2:28am June 9, 2013

Where does this even come from?

What does it even mean when people say “Get psychiatric help” to someone, or “They should get psychiatric help” about someone else?

I mean when (and if) it’s not just a snotty statement meant to dismiss someone and their experiences wholesale.

And I mean differently than it might be said among real friends.

I mean like strangers say it to each other on websites. Not when they’re being completely cruel and nasty. But when they don’t even know the person well. Or are talking about groups of people in the hypothetical. Generally without knowing a whole lot about the person in question.

Because like… psychiatric help doesn’t do nearly as much as people think it does. Some people have problems that respond to something simple like medications or therapy. Most don’t.

There’s no place called “psychiatric help” that you can just walk into and they magically solve your problems. Not even if they put tons of work into it over years. It’s a total crapshoot between getting someone wonderful and getting badly hurt or killed, and everything in between. And even if you get totally wonderful helpful psychiatrists and therapists and the like, it doesn’t mean they can solve your problem. In fact usually, if it’s a serious problem to begin with, even the best help doesn’t solve your problem and may not even help very much at all. It’s fairly rare that psychiatric help clicks with a person’s problems like a key in a lock. And sometimes it’s more like a bludgeon to the face.

I got fairly lucky in that my main psychiatrist, who was assigned to me randomly after a suicide attempt, was a really good and fairly perceptive person. He diagnosed me with autism and he filled out forms with me and stuff. But he also did a bunch of stuff that I’d classify as well-meaning but completely useless. I think he saved my life at one point by assigning me a one-to-one VNA staff person right after the institution staff had tried to allow me to die (long, awful story). So that counts for a lot. But he also did a lot of things that were well-meaning but also really harmful, some of them highly dangerous.

And he never helped at all with my severe emotional problems despite doing both a slew of medications and various kinds of therapy. He didn’t help the receptive language problems that he tried really hard to fix. He didn’t help with social or family problems. He really couldn’t help me with much other than diagnosis and paperwork. And, of course, keeping an eye on my safety in the really scary institution he worked at, trying to decrease harmful medication, and sneaking me candy when they tied me down. But that was sort of… psychiatric help with undoing severe damage done by the psychiatric system. So it probably saved my life but my life should never have been in danger in the first place.

Oh and there was one psychiatric nurse who actually helped me a great deal. But that was because of things that had almost nothing to do with psychiatry.

So anyway. When I was in severe, dangerous levels of distress that harmed both me and other people, even a good psychiatrist could do next to nothing for me. I knew that I was supposed to seek psychiatric help for these problems, so I sought it. Over and over again. I begged for help and I did just about everything they asked to the point of excess. And by the time I stopped seeking help I was actually in worse shape than when I started.

That’s a really common experience and it’s a lot of how people end up chronic mental patients. We know we have problems and seek help, or we don’t know and are forced to seek help. And when we get there the help does little to nothing, or makes us even worse, so we seek help and get worse and it’s a vicious downward spiral from there. That’s one reason that places without psychiatry sometimes have better recovery rates than places with it. I’m not trying to be black and white and say it’s always better not to seek help. But it often works out that way in the end due to the structure of the system.

Another problem with this idea is that psychiatric help is presented as what will help you. The thing. The only thing. Then you get psychiatric help and it doesn’t help. If you were at all inclined to suicide at first, you will generally consider it even more strongly once you realize that the one thing that is supposed to help, above all others, was actually useless to you. Because suicide is usually about perceiving there to be no feasible options for a good life.

By the way I’m being vague about my problems for a reason. There are several psychiatric diagnoses I would have fit the criteria for. But I see my problems in an entirely different light. It’s like how if you have a bunch of dots in different places, you can draw all sorts of shapes that fit them, not just one. My shapes don’t match up to the DSM very well. Suffice to say the problems were both real and extreme and dangerous.

I’m actually extremely lucky. I found people who knew exactly how to help the sorts of problems I had, and aside from that one psych nurse I found them outside psychiatry. I found that most of what psychiatric help had been like, was pushing around thoughts in circles on the surface. These people helped me deepen below that surface and they saved my life in the process. Saved me both from what would have likely happened if I stayed a mental patient, and from myself.

Not everyone has friends who can do that. And not everyone — probably not most people — has severe psychiatric problems that psychiatry can actually do much about. So why do people insist on telling people “seek psychiatric help” as if it’s a cure-all, or even as if help is even likely?

Of course most of the time when people say “get help”, they aren’t actually considering anything that’s in your best interests at all. Half the time they’re just being snotty, and half the time they’re trying to find ways to shut you out of relationships and communities by saying you’re too “sick” to be part of them.

