Asakiyume had a post about romanticism and mental illness with some good discussion in comments.

I wrote, "I have mixed feelings about that one. Yes, it's obnoxious to write stories in which mental illness is actually nothing but magical specialness, whether the magic part is literal or metaphorical.

On the other hand, the flip side of the "mentally ill people are better and more special than the rest of us tools of the system" myth is the "mentally ill people are doomed to a miserable, squalid existence filled with nothing ever but loneliness and pain" myth.

I think there's room for realistic depictions of mental illness in which the intent is to de-glamorize, focus on the pain, and have the hope be in the slow, difficult work of healing. But maybe there's also room for non-realistic in which people live with mental illnesses and have those be part of the fabric of their lives as they have romanticised adventures and pursue villains and do magic and get the girl. Why should the non-mentally ill get all the escapist literature?

The key, I think, is not to take some painful and unpleasant mental illness and pretend that the illness itself is not painful and not unpleasant, and just looks that way because the mundane world doesn't understand how magical and awesome it really is. That's not cool. But I'd love to see, say, a paranormal romance with a heroine in therapy for social anxiety torn between a bipolar vampire and a werewolf with Asperger's.

Why not? Very few of us are out on the streets murdering people because the voices in our head told us to. Most of us are living our lives - with struggle and pain, but who doesn't have that?"

I am interested, too, in stories in which mental illnesses and non-neurotypical states are dealt with not unrealistically by accident, but with extrapolation and deliberate fantasy applied: Walter Jon Williams' breathtaking space opera Aristoi ($4.99 on Kindle; also has excellent martial arts), in which people deliberately induce multiple personalities in order access the full richness of their psyches; the later books of Scott Westerfeld's Uglies, in which the characters take on various cognitive/neurological templates, raising the question of whether identity is something separate from brain chemistry. Very similar questions come up in Westerfeld's novel Peeps, in which vampirism-causing parasites create OCD-like irresistible compulsions and aversions. And, of course, the many, many, many magical or science fictional versions of brainwashing and de-programming, from Cyteen to The Avengers to Mockingjay.

There is sometimes a tendency to see any non-realistic treatment of serious issues as inherently trivializing or even insulting. But I think it depends on the individual work, as well as the judgment of the individual reader. I would like to see more extrapolative works dealing with the subject, as well as more stories in which mental illness or non-neurotypicality is part of a character's character, not the subject of the story.

I would like to see fewer soft-focus, romanticized depictions of beautiful fragile mad girls.

What do you think? Good examples? Bad examples? Things you'd like to see more of? Things you'd like to see less of?
rachelmanija: (FMA: Ed among the ignorant)
( Jun. 9th, 2010 01:04 pm)
I was trying to figure out whether her recent series was two books or three, so I got on her website and ended up finding this recent blog post which made me go AUGH.

Now, I may be misinterpreting it. I hope that what Hobb meant was something like, "Don't mistake normal personality quirks and normal ups and downs for mental illnesses, and attempt to treat them with inappropriate medication. Mental illness is extremely serious business which can ruin your life and kill you if you don't manage it properly, a process which may very well include taking medication, possibly for your entire life. (But it's possible to have an awesome life anyway, just as many diabetics and others with chronic health conditions do.) That is TOTALLY DIFFERENT from being a teeny bit spacy and eccentric. Not the same thing! Don't confuse them!"

...I did not actually read it that way. The way it came across to me was this:

- People with ADHD and ADD do not have real illnesses, and are using medications to make themselves super-attentive, so they never learn to function without them (which they totally could if they applied normal discipline, like her kids do.)

- This is an unfair advantage over people who don't take brain-boosting meds.

- We misinterpret the "artistic temperament" as mental illness and want to medicate artists out of existence.

- If a person who is not actually mentally ill takes drugs intended to treat mental illness, they will obtain an altered personality.

