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I've been thinking a lot lately about my mental health philosophy. I've had mental health problems and experiences of emotional distress for as long as I can remember, and I first sought help from the mental healthcare system when I was 23 and desperate. I experienced a psych ward and psychiatrist offices and therapy and medication and so much of it made me incredibly uncomfortable. As I've learned more about psychology and grown more as a person, I still don't really jive with much of traditional mental health philosophy.
In my undergrad psychology education, it was often parroted that the causes of diagnosable problems are equally psychological, biological, and social. There was no good evidence for one over the other, hence the snazzy made-up word - biopsychosocial. But in reality, it's difficult to even find a service within the mental health system that's based on such a view. Our system is so based on a "biomedical" way of looking at mental health problems that when Johann Hari said obvious, well-founded things about social causes of depression in 2018, it was terribly controversial.
"In my undergrad psychology education, it was often parroted that the causes of diagnosable problems are equally psychological, biological, and social. There was no good evidence for one over the other, hence the snazzy made-up word - biopsychosocial."
I think that we like simple causes and simple solutions. Perhaps that's why we like the clean lines of medicine applied to our messy psyches. The problem, of course, is that no simple biological causes are known to exist for most psych disorders (think of the popular but inaccurate "serotonin deficiency = depression" meme) - certainly no cause so simple that we know how to fix it with medication. We can treat symptoms, for sure (by boosting serotonin, for instance), but that's a different thing. It's causing an effect, mostly a positive one if we're lucky. And with many treatments in many people, we're not.
Outside the System
My unhappiness with the system is why I primarily exist outside of it and very occasionally on its fringes, in the company of specifically sought-out therapists. And sometimes, I get the impression that people think you can't have legitimate mental health problems and deal with them in this way (at least without being horribly in denial and badly in need of treatment - hooray for gross paternalism!). And really, it's not a game and we don't need to sit down and compare our struggles side-by-side. But I'm sometimes a little disgruntled, disheartened, or both by this because - well- I spend so much time and energy managing my mental health. Me and my partners just do it differently.
I grasped around for what to call it. Grassroots? Unconventional? But at the end of the day, it's radically simple. Because it doesn't take a genius to come to the underlying philosophies (though it did take me a hell of a long while, to be honest). They're radical because we, as a society, don't realize that they're sustainable solutions. People don't realize that four philosophies could do as much for me as anxiety meds and regular psych appointments might.
I'm really big on choice, but on fully-informed choice. And I don't believe that a lot of what is being offered in the way of mental health services is informed because we're not being honest about what we know and don't know about psych disorders, their causes, and our treatments. Having choices available to us should never shut down honest discussion about those choices, and about alternatives. The following (plus a dash of moving my body, being in nature, and getting spiritual) is my alternative. It works for me.
I think when we have mental health problems, there can be a bit of a telescoping dilemma. We start out with depression, mania, mood swings, what-have-you. It's no fun. Then at some point comes this meta string of thoughts about how we're feeling. There's something wrong with me. Why does this happen? I shouldn't have to feel like this. What could I do that would express how totally crazy I'm feeling right this second?!
The distress over our distress is a whole new piece of our experience. What started out as a single experience becomes compounded, complicated, further from its origin point. And as the process continues, it gets harder and harder to find our way back and we spend more time expanding ever outward into the space of anxieties and desperation and breakdowns.
I'm currently on Day 4 of a likely hormone-related rough patch. Nervous ruminations began before my morning shower, not a promising start to the day. By the time I'd bought my coffee, the humming inside my body made me think this purchase was a mistake. In more positive news, I was able to take a walk - twice around the park pond. Everything wasn't perfect, but I felt calmer. Later in the day, I saw my boyfriend. He hugged me, I held him, and a tear slipped down my cheek as I thought about the pain. But also, we laughed. I felt good.
"The distress over our distress is a whole new piece of our experience. What started out as a single experience becomes compounded, complicated, further from its origin point."
I drove the forty minutes home, remembering my week. Thoughts flitted across my brain about driving somewhere that was not my intended destination. Finding a way to express in perfect form the abstract fear and desperation trying to concretely etch itself into me. Perhaps park alongside a country road and sob til I wretched to the saddest music? And I could have. But I thought about the talk, the laughing. It had been good. Even right in the middle of the anxiety and obsession, of the raw emotion and doubt, there are these good moments.
My therapist once recommended that my husband and I head to the ER to see about having me admitted; instead, we went driving. We talked and we laughed and I can't tell you how much better it was than spending a week thinking about how terrible I felt. I knew, because I'd spent a week in a psych ward before. (Laughter might deserve its own point because we constantly laugh at the unlaughable and I believe it saves us over and over again.)
I used to be so unaware of the telescope that I'd wind up stuck inside it indefinitely. I still struggle with this, but now there are moments of awareness of this natural juxtaposition. I let go, as many times as necessary, of the belief that bad times equal brokenness and that ridding myself of them is the way out. The bad and the good? Both matter and both come around. Easier, I find, if we let them.
