Category Archives: mental health

Mental Health Coverage Makes Economic Sense

accessibility, class issues, justice, medical practice, mental health

There are a lot of reasons to support health care reform and the inclusion of mental health treatment in that reform. I personally support it because I think health care (including mental health care) should be a basic human right of every human being and believe our government has a moral and humanitarian obligation to provide it to everyone.

But for those not convinced by that argument, there are some strong economic arguments for providing access to mental health coverage. First, evidence shows that overall health costs decrease when mental health care is covered. Second, tax dollars spent on mental health care tend to save tax dollars in other areas, including law enforcement, jails and prisons, homeless services, and emergency room visits – so spending money on mental health services saves money in other areas.

It’s clear that increased mental health coverage would result in increased usage of mental health services. A study by RAND in the 1980s found that decreased out-of-pocket costs for consumers significantly increased usage of outpatient mental health services, much more of an increase than demand for ambulatory health services. Even with this increased demand for services, though, overall costs are reduced, because an increase in mental health spending “yields concomitant decreases in total health expenditures and employee absences.” A study of an individual employer-based insurance policy found that the savings from decreasing coverage of mental health were entirely canceled out by increased physical health costs. Additionally, untreated behavioral health problems create significant costs for employers in terms of short-term disability absences. So even though increased mental health coverage would result in increased demand for and spending on mental health services, overall health coverage costs would stay the same or decrease due to the benefits of the mental health treatment. (See SAMHSA for citations)

Additionally, the effect of mental health coverage in reducing city and state expenditures on services such as law enforcement, jails, and homeless services is well established. After California expanded community mental health services through a ballot proposition, counties reported dramatically reduced use of emergency room visits for mental health issues. Transitional age youth (18-25) provided with mental health coverage achieved a 76% reduction in days homeless and a 49% reduction in days hospitalized. Adult participants achieved an 89% reduction in days spent homeless and about a 40% decrease in incarceration. These effects significantly reduce expenditures by cities and counties to treat the symptoms and consequences of untreated mental health disabilities – while at the same time allowing individuals to live their life without risk of homelessness or incarceration due to their disabilities.

Again, I would support expanded coverage of mental health services even if there were a cost associated with it. But because we can provide these services while saving money spent on physical health care and reduce the need for emergency rooms, homeless shelters, and jails to be primary mental health providers, there’s a very strong economic argument that we need to provide this coverage.

How to Be a Good Doctor

accessibility, bodies, happy posts, medical practice, mental health, normality, sexuality, social attitudes, , , , , , , ,

Update: It was pointed out, correctly, that part of this post contained a statement that made a generalization based on age. That statement has been removed and the post updated with this message. It’s not feminist, and it doesn’t belong here. I’m sorry.

I actually had a really good experience with a physician recently. Like outstanding. With a specialist even — an endocrinologist, so if anyone in the northeast Texas general area needs one, I can recommend him without hesitation. I was kind of nervous; I’d seen an endo before when I was starting my transition but stopped because he was a really huge jerk. (My GP wasn’t entirely comfortable with writing scripts for hormone replacement but has been willing to for a while now. She’s also recommended and trans- and queer-friendly.)

Accessibility was poor to okay: I could have done with a chair by the reception window while waiting for them to copy my ID and insurance card. To get from the curb cut by the reseved parking to the front door, one has to go down the sidewalk across the front of the patio to where the ramp up the patio is. At least three cars were parked so that their noses stuck out over the sidewalk. If you couldn’t squish down to 18″/46cm wide, you couldn’t get through there. The doors were all unpowered and the front doors were on the heavy side. I didn’t see Braille signs at all. There was, blessedly, no music and no TV in the waiting rooms. The exam room was freezing; fortunately for me I’m tall and the ceiling was low and I was able to close the air conditioning vent but that’s not a widely available option. There were wide spaces around the furniture in the waiting room that looked like they’d easily accommodate wheels and other assistive devices. Some of the furniture was squishy but some wasn’t and the non-squishy furniture had arms to push up with.

They got to me right about when my scheduled appointment was. They weighed me, measured my height — 202lbs/91.5kg and 5’11 3/4″ (yes, they really measured me to the quarter inch ((sheesh)) and yeah I’m that tall — people comment constantly on how nice it must be which it kind of is except when I’m trying to buy clothes: for all that they love models my height designers apparently don’t believe women don’t come my size and shop at Target)/182cm — with my boots off, and they did bring me a chair for getting them on and off without my having to ask for one.

