So Tell Me ... What's The Weather Like on YOUR Planet?

24 November, 2007

A Personal Note

Provoked somewhat by discussions on Bastante Already and in reference to Carol Hanisch's 'The Personal is Political', a personal note to the internet.

Those pesky personal problems that I drag into the public arena when I have the time and energy:

Mental health concerns being treated as strongly distinct from other health concerns. Shaming of people with depression and other mental health issues, treating those concerns as being moral failings rather than health matters. Frequent lack of coverage for extended therapy and other mental health concerns in American health care coverage. The dependence of adequate health care coverage on adequate employment in the United States. Attention to diagnosis depending on the sex, ethnicity, class, and other privilege status of the sufferer, such that a suburban kid may actually get the care they need while an inner-city kid may get kicked out of school for being 'disruptive' or something similar. Socially deranged attitudes towards body shape and health that encourage eating disorders, among other consequences.

Privilege-fraught access to education in general. Failure to put forward advancement of actual learning in the schools rather than constant grinding over the same topics repeatedly. Lack of care for students with special needs, whether those are remedial, medical, advancement, or something else. High costs of education. Lack of learning actual essential skills for living. Failure to teach how to evaluate and weigh evidence. The promulgation of misinformation about socially denigrated activities in the hope that fear will keep people from having sex, smoking pot, or whatever else is being discouraged by propaganda. Lack of informed status on such things as the basic beliefs of Islam, the principles of supply and demand, the mechanics of disease transmission, and any of a number of other matters that have worldwide import.

The equation in the United States of form of employment with selfhood. The shortest span of paid vacation in the supposedly civilised world. The expectation that employees, especially but not limited to men, will work overtime rather than have time to spend having their actual lives. The lack of childcare facilities available in most workplaces. The cultural prioritisation of financial gain as measure of success.

The shaming and fetishisation of rape and assault victims as Damaged People. The lack of adequate awareness of social coercion and date rape. Slut-shaming and other tools of oppressive normative sexuality. Seeking to diagnose and pathologise whatever is wrong with people who do not have normative sexuality on the assumption that nobody could be like that without having been abused. Treatment of people who do not constantly adhere to normative sexualities as being intrinsically dangerous, antisocial, abusing, or otherwise disruptive. The unpersoning of sex workers. Treatment of sexuality as something intrinsically unable to be approached with rational thought, commitment-keeping, or human respect. Treating personal sexuality as a political statement.

Lack of awareness and consideration for verbal and emotional abuse. Boys will be boys. Sticks and stones may break your bones, but words will never hurt you.

Lack of social and legal support for alternate family structures. The inability of same-sex partners to legally marry in most of the United States. The presumption that any non-monogamous family unit is polygynous.

The social presumption of Christianity. The fact that questioning the hegemonial status of someone else's holiday leads to accusations of hostility to Christianity, "War on Christmas", anti-religion sentiments, secularism, or whatever other deranged slanders crop up especially around this time of year. Generalised religion-bashing sentiments that only make sense if one assumes the axioms of a particular flavor of Abrahamic monotheism. Anti-Christian sentiments expressed in the assumption that nobody present could possibly object.

Sexism. Including anti-male sexism. Gender essentialism. Mystical frou-frou womb worship. Sexual reductionism. Transphobia. Ableism. Calling things "lame". Calling things "retarded". Calling things "gay". Homophobia. Anti-bisexual bigotry. Racism. Presumption that the customs of one's people are laws of the universe. Ethnic supremacy. Male supremacy. Female supremacy. Kink supremacy. Polyamorous supremacy. Reconstructionist supremacy. Imperialist treatment of non-Western nations and ethnicities.

And quite likely rather a few other things I can't think of right now.

They could sometimes admit that women were oppressed (but only by "the system") and said that we should have equal pay for equal work, and some other "rights." But they belittled us no end for trying to bring our so-called "personal problems" into the public arena - especially "all those body issues" like sex, appearance, and abortion. Our demands that men share the housework and childcare were likewise deemed a personal problem between a woman and her individual man.


From the new intro to "The Personal is Political", linked above.

7 comments:

Annwyd said...

