Friday, February 24, 2012

Backwards and in High Heels

I worked a night shift and I really should be napping now, but I'm too full of thoughts. Thoughts about the patient I saw in the ER last night, her embarrassment at seeking help. Thoughts about the persistent notion that mental illness is a weakness, and discipline its cure. Thoughts about the good old American value of "up by the bootstraps," and how potentially lethal that is for people in crisis.

And I keep thinking about that famous line, "Ginger Rogers did everything Fred Astaire did, but backwards and in high heels."

Because that's what it's like to live with mental illness. So I'll start with a high-five to everyone facing that invisible challenge. Even if you feel like a complete mess, I know how hard you're working.

Maybe you've spent all morning trying to get out of bed. Maybe you're responding to voices and visions that torment you. Maybe you have bulimia, and you're determined to hide it. Or you promised yourself you wouldn't drink again, so you're white-knuckling through the day.

Even if your efforts prove futile, you are determined to fight the awfulness inside you. It might appear to others that you're not even trying. But I know your gears are grinding mightily, even if you're not getting anywhere. With the right help, you could go far.

Last week, I had a brief episode of depression, for the first time in years. I could not sleep, even with medication. I was daunted by the smallest chores. I panicked and cried. Thankfully, I saw what was happening and put all my recovery skills in place. I recognized that I had conflicts that needed airing, stressors that needed adjustment. I asked my husband to take the kids for a day. I also decided that if self-care measures didn't work, I was going to call my psychiatrist promptly. Fortunately, the depression passed with a couple of days.

But what if I had chosen silent stoicism, dancing backwards and in high heels, until I collapsed? I see plenty of patients in the ER who've done just that. They do it because society values rugged independence and shuns helplessness. They do it because this value plays out in cuts to community mental-health services, in the obstacles to getting health insurance. They do it because they think fighting alone is the only option. When it fails, they think they're the ones to blame.

The anguish of being trapped in a mind that can't right itself is beyond words. No one can go on like that indefinitely, but many are forced to try. I'm not a very political person, but I am when it comes to mental health. So pardon me while I rant.

I'm utterly disgusted by the closures of so many mental-health agencies across Illinois. Entire neighborhoods in Chicago, entire counties across the state, now have no public mental healthcare. The assumption seems to be that mental illness isn't quite "real" enough, its suffering not morally significant enough, to care what happens to those who need help. The problem may be framed as one of money, but money follows values.

In a recession, mental-health funding is among the first to be cut. People who should be getting care are going without. Until they can't cope anymore, at which point they end up in emergency rooms. This is far more expensive and far less efficient—hospitals are obliged to stabilize patients regardless of ability to pay, but the wait for a psych bed likely will get longer and longer, with patients languishing in the ER. Then there are those with mental illness who end up in jails and prisons for drug use and other problems related to mental illness. In this broken system, the human cost is the highest. But some humans are clearly considered more expendable than others.

I have met people—even educated, thoughtful people—who have scorn and disgust for the folks who hang out at bus stops, talking to themselves, when they "could" be working. They believe Whitney Houston deserved to die because she was an addict. They use the word "copout" to describe things like going on a disability check, checking into rehab, or taking medications. I don't hate these people, because I recognize they've bought into an incredibly pervasive myth, one so visceral that it's hard to combat through public education alone. The myth is that those with mental illnesses are weak, bad, self-indulgent people.

Those of us in the field reject this myth. We know that people with mental illnesses are often making the best of the limited choices they have. We know that if everyone in America had to spend one day living with a mental illness, they would realize this, and the myth would end.

The person living with schizophrenia who has unstable housing and poor hygiene is not "lazy." He or she is wrapped up in an intense, often terrifying inner experience that others can't understand. People with schizophrenia often live in isolation and poverty, and have a high suicide rate. Community-based services can help people improve their social skills, gain employment, and learn to manage symptoms. But such services are in short supply.

The person with substance dependence who seems to be motivated only to use, who pours incredible time and effort into staying high, is caught in a web of physiological craving and a pervasive lack of hope. With responsive, individualized treatment, that person could start to apply that strong drive toward building a better life. But such treatment can be hard to come by.

And the person with bipolar disorder who's always going off their medications? They may hate the side effects. Many psychotropic meds cause significant weight gain, impotence, diabetes, and other problems nobody wants—not to mention, blunting a manic episode may mean giving up the intense creativity and productivity that goes with it. Compassionate care providers can recognize these as legitimate struggles, and help people make their own informed decisions about medication. But not everyone has such providers.

Even with a mood disorder, I lead a blessed life. In fact, the disorder is part of the blessing—part of me. The same energies that once went into just staying alive have been liberated to higher purposes. But that's only happened because I am fortunate enough to have all the help I need. In my small way, I'm working fervently toward a world in which "backwards and in high heels" is not a lifelong dance for anyone.


Lisa Sniderman, LCSW received her M.S.W. from the University of Chicago in 2003 and has been a licensed clinical social worker since 2005. She is a past member of ETD's Mental Health Advisory Board and one of our storytellers. Click here to check out Lisa's posts.

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