We waited in the exam room less than ten minutes. Maybe five. The office had mailed me a new patient packet with all the usual stuff to fill out (and the usual uninclusiveness of gender- and sex-variant people on the form, sigh *tick* F). The doctor apparently had spent the five minutes reading and absorbing it because he came in and introduced himself and greeted the wife and me as Mrs. and Mrs. Brown. It felt really good because NO ONE DOES THIS even the people who know we are legally married. Holy shit. The wife explained that I had an autism spectrum disorder and was not having a good day communication-wise. Also that even though I was not talking much today I was plenty smart (which is a construction I’m unfond of) and could understand doctor jargon (this I’m fine with — it’s a skill, not a definition of a person). He told us that on Mondays he had a resident following him around and would we mind if he joined us for the exam?

I’ve had doctors ask this badly before. Often it’s with said resident already present so refusal is an explicit personal rejection and difficult for even a lot of neurotypical folks, never mind those of us with moderate to severe social anxieties. This doctor asked it with the resident on the other side of a closed door. It really actually felt like I could have said no and it would have been okay.

He liked that I had typed up a list of all my surgeries and meds, the dosages, the schedules for taking them, and what they’re for — it’s a long list, twelve prescription meds total — and expressed sympathy that I needed them all. Even though my wife was helping me communicate, he mostly spoke with and to me. Once when he was looking at his notes he missed that I was nodding in response to his question and he apologized for not watching to see my response. When he was working out what labs to order, he noticed what insurance we had and apologized that we couldn’t use the lab in his office but would have to go to the one (not far away) that our insurance company had a contract with or we’d have to pay for the lab work. A DOCTOR. I’ve never run into one that noticed this stuff before, never mind knew what to do with our insurance company.

In short he seemed to be respectful of all the ways I was different: physically impaired, neurologically variant, queer, trans, everything. And genuinely respectful, too, not in that fake-ass “I don’t see the ways people are different from me” bullshit. [Age-based generalization removed by the author.] It was a really nice part of what’s been a string of mostly crappy days.

I’d really rather not have anything endocrinologically jacked up (and given the pattern of other Stuff that has been tested for, I’m not expecting that anything will be very wrong here either). But if I have to have something like that, I’m glad I know who to go to. ‘cos expertise is one thing. Respect like this — on the first time seeing me, on one of my bad days? — is rare. I wish I could drag all the bad doctors I’ve been to and gritted my teeth through seeing to make them watch this young man do brilliantly with a patient who is admittedly not exactly the most conformative person ever and yell “See? This is how you do it! This is how you make all your patients feel like you care about them.”

Cross-posted at Impermanent Records.

New Blog: You Make Me Feel Less Alone

activism, biography, media and pop culture, mental health

Samantha Schultz is the author of I Don’t Want to be Crazy, a free verse recounting of her struggles with her anxiety disorder. I haven’t personally read the book, but several of my friends speak highly of it and the Amazon reader reviews seem quite positive. (Although I would skip the School Library Report review, which commends Schultz for having “had the courage and wisdom to seek professional help.”)

After publishing the book, Schultz received a number of letters and emails and found that the most common sentiment was that the book had made people feel less alone in navigating their own mental illnesses. As she says, “I am honored to be your audience of one, but your story—like mine—has the power to help others.” In order to facilitate the sharing of stories and experiences from people who have a mental illness, she’s created a new blog, You Make Me Feel Less Alone,  for people to submit their stories and poems, which she will then post. There’s an option to have your submission posted anonymously as well.

As Schultz says on her blog, and as we clearly believe also, “Your words are powerful. Your words can help people.”

Why I Identify As Disabled

activism, identity, language, mental health, social attitudes

For a long time, I’ve struggled with whether or not to identify as ‘disabled’ (or as a ‘person with a disability.’) It’s only very recently that I’ve identified myself that way in my own thoughts, and even more recently that I’ve begun identifying that way publicly. (As in, my name listed as a contributor to this blog was pretty much my first public identification as a person with a disability.) Because I know a lot of other people who are unsure if they qualify as a person with a disability or are reluctant to identify as such, I thought it might be relevant to talk about some of my hesitations to identify this way and what finally convinced me that I do identify that way and why it was important to me to do so publicly.

My first reluctance came from what seems to be a very common concern – I did not think I was disabled ‘enough’ to identify as a person with a disability. At this point in my life, my disability is fairly well managed by medication and the approximately 900 million hours of therapy I’ve been through. My psychiatrist sees me once every 12 months to check on my blood levels and spend 10 minutes with me checking in, and other than that, I’m totally disengaged from the mental health care system. (Except for the pharmacy.) To everyone except those who know me extremely well, I pass as neurotypical. I work full time at a professional job. I live independently and manage my own household and finances. I often have days where the only thing relevant to my disability is the 30 seconds at night when I take my pills.  Surely I cannot be disabled!

