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The Problem With Policing Someone Else’s Mental Health

In “Head Case,” an episode of the TV show “The Commish,” Michael Chiklis’ character uncovers a plot at a mental hospital to frame an innocent man for the death of a patient. He is kidnapped, locked in the hospital, and drugged – I can’t remember how he ended up getting out of this particular dilemma, but I do remember the numerous scenes where he tried to convince the staff of the hospital that he was sane and being held against his will. At that point, I had narrowed down my career choices to Neurosurgeon, Actor, or Therapist, and it was disturbing to me to watch Our Hero so easily thwarted by being designated as mentally ill.

It isn’t hard to browse a catalog of mental disorders and see things you identify with. Undergraduate Psychology classes are filled with people who are drunk on the power of self-diagnosis and who are more than happy to tell you what is wrong with you. Flipping through one of my Psychiatric Desk References, I see that I have symptoms of Narcissistic Personality Disorder (“Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).”), Avoidant Personality Disorder (“Self-critical about their problems relating to others”), and Histrionic Personality Disorder (“Excessive sensitivity to criticism or disapproval.”)

When you have just enough theory to be dangerous, you tend to err on the side of an affirmative (amateur) diagnosis. You assume that even if you don’t meet the threshold (5 or more of a cluster of symptoms for most disorders) you are probably in danger of developing these disorders in the future.

Mental Health is like other types of health: a single symptom, in itself, means nothing. Shortness of breath is one of the symptoms of a respiratory disorder, but if you show up at my door wearing running shoes and sweat bands and you’re out of breath, I won’t assume you’re teetering on the brink of emphysema. Positive mental responses are not always the “healthy” response to stimuli – being emotionally buoyant and sunny in the face of desperate circumstances is a bigger red flag than crying or becoming emotional. Speculating about “defense mechanisms” isn’t helpful, and it puts the other person in a situation where everything they say is assumed to be an attempt to evade scrutiny.

Mental Health treatments are ultimately about a person’s ability to function. Do I have the symptoms of various personality disorders? Yes. Do they effect my ability to work, to earn a living, to form friendships and relationships? No. If you notice, every single one of those symptoms has an opposite extreme that would be equally problematic. Have you ever met a person who isn’t self-critical about their problems with others? ASSHOLES, every single one.

Trying to pick apart these symptoms outside of a larger context creates a situation where sanity is viewed as the temporary state that most people reside in, and turns everyone else into “the other.” Neurotypical functioning is just that: typical. It is what most people are, most of the time. If you fall outside the normative range of any one trait, that simply indicates that you aren’t typical. The problem arises when other people make value judgements, assuming that the goal is to be completely neurotypical, to calibrate your emotions to the mean, and have the rest of your life play out in placid serenity.

Marginalized people are particularly susceptible to having their emotions pathologized, partly because their experiences aren’t typical. When young queers are experiencing depression related to the stigma of their sexuality, people like Tony Perkins swoop in to point the blame at their sexuality, and not the stigma that they themselves are perpetrating. Women, queers, the disabled, people of color, political dissidents, atheists; all of these groups have a history of being labeled “insane” to control them. In the movie Changeling, Angelina Jolie plays a woman who has a boy returned to her who isn’t her missing son. It was based on a real case where a woman was committed to a mental institution for questioning the police. After being released, Christine Collins was awarded 10,800$ by the court, which the Police Chief that had her committed refused to pay. This is not history, this is topical. We continue to live in a society where, once you have been pushed over some arbitrary standard of insanity, you lose all control over your own destiny.

For marginalized people, it is in our best interest to defend ourselves from the blunt, unstudied ‘splaining of people for whom Psychology is a weapon. You say we’re irrational, we’re unhealthy, we’re sick, we’re hysterical. I, for one, would like a second opinion.

14 Comments

  1. Farore wrote:

    One of the most disturbing things I find, in this diagnosophilia attitude you speak of, is the ‘you can’t prove you’re not crazy’ dilemma. A person says ‘you have x mental disorder’. From that point on, the person is convinced, and your every action, protest, comment or rebuttal is taken as further evidence of their opinion. The old ‘crazy people don’t know they’re crazy’ trope makes it so that by even suggesting that you’re mentally healthy, you’re proving that you’re not. It’s incredibly irritating.

    Note: I am only using the term ‘crazy’ as it relates to the common sayings/”wisdom”, it is not a term I would ever personally use to refer to people with mental illness (except, perhaps, occasionally, in a fit of low self-esteem, myself).

    Friday, October 15, 2010 at 11:45 pm | Permalink
  2. k not K wrote:

    Though I’ve seen a super-helpful therapist in the past, and I have a lot of respect for the discipline of psychology, we really shouldn’t forget the awful things psychology’s been used to do.

