chronically homeless are generally single adults, not families, and generally have some kind of substance abuse issue and/or mental disability and/or physical disability. Most policy analysts believe that nearly every chronically homeless person has either a mental or physical disability.

This population is considered extremely difficult to serve, as lots have tried to engage with services in the past and not found it useful, so are considered “service resistant.” This is a nice way to say that most people and agencies have pretty much given up on them and don’t have any hope of bringing them into services, much less into stable housing. This is also a nice way to say that these homeless folks have correctly figured out that most homeless services aren’t appropriate or beneficial for them, so there’s little point in trying to engage with service organizations. This is partly because homeless services are not really set up for people with disabilities – getting necessary accommodations in a shelter is enormously difficult because of the already extremely limited resources available. If you have PTSD and need a door that locks in order to sleep, a shelter is not for you. If you have a service animal, shelters are not for you. If you need even a minimal level of nursing or medical care, shelters are not for you. (Not that the streets are better at accommodating disabilities.)

These chronically homeless people are, unfortunately but frankly, likely to die. the vulnerability index looks at factors that “place them at heightened risk of mortality,” including 3 or more hospitalizations or ER visits in the last year, aged 60 or above, cirrhosis of the liver or end stage renal disease, HIV+ or AIDS, or co-occurring psychiatric, substance abuse, and chronic medical conditions (tri-morbidity). When this tool has been used in communities, the most vulnerable person identified by the tool usually has all of those risk factors and has been homeless for 20+ years. Can you imagine how difficult it would be for a 62 year old man who is HIV+ and has a physical and mental disability and an active substance abuse problem to enter a shelter, especially after over 20 years of street homelessness?

Traditionally, this group of the chronically homeless is a group that people have given up on. Not just the public, but even homeless service providers. But the first iteration of this program, in the Times Square area of NYC, has produced before and after stories that are flooring. A woman who lived on the streets for 20+ years as a heroin addict is now housed and working as the concessions manager at the movie theater in Times Square. Looking at the before and after pictures seemed like she’d moved backwards in time – she looked 20 years younger. These are the people who we walk by on the street and feel like they’re beyond help and beyond hope. We just don’t think people can come back from that – and these programs are proving that assumption to be absolutely wrong.

Another benefit of focusing on the most vulnerable folks is that it communicates that same message – you are not beyond help or hope, there are programs that can provide meaningful and beneficial assistance – to the homeless community itself. If folks see that the agency promised housing to someone with a substance abuse disorder, a mental disability, and 20+ years on the street, and then delivered on that promise, they’ll be motivated to participate with the agency and trust them in a way they wouldn’t trust the shelters or outreach teams that hadn’t housed that guy in the past. These programs usually see a “tipping point” once the first few, most vulnerable, people are housed – then the rest of the community believes in the promise of potential housing and is motivated to cooperate with the service agency.

2. These programs make economic sense.
These targeted programs are usually seen as an alternative to simply ignoring the homeless and continuing to not spend city and county funds on them. Because there are not a lot of homeless services or programs targeting this group, the perception is that we are currently spending zero dollars on them, and any targeted program will be a dramatic increase in funds directed to the chronically homeless. This could not be more inaccurate. Actually, this group is consuming an astounding amount of public funds, through county health programs, police and jail funding, and public benefits such as food stamps or general relief funds. A recent study by the Economic Roundtable here in LA found that these most vulnerable folks are consuming over $8,000 in county funds PER MONTH, through multiple ER visits, jail time for quality of life infractions, and health care services received in jail. When these folks are moved into housing – even fully subsidized funding with inclusive supportive services – it’s a net savings for the government.

So this popular conception that we’re not already spending a bundle on these chronically homeless folks is simply inaccurate. We, as city and county governments, are already spending an enormous amount of county health funds, justice system funds, and social system funds on this group, with no discernible improvement in their quality of life or life expectancy. (This New Yorker article is a great discussion of how these costs can mount up for a single homeless individual.)

I know that cost savings is likely not the most important aspect of these programs for this audience, but these economic arguments are extremely powerful in persuading localities who do not understand why they would benefit from targeting funds and assistance at the chronically homeless.

3. The overall economic effects of the project help those homeless who aren’t directly targeted.
The economic benefits of these programs mean that there will likely be additional homeless service dollars available for use at other places in the homeless continuum of care – meaning that the program could generate benefits for the non-chronically homeless as well. This is much needed. Currently, in LA, it’s really hard to get into a homeless shelter. that’s because the “emergency” homeless shelters – where you’re supposed to stay for 30-90 days before moving into a “transitional” shelter – are backed up. Because all the transitional shelters are full. Because there’s no permanent housing available, so there’s nowhere to transition to from the transitional shelter. So the transitional shelter is serving as permanent housing and the emergency shelter as transitional shelter and the folks who need emergency shelter … sleep in their cars, or on the floor of a friend’s apartment. This system could benefit from some more cash to build permanent housing – money that might be available were we able to reduce the significant existing county expenditures on the chronically homeless.