But I realized that view erases the very real aspects of my disability that I continue to experience. The periods in my past when I was more severely impaired by my disability (including my hospitalization) still exist and are still a part of me, no matter how well managed my disability is now. And the cyclical nature of many mental health disabilities means that while I’m at a relative peak now, I could find myself in a deep trough at any time. And there are limitations involved even with the minimal treatment I’m receiving – I have to make sure I have a dose of meds with me in case I sleep at a friends’ one night, I have to deal with the punishing withdrawal symptoms when I forget to take a dose on evening, I have the dry mouth and the flaky skin and the lump of belly fat that are side effects of one of my meds. (And there’s my monthly tangle with the pharmacy refill system.)

More importantly, I know that if I tell anyone my diagnosis, if they find out about the hospitalization or the 900 million hours of therapy or the meds I’m taking now, I change in their eyes. It’s easier for them to dismiss my emotions as an artifact of my disorder and thus irrelevant. It’s easier for them to patronize me because they assume I’m not capable of taking care of myself. However I think of myself, I know they will think of me as a person with a disability. (Actually, I suspect many of them would think of me as a “crazy bitch.”)

I’ve also struggled with identifying as a person with a disability because of the split between mental and physical disabilities. Even when I began identifying as a person with a mental health disorder, I still didn’t think of that as being a person with a disability. I thought people with physical disabilities focused mainly on physical access issues, which weren’t at all relevant to me. I don’t need reserved parking spaces, I can walk up stairs, I don’t need a special restroom.

Then I realized how artificial the distinction is between mental and physical disabilities. When I have a panic attack, it affects me physically. When I am depressed, I have no energy and I can’t walk up stairs. I also realized the enormous overlap – lots of people have both mental and physical disabilities, and it’s common for the treatments for physical disabilities (like narcotic painkillers) to have cognitive effects. I also started talking to people with physical disabilities and heard them concerned with much more than physical access which, while very important, is not the sole focus.

All of that is not why I began identifying as a person with a disability, though. I thought of myself as an individual struggling with a very specific and individualized problem. I know other people with the same diagnosis as me, and all of us have had very different experiences and very different approaches to treatment. So I thought of myself as an exceptionally special snowflake that had some exceptionally special difficulties for me to go through, difficulties that nobody else had or would experience. So I thought about my mental health issues as they affected me personally, how they had changed my life, how they had made me the person I am today. But because they were so inherently unique, because nobody had gone through exactly what I’d gone through, I tended to think of my disorder not even in terms of my diagnosis, but in terms of “the very special snowflake disorder that only applies to me.”

Thinking of it that way meant that all the negative reactions I got, all the judgments I got, all the dismissals and marginalizations and refusals to take me seriously, all the hoops I had to jump through to get what other people had – they were just about me. Personally. They were not about how people responded to mental health problems, they were not about how people respond to and discriminate against people with disabilities as a group, they were about ME. I had brought them upon myself because of my disordered behavior, because my special snowflake-ness was so annoying or intolerable that people had no choice but to write me off.

Amandaw recently told me that she thought of disability as a political identity and I strongly agree. Thinking of myself as part of a group of people who routinely encountered oppression on the basis of their disabilities meant that the reactions I got, the disregard, the disgust thinly veiled as pity, the refusal to deal with my emotions and ideas – that wasn’t because of me. That was because I was part of a group subjected to systemic and institutionalized discrimination and oppression. And it was wrong. But it wasn’t until I started thinking of myself as part of that group and thinking about how these systems affected all of us that I needed a term for “people who are discriminated against or oppressed by our culture and institutions in the same way I am.” It wasn’t until I started thinking of it as a group issue, rather than an individual issue, that I needed a word for that group.

These systems that oppress us don’t care one whit about my special snowflake-ness. They don’t care about how well I’m doing now. These systems exclude and marginalize and dismiss and mock me based on my disability status without taking into account any of the individual variations in my life and my disability. And when I hear a caseworker explain that “you can always tell who is crazy because they live in cardboard boxes and tell people it’s a palace and they’re the king,” it feels like a slap in the face whether or not she knows I’m disabled. It’s about the systems, the institutionalized attitudes. It’s not about me.

