Strangers in Strange Lands

natural variation = added benefit, even if uncomfortable

Tonight I have been thinking about mental illness and diagnosis, and the benefits and problems of trying to sort people into boxes.
I'm blessed or cursed with not being a black and white thinker.  When a friend forwarded me this article that showed many diagnostic labels of mental illness share common genetic links, I had a strong internal reaction.  The article said that related people sharing "genetic aberrations" had risks for several mental illnesses.  What they found most interesting is that the effects of the same gene change could be expressed in different illnesses, for example with one twin showing schizophrenia and another bipolar disorder.

I have seen the devastating effects of mental illness in this and previous generations.  I don't doubt that our endocrine system, not to mention our brain, is no less immune to the insults of living, environment, random gene accident that our other organs.  As such I think it deserves absolutely no additional moral interpretation-- it's an organ not functioning as we expect it, or an organ that is ill.  I don't see true mental dis-ease as any more morally damning than a kidney problem or a under/over active pancreas. It's not a matter of poor willpower or moral turpitude when it fails to work properly all the time.  The stigma we hold to mental illness is fear based on an ego level:  "there but for the grace of God/my will/clean living/etc" go I, and let's just blame the victim.  It's our defense mechanisms acting out and claming control over one particular, very complicated organ-- the brain.  I don't blame anyone for feeling that.  We manage anxiety by figuring out all the ways this scary outcome cannot, will not apply to us.

 grateful for artists to reinterpret the world

But what it you are indeed well-represented in the genetic dice roll as an outlier?  What if you are one of those kernels that does well in dry seasons and all it does is rain?  You are incredibly logical, efficient and detail oriented in group that values people-reading and glad-handing and seeing all forests, all trees?  Or exceptionally sensitive, just dripping with mirror neurons such that you can barely hear what people are saying because their pain or agitation or anger is sharply evident to you in your interactions? 

When as a nation or a world we start to judge, to evaluate and grade and degrade varations as being good or bad, it's important to step back and see the forests in all those funny looking trees.  We need most everybody, even those on the edges of the bell curve.  We need engineers that can ignore well-meaning but emotional calls for esthetics that detract dangerously from functionality.  We need artists who can articulate the depths of joy and suffering that are rellly, truly there in most of us even if we don't have the language to express them.  We need the people who are moved to tears by the unspoiled natural environment to save it from slaughter for those of us who may not see its utility and healing potential.  We need the number crunchers and the emoting advocates to create a world that works not just logically, but on a heart level.
We need the schizophrenics who can call out bullshit and make us uncomfortable, and the persons with Autism who can do the same and remind us to question our habits of not saying what we really mean.  We need the melancholic poet and artist  who pull us pearls out of their pain, and the hypmanic who creates entire symphonies in six day no-sleep spurts.

We also need to be safe, and most of us need to be in relationship, to have meaning and purpose, to serve.  On the edges of those bell curves, that doesn't happen.  It's hard to be useful when you are violent and hallucinating.  What if we saw that as just out of balance, not wrong?  If we save "crazy" as a description of out of balance behavior or thinking, instead of applying it to people?

When our kidneys get out of balance, we may have trouble peeing, or pee too much.  Too far our of balance and they aren't filtering our blood, and that can be life threatening.  We can mess them up with poor hydration, certain food issues (for those stone formers, drinking lots of tea and eating spinach can start some painful episodes).  When we get symptomatic, it's important to pay attention get back in balance, through treatment or lifestyle changes.  Sometimes that means medicine.  Few people resist taking an antibiotic when they have a raging infection, or a cough syrup if they are staying up all night hacking.  It's not seen as weak, it's sensible.  When through stress or illness our mental symptoms increase, we need to take care, and that can encompass many forms.

But when we are merely in our tendencies and not particularly imbalanced into illness, perhaps a more sustainable approach is to learn to live with our differences, and do what we can to maximize their strengths: creativity and productivity in hypomania and some forms of melancholia, , exploration and adventure sports for the low-reactors, emotional wisdom, compassion and social sensitivity for those with the extra mirror neurons, exactitude and thoughtful planning and execution for those on the high-functioning Asperger's spectrum. 

more same than different

We all have our soft spots.  Sometimes they present little obvious hardship, espcially if we're aware of them and make reasonable accommodations.
Nearsighted?  Get glasses. Fairskinned?  Disability if you live in a sunny climate(sunscreen and clothing!), good for Vit D production if you don't.  Sickle-cell anemia?  Good mutation if you live in malaria laden countries and hope to reproduce before you die, but not so hot if you want to live past 40.

Every gift has its burden, and every burden has its gift.  Labels are good only as far as they help people predict and avoid or accomodate predictible burdens.  If you know you have "Engineer Mind" you are going to want to develop rules around social intelligence to enjoy positive relationships.  If you're on the other end of that spectrum you'll need to learn that not every problem can be solved via emotion and relationship; sometimes you need MATH.