4. Housing First and other harm reduction policies make sense.
Currently, a lot of housing placements require that the person moving in be clean and sober and, if they have a mental disability, be actively engaged in mental health treatment services. As you can imagine, this turns into a lot of chicken and egg problems. If you are a homeless person living in LA’s Skid Row, which is overrun with illegal drugs and alcohol, and have no money to afford rehab or treatment, you are never going to be eligible for that housing, even if you actively want to stop using. You don’t have anything to lose while living on the street – even going to jail gets you a bed and some food – so there’s absolutely no incentive to stop using. If you’re likely to die within 6 to 12 months, it’s likely that being high during the interim will be more pleasant than being sober.

If you’re placed in an apartment, though, you quickly learn that ongoing abuse is going to cause financial problems in affording the apartment and social problems in not disturbing other neighbors. There’s also an incentive – you don’t want to lose the apartment. The programs have found that people are motivated to enter treatment when receiving housing, even if it’s not a requirement of maintaining housing. There have been similar results with mental health treatment.

Even aside from the incentive effects, these Housing First programs are humane. I know a bunch of people who wouldn’t be able to get apartments if they had to show clean drug tests to get the apartment and to maintain tenancy, but they’re allowed to do that because they have money.

SO, in short: even though it sometimes feels a bit squicky to be ordering homeless folks in terms of likeliness to die and priority for housing, these programs make a lot of sense conceptually and have had amazing effects on the ground. Of the 50 most vulnerable in downtown LA, all of which had disabilities of some kind, 41 are currently in housing. I don’t see how this could have been done any other way.

Deportation by Default: 15% of Immigration Detainees in the US Have Disabilities That Impair Their Understanding of Deportation Proceedings

Human Rights Watch and the American Civil Liberties Union released a report yesterday shedding some shocking light on the immigration detention system in the United States. According to ‘Deportation by Default,’ 15% of immigration detainees have mental illnesses or intellectual disabilities that render them unable to present their cases or understand immigration proceedings in court. Many were held for indefinite periods, like Jose Antonio Franco Gonzalez and Guillermo Gomez-Sanchez, two men who were held in detention for almost five years without adequate care.

Representation is not mandated or guaranteed for people undergoing immigration proceedings:

Some were able to hire lawyers, others received pro bono representation – but there is no automatic right to court-appointed counsel, and most were not represented, the report said. (source)

I know I couldn’t represent myself in immigration proceedings and have a fighting chance at winning, personally, and I have a lot less working against me than many immigration detainees do. The fact that counsel is not appointed for people who may be navigating an unfamiliar legal system in a language they may not understand is, to be blunt, a horrific miscarriage of justice.

The ACLU concludes its summary of the situation with this rather damning commentary:

Due process is part of judicial integrity. It’s a basic principle that this country has decided to prioritize. It’s one of our greatest exports — we send people all over the world to talk about rule of law and how to reform judicial systems but we’re not doing it here in our fastest growing judicial system [the immigration courts].

Not every non-citizen with a mental disability is entitled to remain in the United States; but everyone is entitled to a fair hearing and a chance to defend his or her rights. If the US government is going to detain and deport individuals with mental disabilities, it must do so in a way that respects their human rights, honors US human rights commitments, and ensures fair and accurate court decisions.

The circumstances and situations documented in this study, incorporating interviews with 104 people, are something that the United States should be deeply ashamed of. The justice system in the United States is often touted as a paragon of equal access and fairness; we are told that everyone has access to due process, to representation in court, to the right to understand legal proceedings. Yet, for disabled immigration detainees:

Deficiencies exist throughout the arrest, detention, removal, and deportation process, violating the human rights of affected individuals and offending both American and international standards of justice. The shortcomings include no right to appointed counsel; inflexible detention policies; lack of substantive or operative guidance for attorneys and judges as to how courts should achieve fair hearings for people with mental disabilities; and inadequately coordinated care and social services to aid detainees while in custody and upon release.

The report documents cases of people who did not understand what deportation meant and lacked the ability to comprehend deportation proceedings; one subject asked to be deported to New York, for example. Some interview subjects had intellectual disabilities or untreated mental illnesses that made it functionally impossible to understand what was happening, while others were in extreme emotional distress and had difficulty comprehending the proceedings, let alone communicating. At least two cases included US citizens wrongfully subjected to deportation proceedings. One North Carolina native had bipolar disorder, was unable to understand the case against him, and could not represent himself in court, so he was deported to Mexico. Another, a US citizen since childhood, would have been deported if it weren’t for the actions of an attorney with the Florida Immigrant Advocacy Centre.

The report urges Congress to require appointment of lawyers for all people with mental disabilities in immigration courts. It recommends mandatory training for immigration judges to recognize mental disabilities, and calls for repeal of a regulation allowing a mentally disabled detainee to be represented in court by the warden of the detention facility. (source)

This recommendation would certainly be a step in the right direction if it was followed. It’s clear that we have been subjecting disabled detainees to grave injustice, and it’s going to take a lot of work to remedy that. People with disabilities are also poorly served in the US court system in general, but attorneys at the ACLU point out that deportation proceedings are among the most complex legal matters people can encounter, with the fewest protections in place; if there’s any place where inability to understand court proceedings has high stakes, a deportation hearing is definitely high on the list.

“Owing to their mental disability, people may not be able to share their experience with the judge in a way that helps him understand that they have a mental condition or a valid claim,” says Deborah Fowler, Texas Appleseed’s legal director. “This is particularly true for asylum seekers who have suffered trauma or persecution in their home countries.” (source)

Another serious problem for people trapped in immigration detention is that it can be stressful, exacerbating mental health issues and causing emotional distress for people with intellectual disabilities. Being shuffled from facility to facility has documented ill health effects on nondisabled people, and those effects can be even worse for people with disabilities, especially when they are denied adequate care and treatment. Judges, uncertain about what to do with detainees who clearly do not understand the proceedings, can place cases in a form of legal limbo, leaving people adrift in the immigrant detention system for years.

