
Sane Thinking About Mental Health Problems - devinhelton
https://srconstantin.wordpress.com/2016/12/12/sane-thinking-about-mental-problems/
======
projektir
Wow, this article describes all the things I've been thinking about for a very
long time, and how hard it is to properly talk to someone about anything
because any discussion just goes to "everyone should see a professional and we
can't talk to people".

We made mental issues this unusual thing that only happens to "special"
people, rather than something that may very well be part of the human
condition and should be dealt with collectively.

Also the issue that getting well seems "odd" in that people get suspicious
when a previously ill person gets well and thinks they were never ill.

> She became an evangelical Christian because those were the only people on
> campus who were actually nice to her.

Oh my, I can so relate to this...

Religion likely used to serve as mental health for many people for a long
time, all its issues notwithstanding, but when we did away with it in the
secular world, we just replaced it with cold callousness and nihilism, it
seems.

~~~
mhalle
One long term solution to this problem could be the normalization of
preventative mental health treatment, analogous to a yearly "physical"
doctor's visit.

Many mental health issues are (at least in part) a result of reactions to
events in everyday life. Sometimes they happen suddenly, or are exacerbated by
a biological condition, but in the general population they often exist over
time and never rise to a level that requires intervention on their own.

If we could catch potential problems at this early phase, we might be able to
address some number of serious issues before they become emergent.

Imagine if insurance covered a yearly mental health checkup. If such a service
were available, commonplace, cheap, and considered part of preventative care,
we might start to destigmatize mental health care and treatment, addressing
little problems early while flagging more serious ones. People who go to their
"physical" general practitioner every year aren't usually considered "sick" by
their friends. It would take time, of course.

Physical or mental, when the machine's broken you do something to get it
fixed. There should never be shame in that. Perhaps we should also do more
preventive maintenance.

~~~
hiddencost
I think the point of this article is kinda "we should be caring for people in
our communities" rather than "we should treat mental health as strictly a
problem for specialists".

~~~
mhalle
I agree, but destigmatization makes both approaches easier. Preventative
physical health works the same way.

Also, if many people had mental health checkups every year, they would
probably be better equipped to help others as well.

------
nether
> They are teaching kids not to be kind to sad friends, but to report them to
> the authorities instead.

I've heard that this is a particularly American attitude, that the mentally
ill should be isolated with a clinician before doing anything else in life.
Can any non-Americans say what their cultural attitude is? I've also heard
that Indian culture is pretty much the opposite in this respect.

~~~
zaptheimpaler
I am an Indian immigrant living in America. I think what you said is very
true.

There is even more stigma about "mental health" issues in India so we might
not label many things as mental issues, but people are generally more
supportive and social, even a little intrusive into others lives. When a
friend is having issues, their social group will actively try to get them to
socialize, talk about stuff and cheer them up. They will insist that you don't
go under the radar and disappear.

The American attitude of extreme individuality, personal limits seems kind of
ridiculous to me at times. Like I don't even understand what the hell a friend
is supposed to be if you can't be honest with them when you're down. Someone
to share some good times with is a fair-weather friend, but not at all the
same thing as a genuine friend. Sometimes it feels like you have to constantly
live with a mask on, even with friends and family. And then when you get
lonely and tired of the mask, you are supposed to find a soulmate who will be
the sole person you are allowed to be honest and seek help from.. sometimes
its not enough.

You know a major component in many mental illnesses is letting people isolate
themselves. And mental illnesses have been around forever, but they were dealt
with by help from society around you. This is an innate, human thing. There is
an epidemic of loneliness and isolation in western societies because of the
extreme individualism everywhere.

Finally, its fucking ridiculous the amount of trust people have in
"authorities". "No we won't talk to you about your mental issues because fuck
you, but hey why don't you go pay to talk to a stranger instead"? What? Why is
that better? Isn't a friend/family member much better positioned to understand
your problems and offer some perspective?

Of course, the Indian way has some problems too. One, a shit-ton of stigma and
judgement by broader society if they find out. And at some point you're
supposed to just "man up and get your shit together". And mental health
doctors are still not trusted at all. Although, given the recent state of
psych studies and the replication failures, they might just be right.

/rant

Sorry this is a little hostile.. I obviously don't have a full picture of
everything, this is just my biased but honest opinion.

~~~
pif
I can't and don't want to judge American/Western/whatever attitude towards
these serious problem, but I've 2 cents to add:

> Isn't a friend/family member much better positioned to understand your
> problems and offer some perspective?

While full support from your social environment is important, seeking good
_professional_ help is even more important. The more serious the mental issue,
the less friendliness can substitute proper therapy.

~~~
yummyfajitas
Do we have evidence that "professional" help results in better outcomes than
otherwise? I've not seen such evidence, so if someone has hard evidence I'd
love to see it.