Or saying that you have such horrible problems that nobody but trained professionals should be allowed to deal with them. Which is a horribly toxic belief that has sort of contagiously spread through a lot of communities, to the point where those communities can no longer behave like friends or communities ought to behave, because they honestly believe that only professionals should deal with certain problems. And therefore that friends shouldn’t deal with them, or shouldn’t have to deal with them. I have friends who witnessed communities actually disintegrate after psychiatric ideas got woven through them, because instead of seeking help from each other as they used to do, everyone started going into therapy — which didn’t work any better, and often worked much worse, and certainly disintegrated many of the bonds that had previously been created among various people.

Another ugly thing that “get help” can be used for, is… to be used on people who are actually and truly people that communities shouldn’t have to deal with at that time. Who are much rarer than people act like they are. I’m talking about people who manipulate everyone around them and treat them like toys and hurt them for fun, or… other people who are actually truly dangerous to any community they are a part of. Not people who just happen to be very strange, or very needy, or very unusual in the way they behave and approach people, or people who have difficulty with social skills. But people who are actively and purposefully toxic to everyone they interact with.

Telling those people to get psychiatric help is basically telling everyone involved that being a cruel person without a conscience is the same as having psychiatric problems. Which it isn’t. And psychiatry has nothing to offer such people anyway. Worse, gradually people begin to confuse strange or emotionally needy or socially unskilled people with truly toxic people (sometimes that’s understandable, because toxic people may masquerade as such people, but sometimes it’s something a lot more disturbing). And then will start telling anyone strange or needy or socially unskilled to get out of their communities and “get psychiatric help”. So in those circumstances it’s bad for everyone involved.

(And yes, I am saying that there are people who harm any community they get involved with. I know that goes against the idea that All Means All and all that. But no actual ethical principle worth its salt can be summed up in a slogan or has no exceptions. I have no idea what to do about people like that. But I know they exist. And I know that such slogans about all means all were created because disabled people, especially severely disabled people, were being excluded from communities. Cruelty, the kind of cruelty where people take joy in treating other human beings as toys, is not a disability. I don’t know what it is, but it is not the same as having physical, mental, cognitive, emotional, or psychiatric differences that get you treated badly by society. In fact, in many societies such people are found mostly at the top of the heap, they are not in any way an oppressed group. I don’t know how to handle the problems such people create. But it is not to send them off for psychiatric help that won’t do anything for them or anyone harmed by them. And it’s not to pretend that including them in your community is a wonderful act of “being inclusive”. Far from that, including such people is usually a good way of completely excluding their victims from participating, unless their victims are willing to take the physical and emotional risk involved in participating. At any rate, telling these people to “get help” won’t help anyone, and neither will confusing every strange or truly disabled person who comes along with people like this.)

So… Yeah. I wrote this ages and ages ago, and didn’t send it at the time because I didn’t want it connected with the events that caused me to write it. Which were a bunch of people on tumblr telling people to “get psychiatric help” just because they were stranger or unusual or had emotional problems or whatever reason. And acting like there was absolutely nothing wrong with saying this all the time, and like there was something wrong with saying “hey wait a minute you shouldn’t say that to people”.

As I recall, part of their excuse for all this was that some people really do need psychiatric help. Which, yes, some people benefit from it. But you can’t tell from the outside which people those are, and even two people with nearly identical problems might have vastly different experiences within psychiatry. Bad experiences within psychiatry can be so terrible, even life threatening, that I don’t think it’s ever acceptable to insist that someone you meet on the Internet needs psychiatric help.

The other part of the way they justified themselves, was that failing to tell people to get psychiatric help was just a way of enabling their illness. I don’t even know where to begin with this.

The situations where it’s appropriate to diagnose or undiagnose someone over the Internet are so rare that they’re barely even worth mentioning. Even licensed professionals shouldn’t be doing that. Deciding that someone is psychotic is something that is generally done over a long period of time. Even having hallucinations isn’t necessarily a sign of psychosis, hallucinations are actually a normal part of human experience that almost everyone will have at some point in their life. There are kinds of epilepsy that can precisely mimic schizophrenia, but antipsychotics will make them worse because they lower the seizure threshold, while seizure medications will make them better. (Some of my “psychotic”/“dissociative” experiences – my shrinks did not fully differentiate the two concepts – followed exactly that pattern, when I wasn’t just making stuff up to conform to what psychiatry expected of me. It’s right there in my medical records, that they’d give Risperdal and things would get worse and they’d give Ativan or Klonopin or Neurontin or Depakote or Dilantin and things would get better. My parents noticed that pattern but the shrinks didn’t, even as they were recording it in detail in my medical records, and even as they were saying I had complex partial seizures and temporal lobe abnormalities. To get any more oblivious, I don’t even know… But I’m rambling.) You might consider someone delusional because their internal experience of themselves is, say, not human, but an internal experience of oneself can be just about anything and it doesn’t mean a person is delusional – many psychiatrists even know that, for cripes sake.