If this report outrages you as much as it does me, I urge you to contact Congress to tell them that you would like to see this report followed up, and want to see Congress taking the concluding recommendations seriously. If you are in the US, your own Representative is the best bet for a contact and/or you can write your US Senators. If you are outside the United States, please consider contacting a member of the House Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law or the Senate Subcomittee on Immigration, Refugees, and Border Security and explaining that while you are not in the United States, you are gravely concerned by this report and feel that it reflects poorly on the position of the US in international society (and anything else you care to add). You can also drop a line to President Barack Obama, should you feel so inclined.

Dear Imprudence: Getting It Right! (For Once!)

s.e. smith recently passed on a question from a Dear Prudence column (3rd question down) that, well, actually gets things right. We were both pretty surprised! The question asked is shockingly similar to my own situation, but I swear I didn’t write in to ask it. The questioner writes:

I work in a social-services-related field and have bipolar disorder. I am open and honest about my diagnosis. … I have been having issues with one of our interns, who is in her mid-20s and pursuing a master’s degree in clinical psychology. On the surface, she is very pleasant. The problem is, anytime she and I disagree about something (which is often, because apparently she knows everything and I know nothing), she rolls her eyes, waves her hand, and declares that I am “just bipolar.” This is alarming to me because she intends to work with such populations, and though I can take it without becoming suicidal, many bipolar people can’t. Part of me wants to simply ignore her, but when I do, she continually asks me, “What’s wrong?” She is probably going to be with us for another year, and I want some peace and a little less condescension when I go to work.

Hey! I have bipolar, and I work in a social-services-related field! The difference is, if I ever encountered anyone who put a hand in my face and dismissed me as “just bipolar,” I would have a written warning in their file before they could even blink. This is not only because I don’t tolerate that kind of flip dismissal, but also because the attitudes of social services staff towards people with mental illness can have an enormous impact on the quality and effectiveness of services delivered to people with mental illness. It is damaging to the agency as a whole to have those attitudes expressed to clients by agency staff and it is an amazing disservice to approach people who need social services with such a dismissive, discriminatory, and oppressive attitude. To her credit, Prudence clearly sees this aspect of the issue:

Since she’s an intern and plans to go into your field, take seriously your duties to guide this obnoxious young person… If she doesn’t stop, or escalates her rude and dismissive behavior, keep your cool and explain to the higher-ups that while “Brittany” may have some promising qualities, she needs some serious attention paid to how she treats others.

This is exactly right. Social service agencies need to ensure that staff do not transmit these attitudes to agency clients. Unforutnately, based on my experience, it is not uncommon to encounter agency staff with these kinds of attitudes, primarily because agencies tend to provide little training or guidance to staff in dealing with clients with mental illness. Staff are then forced to rely on the (mis)information about mental health conditions they’ve accumulated through their lives to shape their opinions and actions, which can often lead to attitudes and behaviors like the one discussed by the questioner.

I’ve found that most people have a vague conception of what depression is and that it could be connected to suicide, but have little conception of how depression can affect a client’s everyday life. This is especially problematic when agency staff expectations for client’s behavior doesn’t account for the effects of their depression. For example, we often need to gather and review a client’s entire medical record to evaluate the merits of a potential disability claim. This can be a very complicated process – submitting medical records requests to every medical provider from which the client has ever received treatment, wrangling with records departments who want to charge exorbitant fees, following up with records departments who ignore, misplace, or deny records requests. Understanding the effects of depression is key for agency staff in how they instruct clients to gather these records, how they respond if or when a client fails to follow through, and the extent of assistance the staffer is willing to provide the client in this task. I’ve found that for a client with depression, an instruction to “gather all your medical records for us to review” can be so overwhelming and intimidating that they are unable to manage the task. Staff are likely to perceive this client as “not really committed to their case” and insufficiently willing to cooperate with the agency in pursuing their goals. This can mean the difference between providing the assistance a client needs to succeed and closing the case because the client “didn’t really want this benefit.”

Beyond depression, there is virtually no understanding of the variety of mental health disorders or the impact they can have on an individual’s functioning and ability to participate in their own advocacy. Schizophrenia and dissociative identity disorder are conflated and often ridiculed. Disorders on the autistic spectrum are not understood at all. Post Traumatic Stress Disorder is often dismissed as an overly sensitive reaction to trauma that “everyone has in their lives.”

This lack of understanding means that staff are completely unable to provide reasonable accommodations to clients with mental health disorders. Which in turn means that clients with mental illness, overall as a group, receive less effective and meaningful services from the agency as a whole. Which means that not only are agency resources more likely to benefit folks without mental health issues, but those expended on clients with mental illness are more likely to be wasted and not “land” effectively because they cannot effectively create the change the client is seeking. So, everybody loses.

