Tuesday, January 04, 2011

Needs To Be Said

Sometimes you will catch me railing against patients who aren't all that ill, and just need to get a grip. The older male social workers in my department have what we call our "Buck up, little soldier" speech.

But the danger on the right side of the blogosphere is much more toward denying that mental health issues are all that serious - that everyone should be getting the "Buck up little soldier" speech. I've seen that at Maggie's more than a few times (in the comments, not the posts). This is infuriatingly stupid.

There are conditions, such as schizophrenia, bipolar disorder, and autism, that are so patently physical that people who even remotely suggest otherwise I lose respect for immediately. But even the more controversial items, such as depression or PTSD, are seldom conditions that one can just ignore or resolve to have a better attitude about to overcome. Some people, sure. I've seen plenty. Get a grip. Enroll in a local Get A Life program. Snap out of it. Stop feeling sorry for yourself. All the cliches. But it simply isn't all of them. Major Depression is real and serious. PTSD can create havoc with people for their entire lives. It is not only ignorant, but cruel to suggest otherwise.

Any of y'all who are still holding to that idea - if you ever have a kid with schizophrenia, you will be humiliated to the point of suicidality to remember the cruelty you have inflicted on genuinely suffering people who you dismissed.

Update: The comment thread suggests the recent post of mine, The Cost.


GraniteDad said...

sideways relation to the idea among some Christians that if people just prayed and trusted God more, that their mental illness would go away.

I think we know a family in that situation now.

Erin said...

Your comments on PTSD remind me of an interesting novel I read for a graduate class: Regeneration by Pat Barker. It's an author's "here's how I think the conversations and events went" into the interactions of WW1 soldier & poet Siegfried Sassoon and psychiatrist Dr. William Rivers. Sassoon is set to Craiglockhart War Hospital after writing a letter calling the war "senseless slaughter." He was classified as mentally unsound. The book covers a lot: the conflict of men fighting in WW1 ("be a man" versus the real fear of dying or the often feminine/nurturing nature of living in trenches and fighting with your company of soldiers), shock therapy and other torturous techniques to deal with PTSD (definitely a "buck up little soldier" mentality back then), and exploration into new theories in psychology (namely, Freudian theories).

Assistant Village Idiot said...

ECT is milder now (and insulin shock something different altogether), but even at those barbaric levels, it worked. I thought that was later though that they came in.

Not commonly used for PTSD, though.

Erin said...

Not sure how much research the author did in writing the novel (written in the 90s). It was a bit of a side story, but I do remember Sassoon befriending a fellow patient who had lost his ability to speak (or refused to speak...I can't remember which, or maybe that was never clear) due to his experiences in the war. The doctor locked him in a room and began applying shocks to his neck near his voice box and refused to let him out until he spoke again. Same treatment applied to another soldier with a stammer. Both were "fixed" effectively, although Rivers noted the ironic impression of the men being silenced through the process of regaining their normal speech.

Assistant Village Idiot said...

Ah, that's quite different, then.

Retriever said...

Glad you said it. I used to try to say something similar in the comments there, but gave up. It's pretty prevalent on conservative blogs, don't know why as there are just as many mentally ill people in conservative families as liberal ones.

Of course, I've been known to say heartlessly "When you've finished enumerating all the ways you've thought of killing yourself, could you please pick up your room. Or at least make the bed and put the dirty laundry in the basket..." My version of buck up little soldier...

I think that people are quite disgustingly prejudiced against autistic and special ed kids generally, either blaming their conditions on bad parenting or just brattishness of the kids.

I think mostly those of us with ill or disabled relatives tolerate it because we've internalized the parent blaming, and we also sorta hope that if it is under anyone's control then the person can get better with a little attitude adgjustment or religion which is cheaper and faster than meds, treatment hospital, ECT, whatever.