I'm sure many psychiatrists _assert_ this to be true (pay us, don't use free
resources!), but an RCT would be great.

~~~
wu-ikkyu
I too share your doubt, however psychology is a "soft science"[1], so you will
not find much "hard evidence".

[1][https://en.wikipedia.org/wiki/Hard_and_soft_science](https://en.wikipedia.org/wiki/Hard_and_soft_science)

------
devoply
I personally think that mental illness is the rule and not the exception for
human beings. It's just functioning mental illness which is validated vs.
dysfunctional mental illness which is not validated. Most people, if not every
single person, is mentally ill in some way. It's just when they start being
dysfunctional that we call it out as mental illness and then they have to do a
whole ritual to try to get rid of it or figure out ways to diminish its
effects on the person.

And often it's the environment that makes people mentally ill. It's not even
the person. So how can you treat the effect without changing the cause? You
can't.

Dave Chapelle here is talking about mental illness caused by Hollywood, he
says calling someone mentally ill is dismissive, it's not the people ... but
the environment.
[https://www.youtube.com/watch?v=NRzqsfO8F4U](https://www.youtube.com/watch?v=NRzqsfO8F4U)

~~~
Broken_Hippo
"It's just functioning mental illness which is validated vs dysrunctional
mental illness which is not validated"

To be fair, this is the very thing that makes mental illness ... mental
illness. It isn't that normal folks don't have some abnormalities and
illnesses, but the fact that it _affects their lives_ and _prevents, to some
extent, them taking part in a normal life_. Sometimes it plagues folks.

In a way, it is kind of like blood pressure. Everyone has blood pressure, some
higher than others. A few people that run a little high don't need to do
anything. Some people take meds, and some do diet and exercise and such
things. This all depends on what their blood pressure responds to and what the
cause is - some folks get it genetically, others through diet and lack of
exercise.

Edit: It is an easy example only, not trying to minimize mental health issues.

~~~
BeetleB
>To be fair, this is the very thing that makes mental illness ... mental
illness

True, but the use of the word "illness" is troubling. I had relatives who kept
pushing for me to go for a diagnosis. I refused for years as I did not want
treatment. My condition may have its downsides, but it has its upsides that
make me perform better than others. People only see the downsides.

Mostly, though, I think it was because they want to justifiably apply a label
to me, and I was not willing to oblige them ;-)

~~~
Broken_Hippo
I go back and forth on the "illness" thing. I don't have a better term for it:
In a way, it is the best term, despite folks using it as a label and way out.

"My condition may have its downsides, but it has its upsides that make me
perform better than others."

This is often true and a normal feeling, from what I've read - which is why I
think the best course of treatment is sometimes none at all outside of working
to strengthen the positives and minimize the negatives. It really just depends
on the flavor of the two and your lifestyle.

Sidenote: I hope you were able to keep some of the upsides even if you got
treatment - or at least are otherwise happy.

------
anjc
> The mantra taught to young people today is “If you’re having trouble, get
> professional help.”

This is the same thing you often hear in my country. You're always told to
seek help, but talking to professionals is almost entirely useless due to some
sort of total societal inhibition. As in, the media and lobby groups will push
a message that "we all find it hard to talk about mental health, so if you
have an issue, go to a pro"....but it seems like pros find it just as hard.
They almost definitely will not prescribe medicine, public waiting lists for
therapists are long, the private costs for professionals with medical
qualifications are prohibitive, and people can call themselves counsellors
with almost no qualifications leading to a poor array of options.

Unless you're afflicted to the point that you've already committed a crime,
you're probably not going to get much satisfaction from doctors.

------
orionblastar
I grew up with major depression and a major mood disorder. My doctor thought I
was autistic but when she gave me an IQ test I was high functioning and in
1975 they didn't discover high functioning autism until later in the 1990s. So
I was diagnosed(misdiagnosed) as depressed. I was picked on by bullies,
physical, mental, emotional abuse, etc. Just because I was different in some
way, called an Oddball because of X or Y, that is something the other kids
didn't have.

I managed to graduate high school and college and was working a good job until
I developed schizoaffective disorder in 2001. It is like bipolar with
schizophrenic cycles. Less than 0.5% of the population suffers from it and it
is very rare so not everyone knows about it.

In 2003 I ended up on disability as I could not find a job, and could not hide
that I was mentally ill. ADA says one cannot be discriminated against because
of a mental disability or mental illness, but I was called overqualified or
any other reason to reject me. As I grew older I also have age discrimination.

I wish I can say it gets better, but it is like fighting with demons in your
head to keep the negative thoughts away. The thought that say you are
worthless, or that you will fail, nobody likes you anymore, you are past your
prime, etc. The medicine helps treat a chemical imbalance but not all mental
illnesses are due to chemical imbalances. Getting a good doctor is hard as
well.

I'm 48 and have been suicidal about 14 times in my life. I'm still alive to
talk about it, so I survived somehow.