We all have our stuff.  Some of us seem to have a lot more than a fair share of the hard stuff.  Where ever you are in the spectrum, take some time to apprecaite gifts from those outliers.  We need them over time.  And if like Kingsolver's kernels they didn't land in a time where their difference works so well in the enviroment, don't blame them. Help them to find the place where their difference works.

On that note, here's a couple keen articles about job agencies trying to do just that.
http://www.guardian.co.uk/money/2012/apr/06/autistic-workers-employers-ignorance
and in Corvallis:  http://www.gazettetimes.com/news/local/finding-jobs-for-those-harder-to-place/article_e5118904-7f18-11e2-8e16-0019bb2963f4.html

The Incredible Heaviness of Being: Braving The Stigma of Mental Illness

Kay Redfield Jamison wears many distinguished hats.  A PhD psychologist, she is a tenured professor of Psychiatry at the prestigious John Hopkins school of medicine.  She's been honored by Time Magazine as a "Hero of Medicine", and is the author of at least two international bestsellers and over a hundred published research articles.  She's had dozens of  fellowships, lectureships, and national awards.  She's received the MacArthur "Genius" Fellowship.

She also has, and she will be the first to tell you this, a serious mental illness.

Dr. Jamison first became ill with Bipolar Disorder as a senior in high school.  In her conservative Episcopalian family, mental illness was not discussed, and if anyone noticed how she was floundering, it wasn't remarked upon.  But she noticed.  She noticed the long periods of high creativity and energy followed by the much less tolerable periods of complete, abject and suicidal depression.  The story of these, and her later complete psychotic break and serious suicide attempt, are charted in vivid and heartbreaking detail in her books "The Unquiet Mind" and "Touched with Fire:  Manic-Depressive Illness and the Artistic Sentiment". 

It's unusual for a PhD (as opposed to an MD) to be offered a professorship in psychiatry.  But that rarity pales in comparison to the level of support her employers at John Hopkins gave her for being "out" with her illness.  In an unusual display of wisdom and compassion,  her mentors allowed her to continue to pursue her work after her first major break and hospitalization.  And her direct supervisor urged her to use the experience of her illness to teach and write.  As a result, we have what has been called the classic textbook on Bipolar illness (then called Manic Depressive Disorder), countless research studies, and an example of human courage exemplified.  If she had been dismissed, marginalized-- if she had her license to practice revoked (none of these are unusual situations in our culture, when ignorance is faced with illness)-- we would have none of these great works, which have done much to encourage understanding and treatment.

But it is not only the compassion of her employer responsible.  It is her courage in saying:  "Yes, I have an illness.  It is genetic.  It is not my choice, but it is my responsibility to manage".  Her bravery has had a profound effect in showing people that "different" is not always hopeless.

Dr. Jamison would tell you, as she did the audience of several hundred at OSU tonight, that having BP  is not an easy path. In fact, (and I disagree with her, but I don't have her direct experience to effectively contradict) she says that having a mental illness is "99.5% bad".  As in my last post, I strongly believe that it was her experience of the illness and her ability to humanize and integrate it that led to some of her greatest gifts.

I don't have much to add to information about Bipolar that colleague and expert on affective disorders psychiatrist James Phelps has not already said, much more brilliantly than I could.  If you've not visited his website, I urge you to do so.  (If you or someone you love has BP, get his book as well).  I would add a bit to Dr. Jamison's speech, though.  I'd add that there are some effective management techniques other, or in addition, to medication when folks with affective disorders aren't significantly impaired or completely disabled by their affective differences.  You can read about these on Dr. Phelp's site.  I would take issue with calling those without BP "normal", because I just haven't met anyone who truly fits that description-- we ALL have our stuff.  I think her point in repeatedly saying "mental illness" was to get across that these impairments are not any more chosen, or morally suspect, than having asthma or cardiac disease.   And the outcomes of not treating this illnesses are profound:  50% of persons meeting criteria for Bipolar Disorder attempt suicide.  10% succeed.  That's a very lethal illness.

See also:  http://www.janasvoboda.org/search/label/depression

In some ways, it is easier than ever to get treatment for affective and other dis-eases of the mind.  You can google, ask your MD, look in the yellow pages.  In other ways, it is harder than ever.  There is still a lot of stigma and ignorance about illnesses and differences that affect our minds and behavior.  And even though literature reports that  lifestyle changes and therapy support are as effective or increase effectiveness over medication alone, insurance often won't pay for counseling.  Certainly not everyone has insurance.  Your local NAMI chapter can help you find resources and support.  If you are a student, contact your education counseling center to see what low-fee or free services are available.  If not, call your local mental health center (God. politicians and voters willing that you still have one).  If all else fails, call a crisis line.  There are many you can find on the web.

Here are two: 

1-800-SUICIDE 1-800-784-2433

1-800-273-TALK 1-800-273-8255