Even after realizing all of this, I was still reluctant to identify publicly as a person with a disability. I would share details of my mental health history and the effects of my mental health conditions, but I still wouldn’t come out and identify myself as a person with a disability. At least, until I began talking and working with the amazing women who are my co-contributors on this blog. Because that’s when I realized that identifying publicly gave me power. Gave us power. Allowed us to come together as women who experience oppression and discrimination on the basis of our disabilities. Allowed us to work together to identify and address these problems, to find others affected in the same way, and to come together to try to change things. Thinking of myself as a super special snowflake made that kind of collaboration and support impossible, because nobody could be in my special snowflake group with me.

So while I’ll always think of myself as a pretty damn special snowflake, I also now think of myself as a woman with a disability. And identifying that way has allowed me access to power and support that I don’t think I could have found otherwise.

Note: I’m going to moderate this comment thread with a heavy hand to ensure that there is absolutely no policing of disability. If I self-identify as a person with a disability, I do not owe you the information of my diagnosis, my health history, or my therapy records to ‘prove’ that I am disabled. Similarly, I will respect how others self-identify if they are doing so in good faith and expect other commenters to do the same.

Focusing on College Students’ Mental Health (For the Benefit of the Neurotypical)

media and pop culture, mental health, social attitudes, violence

I live in Los Angeles and the local papers have been abuzz about the recent stabbing of a UCLA student by another student during science lab. Apparently a professor reported concerns about the alleged attacker’s mental health about 10 months ago. And so, according to the LA Times:

The recent arrest of a UCLA student in the brutal stabbing of a classmate in a campus chemistry lab has again focused attention on an issue that gripped the nation after the 2007 massacre at Virginia Tech: the mental health of troubled college students. The Virginia Tech shootings, which left 32 victims and the gunman dead, raised difficult questions about how a disturbed student could have been allowed to remain at the school despite danger signs. The Virginia Tech killings were followed last year by a deadly attack at Northern Illinois University, in which a former graduate student killed five students and himself.

So – to be clear – the focus on students’ mental health has the primary goal of identifying students who are at risk of violent attacks on other students and staff. And presumably treating or confining them. While protecting the safety of students and staff is unequivocally something that a school should be doing, characterizing that goal as “focusing on college students’ mental health” ignores violent crimes against staff or students committed by people without mental illness. It also does a vast disservice to the vast majority of students with mental illness who are at zero risk for committing premeditated violent crimes.

The US Department of Justice estimates that there are 34,000 violent crimes committed against college students on college campuses every year. Most of those were non-fatal, there were 20 on-campus murders in 2000 (there were about 1800 rapes in the same year). While it’s likely that some of those violent crimes were committed by a student with a mental disability, the vast majority of them were not. It’s certainly more likely that a college student who is a victim of violent crime is affected by one of these “garden variety” crimes than something like the incidents in the article – of which there have only been 3 since 2007.

Additionally, the message that focusing on mental health is solely to prevent these incidents marginalizes and harms college students with mental illness who aren’t ever going to kill or physically attack anybody, much less bring a gun to class and start shooting randomly. Those students are being told that people with mental illness are scary and dangerous and need to be found right away so they can be kept away from other students.

Many colleges now require a mental health assessment for a troubled student to stay enrolled and more readily expel those who refuse to comply, said Brian Van Brunt, president-elect of the American College Counseling Assn. who heads the counseling center at Western Kentucky University.

There are a whole lot of things wrong with this. First, it’s very unclear who will be subject to this kind of review – who counts as a “troubled student”? Once a student is required to undergo this review, they’re required to subject to a psych assessment and disclose past traumas, sexual assaults, all kinds of things to the college administration, at the threat of expulsion. And the implication is that if the college doesn’t like the outcome of the mental health assessment, the student might be expelled on the basis of their mental health status.

This gives students a huge incentive to stay quiet about their mental health concerns, to hide them. Going to student health for psych counseling might trigger a review by the administration to see if a student was too sick to be at school. Talking to an RA might result in a report to student services. Even fellow students might report you to be psychologically reviewed by the administration. And it’s not at all clear the colleges are that enthusiastic about keeping these students around:

Colleges try to retain students if they are not violent, said Keith Anderson, chairman of the American College Health Assn.’s best practices task force in mental health. “The goal is to keep them in school, keep them functioning and engaged, and in treatment at the same time,” said Anderson, who is a staff psychologist at Rensselaer Polytechnic Institute in Tory, N.Y

“Try to retain students if they are not violent” is a far cry from “affirmatively and eagerly addresses the mental health needs of students.” It sounds an awful lot like “will tolerate those students, I guess.” And that message is having an effect:

In a recent survey of campus health officials, the American College Counseling Assn. report noted “growing intolerance by faculty and others about students perceived to be odd.”

