31 May 2008

Growing up in a labelled world

I write this in response to the paper "Framing Disease," by Robert Aronowitz, and to the associated commentaries and rejoinder, which appear in the July 2008 issue of Social Science & Medicine. I would like to relate that SSM discussion to a personal account of how labelling and exposure to someone who sought labelling affected me from a very young age...

I was raised on psychobabble. My mother, rejecting one psychiatrist after another and likely still doing so, had gone through 14 of them when last I spoke with her, which was 15 years ago. I learned at my mother's knee what 'psychiatrist' meant, and the psychological jargon of the day, such as 'nervous breakdown' and 'emotionally disturbed'. In this respect I was set up to absorb doubts about my own emotional health, particularly given that life was hell at home.

Thing is, I knew better than anyone that my mother was not sick. She was egocentric, manipulative and cruel, i.e., her personality deviated negatively from the norm. For the burgeoning field of psychiatry, this made my mother an excellent candidate. For her, being labelled played into her egocentricity, which was why she sought out psychiatrists in the first place. My mother became addicted to psychiatry.

Thus made aware, by the age of five, that a harsh childhood could result in psychological damage, I swore to myself on a particular day that my mother would not destroy me, that I would protect myself, my yet-to-be-formed identity, against damage.

I've always called this my "promise day." On that day, as my mother stood before me screaming down abuse, I looked up at her and said to myself: "You won't kill me, you won't kill me, you won't kill me."

The repetition was to pound the resolve into me, to make it stick. I understood "me" to be my identity, not my body. The "won't" represented my determination that my mother would not succeed in transforming me into her own ideal. I understood I was in a triple danger, hence the repetition of three: of being imminently threatened, of my future identity being threatened, and of my future self being the subject of psychiatrists. To be the latter was to be like my mother, something to avoid at all costs. It was my mental health I was swearing to protect, although I didn't use or know that term. (I don't think in the 50s it was in fashion yet.)

For fifty years more, I resisted mental illness labelling. Then came the 18 months around the time I wrote my story, formed WISE (a former group and national movement of low-income women), and ran the project for and published the book Policies of Exclusion, Poverty & Health: Stories from the front. My mental illness buy-in is evident from the first lines of my story, the story of Chris in the book. I regret my lapse and acceptance of the label and have since rejected it. In other words, I've come back to my senses. The bare facts of the story stand on their own; the labelling does nothing but add salve to the mental health industry.

The pressure to accept mental illness labelling was enormous, not least because a good friend, my only friend at that time, was using it and applying it to me. With so much to deal with - an escalating slide into poverty and imminent homelessness - I was in too weakened a state to keep the promise to my 5-yr-old self. It didn't help that funding for the project was more likely if the lead researcher accepted the lingo, rather than not.

I do not blame my friend. The temptation to diagnose, and in the language of current 'wisdom', is hard to resist. She was right that I was distraught almost out of my mind. But the sickness wasn't in me. It was all around me. My distraught reactions were my healthy body's desperate attempts to warn me of a looming threat, of living in circumstances that risked my survival.

§

I suspect that the unquestioned adoption of mental illness labels has grown. My story is but a single example. But it seems to me that a whole generation has grown up with mental illness labels as part of everyday discourse. Now, if one simply accepts a label, all sorts of things can happen. People living on very low income have learned that exposing ourselves to the mental health industry and accepting a label can mean the difference between getting a housing subsidy or not, between getting employment assistance or not; listen to the story of Anna. For criminals, accepting a mental illness label can mean time spent in a psychiatric hospital rather than in jail. For overworked, stressed employees it can mean dispensation for time off.

More people are reported experiencing mental illness. I interpret this as either more people are getting labelled with mental disorders or more people are experiencing distress. Given the ascendancy of the mental health industry and the power dynamics of neo-liberalism, globalization and market capitalism, likely both are at play. But rather than look to causes (over-zealous labelling; manmade sociocultural, socioeconomic and physical environmental conditions threatening people's health), we focus on the individual.

