Maybe “mental illness” isn’t what you think it is…

A different version of this post was published by The Good Men Project where it has been shared almost 400 times so far.  Subsequently, this article was republished by Mad in America where it has been viewed over 1100 times.  I recently submitted it to The Mighty.  I received an email from them explaining why they would not be publishing it which included the line below.

Right now, we unfortunately don’t have the capacity to publish every story on our site.

I sincerely doubt “capacity” had anything to do with The Mighty’s editorial decision regarding this piece.

I’ve spent close to twenty years looking for reasons behind why I was compelled to think and act suicidally when I was twenty seven years old.  While my search has yielded more questions than definitive answers thus far, I’m convinced that sharing what I’ve learned so far will help others.

Events happen, and then people think and say things about those events—let’s call those stories.  No matter how accurate or truthful a story is seen to be, events that have occurred and the stories that people tell about those events, are never the same thing.  They can’t be because one is an occurrence in reality while it’s happening, and the other is an after the fact symbolic representation meant to describe a prior real occurrence.  I’m no linguist, but this is the nature of language, right?  We use language and stories to encapsulate and communicate meaning about our reality and our conscious experience of that reality—every word is a story unto itself making sense of existence.  Every diagnosis of every “mental disorder” relies on a translation of stories.  A person tells a psychiatrist a story, and the psychiatrist maps that natural language story onto a “mental disorder” language story from a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM).  Millions of people assigned a “mental disorder” story or a “mental illness” diagnosis end up failing to see the basic event-story distinction I just pointed out.  They confuse their DSM diagnosis or “mental disorder story” with reality itself.  Unfortunately, many patients are also systematically misled to necessarily attribute the issue that prompted them to see a psychiatrist to a supposed specific brain pathology that mysteriously eludes accurate definition and explanation.

I made these mistakes after nearly killing myself nineteen years ago, in part, because of the forces of institutional corruption at work within our mental health care system written about by Robert Whitaker and Lisa Cosgrove in Psychiatry Under the Influence.  I share this true story as an anecdotal example of those corrupting forces in action.  It is my hope to decrease the likelihood that other people won’t be misled like I was.  I also hope to inspire the many well-intentioned but misguided “lived experience” mental health advocates who are confused like I was to think differently.  They are unwitting participants in this harmful confusion’s perpetuation.

A few days after I nearly killed myself a psychiatrist told me that I was suffering from a “mental illness” called Major Depressive Disorder after talking with me for less than fifteen minutes.  That’s all the time it took him to gather enough information to know which “mental illness” was plaguing me and how to treat it.  He prescribed me an antidepressant as he mentioned something vague about the amount of a neurotransmitter in my brain called serotonin and selective reuptake inhibition.  I also began seeing a psychologist for talk therapy twice a week.  In just three or four months I was feeling like my old self again—the same amount of time it had taken me to go from feeling fine to almost killing myself.  I believed the story my psychiatrist told me about the cause of my despair.  He gave me the name of an apparent disorder with my brain, and a pill to fix the problem.  Back then, it seemed to me that the medication I was taking did more to help me than anything the psychologist and I discussed.  That assumption was a costly one for me, and my family.  It led me to make two consequential mistakes that millions of other people diagnosed with a “mental illness” also make.  First, I failed to see my diagnosis as a view of reality, mistaking it for reality itself.  I conflated a series of actual events from my life with a boilerplate story about a “mental disorder” from a big book.  Doctors are trusted authorities.  When you’re unquestionably hurting, it’s comforting when a trusted authority gives you an officially-sanctioned medical reason for why you feel so horrible, and better yet, a remedy to help you.  My mistake was compounded when I came to believe that my diagnosis mapped onto a specific brain pathology necessarily responsible for my problematic thoughts, feelings and behaviors.  My doctor gave no serious consideration to any psychological, social or environmental factors that contributed to the mindset from which my suicidal behavior emerged.  He couldn’t have—he didn’t know enough about any of those factors.  It is no surprise that I blamed my brain for my problems, like millions of other “mental patients” do.  Our collective confusion about a specific brain pathology necessarily being the sole or at least primary causal culpability for our lack of ease is proof of the influence of the forces of institutional corruption within the mental health care system.