Generation-X is called the suicide generation because of so many of my
generation killing themselves or getting suicidal. It is like life is so hard
to live, you are on expert mode and struggling just to wake up in the morning
and get ready for work, and by the time you get to work you used up most if
not all of your mental energy to get up and get ready.

[http://boingboing.net/2016/12/11/insiders-americas-
largest-c...](http://boingboing.net/2016/12/11/insiders-americas-
largest-c.html)

Mental Hospitals as shown in that above link, are not always for helping
mentally ill people and some are run like prisons and they keep you there
until your insurance runs out to maximize their profits.

A mental illness is an invisible disability, when companies think of disabled
people, they think of someone in a wheel chair, a deaf person, a blind person,
someone missing body parts, etc. They never consider a mentally ill person or
accommodating them. If the stress is too much and it is making you sick, other
employees will do things to you to see how angry they can make you. Just
because you can't smile due to flat effect paralyzing your face muscles, some
employees think you might be up to something because you have a 'poker face'
and didn't wave back to them when you walked in during the morning because you
are too busy fighting demons in your head to see people wave at you.

There is no cure, no magic, it does not go away, you just try to learn skills
to cope with it and find ways to screen out negative thoughts and maybe try a
different medicine and see if it works better.

I am not 100% recovered, but I am making progress and trying to get back into
programming. I am writing this to let people know that there is no magic
bullet to kill the mental illnesses, and that we are not all violent like
those public shooters they call mentally ill but they are sociopaths and most
of us are not, we are just dysfunctional in some way.

~~~
virmundi
This is why I don't seek professional help. In the US we treat depression as a
clinical disease, but more a massive weakness. If you get diagnosed, it's hard
to keep living a normal life. The State comes in and never leaves. You can
never get back to normal. They will say your depression is in regression.

I know how you feel. I'd rather preserve my right to kill myself than have it
medicated, occasionally by force, by the State.

~~~
tptacek
I have a number of friends with serious, diagnosed mental health issues, and
it has not been my experience with any of them that the State has come in at
all, let alone refused to leave. What in your experience suggests otherwise?

~~~
tcj_phx
> and it has not been my experience with any of them that the State has come
> in at all, let alone refused to leave.

My friend got trapped with a court order for treatment - see my comment
history. Most of the drugs her psychiatrists force her to take actually cause
the conditions they supposedly treat. The doctors pretend that her condition
was not caused by the street pharmacy, or by her efforts to counteract the
akathisia (restlessness caused by neuroleptics aka tranquilizers aka "anti-
psychotics").

[http://www.psychrights.org](http://www.psychrights.org) is a great resource
for those who are concerned about being stripped of the right to refuse
ineffective medical care.

~~~
JBReefer
I believe you. That said, my friend just tried to kill herself because she
couldn't get anyone, including the State, to help her with BPD.

There's also a TON of literature about how the inability to voluntarily commit
family members is horrific for everyone around them, including innocent
bystanders. This is probably the most moving:

[http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-
fat...](http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-father-
actually-lost-his-mind.html)

~~~
tptacek
The acute mental health care system in the US is a travesty, something I
believe we'll look back on in 50 years with horror. I don't doubt it has some
effectiveness and that it ultimately helps many people, but I wouldn't want to
be the person mounting the argument that it is blameless or unfairly maligned;
it isn't maligned enough.

But: acute mental health care happens for a pretty short period of time, and
then, from what I can tell, "the State" gets completely out of the picture.

~~~
tcj_phx
> But: acute mental health care happens for a pretty short period of time, and
> then, from what I can tell, "the State" gets completely out of the picture.

This is not what I've observed. If you have a court order for outpatient
treatment and miss your appointments, they'll issue an arrest warrant, for
example.

~~~
JBReefer
I really, really wish that was true. I have done a ton of work with the
homeless, and so many have very serious mental health issues. Where I worked,
we had a holistic approach with therapists, case workers, social workers (for
benefits and housing), and sometimes the police - it did basically nothing. In
the thousands of people I worked with, I never once saw what you described,
despite the pro bono effort of high-power Manhattan lawyers.

People who are not acting under their own volition can be dangerous, and it's
a travesty that there's no functioning mechanism to return their agency with
things like mandated medication.

~~~
snikeris
> People who are not acting under their own volition can be dangerous, and
> it's a travesty that there's no functioning mechanism to return their agency
> with things like mandated medication.

I think there is a bit of an ethical quandary here. Perhaps the person prefers
their unmedicated state and although their life is a mess from your
perspective, they are in fact acting under their own volition.

The act of feeding someone pills against their will because you're sure it's
better for them is...ethically treacherous.

~~~
tptacek
It is treacherous, but really you're just capturing something basic about
mental illness and the extent to which it disrupts our sense of agency.
Rescuing someone from suicidality also involves intervening against a
patient's agency, but we generally don't feel alarmed about that.

------
justindocanto
I agree that it's more productive to advise students to be wary than to
express outrage at an institution. This should be read by all incoming college
freshmen.