(Note: As opposed to a lot of weird side effects. As far as I'm aware, this is not actually how it works. For instance, I am not bipolar, and so I would guess that if I took a mood stabilizer, it wouldn't make me a less moody version of myself, but would probably only make me feel ill and strange. Is that correct?)

- People who are totally normal and happy are misdiagnosed as mentally ill all the time, solely on the basis of having an artistic temperament or being delightfully quirky.

(Note: I'm not saying no one's ever misdiagnosed. I'm just saying that when it does happen, it's unlikely to have anything to do with artistic temperament and forgetting to drink a mug of coffee you poured.)

Some of us are just not standard issue people. I rather suspect that all of us are not standard issue people but some are better at pretending. In my family, both nuclear and extended, I can trace a genetic heritage that means that every one of us could probably be diagnosed with one mental disorder or another. Yet, for the most part, we are successful people with lives we enjoy (even if others think our lives are a bit strange.)

NO SHIT. If you're happy and successful and leading a life you're pleased with, that means YOU DON'T SUFFER FROM A SERIOUS UNTREATED MENTAL ILLNESS.

This is what it feels like to have a serious untreated mental illness. It's artistic and fun! Thank heavens no one tried to medicate all that artsy goodness out of me!
From that book that I finally got around to reading for research purposes (research question: "Why is this book such a huge bestseller?") and which everyone but me loves to bits, Elizabeth Gilbert's Eat Pray Love. Context: During a harrowing divorce, Gilbert becomes depressed. She tries endless "natural remedies," but seeks the care of a psychiatrist after she attempts suicide.

I do know these drugs made my misery feel less catastrophic. So I'm grateful for that. But I'm still deeply ambivalent about mood-altering medication. I'm awed by their power, but concerned by their prevalence. I think they need to be prescribed and used with much more restraint in this country, and never without the parallel treatment of psychological counseling. Medicating the symptom of any illness without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better. Those pills might have saved my life, but they did so only in conjunction with about twenty other efforts I was making simultaneously during the same period to rescue myself, and I hope to never take such drugs again.

There are so many selfish, condescending, and hare-brained statements in that one little paragraph that I need to pull it apart to address each one.

But I'm still deeply ambivalent about mood-altering medication. I'm awed by their power, but concerned by their prevalence. I think they need to be prescribed and used with much more restraint in this country

In the year 2020, approximately 1.53 million people will die from suicide based on current trends and according to WHO estimates. Ten to 20 times more people will attempt suicide worldwide (2). This represents on average one death every 20 seconds and one attempt every 1-2 seconds.

It is, of course, possible for a medication to be over-prescribed in some cases and under-prescribed in others. But considering that, according to WHO, "Suicide is among the 10 leading causes of death for all ages in most of the countries for which information is available. In some countries, it is among the top three causes of death for people aged 15-34 years," I'm going to say that under-prescription is the bigger problem-- a problem which attitudes like Gilbert's foster.

I think they need to be prescribed and used with much more restraint in this country

How callous, priveleged, arrogant, selfish, and smug can you get?! So meds are okay for her, because she had a real problem and didn't take them until she was at the point of suicide and has moral qualms about their use, but all those other ignorant peons who gobble them like candy need to have their access restricted?!

That is one of the most despicable statements and sentiments I've come across in quite some time.

and never without the parallel treatment of psychological counseling.

I agree with that, actually.

ETA: Oops, missed the "never;" I think counseling should always be offered, but should not be mandatory. If nothing else, the experience of having a mental illness for a long period of time will usually give you dysfunctional thinking patterns and ways of relating to people that counseling will help address. But if your problem is being completely addressed by meds and you're doing fine, no, you probably don't need counseling if you don't want it.

Medicating the symptom of any illness without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better.

1. In many cases of mental illness, the "root cause" is either known as a biological and/or genetic problem and so doesn't really need to be "explored" in the sense of discovering its root cause (like schizophrenia or bipolar disorder) or the patient is so ill that she will not benefit from such exploration until medication has kicked her into a higher-functioning mode.

