
When You Picture Someone with Mental Illness, Picture Me in a Nice Tailored Suit - pmoriarty
http://www.huffingtonpost.com.au/osher-guensberg/when-you-picture-someone-with-a-mental-illness-picture-me-in-a_a_22082506/
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sharkweek
I suffered in private for years with OCD and didn't know it. I honestly
thought I was just slowly going crazy/was a terrible person with repetitive,
disturbing thoughts. On the surface, I'm a professional, married, great family
life, etc. but kept my suffering VERY private.

After finally getting fed up/building up the nerve to talk to my doctor about
what was going on in my head, she clarified what OCD was doing (intrusive
thoughts -> anxiety -> mental compulsions to make the anxiety go away ->
intrusive thoughts get worse, more compulsions "required" to make it go away)
and gave me a diagnosis of such, as well as some treatment recommendations.

I just recently wrote about dealing with OCD and posted it to social media,
announcing it publicly. There was an outpouring of support, and even more
satisfying, a few private messages of people discussing their own, very
private battles with mental illness.

It's a huge, private struggle for most, and I think we'd all be better off if
we talked more openly about it.

~~~
maxxxxx
May I ask how you are dealing with it? My girlfriend has OCD and I find it
really hard to deal with. I accept that she has these thoughts but I am at a
loss how to be supportive or helpful.

~~~
sharkweek
Yes! Exposure-response therapy [1] has been by far the best treatment I have
received. It's scary and painful, because it literally forces you to draw the
anxiety out and face your darkest fears head-on without compulsions, but it's
the only evidence-based treatment for OCD currently out there. I'm already
noticing I'm getting my "mind" back, learning that scary thoughts are just
thoughts, and I don't need to battle with them for hours.

There's definitely an element of learning mindfulness that's key too. Learning
to accept the uncertainty of random "terrible" thoughts that pop into your
head, learning to not engage with them and letting them pass, etc.

I recommend two books: The Imp of the Mind by Dr. Lee Baer [2] and The
Mindfulness Workbook for OCD by Jon Hershfield and Tom Corboy [3]

[1] [https://iocdf.org/about-ocd/treatment/erp/](https://iocdf.org/about-
ocd/treatment/erp/)

[2] [https://www.amazon.com/Imp-Mind-Exploring-Epidemic-
Obsessive...](https://www.amazon.com/Imp-Mind-Exploring-Epidemic-
Obsessive/dp/0452283078)

[3] [https://www.amazon.com/Mindfulness-Workbook-OCD-
Overcoming-C...](https://www.amazon.com/Mindfulness-Workbook-OCD-Overcoming-
Compulsions/dp/1608828786/)

~~~
peteretep
Amazing, thanks. My wife has OCD tendencies and has found mindfulness to be
useful so far -- I've just ordered the second book for her.

------
jansho
> _The part of my brain that was able to rationalise the distorted thoughts
> had stopped working, and now I was believing every irrational fear that came
> into my brain as if it were absolute fact.

I descended rapidly into paranoid delusions which had me convinced that the
world was going to end that very day -- and I was the only one who knew about
it._

Yeah that's a pretty deep low. Mine was when I was convinced that a classmate
was a ghost, and seemed to be stalking me everywhere. Eventually I broke down
and confessed to him, and like a smashed mirror, all illusions disappeared. In
horror I took a year off my studies.

Recovery from deep holes like that may seem impossible but it's not. Accept
also that there is no quick fix, no magic bullet, and that even when you're
out of the tunnel, it may still take a long time to be 'normal'.

But this will also make you stronger and more empathic - and that is valuable.
I don't mean it in a hippie way, but too many people lack these, and so in a
way you're blessed, because your worldview has shifted and you to begin see
'more'. You will also eventually learn to make peace with yourself: it's OK to
trip up, it's OK have these 'glitches'.

Final note: I cannot emphasise enough about having a good support network.
Even if you have no one to trust, at the very least avoid toxic company. And
by the way, you'll be surprised by what you'll get when you reach out just a
little. After all, your dignity is nothing compared to your sanity, so confess
to your mom, blubber on the phone with the Samaritans, break down in front of
your tutor ... usually, you will find that at their core, humans are kind.

Edit: typo

------
limeblack
I can't comment about OCD medication but I'm posting this as a bipolar patient
as a warning. Do not I repeat do not take sedatives antipsychotics(there are
lots of antipsychotics for bipolar and schizophrenia that are sedatives) for
more then a couple weeks with out planning to take it long term. Sedatives
mess with your sleep function and destroy your ability to sleep naturally. I
can no longer sleep with out a sedative because a drug called zyprexa
destroyed my ability to sleep naturally. Zyprexa can cause both diabetes and
lots of weight gain and cause other side effects. There are couple of drugs
like it but just thought I should mention that a the medications themselves
can sometimes bring up side effects that are almost worse then the mental
illness can really mess with your brain permeantly.

------
petercooper
A similar situation arises if you're autistic (not a mental illness, but with
parallels in public perception) with assumptions of Rain Man savant-like
abilities and mannerisms as being the norm.

------
davidgerard
I remember a discussion at work where my boss said on IRC "how do you know
when you're having a nervous breakdown?"

The other four of us, his sysadmin team, we have _all_ worked so hard we had a
breakdown from it. It's a hazard of the job: it draws people into overdoing
it. We told him to sign the fuck off for four weeks, with possible
antidepressants. (He didn't, but he did take his next two weeks off without
logging into IRC.)

I've had depressive and stressed periods and I'm happy to publicly say so, so
this is not secretive but normalised.

Watch your coworkers and take care of each others' well-being.

------
goldenkey
Ive lost my mind before. I had a manic episode, my first and only one. Felt
immense euphoria. Saw incredible detail like rainbow diffraction of water from
the sink faucet. I thought I was Jesus and there were only 2 forces in the
world, pushes and pulls. Gravity aka dark light pulls. Light pushes (radiation
pressure.)

I felt enlightened and had an altercation with the police who ended up beating
the living shit out of me causing 3 herniated discs and TMJ that cause me
agony and chronic pain daily. I have to take opiates to deal with the pain -
otherwise I would be unable to have an active life.

This guy didn't experience what happens in most mental breakdowns. If you can
get yourself to the doctor you have truly not lost your mind. But its a cute
story.

Keep downvoting me for posting the hard truth. Real discourse...