A deeper examination of my suicidal crisis subsequent to receiving my “mental illness” diagnosis revealed how childish, fearful, egocentric thinking and bad luck led me down a path towards self-destruction.  To clarify “egocentric” I’m not talking about arrogance, narcissism or even self-preoccupation.  At the heart of my egocentrism in my younger years was the failure to readily recognize that my view of reality, was a point of view at all.  Growing up I prided myself on being right.  I prided myself on objective, quantitative measures of just how right I was.  I was especially proud when I was deemed 100% right.  Egocentric people become attached to being right, and they often are.  I became so accustomed to being right, that I confused my view of reality with reality itself.  I almost killed myself, in part, because of this confusion, this conflation of what I thought was happening with what was actually happening.  There were four other types of childish and/or fearful thinking that led me from being involved in an awkward exchange during a routine business meeting in Toronto to genuinely believing that I was an unintelligent, overcompensated fraud of a human being destined to disappoint my father and myself.  Those types of thinking are called catastrophizing, overgeneralizing, black and white thinking and past counter-example blocking.  Cognitive behavioral therapy is an effective way to address these often disempowering ways of thinking.  This other narrative that describes the conditions and events that led to my psychological and emotional struggle is patently more accurate and more practically useful than anything my psychiatrist told me about my ostensibly malfunctioning brain.  Nineteen years later, it’s evident that me believing that my suicidal behavior necessarily resulted from a “mental illness” was more beneficial to the psychiatrist who told me that than it was for me.  I’m not claiming that this was a fault of my doctor or a sign of bad faith or ill-intent on his part.  His profession trained him to look for different nails to hit with different hammers, and I was a perfect fit for a hit from an antidepressant.  He was just doing his job—playing his role in a system.  Unfortunately, like millions of other people who are given a “mental illness” diagnosis, I came to see my diagnosis as a defining part of my identity because of my respect for my doctor’s authority, and my belief that my problem was necessarily in my brain.  This belief led me to seriously entertain the fallacy that I was biologically destined to suffer from despair over and over again.

My stay at the private mental hospital subsequent to nearly dying by suicide was five days long. I spoke with my psychiatrist on three separate occasions during my five day stay. We spoke briefly on the day I was admitted. We bumped into each other once, and spoke for less than five minutes. And we spoke for about ten minutes on the day I was discharged.  While reviewing my bill, after being released, I noticed that I was billed for “Individual psychotherapy” five times, one charge for each day of my stay. When I called the mental hospital to inform them of the obvious billing error, I was informed that every patient in the facility was charged in this manner. I explained how this seemed patently fraudulent and unethical to me given the literal definition of the word psychotherapy. The person I spoke with apologized but said there was nothing she could do, remarking something like, “That’s just how it works.” The first time I thought and behaved in a way that matched the diagnostic criteria for a “manic episode” found in the DSM occurred after taking an antidepressant. I’m aware this fact doesn’t prove that the antidepressant was the proximate cause of this development in my life, but given the wealth of evidence supporting the hypothesis that antidepressants often have iatrogenic effects on the people who take them, like inducing mania, for example, it’s reasonable to consider that my treatment for Major Depressive Disorder was a causal factor in me exhibiting behavior that led a different psychiatrist to diagnose me with Bipolar Disorder I.

I’m so grateful that someone was willing and able to inspire me to question the stories psychiatrists told me about the cause of my suffering.  Powerful authority figures implying that brain pathology is necessarily to blame for the suffering behind “mental illnesses” increases the chances of people believing that they need to buy pharmaceutical remedies to be well.  How else are psychiatrists who only prescribe psych meds going to their pay bills?  Ironically and probably unbeknownst to the vast majority of people diagnosed with a “mental illness” the National Institute of Mental Health ceased funding research based on the categories listed in the DSM in 2013.  When announcing that no more federal dollars would be spent on research based on the DSM going forward, Dr. Thomas Insel said that diagnosing a “mental illness” by asking a patient about her feelings was analogous to diagnosing a heart patient by asking her about her chest pain.  I’m not arguing that people don’t experience emotional distress.  I’m arguing that the words used to describe the causes of feeling a lack of ease or distress can perpetuate a person’s lack or ease, or worse, compound it.  I am committed to changing the world by changing the words that people use when they talk about “mental illness.”

Here’s an example:

You have a “mental illness” or a “mental defect” resulting from a specific, yet somehow unidentifiable, brain pathology that is causing you psychological and emotional distress.  You can treat your “mental disorder” with a chemical made in a lab that will hopefully mysteriously correct your brain pathology for as long as you can bear the undesirable effects of that chemical.

Learning more about yourself, the human condition and the many different approaches proven to help other people maximize their own well-being will help you to grow into a person who experiences less and less psychological and emotional distress over time.

Which is more empowering?

If I still haven’t convinced you, please consider this final example from history that hopefully more clearly illustrates my point that a “mental disorder” or a “mental illness” diagnosis is necessarily a subjective story about events, and not an objective description of a constellation of thoughts and behaviors that are necessarily caused by a specific brain pathology.

Imagine it’s 1972 and a man visits a psychiatrist because despite having a great relationship with his lover and a job he loves, he’s miserable.  He’s been estranged from his entire family, and he is suffering a great deal as a result.  He can’t sleep.  He’s constantly anxious, and he’s feeling quite hopeless about things ever getting better.  He explains that all of his problems arose when he admitted to his family, a few weeks ago, that his lover was a man.  Shocked by the revelation, his family said they never wanted to see or speak with him again.  The doctor tells the man that the source of his problem is a “mental disorder” in the DSM called Homosexuality.  The man is the son of a southern Baptist minister, and he has been ashamed of his attraction to men his whole life.  He respects his doctor, and his father too.  In fact, he thinks they’re both right.  He sees his love and sexual desire for men as sinful urges that he is supposed to resist, but he is incapable of doing so.  He sees his homosexual acts as mortal sins, and evidence of brain pathology. Feeling utterly hopeless, lost and beyond redemption, a month after being diagnosed with the Homosexuality “mental disorder” the man kills himself.

