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Showing posts with label psychiatry. Show all posts
Showing posts with label psychiatry. Show all posts

Sunday, June 10, 2018

On Being Unhappy

by Lael Ewy


To look out over a barren backyard in the middle of winter, contemplating crows.

To grumble at the idiocy of workplace rules, the stupidity of traffic, the vapidity of the political status quo.

To despair at a planet polluted and melting, the indifference of those in charge, the greed of those in power.

To, considering these, wonder if going on is really worthwhile, if contributing to them through our labor and social compliance is more morally right than to just stop living.

To do these things is to be unhappy.

But they are both common and widely pathologized.

It’s no wonder that the rise of a psychiatry of depression—indeed, of psychiatry itself—tracks parallel with the rise of industrial capitalism. Certainly, unhappiness precedes these social phenomena, but its one-to-one association with a medicalized illness is a product of how we now live, and a reification of it. The Lord of the Manor cared little enough about his serfs that their states of mind were all but immaterial; it’s probable he considered the serfs incapable of the kinds of depths and nuances of thought and feeling of those of his own class. But it bothers the modern master that his employees are not both compliant to his dictates and also happy about it. As with all other things, “employee morale” has simply become a reflection of the ego of the CEO.

The economy of the US has moved toward services and retail, and the imperative for the worker to always be happy has only increased. Customer service representatives at a call center are judged not only by the speed with which they dispatch customer complaints and the adroitness with which they upsell, but by the attitude with which they go about their work.

To be sure, they “represent” the company; increasingly, they are not the company. They are contractors or other easily-eliminated classes of employee. The company is merely a set of legal parameters. Loyalty and pleasure in one’s work for its own sake are expectations of the company, not something in which they feel the need to actually invest.

Like the Lord of the Manor, they want something for nothing.

But even if they did want something for something, it would imply that emotions, just like anything else worthwhile in this system, are essentially transactional, that, like your labor and your time, I can buy your emotions as part of a package deal. And the lower you are on the economic ladder, the less your happiness is worth, and the more important it is to maintain if you are to be employable at all.

The policing of emotions, then, the sanctions against unhappiness, are matters of economic necessity: you can’t afford to be unhappy. The market demands it.

If you’re poor enough or a person of color, your unhappiness is a positive threat, and the displeasure it causes a literal policeman can be taken out on your body with little or no consequence of the cop.

Fortunately, industry has a solution to our problem in the marketing of antidepressant medications—a quick fix for a population that has as its basic mode of living a series of quick fixes.     

At this point, the prescription and monitoring of mood-altering chemicals has become the primary job a psychiatrist does. Insurance companies are happy to reinforce that model: 15 minute “med checks” are efficient uses of a psychiatrist’s time. If psychiatry is, indeed, the medicine of “the soul,” it seems what the soul needs nowadays is a pill, the strength of which is nudged this way and that every other month.

This is a system that, from the perspective of a consumer culture and a market-based economy, ought to make everyone happy.

Only it doesn’t.

We’re sicker, sadder, and more suicidal than we’ve ever been. And when the prescription drugs don’t work or don’t work well enough (statistically speaking, their effect sizes are fairly small), we’re turning more and more to street drugs—heroin and methamphetamine—to fight the depression and the inner pain that still wrack us day to day.

But perhaps my scope here is too narrow: Freud’s theories were built on the discontent of the Viennese middle classes of the 19th Century, mostly of their women, a class which expressed its values as a matter of how contented the household could be. Prior to that, in the US and England, Puritans had gone a long way toward waging war on emotions at large as signs of not being among the heaven-bound. The self-improvement we used to revere in the US was geared toward tamping down both sadness and joy. The former was once considered a sin; the latter a frivolity.

We’ve posited in the Declaration of Independence the right to “pursue” happiness. But now we’ll punish you if you achieve it in excess. And no concomitant right to be unhappy has been widely fought for. Indeed, our scientific community has no solid notion of what emotions are even for.

Sadness, like tears themselves, upwells within us, in unexpected places and unexpected ways. Sad songs, the blues and country, and sad images abound. Edward Hopper’s stark canvases have gained a massive following, and the crying emoji is just as popular as any other. People who would not be able to tell a Picasso from a pizza can easily identify a Hopper. And the same psychiatrist who makes his living waging chemical warfare on his patients’ emotions feels no compunction about indulging in the bluest of jazz.

As someone whose unhappiness has ranged from the merely sad to the existential crisis, I haven’t found unhappiness to be entirely bad. It is unpleasant, and it can be overwhelming. I’d be lying if I didn’t also admit that it has put my life and health at risk. But then, so can the drugs we take to combat it, the work we do that demands we deny it.

