How We Talk About Mental Illness

10 Nov

Jared Lee Loughner was sentenced yesterday. In August of this year, he pled guilty to 19 of 49 charges, including first degree murder, after going on a shooting rampage in Tucson, Arizona. His actions left six people dead and injured twelve others, including former Representative Gabrielle Giffords. Yesterday he was given a sentence of seven consecutive life terms in prison, with no chance of parole. Jared Loughner will spend the rest of his life in jail.

I remember this shooting vividly. It happened on January 8th, the day I was admitted to the hospital on bed rest at 34 weeks pregnant. I spent two weeks in the high risk antenatal unit, with only books and my computer to fill long hours spent in an uncomfortable hospital bed. Because I spent so much time online, I followed the shooting and its aftermath intently, metaphorically holding my breath as I, along with so many other people, waited to see if Gabrielle Giffords would live after taking a bullet to the head during the attempt on her life.

That’s what the shooting was, after all – an attempt to assassinate Giffords, whom Loughner hated for many reasons, chief among which was that she was a woman. In fact, he’d said repeatedly, both online and in person, that women should not hold positions of power. That was why he’d shown up there that day, why he’d brought a 9 mm Glock 19 semi-automatic pistol to a public meeting held in a supermarket parking lot  – because he couldn’t stand the idea of a female member of congress. The thought chilled me, as I’m sure it did many other women.

I’ve continued to keep up with Loughner’s legal proceedings, in part because of the mixture of fear, fascination and revulsion the shooting inspired in me, and partly because, in my mind, this event is somehow bound in the circumstances surrounding Theo’s birth. There was something so strange about sitting in a hospital, doing my best to ensure that a healthy new life came into this world, while someone else worked equally hard to take another life, or rather, several lives, out of it.

I’ve read a lot about the shooting.

I’ve read about Gabrielle’s amazing recovery, and her struggles to regain her mobility and independence.

I’ve read about Christina-Taylor Green, the nine year old who was among those killed.

I’ve read about the other victims, and how this tragedy has impacted their lives and the lives of their families.

Mostly, though, I’ve read about Loughner. How at first he was declared unfit to stand trial after a federal judge ruled that he was mentally incompetent, saying, “At the present time, Mr. Loughner does not have a rational understanding of these proceedings.” How he was given a diagnosis of schizophrenia, and was found to suffer from delusions and disorganized thinking. How, when he finally was deemed fit to stand trial, he was so drugged that he could barely talk. How he still resists being medicated, and has to undergo forcible treatment at the hands of prison officials. How he often doesn’t really seem to understand what happened that day, and has stated in court that he believes that his assassination attempt was successful, and that Gabrielle Giffords is now dead.

It’s pretty clear that Mr. Loughner is seriously ill.

I’ve been reading some of the victim impact statements today, and I’ve been surprised at how some of the victims talk about his illness. Take, for example, what Mark E. Kelly, Gabrielle Giffords’ husband, had to say:

“You tried to create for all of us a world as dark and evil as your own. But remember it always: You failed.”

I found this jarring, to be honest. Let’s be really clear here: I think that Loughner’s actions were, indeed, evil. I know that a mentally ill person’s “world” or mind or whatever term you want to use can certainly be called dark. However, it bothers me that Kelly would refer to the delusional world that Loughner lived in as evil. It also bothers me that Kelly seems to believe that Loughner had some kind of agency over his actions, as if he wasn’t driven by the illness that gripped him body and soul.

Another statement that I read said the following:

“We’ve been told about your demons, about the illness that skewed your thinking.

It’s a painful saga, a tale of missed opportunities and lack of support, of the appalling absence of attention to your behavior. Your parents, your schools, your community –- they all failed you.

That is all true, but it is not expiation. It is not enough. There are still those pesky facts.

You pointed a weapon at me… and shot me… three times.”

While the victim, Ashleigh Burroughs, acknowledges that Loughner was ill, she seems dismissive of his “demons”, demanding, instead, that he answer the “pesky facts” – as if he hadn’t already tried to answer them, only to come up with nonsense, jumbled facts and recollections of the day that are flat-out untrue.

