Don’t Sell Yourself Short if You Have a Psychiatric Disability

Serious psychiatric illness (other than a few developmental disabilities) entails, by definition, a reduction from earlier in the person’s lifetime of the capacity to think, in my observation both as insight into myself and as viewer of others (whom I’ve been thrown in with or see on the streets) who have the problems. The chief difficulty that the person faces in getting better, it seems to me as I look back and as I look around today, is that there isn’t from family and mental health clinicians enough trust that the person can regain autonomy. Yes, there is a recovery movement in full swing; yes, treatment today is deemed to be patient-centered, but the behavior held as potential and prospective for the patient is uninteresting as it is much less than she has previously achieved. Whatever that may have been.

The “human potential movement” of the Sixties had excesses like swimming with dolphins (which latter sounds hard on the hijacked dolphins, but fun for the people), but like many aspects of cultural history had a good point to make. People are more than they present with. Even patients with serious mental illness.

Yes, there is a certain reduction of autonomy inherent in being a psychiatric patient with such a level of disability, but no, that reduction should not be accepted and even colluded in by clinicians.

As someone with ten years of informal and thereafter 34 years of diagnosed status through 2018, I do know that there is “disrespect” given by the world--even by clinicians, as well as the actual provocations given by the patients. (And, yes, I’ve given more than my fair share of trouble, such as reneging on commitments and being hostile to my brother in particular,)

Things are far better today than in the early Eighties, when for example I was turned away from care at a dentist’s office due to having filled in on its medical history form that I had mental illness (the Americans with Disabilities Act and various anti-stigma campaigns have helped). But there is still too much painting today of people who are psychiatric clients as though they are unworthy of dignity.

One aspect of this situation that I believe should garner more attention is that hope for a return to full prior personality  (not for the patients to be obsequious, which seems to be clinicians’ desire for patients at least in hospital and clinic settings still today) should be what is most strongly urged for patients by clinicians, especially for depressed patients--and in my observations, almost all patients have at least episodes of depression. If the clinicians can’t give respect now, they should communicate that respect is around the bend for patients who can hang in there.

The Case for Psychiatric Treatment

Would you let an open, large, and painful wound that is oozing pus go without a trip to the doctor’s and a willingness to use the antibiotic (or other remedy) that she prescribes? Then why not at least try a pharmaceutical remedy for what is awry in your brain, causing mental health symptoms? 

To be sure, there ISN’T ANY perfect mental health pharmaceutical. Almost always, for example, several have to be tried before a workable solution is established by the psychiatrist and you in tandem–and it will probably have to be changed as there come down the research pipeline new treatments. 

Actually, there was a golden era of many decades after Alexander Fleming discovered penicillin in 1928 when antibiotics worked, until gram-negative bacteria started to evolve so that now many microbes are resistant, and, especially in hospitals, vanquishing no longer occurs. 

Just like working with mental health symptoms. Only, while the U. S. National Institute of Mental Health and its counterparts are trying to develop a taxonomy of the genetics that corresponds to various symptoms, essentially there are few clues let alone a road map. This inability to target a treatment to a mental health symptom is why lifestyle changes are so important. Your psychiatrist and mental health team should be treating the whole you. 

But the pharmaceutical or other biological remedy offered is worth your careful thought. I believe that I have walked a mile in your shoes. See if you really have a good reason to refuse trying meds towards making better your mental health symptoms. 

We will have “personalized psychiatry” according to our genetic makeup and various biological markers available someday. But, for now, the available treatments must be administered by trial-and-error.

Florid and Invidious Psychoses Compared

The person with a diagnosis of a disorder that has involved psychotic features can suffer from two kinds of alienation from reality:

·         Florid psychosis. This involves frank delusions and/or hallucinations. The person hears or sees phenomena not perceived by anyone else. For example, I once perceived the day turn into night (on a day without a violent storm) when floridly psychotic.

·         Invidious psychosis (this is my own term.) These are the frequent instances of the person’s not being amenable to reason. The person gets a notion in his or her head that is impossible to shake loose.