The solution is more training, education, support, and guidance for agency staff on understanding these issues and providing effective services to this community. While attitudes like those of the intern in the question are unfortunate and disappointing, some of the blame has to be laid at the foot of the agency itself for failing to provide training, policies, and protocols to ensure staff are educated on these issues and know better. So while Prudie’s recognition that the intern’s attitude is fundamentally unacceptable and must be addressed if she hopes to continue in that area of work, I would go one step further and advise the questioner to push for training and support for all staff at her agency to ensure everyone has the information and tools they need to provide effective services to clients with mental illness.

When She Was Bad

Moderatrix Note: This is a post from my “Summer of Buffy” series (or “Season of Buffy” for my Southern Hemisphere friends, who want to be MONSTERS and have different seasons and ruin my pun, but you are my favourite people EVAH and I love you!), which I thought was appropriate for cross posting, due to the subject matter. I hope you enjoy it, or find it worthy of discussion if nothing else. You may read more of that at random babble… where I frequently blog about and critique pop-culture.

When Buffy Season 1 ended with “Prophecy Girl” we saw a lot of things happen.

The Hellmouth actually opened, for the first of what will be many times (I really hope that isn’t too much of a spoiler for many of you), Cordelia drove her car through the school, and Buffy faced The Master and died. For a minute or two (Hey! It’s TV!).

Also through the miracle of TV, Xander (who can never do what he is told, ever, and it always works out to a convenient plot device) and Angel showed up just in time to revive her and send her on her way to be the prettiest Not Zombie ever (that was The Guy’s thing, OK).

So when Season 2 picks up and Buffy is returning from a summer with her dad we have a whole new Slayer who comes back as a whole new, shall we say, snarkier Buffy with a better haircut.

So here’s the part where Joss is gonna get some shit from me: Buffy is so incredibly obviously dealing with Some Issues. She is having flashbacks while training. She is having some really shit-tastic nighmares where Giles tries to choke her to death while her best friends watch, Giles actually being The Master in a Giles mask. To me the most disturbing part of the dream is that Buffy dreams that her friends are asking how she is doing… something that isn’t happening in real life, and that in a way she dreams that Giles allowed her to die, which I think she might actually believe…

So she is lashing out at her friends. Full scale snark at Xander and Willow and Giles. She mocks Willow —  something she dropped Cordelia faster than Kid drops food under the table on a clean floor for doing. She pulls Xander out onto the dance floor at The Bronze and proceeds to do what was henceforth known as her “sexydance” that made both Angel and Willow jealous. In fact, if you mention Season 2 Ep. 1 “When She Was Bad” to some vaguely familiar with Buffy, the first thing they remember is “sexydance”. She romps about with a new personae that manages to get Cordelia to pull her aside and ask if she was running for “Bitch of the Year”.

If Cordelia is up in your shit about your “Joan Collins ‘tude”, then it is time for a deep inward assessment.

But what no one did was try to actually talk to Buffy, which is what bothered me about the writing of this episode.

See, Buffy died, and I am pretty sure that upset her a bit. I know it might peeve me a bit, if I was 16 and had to deal with that. That might have been something she had to work through a bit, the way she felt about dying. So, instead of anyone talking to her about how that felt, Joss wrote everyone doing the logical thing and talking about her. Instead, it kind of felt like her friends just … got annoyed with her and didn’t try to understand what she was dealing with. Sure, Buffy was behaving in all the wrong ways, but her friends weren’t exactly the pillars of strength she needed to get through her situation, either. But, of course we will see that this becomes a theme.

The only person who tries to reach out to her is Angel, the one person most closely associated with the thing that has caused all of this pain, and the one person most likely to elicit the most harsh reaction from Buffy. She brushes him off, is harsh with him, even though we see peeks of her emotionally reaching out to him at the same time (cue heart wrenching music to imply the Cosmically Forbidden Relationship)… Angel is the personification of all that went wrong with her life. The Slaying, the Vampires, and ultimately death. He couldn’t even save her life before or after her death…

The harsh reality of the weight of her responsibility, the painful truth that even her life is fragile hangs on her weary shoulders even as life doesn’t stop to allow her to mourn her own death. Buffy is obviously angry, hurting, and possibly confused about her future. We see this theme again throughout the series, as she has to decide if she should bother planning a future in her life: career, love, even just graduating or getting through tomorrow. The fragility of her role in the world crashed into her path of vision, and she had to face that in the 60 seconds of clinical death (and later with the appearance of another Chosen One).

This stings close to home for people who deal with real life depression, over loss in their lives, or any of the other reasons that mental illness comes crashing down or tries to suffocate us. Often, the people around us give up trying to support us, and withdraw, leaving us to lash out or sometimes give up.

Perhaps Joss didn’t fail as much as I first said.

Perhaps, in Buffy, he has attempted to personify the utter helplessness and angst that people in a deep depression sometimes feel. Perhaps, he has done a perfect job of showing what it feels like to not be able to yell out exactly what is going on inside, how it feels to have suffered what you have suffered because no one really can truly empathize, no one can truly feel your pain

Perhaps.

If only defeating your demons was as simple as smashing a set of bones with a giant mallet.

The Second Summer of the Sisterhood: Choosing How to Fight Your Own Demons

The cover from the book <em>The Second Summer of the Sisterhood</em> by Ann Brashares. It is lavender with darker printed names of various cities printed faintly in the background, with the title and author name in a green swirly font on the top and bottom respectively. A pair of blue jeans , rear view, takes of most of the rest of the cover, and they have random writing all over them, and an embroidered yellow and orange swirly sunshine on the left-hand pocket.Oh, Young Adult Lit you are my Bravo Foxtrot Foxtrot.

