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mental health mondays :: the curse of coping

i know a lot of people who've had this experience: you go to see a psychiatrist in the hopes of getting some help- not just medication, but an actual plan to help you overcome the feelings and behaviours that are crippling you- and you explain everything that you know is wrong as calmly and cogently as you can. the doctor takes one look at you, determines that you haven't put your underwear on your head and that you've washed some time this month and determines that there's not really anything wrong with you.

not every psychiatrist is like that, but it happens often enough that we should be alarmed. it's a problem, because, as one author and speaker on the subject put it, high-functioning people die just as dead as everyone else. it's also pretty bloody cruel to tell people that they have to be in more pain, or in pain for a much longer period of time, in order to have their condition taken seriously.

if that doesn't concern you, because you don't know people who suffer from these disorders, let me put it another way: people who are high-functioning are time bombs just as likely to hurt themselves as those with more obvious problems. some are prone to outbursts of anger, which is a danger both to themselves and those around them.

or, if you want a purely selfish reason, leaving treatment until it reaches a crisis point [usually resulting in a hospital stay or a period of confinement] is a lot more expensive than spotting symptoms early and working to relieve them. [others have argued that this isn't true, but the response has been that they their argument casts too broad a net.] so, if someone is showing symptoms of mental illness, like any other illness, it's better to address it early rather than wait.

the term that's used for people who are able to dress themselves and make it to work on at least a semi-regular basis is "high-functioning". health activist website the mighty posted a video that pretty much sums up how it feels to be a person with anxiety in such circumstances. other conditions where high functioning is most common are depression and bipolar disorder. the things that link these are that behaviours that result from them can show on the surface as positives: people who feel acutely afraid and stressed, people with abysmal self-image and people in the grips of a manic phase can be amazingly productive; they can get great marks in school, win prizes, they will work themselves into the grave for an employer and demand little in return, or they'll be the first to take on more work in volunteer organisations because they desperately need to fill their brains with anything that isn't their inner voice telling them that they're worthless.



of course, the problem of being high functioning is that what you're capable of doing is no reflection of what's happening inside. there's no persuasive evidence that people who can get by in the outside world feel any differently than those who can't, even if they have a little more control. and, in the eyes of medical authorities, a little control is all the difference between serious and inconvenient. a few years ago, i had a friend tell me how she'd explained symptoms of ocd she was experiencing to her doctor. she knew that they were irrational and she said so. her doctor's response was "so why don't you stop doing them?"

that's what a high-functioning person faces: a trained professional's immediate reaction is the most elementary mistake in the world when it comes to dealing with mental illness. what's worse, those sorts of elementary mistakes are written into the most basic processes of psychiatry. a standard evaluation asks if the patient believes that things like radio and television are speaking to them, or if they hear voices that no one else can hear, ones that they believe to be real. so what happens if a person hears voices, or thinks they're getting messages, and they know that the idea is ridiculous, but the voices and messages have an effect anyway?

what's worse is that i suspect that there's a more sinister undercurrent at work. remember what i said about high functioning people being productive, being willing to work hard, willing to do anything to silence their inner demons and [in some cases] to win approval? that could be useful to a lot of people. having someone who works harder, demands perfection of themselves, is plagued by feelings of anxiety and worthlessness... those are the sort of people who can make things run a lot more efficiently in a business, in a team, or in any organisation. it doesn't change the fact that the person in question feels miserable and desperate [and often in considerable physical pain, since high levels of anxiety and depression trigger inflammation throughout the body]. so when people say that mental illness can have benefits in this way, they mean benefits for other people.

i don't know how you fight the dual stigma of being mentally ill, but not mentally ill enough. i do know that it's high time that people at least felt comfortable telling their doctor point blank when they feel that they're not being taken seriously. and, while it's perfectly acceptable for you to take pride in your accomplishments, trying to maintain the facade of control for your doctor, when you feel that you're on the brink of collapse, can be flat out dangerous. don't accept being told that you're fine when you know you're not. 

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