Crazy Is as Crazy Does


I’ve been wanting to write on here about neoliberalism for while. This post should most likely be preceded by a post devoted solely to neoliberalism, as a concept: where it comes from, what it entails, how it shapes our lives and worldviews.

But this particular post feels more pressing. Maybe it will even help clarify things for me later when I try to write other posts about neoliberalism.

I want to talk about mental health. It needs to be talked about in a different way than the mainstream tends to talk about it, and I want to attempt that, aided by against-the-stream or on-the-edges-of-the-stream perspectives from those I’ve read, those I know personally, those who have spoken to me and others about it.

Mental health is something that most people would rather put on the backburner as far as topics of conversation go. Mental illness is one that most people would rather avoid altogether. It is, admittedly, uncomfortable for speakers and listeners, those who have been diagnosed or treated for it, those who haven’t but feel or fear that they should be, and those who never have and never wish to be.

I wonder what this says, if anything, about the sorts of people who end up in fields and disciplines connected to the study and treatment of mental illness. Are they more compassionate, maybe? Trying to do people and society a favor? Are they ‘atypical’, themselves, perhaps trying to understand their own behavior or suffering? Are they just morbidly curious? (Friends and relations of mine who work in such fields, know that whatever we agree or disagree upon, I am not passing a judgment, but rather posing some earnest questions about the nature of these fields– if anything from a cultural, not moral, position of questioning.)

Whatever their motivations, there is frequently a common thread running through mainstream study, prevention, and treatment of mental illness. This might be hinted at by the very term ‘mental illness’. If it is an illness, it arises within a single person; it is an individual, not collective phenomenon. The same ‘illness’– schizophrenia, OCD, or manic depression, for instance– can present in many individuals, but it is nevertheless an affliction of individuals, not of society. As such, it must be studied, treated, and prevented at the level of the individual.

I recently discovered that there is a thing called dermatillomania— a ‘condition’, I suppose, also called Skin-Picking Disorder (SPD)**. People ‘afflicted’ with this condition pick at their skin: face, arms, legs, backs, scalp. Lips. Cuticles. It is cataloged in the DSM-V under Obsessive Compulsive Disorder (OCD). Those with a related condition, trichotillomania***, pull out their hair, strand by strand. Eyelashes. Eyebrows. These disorders are also considered to be Body-Focused Repetitive Behaviors (BFRBs), and is sometimes seen as a symptom or manifestation of Body Dysmorphic Disorder (BDD).

If you followed any of the above links, you may have been struck by a commonality among several of the treatments offered: Cognitive Behavioral Therapy (CBT), Habit-Reversal Training (HRT), and Mindfulness training and practices are by and large focused entirely on the individual. They encourage patients to think about what they can do to change their environments, their routines, themselves in order to change their ‘habits’. Habits which, while they may be harmful in various ways to that individual, are most like to disturb, embarrass or repulse others– that is, society.

I want to preface the rest of this by saying that I do not believe that we as individuals should not in some way be responsible for our own mental health, treatment or improvement of well-being. To the contrary, I think that such participation can be an empowering and transformative experience. However, we should note a few disturbing observations about this schema.

To begin with, such treatments begin from the presumption that illness like dermatillomania are problems of the individual: that is, they are disorders of single and separate minds. For instance, we might acknowledge that two different people who are each suffering from schizophrenia are experiencing a similar phenomenon, but we wouldn’t suggest that the experiences of those two individuals are in any way correlated– this person is not suffering from schizophrenia because of that person. They might be suffering from schizophrenia due to similar psychologies or circumstances, but this person’s illness is not the direct cause of that person’s illness. As such, being an illness of an individual person, it is up to that individual, or up to us on behalf of that individual, to take some measures to treat it. In any case, it’s the individual that requires treatment.

Now, in all fairness, many people who work on treatments for mental illness acknowledge that it is often the product of exterior factors or circumstances. A person close to you dying might cause severe depression, intimate partner violence might produce anxiety attacks, wartime violence and near-death experiences can cause PTSD. There is also a recognition that many circumstances cannot be changed: we can’t reverse the loss of a loved one, domestic violence can be difficult or impossible to escape, the violence of war may reside in the mind long after the war ends. Keeping this in mind, let’s look again at illnesses like schizophrenia, manic depression, OCD, borderline personality disorder.

