Sink or Swim

One of the things that has been weighing really heavy on my mind lately is the process of recovery in Bi-Polar people. John and I have a few close friends who are Bi Polar as well, (imagine that, similar disorders find comfort in proximity) and at least two of them are in constant cycles of "okay" and then "really not okay" with no real indication they will break out. One friend, in particular, has really been on my mind a lot lately. He's just not coping. At all. It's not that he doesn't have the tools or support. He blames it on a lack of self worth, and is perfectly willing to let his shitty self esteem be the reason that his cyclical behavior produces the predicted and tragic results. It's a catch 22 that I can't get him to comprehend as being a mere excuse. If he feels shitty about himself and feels worthless, he doesn't need to take the steps to take care of himself because the effort to spend on himself is "not worth it" in his eyes. So he cycles. And he crashes. And he feels worse, i.e. more worthless. And the effort it takes to feel better, by making better choices, is unimaginable, because he doesn't deserve it, so why should he try?

It's a victim mentality. Complete and total. No matter your chemistry, no matter your synapse relay, choosing to stay sick because it's easier is just another version of self serving pity partying. I used to put it to John like this: If you try, and fail horribly, and fall several feet, I will still tell you HOORAY for the incremental progress you managed to make, even if it's only measurable in nanometers, because when you are making a commitment to your health and to managing your disease when you are well, you never EVER fall as far or as hard when you are sick. If you have a routine that becomes second nature, the crash that comes may disrupt your routine, but it's still there, like muscle memory. You take your meds because you always take your meds and you know you have to take your meds. You eat real food because you always eat real food and you know you have to eat real food. You look at your lists, you have your network help you identify your flags, and you take the hands that are offered to you when people who love you reach out for you, to keep you from hitting the ground.

Our friend doesn't see it this way. He doesn't want to confront his disease or his triggers when he is more stable because he fears that examining his triggers will in and of itself trigger a cycle. He lives in fear, and so reverts to self pity and blame game. "It's not me. This is just what I do. It's what I know how to do. It's how I was raised."

It is frustrating, to know that he has this potential, to have seen him more happy and more healthy, and see him now, angry and barely coherent. I hate this disease. I hate it so much. I hate what it does to my sweet teddy bear of a husband, to our soft and giving friend, to the other remarkable people I know that fight their own brains, every minute of every day. I hate that I can see the pain in John's eyes on days when he just CAN'T do it, when he can't face people and cannot make himself get out of bed. I look into his face, and I see the small line between his eyebrows, I see this weary and cautious soul. I see it in our friend, too. He has this big love of everything, a childlike glee in beauty and nature, an adoration for all things living, a deep and abiding chest ache for injustice, or people he cares about being hurt. He is sore in his heart parts, lost, and instead of choosing NOT to let his disease define him and NOT to allow himself to wallow in a self-created Hell, he is falling away from us. I can't get through. He spent last night on my couch. I needed to know that he was safe, that he was around other people. I told him to pack a bag and I left a message for his psychiatrist that he was seeing today about his crash. I told him that until he is past this crisis, and still seeing his shrink daily, he should be here at night so we can be sure he is okay.

I'm doing it, and it feels just like starting over with John, at square one. I do not love this person as much as I love my husband, but I sure do care about him a great deal, and it is anguish to watch him flail out like this. I need to set boundaries. I need to keep a safe space for John, and for me. (Too much more like this and we will need to set up another place for our friend to go, because this eventually will push John into a cycle, too.)

So, I told our friend last night a version of what I tell John: Ultimately, the battle to be healthy comes down to a choice: You can choose to be healthy and make steps in that direction or your can choose to not be healthy and live a broken life forever. Choosing to be healthy means taking responsibility for your choices and actions, even when they're not what you intended and you're not proud of them. It means when you get set back and you crash, you go to your routine to pull up, and you do it over and over and over and over again. Living a broken life means you wallow in your misfortune and you end up hospitalized. There is no middle ground for a person who has this disease as badly as our friend, or as badly as John. You either choose to learn to swim, or you sink. I told our friend that I will be here and be support if he wants to be well, but if he just wants to be sick, well, then he needs to do it elsewhere, because I won't watch it and won't stand for it.

I am hoping that in the next couple of days, he will take a turn for the better, and that John helping him out will actually help John level out instead of going from our friend crashing to John crashing.

Ed. note: This was written by my beautiful and brave daughter in law and swiped without her permission... One of my favorite sayings: What if all the dragons in our lives are really princes waiting to see us once beautiful and brave? Love you, Sweetness.

The Americanization of Mental Illness

AMERICANS, particularly if they are of a certain leftward-leaning, college-educated type, worry about our country’s blunders into other cultures. In some circles, it is easy to make friends with a rousing rant about the McDonald’s near Tiananmen Square, the Nike factory in Malaysia or the latest blowback from our political or military interventions abroad. For all our self-recrimination, however, we may have yet to face one of the most remarkable effects of American-led globalization. We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad.

This unnerving possibility springs from recent research by a loose group of anthropologists and cross-cultural psychiatrists. Swimming against the biomedical currents of the time, they have argued that mental illnesses are not discrete entities like the polio virus with their own natural histories. These researchers have amassed an impressive body of evidence suggesting that mental illnesses have never been the same the world over (either in prevalence or in form) but are inevitably sparked and shaped by the ethos of particular times and places.

In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.

That is until recently.

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.

Read the rest of this fascinating article here.