I am not here to criticize Kelly or Burroughs, and I am certainly not here to diminish what they went through. They’ve seen and experienced things that I hope to never, ever encounter. I am not saying that how they are dealing with this is wrong, or that what they said is wrong. What I’m saying is that the way that we, as a culture, talk about mental illness is fucked up.

The things is, this hits close to home for me, because mental illness is something I’ve struggled with. Still do, in fact.

It’s not something I really talk about, ever. I’m deeply uncomfortable even as I type this out, but I want to share this with you, so that maybe you’ll understand where I’m coming from.

When I was in high school, things were tough. I felt sad and hopeless, frequently without any concrete reason. I cried, often, both at home and in public. I wonder, now, if my social isolation lead to this, or if my isolation was a product of how miserable I was. Chicken or egg, right? Certainly both lead to a sort of vicious circle of being alone, then being sad because I was alone, then having no one want to be around me because I was so annoyingly, unendingly down on myself and finally ending up, once again, alone.

When I was sixteen I told my mother about how I felt, and she took me to see our family doctor. He gave me a prescription for Paxil and referred me to a therapist. I hated therapy and stopped going after a few months; the medication didn’t seem to do much, so my doctor increased it, and then increased it again. I couldn’t sleep at night, and I was exhausted all day, sometimes napping on my desk during class. I couldn’t concentrate, and often left my homework unfinished because I was too tired or unfocussed. My grades started to slip, and my teachers grew frustrated with me. One even recommended that I be removed from the special arts program that I was part of. I went from being an A student to barely pulling Cs and Ds and the grownups in my life tsked, shook their heads and told me that I would have to work harder. I failed grade 11 math the first time, and then, the second time around, desperate to pass, I cheated on a test. I got caught. I was suspended. My doctor increased my medication. I didn’t feel any better.

In university, things were initially easier. I had lots of friends, and I was once more getting As and Bs. I forced myself to complete my assignments, working in the computer labs late into the night. My concentration improved, and I tried to be less of a perfectionist with my work – even if I thought something was badly done or incomplete, I submitted it. I turned in every single  assignment on time. I figured that what I’d been lacking in high school was gritty determination; I decided that I could push my way through anything. I thought that if I didn’t succeed at something, it was because I hadn’t tried hard enough.

Then, in third year, things got tough again. I had to leave school due to my financial situation, which was hopelessly snarled after three years of monetary incompetence and inattention. My mood grew worse and worse, and the university clinic doctor frantically tried medication after medication, hoping something, anything would work. Nothing did. I finally received an official diagnosis from him of dysthymia, a mood disorder marked by chronic depression. I started to feel like the future was endless and blank, and that I had no way of getting myself out of this hole. I talked about suicide. My doctor had me hospitalized.

I have literally never told that to anyone other than my mother and Matt until now.

Things got better after that, although I’m not sure why or how. My hospitalization was nearly ten years ago now and, although there have since been some serious dips in my mood, until I was hit with postpartum depression I’d managed to steer clear of that dark place. I even totally went off any kind of medication for seven years, encouraged by a hospital psychiatrist who told me that I wasn’t really depressed, that there was nothing chemical about it, I just had bad coping skills.

I stopped thinking of myself as someone who was living with depression; I told myself that I was just moody, or easily upset. If I had to put a name to what I was feeling, I called it anxiety, which seemed easier and more socially acceptable. Calling what I felt depression made me feel like I was making excuses for myself, and it made me feel like a freak. I refused to us the term mentally ill to describe myself. I went back to my philosophy of pushing myself hard, and then harder when things were difficult. For a while, it worked.

Then Theo was born, and everything went dark, and I couldn’t get out of it.

As part of the postpartum depression program I participated in at Women’s College Hospital, I had to have a monthly meeting with a psychiatrist. My family doctor had put me on Zoloft just before I joined the Women’s College program, and it was up to this psychiatrist to figure out whether or not I was on the correct medication, and what the right dosage was. I gave her as complete a medical history as I could, and then immediately asked how long I would have to be medicated.