Is it possible that the majority of responsibility for mental illness should rest on our sociocultural surroundings? What if, instead of beginning with the individual, we began with society as the place from where illness arises? What if we assumed that it is possible that society– the sociocultural structures by which we are all bound, though in different ways– needs to change in order to ‘cure’ mental illness, not the individual? I’m not suggesting that all mental illness could be solved merely by finding the most ideal sociocultural circumstances, but it isn’t a coincidence that some societies have higher rates of certain types of mental illness and suicide than others; varying societal factors must have a major impact on definition, prevention, and treatment of mental illness. I’m quite ignorant here, and many posts could be devoted solely to this topic, but among ‘modern’, ‘industrialized’, and ‘developed’ countries, there has come to be a very particular way of approaching mental illness, and that is by focusing on the level of the individual.

I want to suggest that this a symptom of the neoliberal worldview. Neoliberalism focuses almost entirely on the level of the individual, even when talking about phenomena like globalization and transnationalism. States, corporations, and organizations are compartmentalized and atomized into individual units: citizens, consumers, employees, members. As members of a neoliberal culture, we see ourselves as part of organizations and states, but at the same time as self-contained, discreet Selves, part of and yet apart. Those who feel their identity to be part of a common or collective consciousness, who ‘lose’ their individuality, must have joined some sort of cult.

Mental illness is often talked about in terms of individual shortcoming, weakness, or failure. Those who kill themselves or attempt to are considered selfish, short-sighted, making excuses and lacking accountability or self-control. Solutions for individuals include being mindful, focused more the present, utilizing coping skills, and so forth. All of these are individual behavior and attitude changes; society is not required to change its behaviors or attitudes. Basically, by trying harder, individuals can work towards greater self-reliance, independence, responsibility and strength. The idea is, after all, that healthy individuals do not or should not have need of a therapist and do not excessively burden those close to them with the side effects of their mental illness or mental health needs. Well, and the therapist exists for that very purpose: to unburden those around us, which contributes to the notion that mental illness is a private and shameful matter. Yet the person who kills themselves for the very purpose of permanently unburdening those around them (and they are likely thinking of the individuals whom they love, not their school or company or country) is considered selfish. We need to have personal accountability to ourselves and others regarding our mental well-being– society is not accountable to us. As such, society should be right to fear, berate and institutionalize the mentally ill individual. Music, TV shows and movies often reflect neoliberal ideals, perhaps unconsciously and unselfcritically.

Briefly returning to dermatillomania: the websites referenced above readily admit that researchers are unsure of the causes of dermatillomania. In spite of this, treatments are still focused upon the individual. Why should this be, if we can’t even be sure the individual is necessarily able to stop these behaviors?

I want us to thing about new and different ways of looking at the treatment of individuals with mental illness. Is it so outrageous to imagine accommodating certain aspects of mental illness? Or better yet, to change sociocultural structures that might be catalyzing mental illness in the first place?

More thoughts to come… In the meantime, what are yours?

**I am wary of any group (bureaucratic agencies, NGOs, academic disciplines, whoever) who are overly fond of acronyms. Fuck, acronyms are annoying.

***How interesting, the insertion of “non-cosmetic” into their definition.

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7 thoughts on “Crazy Is as Crazy Does

  1. It’s somewhat ironic that I came to this post, linked from your Facebook post, picking at my lips like I always do when I’m anxious. Like I’ve always done since as far back as I can remember – and I do remember my mother telling me to stop it when I was in elementary or middle school. I couldn’t tell you why I do it. I just know it happens when I’m anxious. In my case, dermatillomania is really just a symptom of a larger anxiety problem, and in this particular case, I’m well aware of what is setting it off — a health concern my partner is facing. (And to be clear, I wouldn’t really call this lip thing of mine a mental illness, as it doesn’t interfere with my life in any way other than making my lips a bit of a mess from time to time, but it’s not something I’ve ever thought to seek help for. Now, overall anxiety on the other hand…)

    So, that said, in this particular case, I believe both the anxiety and its symptom of dermatillomania is both a function of an external event (my partner’s medical problem) and an internal process (anxiety that especially flares up when I face something I can’t control). I’m not entirely sure where my excess of anxiety comes from in the first place, but I can tell you that my mother has perfected it. I don’t know if that makes it hereditary, or just means I was a good student.

    As far as how to cope – yes, I am seeing a counselor to manage anxiety, and my physician has also prescribed Xanax, which I amazingly never seem to have near me when I could actually use it. I’ve been given strategies like deep breathing (works well, if I can remember to do it), visualization (doesn’t work for me at all) and distraction (works ok while it lasts, but it isn’t so feasible when I get an anxiety attack at work). Over the years, I’ve come up with my own coping strategies like knitting up a storm (at least I get a scarf to show for it), staying up late and researching to find a solution for whatever problem I have (I do get more informed, but it never puts me at ease) and, let’s be honest, I’ve tried self-medicating. All of these things are individual strategies.