A while back I read and reviewed Ann Brashares’ The Sisterhood of the Traveling Pants here. I loved it, and proceeded to immediately read the sequel, The Second Summer of the Sisterhood, but neglected to write anything about it. I have come to you, dearest readers, hoping for your forgiveness, and to make up for such forgetfulness. I have recently checked the third book out of the local base library and can’t possibly read it or the other books in my “To Review for FWD” stack (YES! I really have one of those!) until I rectify this situation.

If you aren’t familiar with the series and are disinclined to read my previous post, which is just fine by me (for reals) here is a quick recap (you may skip ahead here): The Traveling Pants series is about four young women, Bridget (Bee), Carmen, Tibby, and Lena, who are best friends, and who describe themselves as so close that they forget where each of themselves ends and the other begins. They grew up together having been born all within the same seventeen days, each coming from different ethnic and economic backgrounds with different household situations (although they are all fairly securely middle-class, with at least two of the families being arguably very upper-middle, and the series is squarely hetero-normative), starting with their mothers all being best friends themselves. Their mothers drifted apart after the suicide of Bee’s mother following her long depression. The girls, however, remain close right up until their first summer apart when we first meet them, and Carmen comes into possession of the eponymous Pants at a second-hand store. The Pants help them through their first summer apart, when they learn how to be together even when apart, and that the word “friends” is stronger than many people give it credit for. They learn how to be strong for each other through the life shattering events that are part of the growing, aching, and changing from childhood into young adulthood, especially as young women.

It is amazingly poignant, as it gives us stories of four young women told from four young women’s perspectives, and that is what drew me to it initially. I have many criticisms to make of the book, and I am willing to make them and discuss them openly in comments. This book is from a cis, straight, perspective. Much of it passes the Bechdel test, as in, huge chunks of it go by passing with flying colors because it is about the parts of girls’ lives that involve shit that matters to girls/young women and women as they relate to the other women in their lives, and a lot of that, funnily enough, just doesn’t always revolve around men.

(All Together Now!)

The Second Summer of the Sisterhood returns us to these same young women, getting ready to go, once again on their separate ways, except that wasn’t the plan all along. In the beginning only Tibby had plans of going away to a summer film camp, and the other three girls were going to stay behind, getting summer jobs. But suddenly, Bee, dragging along some demons from her past, and new ones from the summer before, made an impulsive plan to go to Alabama to see her Grandmother.

It is Bee’s story that strikes at me the most. Bee, who during the last book was impulsive and active and defiant, who couldn’t sit still and had to run. Bee, who suddenly came home, and quit soccer — an activity which had been a huge part of her life since she was very young — and became quiet. Bee, who died her golden hair as dark as she could get it, and withdrew from everyone but the three other girls in the book who tried to give her the space to figure out who she needed to be at this time. Even then, we see that the impulsive and super-active, full-throttle life was Bee’s way of coping with her mother’s suicide. Bee had always thrown herself forward into life in hopes that she will outrun the sadness of that death, or so it seems to me, and each of her friends sometimes describe themselves as standing back and holding their breaths as Bee makes up her mind to go after something she wants, ready to be there and catch her, or pieces of her, when she gets it. Even Bee sometimes describes herself as running away from something by the end of the first book.

But Bridget has decided that she is going to Alabama to meed the grandmother that her father never allowed her to know — her mother’s mother. This flip of narrative interested me, notably because it is usually the mothers we hear about, distancing and holding their children from knowing their fathers’ families. This interested me, because here is a young woman telling her father that she has a right to know these people, that she has an agency outside of what he decided for her. Her father disagreed with how her grandmother wanted to handle Bridget’s mother’s depression, and he blames her in part for her death, and Bridget wants to meet her and decide for herself.

But Bridget is fighting her own depression.

[Spoilers Ahoy!]

A sexual encounter at the end of the first book has left Bridget reeling. And without my getting into the dynamics of whether or not this could be considered statutory rape or consensual teenage sex, Bridget has realized that she has to find out more about Marly, her mother, and this grandmother she hasn’t seen since she her mother died, in order to face that depression, before she engages in anymore activity that she isn’t quite ready for*.

So she decides, since no one recognizes the young woman depression has made her right now anyway, she goes to Alabama to meet Greta, her grandmother, and puts on a remarkable ruse of pretending to be a young girl looking for summer work, lying to Greta, and doing daily chores for the old woman. Through the summer she rediscovers her love of soccer, loses some weight (because weight and depression and blah blah blah!) that allows her to be able to put the magical Pants on once again, energizing her with the love of her friends, and gives her the strength to tell Greta the truth, which gives her the tools to realize that she doesn’t have to spiral into depression like her mother did…which was her greatest fear. That she would be helpless to follow in her mother’s footsteps.

Bridget’s depression is written in a way that I find strikes me in the heart. Once again, I have to read parts of this book in a room away from others because I get all teary-eyed. The building relationship between Bridget and Greta is important, we get to see two women, separated by an entire generation, with a huge gap stolen by devastating depression, yet brought back together by the aftermath of that depression and a depression unique to each remaining woman. I love the way that Brashares takes the stories of four young women and weaves other women into them. And once in awhile she writes disability in a way that doesn’t break my heart. Or, it breaks my heart in a good way.