The second kind can be worse than the first for family and friends in the picture. The affected person may have good insight into the disease process so far as florid psychosis goes, and perhaps other symptoms as well, but sees the invidious psychosis as merely that “reasonable minds may differ.” Only, his or her reasoning at such an hour is mere pseudo-logic, and does not show common sense.

I am subject to invidious psychosis when under severe stress. Between my Bipolar Disorder and my brain injury, my judgment is always less good than that of someone without these problems, and my weakness to the point of invidious psychosis becomes manifest in very difficult times.

For example, even though I am a Republican, President Donald Trump’s election filled me with such foreboding that until after Inauguration Day by which time I had adapted to the situation, I could not make sound decisions about major issues. Fortunately, I have a loving family who did and do step in to assist me when I lack good judgment.

Invidious psychosis begins “down a slippery slope.” That’s why I call it, “invidious.” Weeks can elapse before the person becomes irrational. This latency just increases the affected person’s confidence that there is “nothing wrong” with him or her….

Excuses, excuses....

All disabilities confer selective advantage, even if only via the responses of others who have learned from the situation. “Selective advantage” is a biological term for that which is helpful to the survival of the species.

But for many a disabled person, the chief advantage of being disabled is to himself or herself.

Erving Goffman, sociologist, in Asylums (1975), built upon the work of Talcott Parsons and others to define the “sick role.” Being diagnosed confers the advantage of restrictions on going to work, or freedom from it. In a “total institution” such as he described, like the closed psychiatric unit in a hospital, patients undergo “the mortification of self.”

A rock-bottom aspect of the self in American culture is being able to give a reply concerning a vocation to the query, “What do you do?” In a psychiatric unit, one does nothing of one’s normal adult life, just art therapy, music therapy, and suchlike. These recreational therapies do not bode well for self-esteem, because when the sole activities, they do not allow the patient to contribute to his or her loved ones (unless it happens that the person’s vocation or important avocation is artistic, musical, etc.)

Many disabled people tend to make excuses for themselves, by manufacturing instances of their truly dominant symptom, in order to obtain some benefit. They may manufacture frequency of the symptom, severity of the symptom, or both. This is true of disabled people with or without psychiatric disabilities.

This behavior is very different from the American Psychiatric Association's Diagnostic and Statistical Manual V’s diagnoses of factitious disorder or of malingering. The person whom I am describing, who makes excuses for himself or herself, is genuinely disabled and is not mimicking a medical condition for sympathy (which is factitious syndrome,) or for a financial or legal advantage (which is malingering.)

And, indeed, it may just be true that everyone, disabled or not, tends to “milk sympathy” by exaggerating his or her problems in conversations with family or friends. Since I know that I do this, and since I am disabled, I am inclined however to think that it is a tendency that may be engaged in frequently by people with disabilities.

“Injustice Collecting" Does Not Help an Employee

If a person indulges in collecting injustices against himself or herself, and reciting them to anyone who seems willing to listen—it rubs others the wrong way!

If an employee has this trait, interacting with co-workers, supervisors, and clients/customers becomes even more difficult than for an employee who lacks this trait but still has a psychiatric disability. (Indeed, in this day and age of blanket media coverage of mass shooting rampages, many listening may fear that such a person may be about to commit such a criminal spree.) While of course seasoned forensic psychiatrists are unable to predict violence in the workplace or elsewhere with any accuracy to speak of, co-workers and supervisors may think that they can.

People most likely to be injustice collectors are those with paranoid features and, in some instances, those with PTSD.

(Those who in groups proclaim injustice against themselves as a group, being a minority of some kind, have no difficulty maintaining gregarious presence in the workplace or in greater society. Unless an individual identifying with such a group happens to be a person with a psychiatric disability that includes paranoia, or in some instances, PTSD, he or she will have no more difficulty “getting along” than any of his or her peers. That is to say about a person with a psychiatric disability free of paranoia or PTSD, he or she will be able to get along to the extent that [s]he has a good socialization history.)

It would be helpful in programs designed for vocational rehabilitation of people with psychiatric disabilities to discourage the trait of injustice collecting.