~~~
safek
I'm disappointed by the downvotes this person is getting. I have a close
friend who went through a manic episode, and can imagine how "cute" stories
like this might seem.

As an observer, the most alarming thing to me about this whole "raising
awareness of mental illness" movement is that it's another judgment-forbidden
sort of "every subjective experience is equal" movement. It's gone mainstream,
too, in the usual sickening, missing-the-point way; you now have neurotypical
college students with essentially easy lives drawing posters and holding
fundraisers. It's not surprising people with authentic mental illnesses are
rolling their eyes.

The downvotes this person is getting are a symptom of exactly this problem.
"How can this person belittle someone else's illness?" In other words,
everyone's illness is equally important. We've got to be diverse and
inclusive. Never mind that some cases of mental illness are actually more
severe than others. If everyone's entitled to their own perspective and
experience, isn't this person entitled to theirs? Why downvote that? Because
it doesn't fit into the modern mental-health-awareness agenda?

I think it's important that instead of lazily saying "everyone's suffering is
a problem," we discern between degrees of suffering. Partly because
perspective matters, but also because being told your problems are non-
problems compared to someone else's is a _helpful_ thing. The truth is, most
people's problems are _to some extent_ self-inflicted/self-created, and it's
never a bad time to examine the size of that extent.

~~~
re
> If everyone's entitled to their own perspective and experience, isn't this
> person entitled to theirs?

The downvotes (not mine) aren't for their experience, they're for the
dismissiveness. It's like the paradox of tolerance; you shouldn't be surprised
if people don't support your viewpoint about not supporting other viewpoints.

> Because it doesn't fit into the modern mental-health-awareness agenda?

Because it doesn't actual contribute anything substantive; it invalidates the
author's experience seemly just to make a point that the author already
acknowledged ("It seemed the only real difference between us was that I knew
something was wrong")

> being told your problems are non-problems compared to someone else's is a
> helpful thing

How so? Far more often, people tell others that their problems are non-
problems in an attempt to shut them up, not to help them. What actual value
comes from attempting to precisely determine who has it worst?

[http://rationalwiki.org/wiki/Not_as_bad_as](http://rationalwiki.org/wiki/Not_as_bad_as)

~~~
safek
Fair enough on the first two points. That makes sense.

 _> How so? Far more often, people tell others that their problems are non-
problems in an attempt to shut them up, not to help them. What actual value
comes from attempting to precisely determine who has it worst?_

Now that I think about it, I do see this on the internet a lot, and agree that
it's highly unconstructive.

What I was more getting at was a critique of a pervasive idea that everyone's
self-reports should be taken at face value, and treated with equal gravity.

A contrived example: imagine someone who feels depressed because they were
pumped full of self-esteem as a kid, then found out in their twenties that
they weren't that special; and someone who feels depressed because of chemical
imbalances they can't control. Both people would use the word "depression" to
describe themselves, and in our culture, you're not allowed to say that one is
"real" while the another "isn't." But in fact it would probably help the first
person to know that their depression isn't, in a strict sense, real: they can
get out it by improving their external circumstances, while the second person
can't.