If you have read my previous post, and remember the story line about Tibby and Bailey, I have a quick note there.

Tibby goes to film camp, and makes a string of poor decisions in an effort to try to be clever and popular with the kids she thinks are important or cool. In the end, she winds up making a film about Bailey, which she gives to Bailey’s parents, but which also has the benefit of teaching her, again, a Very Special Lesson about people, continuing the idea that Bailey was always a plot device, and never a character all along. An event on the Pants, and not a person. Bailey becomes a personality trait about Tibby, and was never meant to become a person, so please feel free to discuss this as well.

Since I spent so much time discussing Bailey and Tibby in the last post I wanted to focus on Bridget in this post, although I feel that there will be more Bee to come.

*Bridget was very young and emotionally traumatized in the first book by the death of her mother. I read her as aggressively and almost destructively seeking the attention of Eric, the coach at her camp, and it was all very messy and complicated and I didn’t read any blame to be placed on any one person. That being said, Eric, as the older person, had the responsibility to stop the relationship if it was unwanted instead of allowing it to continue, being that Bridget was fifteen at the time of the encounter and he was eighteen. Some aspects of the relationship between Bridget and Eric make me uncomfortable, and some read to me as simply something I advocate for: Teenagers being allowed to discover sex on their own terms. Age of consent laws are awkward for teenagers, where the magic number between legal and illegal are literally overnight. I also wonder about the fallout of writing a character like Bridget seeking and having a sexual encounter and having such severe depression. It is just a thought.

Dear Imprudence: The Questions You Don’t Get To Ask

A concerned family member writes to Miss Manners:

Dear Miss Manners:

My brother served in Iraq a couple of years ago. He suffers from PTSD and was wounded. The physical wound is not one you can see, but people (family especially) will still ask him what it was like to fight in the war and even go so far as to ask if he killed anyone.

It never ceases to amaze me the way that people feel entitled to information about other people. They love to ask questions about your disability, and when a person happens to be a veteran and has seen combat, one of the first questions that comes up, almost without fail (unless that inquiring person happens to be a veteran or the family member/close friend of a veteran), is whether or not that particular veteran has killed some body.

Have you ever killed anyone?

I just can not fathom having to live with the reality of having lived through that burden, let alone having to deal w/ having to relive any of the emotions attached to that each time a thoughtless person asks “Have you ever killed anyone?”.

The letter writer wants to avoid having to stay away from a family function to keep zir brother safe from such carelessness from other family members, and honestly that breaks my heart. A PWD should not have to completely cut themselves off from friends, family, and other outside contacts to avoid triggering situations, but the reality is, this is overwhelmingly the way that it usually works.

I know for a fact that there are many veterans living in isolation because of PTSD, and yes, several of them are women, because of people who aren’t veterans, who can’t grasp what that must have been like (and not even all of us, as veterans can know what that is like), who can’t abstain from getting too nosy and triggering their PTSD. Why can’t we just have the same conversations as everyone else? Not everything in our lives revolves around our disabilities and our experiences in The Sandbox. Not everything is about the worst thing that has ever happened to us.

I like the way Miss Manners answers this letter:

Can you do this without creating consternation and even more curiosity about his condition?

She cautions the letter writer to caution the family to avoid the topic of war without creating a more awkward situation that might cause the family to avoid zir brother as if he is a ticking time bomb.

[He] will probably tell us about the war eventually, but right now it’s his least favorite topic, and I know he’d appreciate our staying off the subject.

This is the perfect way to describe this.

This is the 60th anniversary of the Korean War, the Forgotten War, many call it. My grandfather is a proud veteran and a Purple Heart recipient. He didn’t like to talk about the war with us, even when I was a shining eyed, curious young girl, who was almost never denied anything she asked of her grandfather. It was painful for him to remember, and the only time I ever saw him reminisce was when we traveled to Des Moines for his unit’s reunion many years ago.

But after I joined the Navy he sent me a letter at my A-School sharing a moment of understanding for what I was doing, and later, when my partner and I PSC-ed to Korea, he sat and talked to us for hours about what he remembered of the country. He told us harsh and sometimes beautiful stories of his memories. He told his of his marching from Pusan all the way to far North, of being picked up by Navy ships, transported back to Pusan and doing it again, after salvaging boots from the dead to cover their own bleeding feet. He tells it better, and I hope to get it recorded the next time I see him. But he told it to us in his own time, when it didn’t hurt him anymore.

I remember when The Kid’s Tae Kwon Do instructor told us of his memory of being a child during the war. A child in her class said that he was too young to do something or another well. The Master told us a story, of being eight, and of being held by his mother in a drainage tunnel and being told to not make a sound while North Korean soldiers ran over head. He was able to barely breathe, soundlessly, and stand against the side, like you see in movies, as they flashed their lights looking for people. He shared that story with us freely, and I remember the look on his face, as if he could still feel the chills of fear, like he was back there for a moment, but stronger now, sixty years later.

We have no right to ask them to regale us with the details of the horrible things they had to do to get by, to make a living for their families, to live, all because they were told it was the right thing to do. Or because they had to survive. They had a moment to think, but they have a lifetime to live with that decision.

People who live through wars will tell their stories when they are ready, because the pain will give them a moment of release, it will subside for a moment, or forget to pound them with the aggressive flashback or terror.