It's the blame-the-victim approach. And the victims, rarely from other than the plebes, being immersed in this society and absorbing its messages, eventually accept the blame by adopting sickness labels and converting into feelings of shame the stigma imposed by the elite classes and adopted by society's wannabes.

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26 May 2008

Treat depression with brain pacemakers

It's a new frontier for psychiatric illness


Brain pacemakers that promise to act as antidepressants by changing how patients' nerve circuitry fires

Only a few dozen patients with severe depression or obsessive-compulsive disorder so far have been treated in closely monitored studies. Still, the early results are promising.

In reading this article, I was reminded of a science fiction novel I recently finished. Written by Greg Bear in 1997, Slant tells of a possible, not-too-distant future, in which people become so deeply immersed in the electronic information age that civilization reaches a crisis point. Inhabitants of this future world don't know a crisis is unfolding, since it involves the very technology which keeps them submissive to the erosion of their surroundings. Most experiences with other humans are achieved not in person but electronically, by jacking oneself into the 'net. Even sex is not immune.


Which technology is it that keeps people in this future world content and accepting the status quo? It's "therapy" involving surgical adjustments to the brain. Such procedures have become the norm, to the extent that the "non-therapied" are considered the lunatics - the oddballs, malcontents, marginalized - and "normals" are as rare as the dodo. In some cases, the therapy amounts to the ultimate, permanent happy pill: no condition can make the therapied unhappy, even jailing.


A couple of days after finishing Slant, I found myself reading the article in the news, about a surgical procedure to treat depression.


I was appalled, but not surprised.


After all, isn't that where the mental health industry is leading us? Isn't 'mental illness' becoming mainstream and everyday life pathologized?


In present-day society, we have manmade sociocultural, socioeconomic, and physical environmental conditions which are causing people distress. But rather than treating these conditions, we treat (and blame) the human physiology which signals their negative effects on our wellbeing. We insist on adapting humans to their conditions, not the conditions to human need.


This illogical approach is part of governments' lifestyle and individual responsibility mantra. This mantra conveniently ignores the crucial role which the determinants of health play, those determinants being - you guessed it - manmade sociocultural, socioeconomic, and physicial environmental conditions.


One can hardly be expected to adapt if one's lifestyle options have been reduced to zero. Even the power elite seem to have realized this. But rather than taking responsibility for allowing those life-threatening conditions, even promoting them, this same power elite look to their own risk - that of losing power.


Ergo, the masses are encouraged to make a few adjustments to their brains instead, either by means of 'drug therapy' or, soon to come to a psychiatrist near you, surgery. This way they will feel hunky dory while the conditions necessary to sustain their lives fall to ruin around them.


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23 May 2008

Jack Layton, Exploiting Poor for Political Gain

Carbon tax would hurt poor, shouts the headline.


That's Jack Layton, Leader of the NDP, criticizing the Liberals' yet undisclosed plan to introduce a carbon tax should they be elected. As Layton pontificates,


those advocating a carbon tax suggest that by making the costs for certain things more expensive, people will make different choices. But Canada is a cold place and heating your home really isn't a choice.

This speech took place at a homeless shelter. Layton was supposed to be there for a fundraiser. However, never loathe to turn away an opportunity to slur the Liberals, Layton did his disingenuous best on that score and then talked about his own environmental plan.


(Living in BC I wasn't at the event, but I do wonder how much of Layton's presentation was about the homeless shelter, whose fundraiser he was there to promote.)


Liberal Leader, St├ęphane Dion, is expected to announce his environmental plan to penalize activities that contribute to global warming. As Layton would be aware, since it's public knowledge, Dion has claimed that his plan would be revenue neutral: the carbon taxes raised would be returned in the form of lower income taxes and in other tax mechanisms aimed at helping low-income people.


While it's unknown what Dion's plan will look like, I think it's likely to be similar to the scheme introduced by the BC Government.


In the case of British Columbia, low-income residents will be better off. Each BC resident will receive $100 in advance of the tax being implemented. Before people are out-of-pocket, they'll have to have poured about 4,200 litres of gas into their tanks. It will be the gas guzzlers whose pockets get dinged, therefore, not the pockets of the poor.


