Great Articles, Part 4

The Americanization of Mental Illness by Ethan Watters (New York Times Magazine)

Ethan Watters argues that Western thinking about mental illness has gained a foothold around the globe thanks to the aggressive promotion by both the psychiatric and pharmaceutical industries. In the process, Western diagnoses have increasingly taken the place of traditional experiences and explanations for mental illness. Quoth Ethan:

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.

Cross-cultural psychiatrists and anthropologists have argued through their research on mental illnesses that these disorders are not discrete entities like viruses that have their own natural history. Instead their research findings tell them that mental illness has never been uniformly the same across the globe, either in the form the illness takes as well as the rate at which it affects others but are “inevitably sparked and shaped by the ethos of particular times and places.”

It’s not surprising to me that many mental disorders are the result of the numerous socially accepted ways we fuck each other up.

Overall, I agree with Watters in his assessment that manifestations of mental illness are shaped by local culture and customs, that people are presenting with symptoms that suggest Western-style depression and schizophrenia in places where they have been unrecognized in the past, and the pharmaceutical industry is aggressive in promoting the diagnosis of diseases for which it sells treatments. At the same time, isn’t it the manifestations that are culturally bound, but not necessarily the disorders themselves? Depression, schizophrenia, OCD, anorexia: I still believe that these are real entities no matter which culture you observe. That’s not to say that the etiology of the disturbance does not differ by culture. I also have a hard time buying his argument the premodern societies are somehow less stressful than modern ones. Still, this is a fantastic article that was published this prior to the release of Watters’s book, Crazy Like Us: The Globalization of the American Psyche.

The Therapist Who Saved My Life by Ella Wilson (Literary Hub)

This essay is gorgeous.

After many suicide attempts, a variety of diagnoses, and even more prescriptions, Ella Wilson was ready to give up.

I have been diagnosed with bipolar II, borderline personality disorder, anorexia, unipolar depression, generalized anxiety disorder, and treatment-resistant depression. These have been countered with Paxil, Effexor, Remeron, Klonopin, Xanax, Prozac, Zyprexa, Seroquel, Abilify, Lexapro, Celexa, Chinese herbs, electroconvulsive therapy, hypnosis, leafy greens, fish oil, vitamin B12, St. John’s wort, group therapy, light therapy, talk therapy, cognitive behavioral therapy, dialectical behavioral therapy, eye movement desensitization and reprocessing, and acupuncture. But none of these things helped. There was no way they could. You cannot fix someone who does not feel connected to the idea of living with a pill, any more than you can fix a car without wheels by filling the washer reservoir with blue liquid.

Then she met a woman who would pull her back and make her feel of this world again. This woman was her therapist. A very unconventional therapist and many would say a very unprofessional therapist. But effective when nothing else was. Wilson explains:

The only way to come at a problem of this magnitude and confusion is not with sense; it is not with reason or science; it is not with pills or lists, electrodes or clever sayings. A problem of this scale and unnameability needs to be met with nonsense, with moonshine and malarkey. With magic and oracular thinking. Insanity meeting insanity.

Ella engaged in a different kind of therapy, the kind of therapy “they don’t teach at therapy school.”

This therapist was not treating me like another client. She was doing more for me than therapists did. And this did not scare her. She was wonderfully unafraid to like me, to love me, to share her story with me, to walk down the street with me, to want me alive, to care for me. And this lack of fear on her part vibrated as she held my hands and smiled into me. We can do this.

Ella describes her therapist as a connector (as opposed to a professional nodder).

She did not leave me in my pain and sadness, she brought her own out to the moorlands that howled with wind and nothingness and sat down across from me. She offered up her fears and devastations as anchors. Her scars made her a believable hero. She was just the kind of woman who might change someone’s life.

Insane. Invisible. In Danger. by Leonora LaPeter Anton, Michael Braga, and Anthony Cormier (Tampa Bay Times and Sarasota Herald-Tribune)

This investigative report on Florida’s mental health care system won the Pulitzer Prize. It’s so deserved. This is a must-read series that sheds light on the dark and grim realities inside Florida’s mental health hospitals. The accounts of deplorable conditions are harrowing. Florida ranks 49th in state mental-health agency funding per-capita. This series shows how funding and staff shortages contributed to unhealthy and dangerous conditions in the state’s mental hospitals. The reporters documented how the safety and lives of patients and staff were at great risk.

