Semantics 1

1. Semantics 1 • We say that one gets cancer, or a cold, or kidney disease. One would never think to say that one is cancer. But we say that one is depressed, or bipolar, or schizophrenic. • A disease of the body is a condition. But a disease of the mind, we think, is a state of being. • We no longer believe, as we did 250 years ago, that the mentally ill are animals, but we are not yet ready to grant that they are fully human either.

2. Disability • My biggest mistake was in allowing myself to be called disabled. When I did so, I became, in my own mind, disabled. • And once that happened, I was disabled. I defined myself by what I couldn’t do. But the number of things I could do was far greater.

3. Survival 1 • Psychological patients are as wont to write stories of triumph over madness as are their psychologists. This is, after all, the classic, three-part story: man or woman fulfills early promise, is struck down by adversity, and finds redemption, usually in love. • I know many people who are mentally ill. This is the story of most of them: they take their meds, they see their doctors, they go to the hospital from time to time, and they continue to struggle and suffer. The name of the story is not triumph or redemption, but survival.

4. Baby 2 • In many ways, as I have suggested, psychiatric hospitals treat their patients as infants. In doing so, they teach them that the way to wellness lies in being infantile. For example: • If you are bedridden, it is customary to wear pajamas. Otherwise, healthy adults and children alike, in our culture, wear street clothes during the day and bedclothes at night. The exception is infants, who wear “sleepers” all the time. In my experience mental health patients, who although they are ambulatory, are required to wear pajamas all day, whatever the reasons for this policy, are being given the explicit message that they are like infants.

5. Baby 2 • The only people who do not customarily wear shoes when they are up and about are babies and mental patients. • An adult in socks and pajamas who is being interviewed by a psychiatrist wearing a suit and tie is explicitly put in the position of playing the child to the adult. • Plastic-covering mattresses and pillows are no doubt there for hygienic reasons, but the message that is conveyed is, “We anticipate that you will, like a baby, wet yourself.”

6. Baby 2 • If you have to go elsewhere in the hospital for medical treatment, you are required, even though you are perfectly ambulatory, to get there in a wheelchair, just as babies, when they go out, travel in strollers. • The only diversion customarily offered is “occupational therapy,” which consists almost entirely of nursery school activities.

7. Baby 2 • There are undoubtedly good reasons for existing policies. I do not wish to suggest that they are entirely arbitrary and capricious. But quite aside from their practicalities, they carry a powerful symbolism: You are not a responsible adult; you are nothing but a baby. • It is not clear to me how this message promotes emotional healing.

8. Silence • The effects of silence accumulate. The silence of one person alone magnifies prayer, meditation, thought, the music of the universe. The silence of two friends is a communion; silence between two enemies cultivates fear and loathing. • Silence in a crowd breeds solidarity, anxiety, embarrassment, or laughter, depending upon the circumstances. But the silence of millions is the cornerstone of evil.

9. Clinical Depression • People who have had a brush with the blues think they know something about what it is like to be clinically depressed, but they don’t. Clinical depression is as much like the ordinary blues as a wart is like cancer. It is a state of being suspended halfway between ordinary vitality and a coma. • It is an illness in which your sensory systems shut down. Food becomes tasteless, any kind of sound oppressive. Colors fade to shades of nondescript gray.

10. Clinical Depression • The light in the morning is only a slight variation on the light at midnight. Your chest constantly feels as if someone were standing on it. It seems like a lump in your throat, only the lump is strangling your heart. You want to cry but can’t. You crave sleep but it won’t come. • You lie in bed all day anyway because sitting up would take more energy than you possess. You feel as though you have come down with some devastating tropical fever.

11. Paradoxes • The only remedy that I know of lies in peer-led support groups, which teach the art of directing empathy in a positive way towards others. They lead the mentally ill into lives of service. The remarkable success of AA groups is a notable example of this idea in action. • Why are peer-led groups so little used in psychotherapy? The simplest answer is the likeliest. They operate outside the money economy. Mental health professionals can’t charge for them.

12. Paradoxes • I don’t think we’ll have a truly successful mental health system until the mentally ill become genuine partners in their own healing, and the only way to do that is to make them healers, rather than merely the objects of healing.