    Freud convinced himself that female patients who claimed to have been abused by their parents were just having Oedipal fantasies. Generations later, overzealous psychologists who were just starting to realize the extent of child abuse in society used “recovered memory therapy” to convince female patients they’d been abused, and were just repressing the whole thing. Both were just a case of someone with a hammer assuming every patient was a nail.

    Psychology isn’t anywhere near finished figuring out how our brains work, or what is really normal or abnormal. I agree that all of us, especially members of marginalized demographics, need to be careful picking our therapists and selective about what parts of our lives get pathologized in the process.

    Saturday, October 16, 2010 at 9:09 am | Permalink
  3. Anica Lewis wrote:

    It’s interesting, too, what respected professionals in the field can accomplish by declaring that a person ISN’T mentally ill. For instance, Freud’s letter on homosexuality ( http://wthrockmorton.com/2007/03/17/freud-on-homosexuality-letter-to-a-mother/ ), which – despite problematic statements about arrested sexual development and so on – makes the emphatic point that homosexuality is not a disease or a vice, and that the woman should look to helping her son, if he has emotional or social problems, within the scope of who he is. I’d love to know what the woman who got this letter made of it, and hope it helped her relationship with her son.

    (I’m sure many people have seen this letter and have more insight than I do. I just think of it because I see writing those words in 1935 as one of the most impressive things Freud ever did. He was wrong about a lot, but not everything.)

    Saturday, October 16, 2010 at 11:41 am | Permalink
  4. Sooz wrote:

    GEE I WONDER WHETHER THIS IS IN RESPONSE TO SOMETHING -_^

    While knowledge of diagnostic criteria can be helpful if one suspects a friend or relative of having some brand of crazy, for the sake of decent interaction and understanding, it is irresponsible at best to try to ACTUALLY diagnose someone unless you are 1) a practising therapist and 2) familiar with the subject in a (clinically) intimate way.

    You’ll notice people who actually know their headshrinking shit never EVER try to offer any sort of real diagnosis on someone they haven’t actually met and interacted with.

    (And of course there’s also the detail that mental disorders are bad because they’re a normal function of human thinking, only exaggerated to the point that they fuck with one’s life. Hence why I am [OFFICIALLY! :O ] diagnosed with Obsessive-Compulsive Personality complicated by Dysthymia; the former is not normally a problem, even though it’s got symptoms of an actual disorder. Not extreme enough for disorder status.)

    Holy shit I have written a novel here.

    Saturday, October 16, 2010 at 12:09 pm | Permalink
  5. Samantha B. wrote:

    I dunno, the notion of functionality surrounding mental illness kinda squicks me out a little. Obviously, we all want to maximize our personal contentment, and that’s a pretty good goal. But there’s a hint of capitalist callousness to the word “function,” probably just a matter of semantics here but, you know, is very, very often not. My grandmother is bipolar schizoeffective, and she’s never going to “function” the way a lot of American society wants her to, but she’s a pretty fucking valuable human being to me. With a fuckload of insight. And I think there’s always a value to the skew, the shift in perspective that the mentally ill offer. To anyone who takes the time to listen- which means not a lot of people, at least in the US.

    And there’s abundant evidence to the effect that US-style medicalization of mental illness actually makes for lower quality of life for the mentally ill than societies with a different model for integration of the mentally ill. I’m totally dependent on my bipolar drugs so I’m not hearing, you know, torturous voices, contemplating suicide, and other joys. But I refuse, on the other hand, that there’s no value to my illness, that it marks me as lesser. I guess I’m very influenced by Darwinesque thinking, and I’m pretty firmly convinced variegation ALWAYS has to have value. And I think anyone entering the mental health profession really fucking ought to believe the same. And instead the opposite line of thought is, in my experience, by far, far the most prevalent in Americaland, that the goal should always be to shove us back into culturally normative boxes. Dude Foucault had some fucking points!

    Saturday, October 16, 2010 at 3:27 pm | Permalink
  6. AngryPunkPixie wrote:

    i am autistic and i hate it when neurotypical people catagorize autism as a mental disability or illness, it just makes us look like we are not capable of being ratinal or reasonable, or even able to look after ourselves.

    Saturday, October 16, 2010 at 5:24 pm | Permalink
  7. Emily wrote:

    “It is not loving to encourage someone to indulge in such activities, no matter how much sensual pleasure they may derive from them.”

    Yes, the only reason gay people are gay is because of all the sensual pleasure they get from their hot, gay sex. It has nothing to do with butterflies at having a crush, contentedness when cuddling in front of a movie on a Sunday evening, or dreaming of saying “I do” to the person you love. Nope, it’s all about the sensual pleasure.

    Sunday, October 17, 2010 at 5:54 pm | Permalink
  8. Betina wrote:

    I’d tread somewhat carefully here. One of the things that most annoyed me while psychotic was having my suffering denied to me by people who were trying to tell me that it was actually a good thing and that I was just a special little snowflake and I should be positive or something.