Moving through it, wrangling with it, and coming to terms with it can also be deeply satisfying.

If unhappiness exists for a reason, and its ubiquity would suggest that it must, it can help us to see that something needs our attention—something in the way we live, in our relationships with those we love, our orientation to the world we inhabit.

It only makes sense to be unhappy if we’re being abused or oppressed, if we’re dealing with trauma or constant pain. What doesn’t make sense is that we should blame the sadness for the sadness, that we should try to do away with the unhappiness itself instead of trying to change things if we can.

At the very least, the lassitude and disengagement that unhappiness can cause is able to lead us to deep reflection and taking stock, two things our productivity-obsessed culture considers wastes of time. It’s OK for you to express gratitude, of course, because you’re supposed to be grateful for your shitty lot in life, but purely and openly contemplative? Heck, no.

I’m getting upset again. I’m getting unhappy at the disdain in which our culture holds unhappiness.

And maybe that’s not an entirely bad thing. 

Sunday, December 24, 2017

On Ward C


Fiction by Doug G.



Again the click-clack and the doors open.

Voices down the hall and it don’t smell like pee.

It don’t smell so bad here as you might think, though sometimes it smells real bad.

Sometimes, I think I smell it—blood, dirt, gunpowder, what-have-you.

I can smell the bad coffee now, and my stomach goes whooom it wants it so bad, but a few more doors need to click-clack open before all that can happen.

A couple guys got a puzzle going, and maybe I’ll help them after breakfast and group. They got ladies here, too, and I see them sometimes when we do classes, like we have one on anger management and there’s some in there.

One day, the girl with the green hair was wearing a space kitten t-shirt—like it had on it a kitten in space with Saturns and stuff and glitter on it that I guess they let her keep.

Cracked me up, for sure, but I knew I had to raise my hand to say anything—them are the rules—and I didn’t want to get in trouble, so I hushed up.

Later on I had a laugh.

Sometimes, I think about Greengrass and how we used to have horses there we could keep and pet. The work wasn’t all that bad—I don’t mind working, like I keep sayin’—and the horses were always right there, waiting for us.

I turned a hitch at Greengrass, then on the street. Then here.

John, he’s my therapist, is not so bad as everyone says he is. And the psychiatrist sees me once a month or so and adjust my meds.

Which I guess I’m doing better now.

Once, they brought in some people from the outside for a class. All the people they brought said they were like us, but they didn’t look too much like it.

There was an older gentleman who didn’t say much, and a bigger lady with a pretty face and a black lady, and they talked about how they rebuilt their lives. And the old man said he was better now that he got his correct diagnosis and the black lady started to cry when the topic of hope came up.

And it hurt to see that. She seemed so nice.

She had nice clothes—real put together—and good hair and a badge on. Not just the visitor badge, but one from where she worked outside. I bet she smelled good too.

It’s the smells I miss: nice perfumes from the business ladies downtown or good coffee or even the street smells like the exhaust smells for the parking garage where I used to flop or the asphalt or bricks.

See, I got my hitch, and it’s time I got to to do, then John says involuntary for a while and then, John says, “Well, we’ll see.”

He says that a lot—doesn’t want to promise anything—and sometimes that gets under my skin a little and sometimes not.

Once, when we were all still kids—there were five of us kids—and we were living in that trailer outside Wamego, and we find a hole full of baby bunnies,and we pulled them out. We was just playing around with them, not hurting nothing. We was just kids, but I remember the little rabbits and how they felt just struggling against my hand and how soft.

Then Big Mike came out the back door and yelled at us and the bunnies just start jumping everywhere and we all ran back inside.

Next day, the hole was empty. The bunnies were gone, and Sam said they were dead or got eaten by coyotes ‘cause they smelled like people now, not bunnies, and their momma would never take them back.

Sam was a liar. A natural-born liar.

But he might of been right about that.

Next day, Big Mike was gone, too, and Catherine, too, but I could see she’d busted up her compact and dropped her lipstick in the toilet because if Big Mike was going to have her all to hisself, he was going to have her “warts and all.” Which is how she described herself when she was in curlers and her bathrobe in the IGA and had been crying all night.

I didn’t hear her say it that night, but I knew she would. I didn’t see she ever had any warts, neither, but she always tried real hard with us kids.

She left a note and everything, with the social services number on it, and I bet Big Mike beat her bad for that too, but it was all she could do, and I knew she wouldn’t just up and leave us and not do it.

We lost the note, but I hung on to the Bic pen laid next to that note for a long, long time.

John says I got PTSD, and he wants to do some eye thing with me, but the psych says I’m schizo, and he won’t ever budge.