Also, some forms of talk therapy are specifically about the present and not root causes -- and those forms are statistically more effective for some disorders than classic "root cause" therapy. (ie, cognitive-behavioral therapy vs. psychoanalysis for depression.)

2. What a stupid statement!

"Medicating the symptom of a broken leg by setting it without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better."

"Medicating the symptom of the bubonic plague with antibiotics without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better."

"Medicating the symptom of a cataract with surgery without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better."

3. Gilbert's Asia-philia blinds her to the reality of actual Asian medicine, which is not necessarily as holistic as she thinks. She should read Atul Gawande's Better for an excellent portrayal of actual doctors in India doing brilliant work under extremely difficult conditions.

Those pills might have saved my life, but they did so only in conjunction with about twenty other efforts I was making simultaneously during the same period to rescue myself,

I am absolutely not against doing whatever might help. All the same, the plural of anecdote is not data.

and I hope to never take such drugs again.

Well, I hope you DO!

I can't believe I'm wishing such ill on anyone, whatever sort of scumbag they are... but this book was a huge bestseller, people are influenced by what they read, and so Gilbert's screed may be indirectly responsible for someone committing suicide because they were trying to make sure they waited to use them as long as she did -- and she waited till it was down to her, a knife, and a worried friend. What if some reader doesn't have a worried friend?

What a loathesome and damaging thing to write.

Here is a three-part essay on my experience with depression.

Here is a three-part essay on my experience with post-traumatic stress disorder.
rachelmanija: (Default)
( Feb. 5th, 2005 10:46 pm)
My hateful landlord telephoned me (I'm at my parents' place) to leave a message upbraiding me for my hair blocking the pipes. He claims I'm not using the hair trap. I am using the hair trap. It's not my fault that I have very fine hair (I mean texturally) and plenty of it, and that THE PIPES ARE OLDER THAN THE SABRE-TOOTH FOSSILS UNDER LA BREA!

Also, I not only got turned down for a blurb, I got refused permission to quote an email in the memoir. This was surprising as it reflected very positively on the person who wrote it, but he's a well-known figure so I can sort of see why his manager doesn't want it to get out that he was communicating with his fans... you know, that sentence made more sense when I first thought it.

It occurs to me that the hallmark of not being depressed is the ability to go from "GOD DAMN IT!" to "Oh well" without the intervening step of "This proves that my life sucks and everyone hates me and I deserve it because I suck and my book will fail and this will prove to everyone what a failure I am which is why no one has ever loved me and no one ever will..." Etc.

I really used to think that way. I remember it vividly. Except that I try not to remember it too vividly, because I'm not one hundred percent certain that I won't get sucked back in if I think about it too much, or without putting up a mental plexiglass shield between that time, which lasted about ten years if you don't count my childhood.

I remember one time when I hated myself so much that I punched myself in the face-- a couple times, I think-- then ripped up my cheek with my nails. And when I say punched, I mean hard: I looked much worse after that than I did after a very strong guy at my dojo accidentally clocked me in a sparring match.

It's very odd to remember being crazy. I know that's not a polite way to put it, but I think it's important to remember that when I say "depressed," I don't mean grieving or sad or upset or any other normal emotion. I mean out of my fucking mind.

Well, I was there, and then I came back. So it can be done.

But the trouble with mental illness is that by definition, it prevents you from thinking clearly or correctly. I remember-- God, I remember-- people saying I wasn't thinking realistically, that I wasn't worthless or a failure or doomed to be alone forever or doomed to feel the way I felt forever-- but I just thought, "Easy for them to say. I know what's true."

And now my biggest fear-- OK, maybe my fourth biggest fear, after 1) being paralyzed or blinded or acquiring some really serious disability, 2) killing someone by accident, like in a car accident that was my fault, 3) failing to do soemthing which, had I but known, would have saved someone's life-- is dying young. Ironic, huh? I spent all those years wishing I was dead, and now I'm like Roy Batty, demanding more life because I love it so much.