ALso, Americans are not genetically loaded for being philosophical and accepting the inevitable. Mostly we cope with illness and disability in ourselves or relatives with denial, anger, distraction, evasion, anesthesia, rarely acceptance.

Fred Z said...

I largely agree with the post. I came to realize after many years of hiring laborers in my contracting business that most of them were doing the best they could.

This included life. They could not stop stealing, drinking, fighting, missing work, et cetera, et endless cetera.

I hope you understand your observation has repercussions for all of us conservatives. We sometimes claim that the poor just need to tighten their belts, pull up their socks etc. etc and get to work, save their money, get married, educated, invest and get all middle classy.

They can't, no more than the mad can behave sanely.

Even so, their behavior pattern is a pathway and we need both carrots and sticks to keep them as far on the right side of that path as possible. I consider that those sticks can include both physical and mental pain.

I include myself in the class of the mad and bad, as I do everyone on earth, to greater or lesser degree. We are all hairless monkeys with a taste for gin, bad women and trouble.

buddy larsen said...

Well said, AVI and commenteers. The ''buck up, little soldier'' speech --when used on someone with uncontollable affliction who actually cannot buck up regardless how hard that person might try --is not even a waste of time. It's to add leeches to someone already bleeding.

Anonymous said...

I think what you are missing in this is the cost. I totally agree that someone who is bi-polar cannot help it (although the medication does help a lot) and certainly someone who has autism cannot help their condition. That is true now and was true 100 years ago a a thousand years ago etc. What is different now is that the moms and dads want to put their hands in my pocket and take my money to pay for "special treatment". Is it moral to take my money to solve YOUR problems? I need to pay my mortgage could you please start sending me $1500 every month??? What! You don't want to pay my mortgage!! Well I don't want to pay for a full time teacher to take care of your little autistic child!! I don't want to pay some shrink $150 an hour to talk to your bi-polar daughter. If this car is something you truely believe in then YOU pay for it....

Retriever said...

"Is it moral to take my money to solve YOUR problems? "

Well, Anonymous,I'm assuming since ask this that you do not take anyone else's money to solve your problems. This would mean that if you get a heart attack (after a lifetime enjoying good cigars and booze and good food--your privilege,I am not a Nanny), you would not expect health insurance paid by nonsmokers and nondrinkers like myself from families where the women do not get heart disease and live into their mid 90s, to payfor your cardiac care, surgery, intensive care, ambulances, rehab, and rehospitalizations. I am assuming that you will not take Medicare when you reach 65.

If you get pancreatitis from being a heavy social drinker, I assume that you will not expect health insurance or Medicare to fund your medical care.

If you get cancer after smoking two packs a day of satisfying cigarettes....you get the idea.

You wouldn't expect someone else to take care of your problems.

The thing is, there is a big difference between developmental disorders and biologically based mental disorders and the health conditions that most people feel entitled to receive health insurace and Medicare to treat. Even tho the latter are often largely self-inflicted (I used to work in a hospital and you should have heard the nurses on the subject of yet another white male coming in with a heart attack,and devastated family, after years of being a social alcoholic who thought their behavior "hurt noone")

I find it quite staggering that anyone can consider withholding care for mental illness because it costs too much, whereas a middle aged man with a heart attack would not have care withheld because it costs too much.

You also have no idea just how much money the families of kids with disabilities and mental illness already spend on their care.

I happen to have an autistic (high functioning) kid, who will almost certainly be able to function independently and work and NOT be a drain upon society in a few years. Only because we have an enlightened school system that put the money into appropriate education to help educate him and prepare him to function in the real world. Oh, and our family living in virtual poverty (I spend half my salary on uncompensated care). The thing is, had we lived in a state where people had your attitude, he would still be completely non-functional. You should try volunteering in a center that helps autistic kids for a while. Learn something.