A friend of mine called on her friends for their opinions on anti-depressants recently, and the people telling her, "Don't take them, they're bad, you have to get through it on your own" made me twitch and foam and want to write a rant about how this is a kind of bigotry against the mentally ill.

Listening to Christmas carols all the damned time also makes me want to write about how Christian our society is, and how that comes off to a religious outsider.

So you're not alone with quite a few of these.

Alison Hymes said...

Might not be bigotry, as a person with a mental illness, I might say don't take them to someone myself because they're bad and mostly don't work. I wouldn't say you have to get through on your own though, I would recommend psychotherapy and peer support and ask what I could do to help. I'm not saying no one should ever take an anti-depressant, but the success rate isn't much better than placebo and the side effects and withdrawal syndromes really are awful for lots of folks, not to mention the folks who will be triggered into mania by an anti-depressant, a minority but a very big deal for those people.

The bigotry I see most is equating mental illness with bad or dumb behavior or simply with evil and danger.

Annwyd said...

First off, let me address the factual errors and sloppy logic here.

"Antidepressants are bad--"
Bad how? Morally bad? Philosophically bad? Politically bad? Religiously bad? Or some tangled, deep-rooted combination of all of those?

"--and mostly don't work." combined with "the success rate isn't much better than placebo..."
This is a misconception based on two issues. One is the unfortunately scattershot nature of antidepressant drugs in their current less than ideal incarnations. For any given antidepressant, a handful of people will spectacularly improve, most will have a small improvement, and some will get worse. To become one of the handful of people who spectacularly approve, the other people may simply need to find a different antidepressant. Or there might not be any currently in existence that works just right on them. But just because our current medical science is imperfect doesn't mean that antidepressants are inherently bad.

The second issue at hand here is mentioned here:

...increased severity of depression was associated with greater change in depressive symptoms in those treated with antidepressants, with the reverse effect observed in those in the pill placebo condition.

In other words, yes, some people respond similarly (although not identically) to antidepressants and placebo. But these are people with mild depression. People with moderate to severe depression see changes greater than can be accounted for by placebo--and these are the people whose lives would be most improved by a treatment for their depression.

"I would recommend psychotherapy..."
The problem here is that psychotherapy is likewise unproven. It seems common sense that talking your problems out would help them go away. But common sense is often wrong--you think with your brain, not your gut, and the earth is not flat. Indeed, there is evidence that talk therapies that focus on discussing past trauma can actually worsen depression. In other words...psychotherapy can have unpleasant side effects, just like antidepressants.

More pertinently, the benefits of most forms of therapy are largely unsubstantiated. Cognitive behavioral therapy has evidence in its favor--but said evidence points to it being equal to antidepressants properly administered, not better. Time and time again, the statement surfaces that the best treatment is a combination of pills and talk, not one or the other.

Now there's the more ethereal issue of the philosophical underpinnings of your argument. What you're saying boils down to this: "I think antidepressants are bad because they are risky and I've heard that they don't work. So I would tell other people to use a different, probably less risky unproven treatment instead."

I'm going to address your mention of side effects here. Do antidepressants have them? Yup. Do they outweigh the benefits? For some people, yes, and avoiding antidepressants is a valid decision for them (more on this later). Overall? Not so much. For instance, much has been made of the "suicide effect" of SSRIs. It's probably real. But studies have shown that antidepressants prevent significantly more suicides than they cause. In other words--given that the suicidal are likely to be severely depressed and thus benefit far more from real pills than placebos--antidepressants save lives.

Other side effects? The common ones are weight gain, sexual dysfunction (such as loss of libido or difficulty reaching orgasm), and usually transitory symptoms such as nausea, tremors, or agitation. Some people may disagree, but I don't think those side effects are reason enough to recommend avoiding the drugs.

There are, of course, more serious side effects in rare cases. Likewise, withdrawal can be an issue, although it is fairly rare with most of the drugs other than Paxil. This brings me to my main point here: whose job is it to decide whether the risk is worth it? Is it fair to deem certain helpful drugs "off limits" because of side effects that are rarely serious?