Now I love it so much.

In case that wasn't enough rambling for one night, here's a post I wrote last year, before most of you were reading this journal, which has more details on the subject of how I got from there to here: http://www.livejournal.com/users/rachelmanija/10020.html
Obviously. It doesn't have the little padlock on it. The thing is, I thought of friends-locking it, because eventually I'll have a website and then I'll link this journal to it and then if I don't lock it, anyone in the world who's curious enough to rummage through my memory files, like my parents and the dojo folk and who knows who, will know a few things about me that they didn't know before. But I guess that's the point.

I'm about to tell you some semi-secrets. But this post isn't really about me. This post probably isn't for most of you who read it, either. If it isn't, you'll know soon enough. If it is, I hope you keep reading.

Through other online connections, I knew a writer named Katherine Lawrence. She had a livejournal under the name of [livejournal.com profile] kathlaw. I wasn't a friend of hers-- I didn't know her at all, really-- but I'd see her posts now and then, and some people I am friends with were friends with her.

She committed suicide a few days ago. Details can be found at [livejournal.com profile] windrose's journal. I don't know why, exactly. I've heard that she was haunted by something in her past, her childhood, I guess. I assume she was depressed. I don't know if she was never treated, or if she was and it didn't take.

I didn't know her, and yet I instantly put myself in her shoes. That could have been me. Those friends of hers feeling so guilty, wishing they'd emailed her just to check in, wishing they'd picked up better on subtle hints she might or might not have dropped-- those could have been my friends.

Not now. Now I'm fine. But not so long ago.

Advice is cheap. It's easy to find people who'll say, "Hang on. Suicide is not the answer." Why should it make a difference coming from me, on this journal that only a handful of people read?

I guess because I'm one of those net junkies and nosy people who paws through other people's archives if I like their writing, and does google searches for posts by people whose novels I liked. So maybe some day someone who wants to read more of what I wrote will come upon this, and maybe they'll be the person I wrote it for. So here goes. Here's my story.

I'm copying a lot of this from a post I made to someone else's journal recently, because I'm lazy and because writing it combined with Kath's suicide combined with doing the final polish on the memoir which details everything that still haunted me twenty years later is what brought me to writing this now.

I had a luridly wretched childhood. My family was beyond dysfunctional, I was a natural-born skeptic growing up on an ashram devoted to worshiping a guru 24-7, I was the only foreign child in a sort of Indian redneck town, the school was Dickens-level abusive, the other kids bullied me, etc. Then I came back to America when I was twelve and was extremely depressed for the next fourteen years.

Although I don't think I was ever officially diagnosed, I also fit the DSM IV criteria for post-traumatic stress disorder, the type where you hit the floor if a car backfires and if you're out for a business breakfast and a waitress tries to reach over your shoulder with a cup of coffee, you knock it out of her hand.

Keeping in mind that I had about the best possible response to treatment and not everyone does, and also that everyone has somewhat different problems and will respond best to different treatments, this not being rocket science, here's how I turned into the rather happy (honest!) person I am today.

Every few years I'd have one session with a mental health professional, then flee because I thought they were smarmy jerks and they'd want me to take medication and that would destroy my creativity and turn me into a zombie. (In retrospect, I think they _were_ smarmy jerks.)

Then (long story short) about six years ago I went to the most respectable medical center in LA, and spent six months taking Prozac and meeting with a cognitive therapist who was not smarmy. Actually, she was kind of confrontational, which appealed to me. We didn't talk much about my childhood, but about how to fix my problems in the here-and-now.