We've always felt that tho the costs of educating our kid were great, the costs of not educating him would have been greater. AVI knows better than I do how much institutions for the "incurable" used to cost to house people who were viewed as throwaways just fifty years ago. Cost in money and human misery. My kid will end up a worker, a taxpayer, and hopefully a virtuous churchgoer with friends and family because money was spent on his education.

And it probably evens out financially in the end because the rest of us are so disgustingly physically healthy that we will likely live into our 90s with no cancer or heart disease, etc. while our neighbors succumb.

But I understand that many people feel as you do. There are more and more communities for old people where you won't have property taxes levied to support any local schools, so that might be a good solution? Only thing is, such communities tend to rely on the power of human denial and to be designed for fit oldsters, and not to have many medical facilities for miles, so one tends to have to move to communities with those awful taxing young people again to be near one's own doctors.

Sorry to be so cranky, but our family are NOT moochers, and it really angers me when people talk about Special Ed or needed mental health care as if it were a luxury option.

Retriever said...
This comment has been removed by the author.
Cassandra said...

Major Depression is real and serious. PTSD can create havoc with people for their entire lives. It is not only ignorant, but cruel to suggest otherwise. Any of y'all who are still holding to that idea - if you ever have a kid with schizophrenia, you will be humiliated to the point of suicidality to remember the cruelty you have inflicted on genuinely suffering people who you dismissed.

The suicide of someone you know well will do that to a person, too.

One of my favorite movie quotes - I can't recall the exact words - said something like, "Moral courage isn't worth a damn without a bit of moral humility."

It sounded better in the film but that doesn't make it any less true. Great post.

Assistant Village Idiot said...

I think politically, people try to characterise this as an either-or, as Anonymous does here: we either help others or we don't. In fact, all societies grant some help and withhold other help. The issue to be decided is at what level, and for what reasons.

Libertarians prefer rhetoric much like Anon's. What is the moral basis for the government to do any of this? By extension, why have public schools at all, never mind expensive SPED arrangements? Why have fire departments and ambulances? Or county nursing homes? Aren't they used disproportionately by the irresponsible as well? Since colonial times, and stretching back to English traditions, Americans have always made some provision for others who cannot manage entirely on their own. One could make the argument that even poor houses cannot be justified on similar grounds.

On the other side, the political left uses rhetoric that suggests that we are doing nothing, and a society which does not want to fund their current program is thereby heartless, throwing grannies into the snow.

In fact, each society works out its consensus over time, of what help shall be granted by government and what help withheld (or problem ignored).

Into this picture come issues of fairness, culpability, general benefit, and encouragement. And not least, what does any society actually have resources for?

Retriever notes how we have assembled a collection of government benefits, which when compared to some that are withheld, don't make a lot of logical or moral sense. I will link to another recent post.

Ben David said...

... curious at to the original poster's opinion of cognitive therapies?

Navel-gazing traditional approaches are not the only - or most effective - way to recognize psycho-spiritual problems and help with them.

Assistant Village Idiot said...

By the nature of my work, I am most familiar with medications as treatments. For what are classified as Severe Mental Illnesses, such as the schizophrenias and other psychotic disorders, BPAD and Major Depression, I consider them not only the gold standard, but the only current treatments. ECT, and now the new transcranial or vagus nerve stimulating interventions, also have a body of good clinical evidence for their effectiveness. Many other conditions, such as anxiety disorders, mild-to-moderate depression, OCD, PTSD, phobias, have been shown to respond to cognitive-behavioral or other talk-therapies, however, and I understand that many people would prefer to try them first.

The problems with medication usually come from side-effects, which can be quite nasty. Also, there are many folks out there who can be helped partially by antidepressants or anti-anxiety agents, but have personality factors which need to be addressed as well. The hope of a magic pill that solves all helps them avoid those changes - and some of those pills are addictive, creating another problem. Yet even in those cases, the medications help some.

People even with serious and clearly biological problems can make remarkable adaptations and assemble a life. Often the key is the recognition that it is they who must adapt, as the world and their bodies are not going to change.