The stories (and accompanying surveillance videos) are devastating: staffers alone on the wards being brutally beaten or stabbed by patients; patients with no protection being killed—in one case stomped to death—by other patients; patients with life-threatening injuries ignored until it was too late to save them; 1,000 patients who have injured themselves or others over five years; and the relentless bureaucratic neglect amid draconian budget cuts that enabled it all. Not to mention the “wall of secrecy” protecting the hospitals and abusive workers that the two papers spent more than a year trying to penetrate.

The reporters immersed themselves in the day-to-day realities of the state’s six main mental health hospitals and discover their disturbing secrets. These reporters spent over a year investigating life in these mental hospitals including interviewing patients, their families, and examining numerous official records as well as hospital and police records. They found:

• Over the past five years, at least 15 people died after they injured themselves or were attacked by other patients. One man with a history of suicide attempts jumped off the eighth floor of a parking garage. Another was stomped to death because no one separated him from rivals even though they had beaten him up the night before.
• Staffing shortages so acute that violent patients wandered the halls unsupervised.
• Employees left alone to oversee 15 or more mentally ill men. Sometimes they carried no radio to call for help, with the nearest guard in another building or on another floor.
• Even when patients were placed under special watch, they were still able to swallow batteries and razor blades or hoard weapons to use on other patients. At a hospital in Florida City, a patient needed nothing more than a stack of paper to break out of his locked room and stab his neighbor 10 times. As the man bled on the floor, a staff member, unaware of what had happened, helped the attacker wash his bloody clothes.
• Florida has no statewide minimum staffing requirements. And there are virtually no repercussions for administrators, even when someone dies. State regulators have fined the hospitals a total of $2,500 in the past five years. One hospital paid $1,000 after a patient escaped and was run over by a truck.
• At least three people died because hospital workers took too long to call 911. Some employees said they felt pressure not to call paramedics because of the expense. Others said they were required to track down a supervisor first, leading to delays.

The series was so powerful that it prompted change from lawmakers who appropriated an extra $55 million toward fixing systemic problems in the mental health care system. This is truly important and impressive reporting that is truly a public service. Extraordinary work.

Madness and the Muse by Tom Bartlett (The Chronic of Higher Education)

“We’re captivated by the idea of the troubled genius. But is it a fiction?”

And is it tenable? Is it safe?

Tom Bartlett explores Nancy Andreasen’s evidence that mental illness corresponds with creativity. A psychiatry researcher, Andreasen presented the results of her landmark study that found that 8 out of 10 writers had experienced some form of mental illness in their lives.

For more than a decade, Andreasen interviewed and tracked 30 faculty members from the renowned writing workshop at the University of Iowa, where she is a professor of psychiatry. She also interviewed and tracked 30 control subjects of similar age and IQ who worked as administrators, lawyers, social workers, and so on. She questioned and diagnosed subjects using a methodology she devised. Instead of identifying a passel of schizophrenic novelists, Andreasen stumbled on extremely high rates of mood disorders like depression and mania among the writers. The gap between the writers and the control subjects was huge: Eighty percent of writers reported some mental illness compared with 30 percent of nonwriters.

This research paved the way for Kay Redfield Jamison, who in her book, Touched With Fire: Manic-Depressive Illness and the Artistic Temperament, examined 47 prominent poets, playwrights, novelists, biographers, and artists and found that a significant portion of them had mood disorders.

However, not everyone agrees. Other researchers argue that the evidence is lacking and have suggested that creativity is more associated with psychological stability. One of Andreasen’s stanchest critics is Judith Schlesinger who authored The Insanity Hoax. I tend to agree that the “mad genius” stereotype is not only simplistic and underdeveloped, it is also risky. The concept of a mad genius suggests that treatment kills creativity and as a result most people who believe this will not seek psychiatric treatment because they fear losing this elemental part of their lives. Patients who resist treatment are at serious risk for death by suicide.

Those who are high-functioning and productive may find that their volatile and destructive symptoms give them a characteristic authenticity, a raw-nerve emotional oomph and they may resist treatment. It may take a rock bottom attempt at self-harm to get them to accept the severity of their illness. And it may in some cases be too late. Relinquishing the idea that romanticized capital-M Madness makes one more productive and authentic instead of identifying as someone who has an illness can be difficult and unsexy, but it may be the key to saving their life.