Thursday, October 16, 2014

But I Don't Want To Go Among Mad People

“But I don’t want to go among mad people," Alice remarked.
"Oh, you can’t help that," said the Cat: "we’re all mad here. I’m mad. You’re mad."
"How do you know I’m mad?" said Alice.
"You must be," said the Cat, "or you wouldn’t have come here.”

- Lewis Carol, Alice In Wonderland.

There are times in my life where even I must be careful of what I say, lest I say something I don't wish to say instead of what I do mean to say.

So let me be clear, Mental Health Issues and psychotherapy (in all its forms) are severely burdened with stigma. There is much to be understood, much unknown and subsequently high chance that whatever opinion you hold about the mind and its various maladies and treatments are naive and possibly damaging. And here the general 1st principle of healing is probably as good a guideline as you can get - first do no harm. 

Perhaps the best way to deal with Mental Health Issues (MHI) are to find out as much as you can from reliable and noteworthy sources (wikipedia and higher) and then say as little as possible. Particularly voicing opinions of mere conjecture as though they are objective truths.

Now, what of Alice? I think the Cheshire Cat is guilty of affirming the consequent - (everyone here is mad, you are here, therefore you must be mad) a logical fallacy, but don't quote me on that. Alice's sanity though and her aversion to the company of mad people is kind of central. 

Consider a paraplegic. The question of somebodies paralysis below the waist is relatively easy for an outside observer to determine. While medical technology advances, at the time of writing, it is also easy to accurately estimate or account for the possibility of that person walking in the future.

Now consider the question of dating a paraplegic, the basis of attraction would be the whole of that persons identity (probably), and while you could allow for somebody pursuing a relationship with somebody who was paralysed to underestimate the impacts of that disability, I think it still reasonable that that person would realistically appraise and reevaluate the impacts as they arose.

Switch paraplegia to a MHI. It's not a smooth mapping exercise because we don't have a complete theory of mind. We do not know how the consciousness works, what it is really and how thoughts arise. But on your first date, suddenly we have gone from a visible debilitating condition to an invisible one. It is going to manifest in behavior. Furthermore it is hard to recognize if you do not share the MHI to some extent, owing largely to the aforementioned stigma.

With these differences, our assumptions in the first case have to be relaxed. Already it is hard for an outside observer to determine the MHI's presence in the first place. Getting slightly drunk can suppress all symptoms of anxiety, whereas getting drunk does not suppress any symptoms of paraplegia. Steven Fry claims that cocaine could actually calm him down during a mania. Whatever.

The next assumption is more crucial. When the person learns of their partners MHI, the chances of them realistically appraising and accounting for the possibility of that persons recovery from the MHI are not high. 

Following from this, given that they are more likely to underestimate the debilitating impact of MHIs not just on individuals but on a relationship, it does not follow necessarily that given these insults from reality that the partner will realistically appraise and reevaluate the impact as they arise.

Now the stark reality for people dealing with MHIs and living with personality disorders in their minor and major forms, is that the services provided by our health care system are probably going to be strained and inadequate. (50% of us have some kind of MHI) and in that absence, family, partners and friends can and have stepped in to provide lifesaving support for people in need and it is a beautiful thing.

With one possible exception, and even then I will not discount that in the short term it can provide real benefits. It's a cluster of adaptive behaviors that forms it's own pathology. 

If you go here, and read the first one star review, I think it highlights the dilemma of Alice in Wonderland (though 'mad' is a ambiguous and meaningless term, I'm not going to try and adapt Carol's work to modern vocabulary)

This is a book I read a number of times. If n equals the number of times I read it, then n-1 is how many times I read it and missed the point. Much of my psychotherapy I missed the point as well.

Consider our haplessly in love guy/girl who is dating the paraplegic. What if he wasn't attracted to the whole of her identity, but primarily the component of her identity that was her disability? And somehow he managed to muster up enough ignorance of medical history to have the notion, that if he just loved and understood his partner enough, that they would one day walk again? And on that day, he would be recognised as his partner's savior, a miracle worker, the greatest person they ever met.

I would hope you can see that the above person's motivation for entering the relationship are screwed up. You may also be able to imagine all the possible things that could go wrong in that relationship.

Substituting again for a MHI, it becomes less obvious. It's less obvious to any observer and the love struck partner themselves that they could be selecting for the MHI component of their partners identity. Thanks to stigma, MHIs can be kept a secret till post courtship. Thanks to how little we know about the mind, a partner adopting a belief that with enough love and understanding that persons MHI may be cured is more plausible. Some schizophrenics go into complete remission, others need medication for the rest of their lives that robs them of much of their ability to function.

Even with something like depression, you can get two people that meet the clinical definition of depression that have completely different experiences to each other and completely different reactions to the same treatment. The medical history of almost all MHIs and even personality disorders are very very recent histories, being constantly revised.

It is not in other words, the madness of the mad hatter, the march hair, the Cheshire Cat, the Duchess, Tweedle Dee and Tweedle Dum, the Red Queen etc. that Alice need be concerned with. It is her own sanity. 

Here is the clear dividing line:

If you love and accept somebody for who they are, truly accept them and the realities of their condition. That's fine. That's beautiful.

If you love somebody for their potential to be somebody else, refuse to accept them as they are and the realities of their condition. Then it's now about you, and you should doubt yourself and proceed with caution.

I read an article that I can't unread, and could no longer find, but it had a simple rule, a heuristic and I love heuristics. It's if you ever use the term 'better' to describe your partner (not better than, but getting better, or they've changed, or they're making progress etc.) then you are waiting for somebody else to change for you and not accepting them for who they are. That's probably the best red flag I could offer somebody to catch themselves. 

Obviously, if somebody is recovering from the flu, then the context shifts.

But I read 'How To Love' a bunch of times thinking the 'who to avoid' chapters were bleak as they appear to many. The thing is that Depression might be the Mad Hatter, and substance abuse the March Hair, and sociopathy the Red Queen, Narcissism the Duchess. The key being that you shouldn't want to go among Mad People. It is as reasonable to a position to say a person shouldn't want their partner to be paraplegic as it is to say that you shouldn't want your partner to have Cancer or ALS. 

Same same with MHI. They are issues because they are debilitating. They take a toll on their hosts. You can share that burden, and it seems that some people overcome it. You can also increase that burden by not understanding it, making demands of it, and taking a failure to get better personally and resenting your partner for the choices you made.

It's not about them, it's about you. Have you accepted the reality of their condition? Most of these conditions are still mysterious and not understood by the experts. Too bad. You need to accept that reality as well and subsequently accept just how little of the reality you understand.

Failing that, try to do no harm.

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