Mental Disorders and Illnesses: Part Three

Oct 8

Last week I ended with the video ‘Normal’ Was Not Working for Everyone. You may want to revisit it in the post as a refresher before reading further here (scroll to the bottom): Part Two. The takeaway from ‘Normal’ Was Not Working for Everyone is that a different environment can redefine your whole way of being in the world.

Expand the Story Expand the Opportunity

The folks in the New York Times piece found that working from home, in their cases, brought peace. They were able to be professionals alongside their colleagues without having to take on the extra cognitive and physical load of being different. You are on time to every Zoom meeting as opposed to making apologies as you wheel in 30 minutes late to the second-floor meeting room because there was only one elevator working in the lobby. There is no blatantly homophobic throwaway chatter on the other side of your cubicle that you have to hear and process. The list of what you are spared (as someone different than what is expected in these spaces) is very, very long.

I am not in any way condoning the ableist, homophobic, racist, sexist garbage rife throughout all of these work environments. But I do recognize that a remote team means we stop putting all the work on those who are the target of these kinds of abuses to take the risk of correcting or suffering in silence. In a just world it would be everyone’s great workplace where we do not make the victims fix these problems; but in the real world a distributed team that comes online together to get professional assignments done, is a safe place for many more employees. The abuses simply cannot occur as they do when everyone comes to cubicles in offices together. And yes of course, this would only apply for office workers.

But I am heartened to see that the service industries cannot get staff these days as it reflects the ridiculous topsy-turvy society we have where we do not pay them enough to suffer those jobs even though we deem many of them so essential to our existence. At least at this moment in time many are finding other ways to figure it out without having to return to those miserable-paying jobs filled with the entitled people they have to serve. Canadian author Lori Fox, a 15-year veteran of the restaurant industry, observed that she and many of her coworkers had time to consider options in the pandemic’s initial shutdown and many chose to leave the industry for good. Her article in the Globe and Mail on this topic can be found here.

And if I hear one more person say that it is because we are supporting them through the various government help that was offered way back when the pandemic first hit and we should cut them off, they absolutely miss the point. If they need to go to a restaurant where the servers are paid less than any government subsidy in order to dependably get their tapas and wine, then they are the problem and not the government subsidies. They have a tragic world view where they believe that an environment of fear and inequality is the only motivator…and motivator for what? Fear is a pretty poor biological state in which to make all but the most instantaneous decisions to avoid immediate harm and severely limits cognitive capabilities (in particular memory—so expect that tapas order to be wrong) and overall health over time as well. And that kind of fear, desperation and inequality is a major reason why life expectancies between rich and poor in the US keep widening (currently men in poverty live on average 14.6 years less than their rich counterparts and women live on average 10.1 years less than their rich counterparts).

“There’s an archetype in media that destruction and upheaval bring out the best ideas and creates jobs. In literature and in society, upheaval, necessity and desperation are portrayed as the prime motivators of innovative behaviour. The problem is that outside of soap operas and medical dramas, people usually have something to lose…Yes, disruption results in innovation; But to be more precise, studies, including my own, show that stability results in more innovation than disruption would.”

— 1

While I am smacking down those who prefer their service providers terrified and miserable, I am also going to put a small marker here on the value of stability for innovation as it will have relevance for where I go next on this journey of creating spaces for better navigating mental conditions.

What if the seeking of treatment for mental illness was not treatment for mental illness, but rather an exploration of how you and your coping behaviours are going to find and/or co-create a new environment? Or perhaps a more accurate description might be to co-create and curate new environments (plural).

Farfetched? Perhaps.

Our challenge is that there are very few ways to be in the world these days. If, as an individual, you cannot achieve, or even simulate, the acceptable level of individual stability and productivity identified as “normal,” then you may be given a silo in which you might feel you belong, but most of us would really prefer to be included and accepted in a broader definition of “normal” if given the chance.

I recently read the book, Tribe: On Homecoming and Belonging, by Sebastian Junger and while I am not fully aligned with all of his concepts, it was still a good read that got me thinking. Belonging is survival for the social primates that we are. For many, many people, the online world has given them a lifeline of belonging in ways that they cannot possibly experience in their existing physical communities. I would say this has been very true for many with physical or mental health concerns. When I wrote at some length on virtual communities in the piece: Pro-Ana and Pro-Mia Sites: What’s the Deal? I did identify that communities might ratchet you in the wrong directions but I think that this is equally true for in-real-life (IRL) communities. We will get into how to assess the community you have against the community that you might wish to co-create and carefully curate a bit later on in this piece.

Treatment

While the ultimate goal is to stop and replace the coping behaviours that have now trapped you in some seriously bad stuff, we spend most of the time in treatment settings on the individual basics and almost nothing is focused on the environment in which you must exist.

For eating disorder treatment, along with many other acute psychiatric conditions, it is medical stabilization first and foremost. Very little of it (if any piece at all) constitutes change preparedness or behaviour shift training. Medical stabilization is very important for eating disorders as they kill so many. However, discharge from an inpatient setting is no different than release from hospital after scheduled surgery to replace a damaged hip: you are no longer in need of around-the-clock medical attention and that is all. Now you must actually undergo physiotherapy to fully heal and recover from that point forward.

Even when there are group therapy sessions woven into very intense interventions to re-feed, everything is in the abstract. Yes, you are often surrounded by those who understand what you are going through because they are in the same boat as you, but that boat is essentially sinking for all of you as the coping behaviours you all share are damaging, and what the treatment team tells you is going to be needed to recover is both vague and suspect.

And I will say this one more time with feeling: inpatient treatment is not designed to heal; it is designed to medically stabilize. Stabilization is still a critical first step for many, but it becomes a revolving door when there is nothing beyond it put in place as a next step.

Next week in Part Four I will be delving into editing, curation and protection and concepts during and post-treatment for the under 18’s.