And the thing about enabling…

Enabling was originally an idea thought up to describe how people in relationships with alcoholics often behaved. In that they made it easier for an alcoholic to continue their addiction without consequences. Since that time, the idea has become misapplied to a broad range of situations that it should never have been applied to. Including the idea that you can enable a person’s mental illness by doing anything at all other than forcefully insisting that they get psychiatric help immediately. Which is an idea that makes me want to slam my head on walls. That is not something that enabling was ever intended to mean.

Lately, I’ve seen people apply this concept of enabling to anyone they consider hateable. Hateable being a word I made up to describe types of people that wouldn’t always, under SJ concepts, be considered oppressed, but who are considered acceptable targets for hatred and bullying by a lot of people. I’m talking furries, therians, soulbonders, Otherkin, plurals who weren’t created by trauma or otherwise don’t fit modern psychiatric definitions of MPD/DID (definitions that were created by assuming that everyone was like a tiny number of plural systems who were already being vastly misrepresented by their therapists – rather than seeking a definition that went by the last couple centuries worth of data on a much wider variety of systems), etc. People that it’s okay to hate because generally only other hateable people will defend them, and most people consider them a bad joke at best.

Anyway, it’s become trendy lately on tumblr to pretend that hateable people are a new thing somehow (trust me, they’re not), and that they all need psychiatric help (trust me, they don’t, and even many psychiatrists will back me up on this), and that failing to tell them they need psychiatric help is enabling them to be delusional or psychotic or otherwise sick in ways that only psychiatry can fix (wrong again). Oddly enough, people will say this in the same breath as saying that such people aren’t oppressed and should get over themselves. (You can’t have it both ways. People who “need psychiatric help” have a psychiatric disability and are therefore oppressed. If they’re not oppressed, stop saying that to them. If you want to say that to them, you have to assume they’re oppressed. Pick one. Mind you, I don’t give two shits who is oppressed and who isn’t, that’s largely a word thing to me and I don’t do word things… I’m just saying that people aren’t being consistent here.)

So in that context, I see “get psychiatric help” as outright dishonest. It’s a form of bullying hateable people. That’s all it is. It’s not sincere concern for anyone’s well being. If you are concerned enough about someone’s well being to think they need psychiatric help, you have a talk with them in private about how you’re concerned for their safety and mental health and that therapy or meds is an option they might want to consider. Of course, such a talk is a talk you can only have in any sincerity with people you are close to and really care about. And you have to be prepared for and accepting of the fact that they might have good reasons to reject treatment at that point in time, or ever. That they might consider it upsetting to be approached about the matter. You have to be sensitive and understanding.

All of which is the opposite of what people are when they tell hateable people to get psychiatric help because of their hateable identity. They are snippy. They are cruel. They are nasty. They are mean. They are snide. They are obnoxious. They are snarky. They are mocking. They are rude. But they are never sensitive or understanding. Sometimes they treat it all like a big joke. They never treat it with the gravity or sensitivity that the subject would deserve if they were serious about it. They sneer at people, saying “Oh come on, nobody who believes that a version of Gandalf lives in their head could possibly be in their right mind.” They accuse non-DID plurals of appropriating the experiences of people with real DID, or they say that they’re actually people with DID in deep denial, or that no kind of plural including DID even exists… and that either way they need psychiatric help. In all instances like this, “you need psychiatric help” is shorthand for “I don’t believe you should exist as you are” or even “I don’t believe you do exist as you are.” The entire idea that they are doing this out of concern for anyone’s well being is just an excuse to be hateful to people who are already hated. People who bring up psychiatric help out of true concern tend not to be so public or so cruel.

Anyway… Long story short, in the vast majority of situations where people are telling people “get psychiatric help, NOW”… They don’t mean what they act like they mean, and even if they did, the entire idea of getting help in that way doesn’t even make real sense. It really bugs me to see that phrase thrown around all the time as a shorthand for “I hate you” or “I want to be mean to you” or “People like you don’t belong around here.” It doesn’t help people who really need help, and it makes it sound like psychiatry is the only place to get that help. When even by the estimates I was given by psychiatrists, let alone actual reality, many if not most people who need some kind of help with things can’t get it from psychiatry. Or can’t get sufficient amounts from psychiatry. And… It just bothers me for all sorts of reasons, only some of which I can name.

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