There have been quite a lot of times in my life when I've been going along, doing something, and it didn't feel good. Maybe it was wearing me out. Maybe I was spending too much time crying in bathrooms at a job. Maybe I just wanted a change. Generally, I made the change. Being the sort of person who generally makes the change has its ups-and-downs. Some would argue I change too many things and too often. But what I am 100% certain of is that many people aren't willing to make changes often enough, even when they really need to.
There may be times I've regretted rash decisions made out of anxiety, but I rarely regret changes based on actual unhappiness. After staying in a job that I was increasingly unhappy in for its security and benefits, my dissatisfaction grew to a breaking point and I started a job search in the middle of an emotional breakdown about my job.
Here's the thing, though. This wasn't the first emotional breakdown I'd had about this job; this had been going on for years. How many times is too many times to cry over what your paycheck will look like this time? How long is too long to be frustrated by a company that doesn't seem to care about its employees? Yes, I was emotional, but it was frustration based on a long history of emotion. By the time I made it, the decision more than made sense.
"...few people told me I should make the change and more than one person actively told me I shouldn't."
In the end, I found a job that worked for me financially, that was just the right amount of hours, and that suited my personality and needs. But here's what you need to know: few people told me I should make the change and more than one person actively told me I shouldn't. In fact, they told me I should keep both jobs just in case. I didn't, and I haven't regretted it once. Change is not disaster, but an unwillingness to change things that aren't working will keep you stuck in situations that destroy your happiness and mental health.
There's this idea that's become prevalent in our society that certain issues or experiences are only within the scope of mental health professionals. If certain topics come up, we've been trained to start talking about "professionals" and "helplines." But it's my sincere belief that there is literally no replacement for the compassionate listening and presence of everyday people.
In my relationships, we believe that nothing is outside the scope of our partnership. It could be something with a diagnosis attached, or it could be something with suicidal thoughts attached. It doesn't matter. We're not going anywhere and we're not pawning each other off on someone more "qualified" to listen.
"...it's my sincere belief that there is literally no replacement for the compassionate listening and presence of everyday people. "
What we do instead is just be there. It turns out my boyfriend is naturally great at this and it has been kind of fascinating to watch him respond to me in times of acute emotional distress. He doesn't talk if he feels like it's not helping or if he's not sure what to say. He offers to hold me if I'll let him. He's simply there, and lays with me as I wordlessly sob for as long as it takes.
He doesn't act like it would be much more convenient if I didn't have issues where I broke down on a random Tuesday night when we really could have been doing something so much nicer. And neither he nor my husband act like my struggle needs an end-point, or a healing, or anything else. They are just there for all of it and it has made me realize how powerful this simple (but sometimes difficult) act is, and how many of us have been lacking this kind of community and close support.
We need people who we can tell when we aren't feeling good, people who care about our ups and downs. Whether it's romantic partners, support groups, friends, or family, we need authentic community - people who tell their shit and support one another. I don't mean polite company - I mean gritty community. They're worlds apart, and too many of us don't have the essential connections we need to survive emotionally in this life.
I'm realizing I've spent a hell of a lot of time trying to make myself fit into things I don't fit into, trying to be someone I'm not. It turns out I have my strengths, weaknesses, and traits. They're the only ones I've got, and if I go on trying to live a life that requires a different set of strengths, weaknesses, and traits, I'm going to have a very bad time.
For me, realizing I'm autistic has recently been a big part of this. It's like this magical unfolding, discovering bit-by-bit all the things about me that are totally okay just the way they are, leaning into "different." But I think the basic concept is relevant to everyone. How many things about you make you feel a little off, a little broken or fucked up? What do you do that makes others look at you a little funny? What doesn't come easy to you that you feel should, that keeps you from fitting in?
"...the difficult truth is that the possible lives that would be awesome for you may not be the most societally-approved ones. Or they may not include the career your family has in mind for you..."
We've spent a lifetime internalizing the feelings of separation and shame caused by our differences. The first thing to do is recognize and try to lovingly accept them. After that, it's time to recognize that there are lives that will work for you, that make sense for you. Note that they're plural: there are possibilities! But the difficult truth is that the possible lives that would be awesome for you may not be the most societally-approved ones. Or they may not include the career your family has in mind for you, or that you've dreamed of since you were in high school.
You can cave to pressure to do things in ways that don't fit you, but this only makes life harder than it needs to be. On the flip-side, you can choose what's best for you in spite of outside opinions and judgment (you'll notice they often come from people who aren't actually that invested in you anyway). Between accepting a standard, default life that is constantly being pushed at you and creating one that really works, the DIY is honestly so much more worth it in my opinion.
Those are the four major philosophies that came up as I searched my mind for what works in my off-the-grid, crazy little life. They don't work perfectly, and I certainly don't work them perfectly, but that has never been the point. Differences are human and okay and there is more than one way to successfully tackle living with the obstacles that those differences bring to the surface. For some of us (or possibly many of us, if given the chance), a more back-to-the-basics, organic approach works best. An approach based on a few foundational beliefs and philosophies.
So, what are yours? What are the foundational ideas that make surviving or thriving possible for you?
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