“Well, let’s see,” she said, looking back through her notes. “It looks like you’ve had two, maybe three major depressive episodes in your life. You’ll need to be on the Zoloft for at least a year, but I would recommend that you stay on it for five.”

I was shocked. The medication was supposed to be temporary; I wasn’t sick, just fucked up on hormones. I’d thought that I would only be taking Zoloft for a few months, until this whole postpartum depression thing cleared up. That was how it was supposed to work, right? When I told her that, she just smiled.

“I think your old doctor’s original diagnosis of dysthymia was correct,” she said, “and, based on what you’ve told me, I think it’s likely you also have generalized anxiety disorder. This isn’t going to go away once your hormones settle down.”

So here I am, nearly two years after the birth of my son, still medicated and still struggling with my mood. I’ve more or less come to accept this, though. I am a person who is depressed. I am mentally ill.

This is hard to talk about, and what makes it harder is the way our society views mental illness. In the media it’s portrayed as frightening and dangerous, or else as funny and laughable, but rarely as something normal, rarely as something that so many people live with every day. We throw around words like crazy, insane, or psychotic when we’re talking about people whose actions we disagree with. In spite of strong evidence to the contrary, we view it as something made up, or an excuse not to get work done. We want people to pull themselves up by their own bootstraps, and we don’t believe them when they tell us that they can’t. We marginalize and mock the people who need us the most.

Mental illness is deeply stigmatized in our society, and will continue to be so until we do something about it.

When we believe that Loughner had agency over his own actions, rather than being controlled by a serious illness, we contribute to that stigma. When Mark E. Kelly refers to the world view of a schizophrenic as evil, he contributes to that stigma. Hell, the fact that we even use words like “evil” or “demons” to describe mental illness contributes to that stigma.

The tighter we hold this stigma, the longer we continue to have beliefs about mental illness that are untrue and have no basis in scientific fact, the harder it is to talk about it. And the harder it is to talk about it, the more people will go untreated. And the more people who go untreated, the higher the risk of something like this happening again.

Which is why I’m talking about this now.

Edited to add: I certainly don’t mean to imply that all those who are mentally ill lack agency over their actions, or even that that those who do lack agency do so all of the time. I also don’t mean to say that someone who is gripped by mental illness will suffer from it forever. I don’t really know how to talk about this, and I acknowledge that I am probably missing a lot of information, and communicating badly. I apologize for that, and for any offence that anyone might take from this.

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7 Responses to “How We Talk About Mental Illness”

  1. krissy November 10, 2012 at 12:50 am #

    I recently read some books about cross cultural psychology, schizophrenia, depression and voice hearers and one of the most damning things that western psychology has done for the mentally ill is assert that its some sort of inborn genetic brain problem stemming from a chemical imbalance. I was shocked to hear that the brain chemistry theory hasnt been proven.

    While some mentally ill lack “agency” I think its far more dangerous to label people as permanently ill because that stigma leads to hopelessness and social alienation, and its reminiscent of eugenics and the third reichs theories of defective people. Often the biological theory deprives people of the care that they most need which should include talk therapy and a caring social network (which so many of us dont have) in addition to medication. A lot of times mental illness is related to trauma. But mental health seems to come with the expectation of not talking about it.

    One interesting concept that I came across from arab countries was this ancient idea of spirits influencing human emotions for good or bad, and with that came the understanding that the mentally ill was not irrevocably messed up, but had the potential to return to normal, which reduced their social alienation. When family members embraced the biological message however, they were more prone to frustration and shunning when the medication didn’t work.

    As for Jared Loughner, Arizona failed all of us because there should have been enough red flags to get him the help he needed. That culture seems to glorify violent talk and he obviously needed help. The outcome was absolutely terrible.

    • bellejarblog November 10, 2012 at 1:24 am #

      You make a lot of really good points. Thanks for the comment! I put an addendum at the end of the post to address the things you said.