My hope is that Dion's plan will be more robust than the BC plan, with the at-pump penalty considerably heftier. However, implementing even a low-rate carbon tax would be a start. It could be increased as need - more likely, political will - dictates.


As for Layton's latest foray into sleaze politics, this financially-challenged person is tired of the man's presumption that he speaks for us all - as though the poor were one undifferentiated blob.


Having recently been Coordinator of a national group of low-income women, I can say that Mr Layton does not know what's best for us all. The experts on poverty and its solutions would be the people living the experience. The NDP - which paints itself as the champion of the poor and disenfranchised - insists on solutions which do not take into consideration the heterogeneity of persons living within Canada's lowest income group or the differences amongst us concerning our most basic needs.


For the NDP, solutions always lie in bigger government - i.e., bigger federal government, bigger provincial governments. But most low-income groups realize that electoral and democratic reform must be our top priority - so that we get to have our say, and are enabled to participate more in decision-making and influence the political process.


Democratic reform should include shifting some of the power wielded by Canada's largest governments downward, to the municipal level. In this way - provided revenues also get shifted downward - local governments, which end up facing the consequences of failed upper-tier policy, can be held answerable to their neighbours. More power and resources held in the hands of local politicians could only encourage healthier, sustainable community economic development.


It's no surprise that this proposal is one that no party, particularly the NDP, seems willing to endorse. It would require relinquishing a good part of their power.


(For the record, I'm not a Liberal supporter.)


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21 May 2008

Meanings - Belonging, Home, Community

I filled out a survey yesterday on community meaning. For each question, respondents were to give the first answer which came to mind. Along with questions about the respondents' understanding of various concepts, including belonging, home and community, was this question, the last one:

When do you most feel a sense of community?


Here was my response:

It has been a very long time. I'm 57 yrs old now and the last time I felt a sense of community was at the age of 14. Then, I was in an environment in which to be and express who I am was permissible; it was the first time in my life I'd experienced that. Unfortunately, it lasted for only 11 months, after which I had to leave that community. When I think of belonging, I think of home, and that's the place I associate with the latter.


I went for a walk after completing that survey and began reflecting on my answers. I soon realized that underlying my sense of the meaning of belonging, home and community was a single, uncomplicated idea: acceptance.

It was nothing so robust or overt as welcoming. Just acceptance, manifested in an environment in which everyone adopts a live-and-let-live attitude and respect for difference.

In that place, I was FREE TO BE ME, without pigeonholing or labelling.

Actually, the latter isn't quite right. ALL of the residents at that place were labelled, which meant that we ended up undistinguished from one another. That is, being labelled made us all equal - at least in each other's eyes, which was all that mattered to us.

You see, that place was Lakeshore Psychiatric Hospital, which doesn't exist anymore. In the 60's, that location on Lakeshore Blvd. in Toronto was a 'mental institution' or 'looney bin'. I'd more describe it as a warehouse for undesirables and strays, people who society was happy to throw away.

Now, given the horror of that place, how could I possibly recall it to mind whenever triggered to think of home or belonging or community?

It's because the patients were expected to have an emotional life and licensed to exhibit eccentric behaviour. We were permitted to be normal, as judged by our own standards.

The relief to be who we were was enormous, and the sense of freedom intoxicating. Never before or since have I felt anything like that degree of acceptance and with it, the freedom to stretch my faculties, explore who I was and who I could potentially be. It was mind expanding in the best sense of that term.

As bad as most of these institutions were, including LPH, they got some things right. For LPH, it was its failure to psychiatrically treat certain of its residents - to leave us alone. Its failure to treat summed up, in a word, acceptance of us just the way we were.

Curious about LPH? For a start, check out this site.


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18 May 2008

Mental Health & Religion - A comparison

The more I think about it, the more the Mental Health Industry (MHI) appears to me to be no more than the secular version of the Organized Religion Industry (ORI). Indeed, the MHI is well placed to take over the de facto functions of the ORI.