“Maybe if we shun the weirdos, they’ll leave before we have to expel them!” It’s clear that this focus on mental health is not at all for the benefit of those college students with mental illness – it will affirmatively interfere with their ability to get support and treatment. It will make things worse for them. So the only motivation for this increased focus on mental health is to protect the neurotypical from the violent attacks from individuals with mental illness, who are considered universally dangerous and deserving of suspicion. This new focus is for the comfort of the neurotypical, at the direct expense of students with mental illness.

This is Hard

activism, identity, media and pop culture, mental health, Uncategorized

I sat down this evening to find some stuff I could write a few posts about. I went to google news and did a search for “mental illness” and one for “bipolar disorder” and looked through everything that had come up in the past week.

There was a fair amount of stuff – some workers in the CA Department of Mental health are working enough overtime to double their salaries, continuing involvement in your field of work after retiring may help mental health, some news updates on the British guy scheduled for execution in China – so I just picked out a couple of stories to look at.  I was specifically looking for something that would be positive or at least neutral – something that wasn’t about people with mental disabilities being violent criminals, or about how pharmaceutical companies are making money.

So I picked an article that seemed positive: a piece by Glenn Close in the Huffington Post about ending stigma. It’s titled Mental Illness: the Stigma of Silence, and there’s a lot in it that’s great. She criticizes the movie Fatal Attraction (in which she starred) for portraying her character as a dangerous psychopath and misrepresenting the reality of mental illness. She points out how other “topics that were once unspeakable,” like breast cancer and AIDS, have gained wide acceptance and awareness, while there is largely silence on the issue of mental illness. She is frustrated by the societal assumption that people with mental disabilities are lost causes. She even calls out ableist language like “‘crazy,’ ‘nuts,’ or ‘psycho’.”

But. She opens the piece by saying that “mental illness and [she] are no strangers” – and then cites her “challenge — and the privilege — of playing characters who have deep psychological wounds” as the basis of her authority. She also mentions that her “sister suffers from a bipolar disorder and [her] nephew from schizoaffective disorder” (emphasis mine). Which … isn’t great and made me frown a bit. But I could have overlooked that – it’s an article with a lot of visibility that makes strong arguments against stigma, it’s connected to an organization “that strives to inspire people to start talking openly about mental illness, to break through the silence and fear [and has] the support of every major, American mental health organization and numerous others.”

Except then I clicked through to the website of the organization, Bring Change 2 Mind. And here is the first thing I saw: (screencap of a video, so excuse the graphics)

Bring Change 2 Mind

I literally gasped out loud. She is a mom, his mom. And he is not even her son, not even a person, not even a person with schizophrenia, not even a schizophrenic, he is labeled with his diagnosis. There’s other photos on the front page- someone with a “post traumatic stress disorder” shirt, and Glenn Close (wearing a “sister” shirt) sitting next to her sister, who is wearing a “bipolar shirt.” And I closed the window. Any kind of anti-stigma campaign that would involve me wearing a shirt saying “bipolar” on it is not a campaign I want to be a part of. More power to those who did choose to be involved, but it just feels wrong and isolating to me. Like that is the only relevant characteristic of the person with mental illness, while people without mental illness are defined in terms of families, relationships to other people.

And that’s why this (and by ‘this’ I mean being a person with a mental disability) is so hard – even those allies who genuinely want to end stigma and address ableism can do things that feel like a slap in the face. We are embedded in a culture so steeped in ableism with institutions providing a long term structure for discrimination and dismissal that it shows up everywhere you look – even when you’re intentionally looking for something good and supportive. So some days it seems easier not to pay attention to mental health issues at all, because around any corner could be something like this.

Ableist Word Profile: Intelligence

101, Ableist Word Profile, activism, blaming, class issues, feminism, identity, intersectionality, justice, language, mental health, military, normality, shaming, social attitudes, , , , , , ,

Welcome to Ableist Word Profile, a (probably intermittent) series in which staffers will profile various ableist words, talk about how they are used, and talk about how to stop using them. Ableism is not feminism, so it’s important to talk about how to eradicate ableist language from our vocabularies. This post is marked 101, which means that the comments section is open to 101 questions and discussion. Please note that this post contains ableist language used for the purpose of discussion and criticism; you can get an idea from the title of the kind of ableist language which is going to be included in the discussion, and if that type of language is upsetting or triggering for you, you may want to skip this post.

Wait! you may be saying to yourselves. Kaninchen Zero, what the hell is ‘intelligence’ doing in the Ableist Word Profile series? Intelligence isn’t a disability!