    It didn’t help. I do think the categorisation of pathologies is somewhat misleading and seems a bit arbitrary to me, but those (in my experience) who were most understanding, most helpful and least judgmental were psychologists. I *did* want to be treated, and I’m not comfortable with people telling me I shouldn’t have been because somehow admitting to a pathology (or to the suffering) is a damning thing. It saved my life.

    Sunday, October 17, 2010 at 8:18 pm | Permalink
  9. Samantha B. wrote:

    Betina, I totally agree that it’s kind of a fine line to tread. Really it’s about basic respect, which shouldn’t be that elusive but consistently seems to be. It’s not respectful to negate other people’s suffering, but it’s not respectful to treat them like they’re fucking less than you because they have a diagnosis. Which is what I myself have experienced from many doctors, although I’ve had/have fantastic doctors, too. I think treatment saved my life too, but the idea of “treatment” is different than a “cure,” you know? It’s not something you eradicate from your life experience for me- it’s something I try to integrate.

    And there is abundant research that indicates that the mentally ill in the US do poorer than in countries where they don’t stop and end at a medicalized model of integration. I’m the last person to say that means treatment isn’t valuable, but I do think that it’s incredibly important to acknowledge that it’s fundamentally inadequate in of itself. There are people that treatment is never going to “cure,” people like my cousin who only respond so much to the available drugs. And if “curing” the mentally ill is the only goal on the table, then those people have to be seen as failures. Which upsets the hell out of me because I care about a bunch of those people, and they make my life a lot better just the way they are.

    Monday, October 18, 2010 at 12:46 pm | Permalink
  10. I want to also be very cautious here. I am autistic and being an autistic woman is something that is very important to me. I know I am different. I know I have needs that are different. I know that I have difficulties that other people don’t have. I feel different.

    My label, my ability to say “I am autistic” is a huge base of power and pride for me. It allows me to feel belonging for who and what I am. It allows me to own my needs, my differences. It allows me to feel secure in who I am, to not have to compare myself always to my neurotypical peers.

    Knowing that I am autistic is wonderful for me. Yes, in a way I am just “not typical” and yes, I am still human. Yes, I am just a variation of normal. But still…

    … I am autistic and that means something.

    These days, because my outward symptomology is either muted or unexpected, I am very often told that I am not autistic or that, if I am, I’m “very high functioning” and thus I really am normal and not truly autistic. It erases my needs. It erases my difference which I am proud of. It erases who I am. It’s not okay.

    Monday, October 18, 2010 at 3:16 pm | Permalink
  11. bellacoker wrote:

    I am reminded of this experiment: http://en.wikipedia.org/wiki/Rosenhan_experiment

    Monday, October 18, 2010 at 6:20 pm | Permalink
  12. One of the most valuable things one of my therapists told me while I was seeking treatment for an Eating Disorder and Depression is that “mental health” isn’t the absence of all the things that people consider detrimental (depression, mania, etc…), because EVERYONE has those things, it’s whether they impact your ability to live your life.

    Thursday, October 21, 2010 at 3:44 pm | Permalink
  13. Laura wrote:

    I am so, so wary of conversations like this, as a person with mental illnesses.

    It’s a catch-22, for me; people are happy to measure my “productivity” and “functionality” by neurotypical, capitalist standards and conclude that I am totes crazy when I don’t seek treatment, when I’m suicidal or can’t leave the house due to overwhelming fear – people are more than happy to conclude that I am a drain on society, on my community, that I can’t reason and that my opinions are thus invalid when I decide to try to manage my own illness. But when I do seek treatment, I’m just a gullible, stupid tool of the institutions who should just drink some tea and learn to celebrate my uniqueness because psychiatrists are the same people who pathologize queerness and anti-authoritarianism, etc (note: I am a queer anarchist) and have an extensive history of racism and transphobia which I am contributing to by playing into their hands. Great. Whatever. What is the perfect anti-oppression thing I should do, as a mentally ill person? Off myself?

    Sunday, October 24, 2010 at 10:17 am | Permalink
  14. Dawn. wrote:

    It’s a catch-22, for me; people are happy to measure my “productivity” and “functionality” by neurotypical, capitalist standards and conclude that I am totes crazy when I don’t seek treatment, when I’m suicidal or can’t leave the house due to overwhelming fear – people are more than happy to conclude that I am a drain on society, on my community, that I can’t reason and that my opinions are thus invalid when I decide to try to manage my own illness. But when I do seek treatment, I’m just a gullible, stupid tool of the institutions who should just drink some tea and learn to celebrate my uniqueness because psychiatrists are the same people who pathologize queerness and anti-authoritarianism, etc (note: I am a queer anarchist) and have an extensive history of racism and transphobia which I am contributing to by playing into their hands. Great. Whatever. What is the perfect anti-oppression thing I should do, as a mentally ill person? Off myself?

    That’s pretty much what I was going to say, so thank you Laura for saying it better.

    Thursday, October 28, 2010 at 3:05 am | Permalink