    I don’t honestly know how society could change to make my own problem with anxiety better. I don’t see a big-picture societal fix. However, I do think that there are things that people close to me could do that would help. For instance, in this particular situation I’m in tonight, I would love it so much if my partner and I could talk about what’s going on with her. But while it makes me feel better to talk about a scary thing, it makes her feel worse, and since it’s her battle, well… here I am, up late, trying to research and find that elusive answer that will solve everything.

    And all this said, I honestly don’t know if I’ve answered any of your questions here :-)

    I do think that a part of our problem as a society, in regards to mental health, is that we’ve given no real role to people with mental illness. We’re not comfortable with it, so we push them to the margins, lock them up in medical wards and try hard not to notice. In other times and places, people these same people may have been valued for having different perspectives and different ways of experiencing the world around us. And I can’t help but think that being valued like that must make a world of difference as to how you see yourself, and how well you cope with your own anxiety, schizophrenia or whatever it is you have.

    Liked by 1 person

    • It’s interesting that you point out how your mother would tell you to stop picking your lips. My parents did, as well– and teachers, and coaches, and aunts and uncles and so forth. Oddly enough, it never helped me stop. People telling someone to stop picking their lips/eyebrows/scalp/cuticles/arms/etc. is essentially telling them to stop the underlying cause– anxiety, perhaps, or boredom or fear. “Stop feeling anxious.” Well then, why didn’t I think of that??

      So it wasn’t just your mother, and it was just people in my life; these various people in the lives of those with dermotillomania may offer different solutions to the problem (“Just stop”, “visualize”, “yoga”, “deep breathing”, “count backwards from 100”), yet these appear to be treating a symptom, rather than the root cause? It’s unlikely that all people with dermotillomania have the exact same root cause. I’m not positing that a single solution will resolve dermotillomania for everyone. Rather, I’m wondering what it is that links your mother with my parents and others who throw up these ‘solutions’, why do they think it is something that should be resolved solely on the part of the person experiencing dermotillomania?

      I travelled this past summer for about a month. I had been worried while I was planning the trip, about various things: what if I missed a flight, or train or bus? What if I lost my passport? What if someone stole my luggage, as has happened in the past? What if I get lost in a place I don’t know? What if…?

      But a remarkable thing happened. During that month, my lips had a chance to heal; by the end of the month, they looked, well…normal. What they’re ‘supposed’ to look like, perhaps. All the anxieties I’d had about travelling never came to fruition. That isn’t to say that I did NOT miss my train, or lose things, or get lost. All of those things happened, and yet, I had little or no anxiety about it.

      What was different about that month, compared to every other month? Would there be any way of replicating the circumstances which resolved my anxiety in my everyday life?

      This is what I’m hinting at, with a societal solution. Perhaps that thing which motivates your mother or my parents to pinpoint the locus of the problem on us, the individual, which only increases our (or at least my) anxiety, is in some way related to this other thing which resolved my anxiety during that month last summer? You said it yourself, that you have picked your lips, all your life, and that none of the quick fixes offered up has ever been a lasting solution; perhaps we need to try something different, and maybe potential directions actually lie outside of ourselves?

      Thanks so much for sharing your insights, experiences, and ideas! Exploring these things with others, especially those who are having similar experiences, is really helpful to me. Best wishes, and I hope that your partner’s health concern can be resolved.

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  2. Also, not all disorders are created equal: schizophrenia and bi-polar disorders, for example, have strong genetic foundations as well as major bio-chemical causes. And, in terms of epigenetics, your DNA can be “methylized” by a trauma in your own life and you can then pass on this mutated DNA to your offspring.

    Why do we not look at disorders from a societal viewpoint? Because there are literally millions of individuals with disorders living productive lives on their own terms and managing that disorder in a way that works for them….fuck what society thinks. That is what a good therapist does – they don’t “unburden the rest of us” of that person.

    Liked by 1 person

    • First of all: I wanna talk to you more about epigenetics! Especially related to mental health. Maybe I can pick your brain, and/or you could suggest some reading?