Okay, so maybe you’re not saying that. But I’m serious. I hate this word. Hate the concept. With a hatred that is a pure and burning flame. True, part of this is because I get told all the time that I’m like wicked smart. When it’s some of the more toxic people in my family saying it, there’s more to it: You’re so intelligent so why are you poor? Other people use it as an opportunity to put themselves down: You’re so smart; I’m not; I could never do the things you do.

Does intelligence exist? At all?

Maybe it doesn’t.

There are tests that measure… something. They’re called Intelligence Quotient tests. The idea is that these tests actually measure some fundamental, real quality of human cognition — the people who believe in IQ believe that there’s a single quality that informs cognition as a whole and that people who have higher IQs have more of this and think better and perform better generally while people who have lower IQs have less of this quality and perform more poorly. Sorry; it’s a muddle of a definition, I know. Partly it’s a conceptual and linguistic problem — some things are not well defined and these things tend to be the things we consider to be fundamental. It’s much easier to define smaller things at the edges; it’s easy to define a fingernail. It’s harder to point to where blood stops flowing away from the heart and starts flowing back towards it.

The man who developed the first intelligence tests, Alfred Binet, wasn’t actually trying to measure intelligence. He’d done some work in neurology and psychology and education, and in 1899 he was asked to become a member of the Free Society for the Psychological Study of the Child. Primary education in France had become mandatory, so a lot of work on educational psychology was being done due to the large demand and the large available sample population. Binet, and others, were assigned to the Commission for the Retarded. (Again, please accept my apologies; I wouldn’t use the word if it were mine.)

The problem he was trying to solve was how to identify — consistently, without having to rely on the judgment of people who could be swayed by all sorts of personal biases (as we all are, including me) — those children who needed extra help. Maybe they had developmental disorders, maybe they had learning impairments along the lines of ADD/ADHD, dyscalculias, dyslexias, maybe malnutrition, injury, or childhood disease had caused neurological damage or limited development. The specific etiology wasn’t the point; the point was to be able to know who these children were and get them assistance. Which may be ascribing too-noble motives to him, but he doesn’t do so great later. Continue reading Ableist Word Profile: Intelligence →

Ableist Word Profile: You’re so OCD!

Ableist Word Profile, language, mental health, Uncategorized, , , ,

Welcome to Ableist Word Profile, a (probably intermittent) series in which staffers will profile various ableist words, talk about how they are used, and talk about how to stop using them. Ableism is not feminism, so it’s important to talk about how to eradicate ableist language from our vocabularies. This post is marked 101, which means that the comments section is open to 101 questions and discussion. Please note that this post contains ableist language used for the purpose of discussion and criticism; you can get an idea from the title of the kind of ableist language which is going to be included in the discussion, and if that type of language is upsetting or triggering for you, you may want to skip this post.

Someone walks into my kitchen for the first time looking for something they will more than likely find the cupboards nicely arranged.  I like things with the labels facing out, neatly lined up, dressed to the front.  I like to have like items together (my cooking items are in a separate area from my baking items, and snacks, to begin to scratch the surface) to make it easier to find things.  Our Korean apartment is smaller than we are used to in some areas, so being organized is a must when it comes to storage.  We have Tupperware canisters lining the counter tops with frequent used and bulk items in easy reach, and also in the fridge w/ the produce already prepped.  When we bring meat home from the market we divide it into portions and vacuum seal it before storing it.  Some of this is for space sake, some of it is because I like to cook and will use spoons I sometimes steal from elsewhere to do so, and having the kitchen arranged as such makes that easier.  I have had more than one guest wander through the kitchen chuckling and mention to me how OCD it is (which really doesn’t make sense if you think about the acronym).

No.  My kitchen is clean.  It is neat.  It is sometimes meticulous (when the dishes are done), it is user friendly, well organized, color coded, over-the-top arranged, even.  My aunt would say you could eat off of my floors (some days, but we do have a seven year old).

OCD, or Obsessive Compulsive Disorder, isn’t just the tendency to keep things all tidy like Mary Poppins on a sugar rush.  It doesn’t mean that you like your clothes hung in chromatic order or your socks folded a certain way, or even that you sort your M&M’s into color groups before eating them.  It isn’t your friend with her dust free home or Bree VanDeKamp hair or Emily Gilmore six-inch tapers.