Once I met a guy in here got TD real bad, been on Haldol so long he could barely talk, but he could tell you every Top 40 hit for every week from, I swear, 1956 to 2104, when he says his radio broke and nobody to fix it.

He could sing some of ‘em, too, but ‘cause of the TD, he’d sing it real bad. But, thing of it is, nobody here made fun of him. It’s like that in here, since we all know that in a few years, who knows? That could be us.

The other day, I heard one of the ladies had a baby in here. They had to rush her over to the clinic as if they couldn’t see it coming. But then, she wasn’t due for a long time yet, I guess, and they had her so wacked out on Risperdal that she couldn’t tell them she was havin’ contractions, then her water broke, and all hell broke loose.

She’d just cry anyway when anybody asked her anything at all.

So they rush her over, and a OBGYN from town rushes in in the middle of the night, and he gets in past security faster than anything, is what I heard.

But I never heard what happened to the kid.

What could happen to you when you’re born and your mom’s in a place like this?

Sunday, January 15, 2017

Co-Evolution and the Cultural Dance

by Lael Ewy


One of the most powerful ideas that currently drives my thinking, one the psychiatrist Ronald Pies called “speculative,” is the notion that human beings co-evolved with culture.

I would imagine some anthropologists and primatologists wouldn’t find the notion so radical.

Consider this: theories assuming a linear progression from biological structures to cultural expressions tend to downplay what culture is for: helping assure the survival of those species for whom it is a feature. This suggests that as a species practices culture, that practice itself would influence the genetic variability and expression of the species. To worry too much about whether clothing came first or hairlessness came first is to get yourself into a pointless chicken and egg loop. To questions of nature vs. nurture, the correct answer, I think, is “yes.”

Consider also that for those species who use culture, being cut off from that culture leads to extreme distress. People in solitary confinement go crazy pretty consistently; people outside of a cultural context quickly cease thinking of themselves as human in a way that we commonly recognize, becoming severely depressed, delusional, sociopathic.

It’s along these lines that I’d like to explore a little more, since the idea that we’ve co-evolved with culture has some deep implications about the roles of spirituality, politics, gender, criminality, and behavioral health. It calls into question the often simplified cause and effect relationships posited by pundits and researchers, reporters and politicians.

We want to believe that, whatever the problem, we are not to blame, that the origins of what ails us lie in some biological, natural, or extra-cultural “other” preying upon us and making us miserable. When we shift blame, we also shift responsibility. These ideas are often linked in legal considerations because we view them as interdependent aspects of culpability. We reinforce power structures, if we benefit from them or fear their realignment. We place somatic and psychological suffering on the individual and ignore her sociocultural situation.

But all of the bases for these actions and desires are culturally determined; our thoughts and feelings are, themselves, influenced by how we live our cultures, ways of being to which our bodies and the brains within them are constantly reacting and are helping to create. The much vaunted “brain chemistry” explanation for psychological distress ignores the fact that brain chemistry in humans does not exist outside of the cultural and ecological contexts in which the human brain evolved. Treating it separately from a person’s sociocultural situation is not only inaccurate, it’s nonsensical and cruel.

Likewise, what we view as criminal or what we view as politically or economically acceptable are impossible to fully grasp outside of the contexts of shame and blame, feelings of responsibility and rage, that we tend to view as highly internalized or personal. Yet what is our reaction to tragedy or loss? We gather together for public rites of mourning and solidarity. We “check in” with others to make sure that, despite devastation, destruction, or violence, we’re all still “ok.”

Trauma research increasingly suggests that psychological healing happens through meaningful connection with trusted others, yet our “scientific” response is still, for the most part, to isolate the suffering person through medical or pharmaceutical means, to criminalize the person or render her legally “disabled,” kicking her out of the world of social contribution through compensated work.

Perhaps we do this because of baser urges, no matter how gussied up with professional jargon. Isolating individuals, and locating larger problems within individuals, justifies the power of the medical and legal structures that perform this kind of work and serve to maintain the status quo. It’s preferable to those in power to place the problems the institutionalization of that power creates on “problem” individuals, “the mentally ill,” “thugs,” and “lone wolf killers.” But maybe doing this sort of thing also derives from the perceived need to contain or purge what we react to as social contagion. We rid ourselves of suffering people because being in the presence of suffering causes suffering for cultural beings. The brief emotional turmoil of sentencing or diagnosis, execution or exile, will lead, we hope, to the contentment of “closure,” certainty, settled science.

As humans, then, we sit on the balance of favoring the offending limb or cutting it off—and perhaps what side of the scale you’re on determines whether you lean toward the political left or right, toward the traditionalist’s “sensible” exclusion or the radical’s inclusive communitarianism.

That we can even contemplate this is another indication that the dance between the cultures we comprise and the brains that create them never ends.