Consider the following.

The MHI uses the amorphous stuff of the mind, not brain, as its guide for distinguishing mental health from mental illness.

The MHI determines mental illness not by a malady evidenced in the body; no, instead 'mental health professionals' look to people's behaviour. Conveniently, what they or society deem as abnormal, deviant, - in a word, sinful - behaviour comes to be associated with mental illness.

Conversely, mental health marks a set of behaviours which demonstrate a person as being faithful to society's standards, behaviours which conform to the precepts of good, civilized, NORMal conduct.

Conveniently, psychiatrists have positioned themselves as the most qualified to define normal behaviour. I wish I could just laugh at the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which is the bible of the MHI, but it horrifies me too much.

Like the MHI, the ORI works its magic - its hocus pocus - on people's minds (spirits, souls). Since a person's internal life can never be known by another, the stuff of religion is, as is the case for the MHI, our behaviour: what we do, including ritualistic motions; what we say; and what we say we believe.

In other words, the ORI takes as its speciality the entire field of morality; indeed, its devotees will argue that "without faith" a person can have no morality. The MHI too has taken up morality, i.e., the NORMal. Both exude paternalism.

The ORI is big business, tax exempt, and supported by governments in a myriad of ways. The aim of the ORI is to modify people's thoughts, beliefs, and behaviour, to ensure that these conform to certain standards - standards which the ORI judges itself alone qualified to determine.

The MHI is big business, faithful to the medical model of health and therefore tax exempt. Government and the acute care system (the Healthcare Industry, minus the MHI) have worked well together - to ensure their own survival and power. In one way, the MHI is still the new kid on the block, since government has been reluctant to include 'mental illness' as a health priority. But things are looking up. With government coming around, clearly the benefits of inclusion - of the MHI - have been recognized.

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04 May 2008

My First Podcast

With the number of available copies of Policies of Exclusion, Poverty and Health: Stories from the front rapidly diminishing, Daphne and I had begun thinking about other ways of making the book available. Three methods came to mind: a) e-book, b) audio book, and c) podcasts.

E-books can be read on most computers. Devices such as the CyBook Gen3 make a great alternative to having to sit at one's desktop. (I want one - SERIOUSLY.) They make possible a library of hundreds of books with never a cluttered, dusty bookshelf in sight. The books are neatly stored in a single, light, paperback-size device and can be read anywhere, anytime as long as battery life continues.

Audio books are typically standard MP3 files of an entire book. Most podcasts are also MP3 files and tend to be under one hour in length.

Online book stores and many public libraries make audio books and more recently, e-books, available for purchase and download.

I'd be reluctant to recreate the WISE book in a single audio file due to bandwidth issues, and converting it into an e-book would require a software upgrade. Given the currently small niche e-book market, getting the software would likely not be worth the effort. Besides, I haven't the money for it.

There are advantages to presenting a book in a series of podcasts, particularly a book of the type that Policies of Exclusion, Poverty and Health is. Therefore, it was agreed that offering the WISE book in a series of podcasts would be ideal, if it were possible. I'd create and publish one podcast per week, over 24 weeks. The first podcast would feature the Acknowledgements & Introduction, with each of the 21 stories following. The series would end with one podcast each on the reports at the end of the book: "Phase I - The Issues" (an analysis of our stories) and "Phase II - The Recommendations."

The only problem to this plan was: a) I didn't have a headset, and b) there was no room in my budget to buy one.

Enter a supporter of WISE who, two days ago, encouraged me to talk about some of the things WISE had hoped to do before its demise. Podcasting was at the top of the list. I'd no sooner begun uttering that wish when I was presented a cheque to cover the cost of a headset.

Yesterday I cashed that cheque, bought a headset, and then set about learning how to make a podcast. 

Below is my first podcast, dedicated to Sherrie Bade, without whose support this effort would not have been possible.

Policies of Exclusion, Poverty and Health: Stories from the front - Episode 1








For the collection of episodes, visit my podcast site

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