      I do fuck what society thinks, but I prefer to fuck with what society thinks. ;)

      How do we account for the fact that rates of different mental ‘illnesses’ and their symptoms vary from country to country? For example, suicide in Greenland is far and away the highest in the world– very likely influenced by insomnia produced by drastic reductions or increases in hours of sunlight during the year, and a 10%+ unemployment rate. As another example, per capita alcohol consumption is far greater in Russia compared to the U.S., and yet rates of heavy episodic drinking are the same in each place. Also, those with high income are twice as likely as those with low income to drink heavily. It seems likely that there are sociocultural factors in play here– including in terms of labeling and treating mental illness. Does the U.S. have the highest rates of mental illness in actuality, or are we just better at counting it than other countries? Or are we mislabeling or over-diagnosing, relative to other places? If mental illness were a matter of individual pathology, it seems likely that rates would be more evenly distributed across region, country and class.

      For me, at least, I really can’t say “fuck what society thinks”. If I did that, then I would probably be short several (more) friends, might not have been accepted to graduate school, etc. If it’s a matter of ‘hate the game, not the player’, then why not try changing the game?

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  3. I worked at a children’s museum for eight years. Each year we had a night where we kept the museum open late specifically for families affected by autism. We shut off the florescent lights, put up visual barriers, removed any loud exhibits, and put out a lot of sensory activities. We made the accommodations for them. And when they played, they smiled like any other kids.

    Part of me wishes that they could have that experience every day of the year. But most kids like banging on drums or blaring a fire engine siren. Parents want brighter lighting and fewer barriers for seeing around the building. The unfortunate reality is that we could not cater to our largest audience and still be friendly to the most extreme cases of autism. We were able to make some adjustments for less extreme cases, such as choosing color schemes that were less likely to cause visual overstimulation. But if there is one thing we could do, it was question how you treat someone who behaves oddly.

    Most people respond poorly when they meet someone who compulsively self-stims (flaps hands, makes a noise, blinks repetitively, etc.). They do exactly what was mentioned above: They tell the person to stop. They try to control the behavior.

    So when I had interactions with kids that would rock back and forth or wring their hands unendingly I tried something else. I just pretended like what they were doing was normal and treated them like human beings. This is only anecdotal, but I thought it worked incredibly well. Children with visual displays like that wouldn’t usually speak to me, but they would still communicate. I don’t know how to describe it in writing, but a lot can be expressed with a grunt or a point. “Hand me that block.” “I’m going to do my own thing with the dominoes.” “Make another bubble.” Just because they aren’t speaking, doesn’t mean they aren’t saying anything.

    The notion that autism is a disorder bothers me. Autism is just another way of being human. Sometimes social cues are hard for me to pick up on. I have a disposition towards compulsive behavior. I’m on the spectrum, though I would qualify as “high-functioning.” When I speak with someone else on the spectrum it is hard to not relate to them.

    Before going on, I want to acknowledge that some people, specifically those who have close family members that struggle with sever cases of autism, strongly disagree and think that my perspective is a barrier to finding a cure. Each case needs to be treated uniquely. There are times where controlling behaviors is practical and needed. But I think that understanding and acceptance are helpful at any level.

    There are two other things I would like to mention from above. First, I am interested in the notion that neoliberalism has an impact on how we view mental health. Honestly, I am not well enough versed on the subject to make an intelligent statement. I hope you will write a post about neoliberalism and its history. I would like to hear your take on it.

    Second, your story about traveling last summer…I’m not sure what I’m trying to say about it, but I liked it.

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    • Thank you for sharing your experience at the children’s museum– I feel like it is a great example of how things could be done differently. Even if it was just one day a year, that one day is enough to get us thinking in a different direction, to show that there are possibilities… Sometimes by myself, solutions feel distant and situations feel immediate and overwhelming– I don’t have the answers, obviously, so, what can I do? But stories like yours demonstrate to me that there are all sorts of people out there with different ways of thinking and doing. That’s inspiring. ^_^

      “Each case needs to be treated uniquely.” I totally agree with you here. When I say that we need to consider society’s “disorders” as much as the individual’s, I do not mean that we should throw out the cause of the individual, altogether. Surely there is a way to do both? To approach the individual as a cultural being, instead of treating them like they exist in a vacuum? Maybe your museum experience could stand as an illustration of this?

      “The notion that autism is a disorder bothers me.” Dis + order… Order disrupted, the opposite of order. It is such a negative way of talking about how another human being functions, behaves, feels, isn’t it? I also have a problem with this. Once the label of disorder, pathology or syndrome is applied to a person, the way they are perceived and treated changes entirely. Sometimes this is helpful, but often this is extremely stigmatizing. I have thoughts about how empathy and individualism play into this, but they’re sort of unformed. I’d love to hear more of what you have to say about this.

      As for neoliberalism, I am trying to get my head around it still– if I come up with something coherent, I’ll definitely post about it!

      Thank you so much for your comment. ^_^

      Like

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