(That's not analogous to the situation here; it's just a random example.)

~~~
mercer
> But in fact it would probably help the first person to know that their
> depression isn't, in a strict sense, real: they can get out it by improving
> their external circumstances, while the second person can't.

But that's kind of the crux of the matter, isn't it?

First off, we still know so little about mental health that we can't
accurately tell which is which. And it strikes me as really harmful to
categorize people's issues as 'real' or 'not real' based on vague notions.
Autism, for example, was initially seriously considered a result of bad
parenting, and the consequences are noticeable to this day.

Second, even if we can distinguish between, say, depression because 'raised
with too much self-esteem' or 'chemical imbalance', this is mostly relevant
for _treatment_ , not diagnosis.

If the person in question cannot find their own way out of the situation, the
problem is by definition 'real'. The only difference might be how the
situation is handled. In fact, in many cases the treatment is the same,
regardless of how someone got there.

I've seen a lot of harm caused by people arbitrarily distinguishing problems
as either 'nature' or 'nurture' or 'internal' or 'external'. This distinction
is not only extremely vague, it doesn't actually matter to anyone except those
who are developing or implementing solutions. To everyone else, I'd advise
compassion, support, and avoiding judgment.

That said, you do have a point. Personally I've become more and more convinced
that for various reasons, some good, most bad, our current treatment models
err on the side of adjusting yourself to fit your environment, while the most
beneficial solutions I've seen involve shaping your environment to fit 'you',
or at the very least a combination of both. Regardless of whether an issue is
'internal' or 'external' (again, I don't think making the distinction is as
valuable as it seems).

~~~
safek
I'm guessing that where I'm maybe communicating this badly is in the word
"real." I don't mean to suggest that people whose problems don't meet some
arbitrary criteria shouldn't be taken seriously. And I certainly think hasty,
dismissive judgments can have sinister consequences.

What I do think it's productive to do is to assess based on evidence the
relative weight of people's issues. I think we'd agree that treatment depends
on successfully and accurately identifying the problem. A huge part of that is
figuring out what order of magnitude of difficulty you've got in front of you.

I'd say that in distinguishing between 'raised with too much self-esteem' and
'chemical imbalance,' the difference in the resulting treatment is so drastic
that it may as well be a different diagnosis. Someone in the former category
needs to acquire some combination of acceptance, a sense of agency, and goals
to strive toward. Someone in the latter needs medication. The former is easier
to solve, because the latter in some cases may not be solvable at all. This
doesn't mean we should abandon compassion and start yelling at the person, but
isn't it a good litmus test? Shouldn't someone who genuinely wants to get
better be delighted to hear that their problem wasn't so big after all?

It sounds like you're less against judgment in general and more against lazy,
dismissive, heartless judgments. But that's not what I'm advocating at all. I
just have sympathy for the war veteran rolling his eyes when he hears a story
about someone who got mugged getting PTSD. Of course no one should be mugged,
and getting mugged sucks, but oh come on, let the guy roll his eyes.

~~~
mercer
> I'd say that in distinguishing between 'raised with too much self-esteem'
> and 'chemical imbalance,' the difference in the resulting treatment is so
> drastic that it may as well be a different diagnosis. Someone in the former
> category needs to acquire some combination of acceptance, a sense of agency,
> and goals to strive toward. Someone in the latter needs a careful balance of
> medication.

Thing is, as far as I know, and correct me if I'm wrong, our knowledge of
depression and it's causes and solutions is so rudimentary that we can't
really make that distinction in the first place, which means we can't really
argue whether treatment needs to be 'drastically different'.

I'd argue that based on this lack of knowledge, both categories should
probably first try the first solution you mention, and settle for the second
if that's no help. Who's to say, for example, that someone who's entire being
has been shaped over decades into 'having too much self-esteem' can actually
be 'fixed' without medication?

Or consider schizophrenia. Is it nature or nurture, when there's some evidence
that it can very well lay dormant until it's 'triggered'.

tl;dr: what's the value in creating ill-supported distinctions on an issue
that is already rife with judgment, unwanted advice, self-esteem issues
(across the board, whatever you suffer from), and so on?

> It sounds like you're less against judgment and more against hasty, lazy,
> dismissive, or leave-them-out-to-dry judgments. But that's not what I'm
> advocating at all. I just have sympathy for the war veteran rolling their
> eyes when they hear someone who got mugged telling a story about PTSD. Of
> course no one should be mugged, but come on, let the guy roll his eyes.

Such a person is free to roll their eyes, but I don't see how we should have
sympathy for the 'my situation is worse than yours' kind of judgment. We can
tolerate it and perhaps understand it, but it's still harmful, judgmental, and
pointless.

I lost my sympathy over this behavior once I realized that much of the worst
judgment I've seen and, sadly, experienced, is caused by this attitude. The
people with the worst attitude to the poor are often those who used to be poor
but are not anymore, obviously by not being lazy like the rest of them. The
same goes for the attitude of people who used to be fat, ugly, insecure, etc.
At least in my experience (and overwhelmingly so).

~~~
safek
Hm, yeah, good point. I'm not sure how much we know. Maybe you're right and we
really don't know enough to make those distinctions.

------
njharman
I don't have to picture anything, just look in mirror.