We, as people who have never lived through that, have no right to inflict that upon them.

The Inner Critic

[Warning for possibly triggering content regarding mental health, specifically depression.]

I’ve been reading a fair number of how-to creativity books (yeah, I know, creativity is not something you can “learn” from a book) recently in preparation for a long-term project, and one thing I have noticed about some of these books–and a lot of the “advice” floating around out there about creativity–is the notion of the “inner critic.” The inner critic, according to some Professional Creative Types, is the voice that tells you that you are not creative, that you can’t write, or draw, or paint, or accomplish whatever creative project you want to. The inner critic is supposed to stand in for everyone who’s told you that you are a crappy artist, that your creative pursuits aren’t good enough, and all of that fun stuff that apparently wasn’t there when you were a kid. And, in the course of becoming truly creative, you are supposed to silence your inner critic.

This got me thinking, however: What if that critic was there when you were a kid? What if the inner critic is, well, part of you, and you cannot “just silence” that part?

One thing that I really don’t talk about publicly (on the internet or off) is my history of major depression. There are many reasons as to why, and I think that those might best be saved for another post. However, there is something that really bugs me about the “inner critic” model of creativity: it does not take depression, anxiety, or other mental health conditions into account. What if that voice in your head has been there for a while, and is an active part of your mental health issue? It’s not so easy to turn off that voice that tells you that you suck, or that your art or writing is a bunch of crap, or that you will never amount to anything when that voice is there because of a mental health condition.

There’s another assumption in writings about the importance of “turning off” the inner critic, which is that all children have a magical reserve of resilience and that is why they are so creative. These children simply don’t care what anyone else thinks, and the Creative Adult must recapture that sense of adventure by silencing the inner critic! It sounds so easy! But what of the depressed child, or the child with mental health issues? As someone who had depression issues as a kid — and still does — I question the supposedly “universal” applicability of this whole inner critic business, the assumption that it can be turned off like a damn light switch, after which we will all Recover Our Childlike Capacity For Creativity, or something.

I remember having my own Inner Critic as a kid, and it was not fun. Certainly, I did have years where I had that sense of Childlike Creativity and Wonder, but those were also interlaced by a voice in the back of my mind that would tell me awful things. And it never left, after a while. It would hiss: You do not belong. You are weak. Your bum leg is punishment for something, and you sure as hell aren’t going to “make up for it” with your stupid cartoons, give me a break! You think you’re going to be popular because of your cartoons? Because of your writing? Please. You are worthless, and also none of the other kids like you. Your art is just a hobby, nothing more.

Then, once the depression came on the scene, those little hissings became, well, much bigger. They’d been there when I was a kid, no doubt, but with major depression, they stuck in my brain like a particularly awful tape loop that just couldn’t be turned off. Things with my depression are much better now — as they have been for a few years — but I am always, always on the alert in case it comes back full-force. My depression not totally gone (nor do I expect it to be), but I manage it with care. And the “inner critic” that artsy self-help types slam? She’s still there, and I think she will be there permanently. The trick, for me, is learning to live with her instead of assuming that silencing her is an easy step.

Quick Hit: The Horrors of Solitary Confinement

When I first saw this post on the ACLU’s blog about solitary confinement for juvenile girls in criminal detention, I was so horrified that I opened it in a tab and then couldn’t look at it again for several days. When I read through the entire post, I cried. I believe that when the United States takes control of a person, whether in criminal or immigration detention, they take on an obligation to care for that person, or at least not put them in mortal danger. And that is simply not happening. On the contrary, the solitary confinement policies seem to target girls with existing trauma and/or mental health histories for further isolation and victimization.

[Trigger warnings for sexual assault and abuse based on disability.]

In June 2008, the ACLU filed a class action lawsuit challenging inhumane practices at the Brownwood State School, a youth prison in central Texas. Girls at Brownwood are regularly placed in punitive solitary confinement in oppressively cold, concrete cells, that are empty except for a metal slab intended to be used as a bed. Solitary confinement is imposed for minor misbehavior, for self-harm or for expressing a desire to commit self-harm, and can be brief or can last for days, weeks and even months. It’s hard to imagine a more destructive reaction to a child in crisis, but it’s the norm. Unfortunately, these practices are not limited to Brownwood, or Texas, for that matter.

There are currently more than 14,000 girls incarcerated in the United States, a number that has been rapidly increasing in recent decades. Most of these girls are arrested for minor, nonviolent offenses and probation violations. Locked up under the guise of rehabilitation, girls nationwide — the vast majority of whom have been sexually/physically abused — are subjected to punitive solitary confinement, routine strip searches, and other forms of abuse. Meanwhile, they are denied the essential mental health care, education, and social services they need. Far from helping girls cope with the trauma they have suffered, youth prisons’ use of solitary confinement only retraumatizes them and further impedes their rehabilitation.