It does mean that you tend to have thoughts (obsessions) that intrude into your mind and make you extremely uncomfortable, because you know that they are unreasonable.  Some people have thoughts where they hurt themselves or their loved ones.  When I was much younger I once had repeated visions of shoving a corkscrew into my eye while at the bar where I was working.  Understandably it was bothersome, and actually there were times that it worried me to tears, because I knew I wasn’t going to shove a corkscrew into my eye, and I couldn’t figure out why my brain was giving me that picture.  People often engage in repetitive actions (compulsions) to alleviate the stress of these thoughts.  I wiped bar glasses and liquor bottles until they were spotless, and later at home plucked my eyebrows into oblivion because they were never quite symmetrical.  I brushed my teeth until my gums bled…anything to keep my mind off of that fucking corkscrew.  In your mind you know that having washed your hands or brushed your teeth fifteen times before school has probably already taken care of any germs (and skin or enamel), but you can’t get the thoughts of those germs gone.  So you brush, or you wash.  And you still think your hands are covered in bacteria or you can feel your teeth rotting in your head (even though you know it isn’t true).  So you wash again…and you miss that first class…even though you know better.

It overcomes your life.  OCD isn’t just some cute little habit you have of always placing everything on your desk perpendicularly or always lining shoes by the door. It actually interferes with your life and how you are able to live it.

When I was in college I knew that I wasn’t going to blow up my apartment.  My rational mind was well aware of that fact, even though I could see the building on fire and me standing outside of it.  But after cooking, when I had to leave for class, I had to go over to the gas stove and turn all of the dials on to make sure I had turned them off…even if I hadn’t used them.  The oven too.  I just couldn’t stand the thought of leaving the gas on and having something happen to my roommate while she slept.  Then I would grab my bag…and even though I knew I had just. checked. the. damned. knobs.  I had to go back and check them again.  After this I might get out the door and lock it, but then I’d have to go back in and check again.  The next time I might make it all the way down to the main door of the building.  “What if you missed one?  You could blow up the whole building!”.  Back up three flights of stairs, unlock the door, and check the knobs again.  Of course they were fine, just like the last three fucking times I checked.  That didn’t stop me from having to go back two more times, once after thawing my car, and once after I had actually left the parking lot, made an illegal U-turn, and gone back.  I kept seeing the whole building go up like a giant bonfire on a July evening in Michigan.

I was two hours late for class.

I was obsessed with numbers.  If I had pieces of something I couldn’t eat it unless it could be divided into odd-numbered groups of odd numbers.  My weight became an obsession, which isn’t at all uncommon in people with OCD, and no matter how much I lost I was certain that I was disgusting and fat and gross to everyone who saw me.  I actually measured “ins” and “out”, and I will leave you to those pleasant details all on your own.

Years of therapy later I am able to find myself in a place where I can control my OCD, and I have come a long way in managing it.  This isn’t true for everyone, because each of us are unique and what worked for me isn’t going to work for the next person.  I am by no means “cured”, but there is something to be said for being in a stable home environment for the first time in my whole life that has turned the corner for me.  There are things that will cause me to slip…

Some other fun facts about OCD.

There are some lesser known offshoots, such as Trichotillomania and Dermatillomania.  These conditions begin with the same intrusive thoughts, but instead manifest with compulsive hair pulling and skin picking.  I have both of these conditions.  The hair pulling left me with little to no eyebrows, and an embarrassing bald spot on the back of my head that covered nicely with a military style bun.  Without babbling on as I am wont to do, it was another thing I had to work through with a mental health professional (and one awesome esthetician).  The skin picking is still a challenge, and as stress in my life heightens so does that.  This is the most embarrassing of my anxiety issues because this leaves the most obvious marks on my face.  My arms I can hide with long sleeves.  Even though I am incredibly aware of the marking and scarring left, most people don’t notice it, unless they are very close to me, and even then most don’t unless I am comfortable enough around them that they have actually seen me doing said picking.

So, I believe we can see why the usage of OCD is ableist here: it isn’t some funny quirk.  You are trying to be witty.  I get that.  But your witty words mean things about my life, parts of my life that I have worked to overcome, and which people I know are still living with daily and that just isn’t funny.  It isn’t something we close up in a cupboard and laugh about with friends*.  It is a daily struggle for people who absolutely know that they are doing things that are unreasonable to help them cope with the anxiety of things that they also know are unreasonable.  We slog through it, grind it down over years, beat it back, and work our asses off to gain chunks and pieces of our lives back from it.  That is no joke to us.  It is extremely ableist for a person who is in control of their thoughts and actions to appropriate this term to mean that someone is really particular about the way they like things.

So, no, your very tidy friend is not OC.  Unless sie is.  And then, ha ha, sie probably doesn’t appreciate having hir life poked at.

*OK, you got me.  Sometimes we do.  But that is our right, not yours.