Instead, it would make more sense to treat the drugs with respectful caution. Be wary of doctors who prescribe without listening to you thoroughly and studying your history first. Keep a close eye out for the more dangerous side effects if you take an antidepressant and instruct those close to you to do the same. Combine it with a clinically proven variety of therapy if possible.

Doing or saying otherwise smacks of a nanny-like attitude. If a drug works and has a low chance of killing or disabling you, why shouldn't it be treated as a valid option for the people who need it? There's no reason not to...unless one believes, subconsciously or otherwise, that depressed people cannot make decisions for themselves, cannot properly evaluate and develop strategies for tempering the risks. It's not the sharp, nasty bigotry of racism or homophobia, but the soft prejudice of ageism and ableism. I know better than you. I think you are weak and wrong unless you do this my way. And you can fall prey to it even if you are yourself depressed or otherwise mentally ill.

Dw3t-Hthr said...

It seems common sense that talking your problems out would help them go away.

Actually, it seems blitheringly implausible to me, for all that I'm, y'know, actually in therapy. It's blatantly apparent to me that talking about and intellectualising one's issues does not necessarily actually translate to doing anything useful with them.

Never mind that it is blatantly obvious that I have something biologically wrong with me, and the particular deficiencies of my system are about as responsive to talk therapy as diabetes would be. Not that I treat the blatantly obvious biologically wrong with me bits with anti-depressants, because they're a vitamin processing deficiency, but the principle still holds.

I know too many people whose mental health issues have a significant component of fucked-up biology to believe in psychotherapy as panacea. Psychotherapy for my mommy issues? Sure, maybe that will help something if I can manage to work out some different ways of thinking there (jury's still out). Psychotherapy for the digestive disorder that runs in my family and fucks up critical neurofunction vitamin uptake? Moronity of moronities.

It's the "it's all in your head" logic that I was complaining about. 'There's nothing medically wrong with you, you just need to talk it out.' This is utter nonsense in many cases.

For instance, much has been made of the "suicide effect" of SSRIs.

Which comes about because severe depression has two major components -- the actual mood disorder and the inability to implement any actions -- and antidepressants tend to fix the motivation problem before the mood problem.

Lisa Harney said...

Dw3t-Hthr,

Thank you for linking this. I especially like where Carol Hanisch says:

Political struggle or debate is the key to good political theory. A theory is just a bunch of words -- sometimes interesting to think about, but just words, nevertheless---until it is tested in real life. Many a theory has delivered surprises, both positive and negative, when an attempt has been made to put it into practice.

It's interesting how modern theory is not supposed to be subject to real life.

Lisa Harney said...

Man, if only I could resolve my own issues just by talking them out. I could've stepped out of my depression years ago!

Now if only I could get an SSRI that doesn't try to kill me...

Alison Hymes said...

I have had personal experience with every anti-depressant except MAOI's. None has helped me, many have caused bad side effects. No psychiatrist will prescribe me an anti-depressant at this point. This isn't just my opinion and it certainly isn't prejudice, sheesh, that's insulting, it's my lived experience and the lived experience of many people I know personally.

If anti-depressants work for someone, great, more power to them and I'm glad for them.

If psychotherapy doesn't work for someone, well that's a shame but makes sense to me, it certainly isn't right for everyone. Psychotherapy has a biological effect however, so saying there's something biologically wrong with me so therapy won't work doesn't make sense, psychotherapy is proven to change the brain.

My depression is definitely biological, over 60% of people with chronic kidney disease are depressed due probably to the parathyroid hormone overload and toxicity issues. And still, peer support and psychotherapy are what have enabled me to cope and recover.

I really resent being told my thinking is sloppy and that I am prejudiced against myself and my people because I look at my experience and the many research articles on anti-depressants and conclude they may not be worth it for most folks. Doesn't mean if they come up with something better I won't try it if my psychiatrist agrees. In fact I'm fascinated by the Washington Post story on therapeutic uses of ecstasy, currently in research.

For anyone that has benefited from anti-depressants, I'm very happy for you. Keep on keeping on. For those who haven't done well on them, I'm saying there is still hope, other options, alternatives.