      I’ve really never talked about this before, so I’m sure that there are things that I’m missing or getting wrong. I appreciate you taking them time to point these things out 🙂

    • Matt November 10, 2012 at 2:27 am #

      That’s an.. odd coincidence that you bring up the notion that the West has described as, well, demons. There was a time, probably three hundred years ago, when Loughner would have either had a hole drilled in his head (and likely died in the process), or been exorcised, then lit on fire… because his actions and words would have been simply ascribed to demonic possession, and medicine and religion had very limited solutions available to such a condition.

      Then the notion of possession devolved into two much weaker, socially acceptable expressions.. the 99-times-out-of-100-obvious-cop-out, “the devil made me do it” (about which Neil Gaiman gave Lucifer some particularly choice words), and the use of the word “demons” to refer to all manner of mental illnesses and distasteful predilections (alcohol is a particularly popular example). When Burroughs describes Loughner’s spectacularly violent and destructive illness as “demons”, it’s getting lumped into the same category as alcoholism.

      Anne and I spoke about this earlier; it seems as though Kelly and Burroughs need, personally, to compartmentalise the cause of this terrible event into something deliberate, something that could be prevented “if-only”.. something that can have a box put around it, and put away.. because, honestly, thinking about just *how* dark it must be in Loughner’s world when he’s off his medication is *fucking scary*.

      But I see your point about the pathologisation of mental illness. To a person whose understanding of the modern treatment of mental illness is a simple calculus of “there’s a chemical imbalance, so add this chemical to correct that balance”, I can absolutely see how you could easily put too much faith in that alchemy of MAOIs, SSRIs, antipsychotics, and the rest of the gamut. The fact of the matter, that I think always needs to be underscored when discussing pharmaceutical treatment of mental illness–and this is emphasised in the current study of psychology, even for first-year students–is that, by and large, *we have no idea what the hell we’re doing*. We know that when *this* drug, at *that* dose, goes into a person with *these* behaviours, they usually change to *those* behaviours.

      Fortunately, more and more doctors are being pretty upfront about it, and know that while we don’t know much about the brain, we do know that some people who are exhibiting these chemical imbalances can eventually correct them using cognitive behavioural therapy, and so encourage a dual approach–pharmaceuticals to address the most pressing problems, and therapy to work out the underlying issues. Worked a treat for me.

  2. Matt November 10, 2012 at 2:36 am #

    Reading through this again and again, I’m slowly realising that there are even more stigmas present in modern society about mental illness, that cross a lot of different avenues of, shall we say, social acceptable abuse. The most prominent one in my mind–because I saw an image macro borrowing a line from Donald Glover’s stand-up act about it not twenty-four hours ago–is the phrase “crazy girlfriend”.

    The line is, “every guy has a ‘crazy girlfriend’ story. Why don’t women have ‘crazy men’ stories? Because if you have a crazy boyfriend, you’re gonna die.”

    More examples of casual misogyny. A crazy ex-girlfriend can be the woman who won’t acknowledge that you broke up, and tries to give you a gun rack for your birthday (despite not owning a gun, much less multiple guns).. but a crazy ex-boyfriend is the guy who’s actively trying to kill you because you broke up.

    That sure does a number on how we approach the word “crazy”, doesn’t it? It becomes such a versatile word, for describing any number of behaviours that we might not like. Hell, “crazy girlfriend” could easily be used on a woman who is particular about her bath products, and where they’re positioned in the shower.

    Thinking about that makes me even more relieved that the CAMH in Toronto is working as hard as they are to try to break down these stigmas, by pointing out so prominently the ways we casually dismiss mental illness.

  3. annie November 12, 2012 at 4:25 am #

    thank you so much for sharing this, anne. i think it’s an incredibly important topic, and i think you wrote about it very well, and very bravely. i don’t have a lot to say (or maybe too much, actually) but i wanted to say that your sentiment really resonates, above all.

    i recently directed a very beautiful one-woman-show about living with/recovering from mental illness and the stigma surrounding it. i wish you could’ve seen it. i think you would’ve approved.

  4. Katharine November 13, 2012 at 7:36 pm #

    This is… much too familiar.

    I send you love and hugs and strength and deep breaths.

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