Ill

101, activism, blaming, identity, intersectionality, language, mental health, , , , ,

The topic of mental illness came up again with the latest large-scale hate crime against women to make national news. It’s a nice easy narrative for George Sodini to be a psycho, to be crazy, to be mentally ill because then we don’t have to understand him. We don’t have to relate, because we’re not like that.

Thing is, we’ll never know if Sodini was mentally ill or not. We can’t tell from what he left behind, and he’s no longer around to ask. The things he wrote aren’t all that unhinged; he just took the workaday hatred of black people and women that is everywhere in our society and picked up a gun and went hunting.

And the mentally ill means violent narrative is false anyway. Mental illness correlates with an increased risk of being a victim of violent crime, not of committing it.

It’s been said before, but it bears repeating because there’s so much silence and stigma and ignorance surrounding mental illness. I’ve had kind of a lot of experience with mental illness and the mental health professions. Some of it may be triggering.

I have taken (in no particular order) Prozac, Zoloft, Paxil, Effexor, Serzone, Xanax, Ativan, Risperdal. I’ve self-medicated with alcohol a lot and smoked cannabis and taken LSD when I could get it. I have been diagnosed, at various times, with clinical depression, bipolar type I disorder, bipolar type II disorder, borderline personality disorder, post-traumatic stress disorder, gender dysphoria disorder, depressive psychosis, and paranoia. I strongly suspect that I have Asperger’s Syndrome, which would explain a lot of my symptoms, behaviors, and difficulties. I have spent time in private and public psychiatric hospitals and spent years in weekly or twice-weekly therapy. I have damaged myself in ways ranging from very small — pulling on my hair repeatedly — to very serious — shooting myself in the left hand between the third and fourth metacarpal bones. I still have PTSD-like symptoms from the last and from growing up in an abusive environment, though episodes of it get farther apart as time passes. I have had suicidal thoughts that became elaborate plans. There were times that the only thing keeping me alive was someone needed to feed the cat. I am not alive for big important reasons; I am alive for small stupid reasons. I am alive because I didn’t want whoever found me to suffer the trauma of it. I have suffered delusions and intrusive thoughts and I have always had minor hallucinations (words printed on a page are red instead of black, patterns on a floor or wall shift while I look at them). I often have trouble understanding people when they talk and try to pass it off as being hard of hearing. I’m not; I hear fine. I have trouble processing auditory information and especially picking conversation out of background noise.

You’d think I was dangerous. I’m not. Really. I’m not even dangerous to me. Damaging myself — like it is for so many people who self-harm — is a way to stay alive, to cope with trauma. I have better ways to cope now and I don’t do that any more, but sometimes when I’ve had a really hard day and I hurt a lot and the noise in my head is very bad I remember how comforting it was to draw a blade across my arm, to feel the skin part, to see the blood well up, and how it made the noise go away for a while. Maybe it makes me crazy, but that is a warm fond memory for me. And it is what I needed to do when I needed to do it. I have the same memories about smoking, and I don’t do that these days either.

I’m much better now than I was. There are long periods where I don’t need psychiatric meds at all. But I am not cured and I never will be. I will always have mental illness in my life, just as I will always have fibromyalgia and physical pain. I’m back on an SNRI now and it’s helping and that’s good, because I could feel the old illness patterns coming back. Things have been bad lately with the economy. But I’ll be okay. I know how to cope with the bad things in ways that aren’t so drastic. There are people I can ask for help. I’m not alone.

Even if I am crazy.

More Research Like This, Please!

mental health

There is a neurochemical link between psychosis and creativity, according to psychiatrist Szabolcs Keri of Semmelweis University in Hungary. He studied neuregulin 1, a gene that typically is involved with neuron development and communication. A variant genotype, though, is associated with a great risk of developing mental disorders like schizophrenia and bipolar.

Keri studied a bunch of people who considered themselves creative and had them undergo assessments for intelligence and creativity. They also gave information on their lifetime creative achievements. Those who had the variant genotype of neuregulin 1 scored higher on the creativity assessment and had greater lifetime creative achievements. So, and wait for it, because this is exciting – a study has shown that a genotype associated with psychosis is also associated with traits and functions that people think are good and beneficial!

I don’t love the methodology of the study – measuring creativity is a difficult task in a scientific study, but I love the idea of somehow documenting something I believe about myself: my disability is not exclusively defined by diminished or impaired functioning, but also by abilities or skills beyond those of neurotypicals. I believe that we, in general, not just disability activists, should be thinking about and talking about and studying this perspective more.

(h/t Greysteppenwolf)