This is abundantly clear in a recent collection of testimonies from girls imprisoned in Texas juvenile institutions printed by Harper’s magazine this week. On newsstands today, the May 2010 issue features excerpts from ACLU interviews with incarcerated teenage girls. A few noteworthy excerpts include a girl who states that her crying is treated as “problem behavior,” another who was locked in a solitary confinement cell surrounded by her own vomit for over 24 hours, and perhaps even more disturbing, the following testimony from a girl in solitary confinement:

“A staff [member] gave me a pill, and he told me he was going to take me to get my meds. We ended up in this dirty room. It had pipes, buckets—it was dusty, it was nasty. I was like, I want to go to sleep, and he was like, You’re not leaving until we have sex. I didn’t know what to do. I didn’t know to scream, I didn’t know to do none of that stuff. I told him I wasn’t going to lie on that dirty floor, and he was like, Well, just bend over, and so—I didn’t know what he was going to do to me. I don’t know if he could’ve killed me and it would’ve been on the news: We just found a dead teenager at TYC and nobody knows what happened.

— 17-year-old, Marlin Orientation and Assessment Unit

Recommended Reading for June 21, 2010

A man in a hand-pedaled wheelchair holds hands with a standing woman below a signpost saying "John O'Groats"
A man in a hand-pedaled wheelchair holds hands with a standing woman below a signpost saying "John O'Groats"

Brine and Kath traveled from Land’s End, England, at the very southern tip of the UK, to John O’Groats, at the very northern tip of Scotland, the two settlements in Britain that are furthest apart, by hand-pedaled wheelchair and bike, arriving in John O’Groats on the summer solstice.

A Voice For Neli [this site is by the mother of a young black man with autism who was recently arrested and harassed in Stafford, Virginia, primarily due to his race and disability status]

My son was traumatized.  He has since been transferred to a mental hospital to receive treatment.  I have placed a link to the story below for the world to see.  How very sensational and yet sinister at the same time.  What is so suspicious about a young man sitting under a tree at the library.  The library is where my son goes quite frequently because there is a teen room there.  What made him suspicious?  Was it because he is a young black male?  Possible gun?  Why was the assumption made that he had a gun when there was no visible gun seen? Again was it because he was a young black man?  These assumptions are what catapulted the events of that day and has turned our family’s life completely upside down.

Bad Cripple – Conjoined Twins, Disability and Ethics

Few books I read cause me to radically alter my preconceived ideas or thoughts. One such book that did this for me was One of Us by Alice Domurat Dreger. Dreger’s book, subtitled Conjoined Twins and the Future of Normal, stunned me. Prior to reading One of Us I thought that the effort to separate conjoined twins was logical, the only viable choice parents had even if the mortality rate for such a procedure was very high. By the time I finished reading Dreger’s book I learned that my preconceived ideas about conjoined twins, largely gleaned from the mass media, was wrong. Not only did I feel enlightened thanks to Dreger but I learned much about what she termed anatomical politics.

Astrid’s Journal – On Disability and Suffering

Disability is not a tragedy. Both of these framings assume that. Someone can be suffering and have a disability, but that doesn’t necessarily mean that the person is suffering because of the disability. (Correlation is not causation!) This immediately reminded me of the first time I fought this terminology, back in 2007. My support worker wrote into my care plan that I suffer from an autism spectrum disorder. I asked her to correct it to say that I have an ASD, which she at first refused. We got into a pretty lengthy argument, in which she used all kinds of ableist misconceptions about the suffering of people with autism, until she gave in and changed the wording. Most of these misconceptions are rooted in the medical model of disability. That is, they assume disability to be an inherently bad affliction, and of course from there conclude that disability is something someone suffers from. Here are a few examples of arguments people use to base the idea that one suffers from a disability, upon…

After Gadget – Lyme Awareness Month, Part I

The next three After Gadget blogs will specifically address Lyme awareness from the service dog perspective:

  • How Lyme can affect your dog, and what you need to know about it (that your vet might not).
  • How Lyme can affect you, and what you need to know about it (that your doctor might not).
  • How Lyme transformed my experience specifically as a service dog partner.

Note: Since this blog series focuses on awareness, I’m honing in on the issues that I think are most important for you to be aware of. My goal is to prevent more cases of Lyme — especially chronic or untreated Lyme — in dogs and people. So, I’m going to skip a lot of general information. For example, telling you the name of the strange organism that causes this disease will probably not be what impels you to rethink the limp that comes and goes in your dog, or that frustrating “flakiness” of your sister-in-law. It won’t change your mind about whether you are taking adequate precautions against tick-borne disease (TBD). On the other hand, I hope this series will.

Leaving Evidence – Creating Collective Access

What is collective access?  Collective Access is access that we intentionally create together, instead of individually. Most of the time, access is placed on the individual who needs it.  It is up to you to figure out your own access, or sometimes, up to you and your care giver, personal attendant (PA) or random friend.  Access is rarely weaved into a collective commitment and way of being; it is isolated and relegated to an after thought (much like disabled people). Access is complex.  it is more than just having a ramp or getting disabled folks/crips into the meeting.  Access is a constant process that doesn’t stop.  It is hard and even when you have help, it can be impossible to figure out alone.

USA Today [so take it with a grain of salt!] – World Cup matches may boost your mental health

Scientists have shown that fans who feel personally invested in a team or, better yet, who attend games and cheer along with like-minded fans, reap the mental health benefits that come from a feeling of social connectedness. “The main thing that people achieve via sports fanship is a sense of belongingness, or connectedness, with others,” said Edward Hirt, a professor of psychological and brain sciences at Indiana University. “Sharing a common allegiance with others bonds people together in a special way. We can relate to others who share fanship with our team and feel a camaraderie with them that transcends ourselves.”