After six months she said, "Time to leave the nest," and that was the last time I've been in therapy and the last time I've been depressed. I didn't refill the Prozac prescription when it ran out because I didn't want to keep paying for it if it wasn't necessary, and so far it hasn't been necessary. But I think I really needed it, as a sort of reboot for the brain. It did not mess with my creativity, by the way. If anything, it improved it by reducing my anxiety over creating something that might not be perfect and would shame me forever.

However, I still had a fair amount of trouble with PTSD until I took up karate and it mostly went away.

Now, I lucked out with an excellent psychiatrist and psychologist who understood my qualms and issues and were able to fit my treatment and medication to my personality as well as my illness.

For instance, I'm comfortable or at least used to a certain level of jitteriness, so I was OK with taking medication that tended to make people a bit edgy-- in other words, made me more like I was already. But I'm not a mellow person, and if I'd taken a medication that made me feel at all sedated I would probably have freaked out, thrown it out, and never gone back. So they didn't prescribe the type where that's a common side effect. And so forth.

Regarding karate, about a year or so after I had last been depressed was that I felt good and everything in my life was going well, and so the startle reflex issues and similar matters were more noticeable to me, now that they were the only thing wrong with me. (Other than, for lack of a better term, normal neuroses.) For instance, I couldn't walk down a busy street without so many things setting off REACT OR DIE! alarms that although I was pretty good at controlling them, I'd be a nervous wreck inside after ten minutes.

It occurred to me that I'd been thinking about it as a psychological problem with a physical expression, and trying to deal with it by fixing myself psychologically. But maybe it was actually a physical problem with psychological roots, and it could be tackled from the other end, by retraining my body much as therapy and medication had retrained my mind. Maybe, I thought, any kind of intensive physical activity which completely engaged the mind and body by learning a new skill would work to get my body back under my control.

I'm sure there were a number of things I could have tried, but the two that came to mind were martial arts and dance. I'd always wanted to study a martial art, so I made a list of schools, happened to visit my current one first, and liked it so much I never got around to the others.

The funny thing is this. I'd expected that this therapy, if it worked, would be very gradual and I had prepared myself not to see any noticeable effects for months if not years. But all the dramatic symptoms, which had dogged me for, oh, the last fifteen years, went away in a couple of weeks and pretty much never came back. It was so fast that I suspected the placebo effect, but if so, it was one heck of a placebo.

I do get edgier and jumpier if I'm out of training for a while or really stressed, but it's nothing like as bad. And I've scared the living daylights out of a couple people who walked into my room when I was asleep and wasn't expecting anyone to walk in. (It's OK if I _know_ someone might be coming in and out.) But then I'd want to wake up if someone unexpectedly came into my room in the middle of the night.

Now, my experience was probably ideal. A lot of people do get depressed as soon as they stop taking medication. Sometimes medication stops working. Not everyone has health insurance. And so forth.

But if any of this sounds remotely familiar and you haven't made a persistent attempt to deal with depression as a medical problem, you should. (Try a free clinic.)

Once I was in so much pain I wanted to die. Every night I went to sleep crying and woke up still crying, my pillow soaked with tears and my sheets with sweat. Now I look back and it's more remote than trying to remember physical pain. Did I really feel that way? (I ask myself.) How? Why? Why did I wait so long to do absolutely everything I could to fix it?

I think part of the problem is that when you're depressed you feel worthless and like nobody loves you or cares about you, so why bother taking care of yourself?

I'm speaking now as a messenger from the other side. I still get angry and sad and pissed off and so forth, but when I think of how, if I'd killed myself, I'd have missed drinking sake with my awesome friends and discovering anime and seeing Ian McKellan as Gandalf and Hugh Jackman as Wolverine and making out with a better class of men than I'd previously dated and having J-- teach me reverse roundhouse kicks and selling my first book and flooring it past the ocean with the roof open and "Thunder Road" playing--

If all I got from not killing myself was one hour in Kyoto when the autumn leaves were falling, it would have been so, so worth it.

Your list will be different from mine. But I hope you make it some day.
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