Please consider helping me spread the idea that “mental illness” is a harmfully misleading phrase that causes suffering by design.

Responding to Rudy Caseres “I Have Bipolar Disorder – This is What Manic Means to Me” video

In 2002 a psychiatrist unjustly stripped me of my liberty and the right to pursue happiness because I fit a description of a type of “episode” (manic) listed in the DSM, eleven years before the NIMH abandoned research oriented on the nosology.  I don’t argue that I did not exhibit some behaviors that matched some of the diagnostic criteria for mania as described in the DSM. That said, it’s a fact that my doctor patently mistreated me by claiming that I had delusions without ever asking me a single question related to my ostensible false beliefs guiding my presumed to be utterly unreasonable behavior (trespassing at the CIA with weed and a big poster of Albert Einstein with his tongue sticking out).

I recently wrote an open letter to the doctor that used the “Bipolar Disorder” “mental disorder” story as a justification for why I was in need of emergency psychiatric care.
Here’s an excerpt of the letter:
 

You necessarily took action to have the police waiting outside your office prior to your examination of me, and to this day, you and I have still never exchanged a single word about my unauthorized visit to CIA headquarters in 2002.  Four federal CIA police officers and a staffer from the CIA questioned me for about three hours with a degree of professionalism that still blows my mind, especially considering that I pulled this stunt just forty-one days before the first anniversary of the 9/11 attacks.  It’s worth pointing out that these men, despite the fact that I was in possession of a controlled substance when I illegally trespassed at the CIA, decided to release me on my own recognizance versus throw me into a jail cell for the night, pending arraignment.  Things played out the way they did for me at the CIA because the people there that I spoke with were open to hearing a reasonable explanation for my actions… which is precisely what they received from me… and precisely why they let me go.  

committal documentYou and Dr. Ekong on the other hand, were patently not open to even attempting to reason with me. You failed to give me a chance to explain my actions before stripping me of my liberty, and she treated me with a potentially life-threatening medication before ever meeting or speaking with me.  It is clear to me, as I am confident that it will be to many others, that the forces of institutional corruption in psychiatry were at work in your respective decisions.  The knowledge that you had about what happened at the CIA was the by-product of a five-person game of Telephone or Whisper Down the Lane.  I told my father some of what happened that day, without much explanation as to why at all.  My father told my mother.  My mother told my brother.  And then my afraid-for-the-life-of-her-son mother told you.  You did what you did, and then Dr. Ekong became Telephone/Whisper Down the Lane player number six. The assumptions that you both necessarily made about me are gross examples of professional misconduct.

While you were very sympathetic about the anxiety experienced by your patient’s mother, you failed to even try to understand me, your patient, whom I believe you assumed was psychotic.  The fact that I was exhibiting some of the symptoms of a “mental disorder” described in the Diagnostic and Statistical Manual of Mental Disorders—a nosology disavowed in 2013 by Dr. Thomas Insel, the former Director of the National Institute of Mental Health—is a pathetically inadequate justification for involuntarily subjecting me to forced care that could have ended my life.

You can read the whole letter here.

I applaud and champion your activism Rudy. You’re an inspiration.
 
That doesn’t stop me from thinking it’s reasonable to consider that continuing to use the “mental disorder” condition names themselves from the DSM without any qualification or mention of the fact that the NIMH no longer researches “mental illnesses” as described by the nosology, lacks nuance and depth.
 
Finding yourself in a “mental disorder” storybook and championing the notion that you necessarily have been or are sick, ill, diseased, etc. may be helping to perpetuate the ostensibly intractable problem of the stigma surrounding “mental illness.” Using the nosology’s “mental disorder” names without qualification or clarification certainly perpetuates the “mental illness” diagnostic narrative of non-normative human behavior to ill-effect for many people.

The brand new greatest story ever told is about Albert Einstein’s Unheralded Prescription for Peace

 

The brand new greatest story ever told… is about Albert Einstein’s Unheralded Prescription for Peace and why he was like @thedigitaljesus of our time.

I’m compelled to suggest that Albert Einstein’s free will skepticism–his belief that a person is mistaken in thinking that he or she could have done other than he or she did–is an unheralded prescription for peace that this insightful genius left for the benefit of humanity.

I’m compelled to champion this idea within the suicide prevention community. We have GPS technology and many other modern marvels because of Einstein’s genius insights about reality. It’s time to consider leveraging Einstein’s apparent genius insight into the human condition too.

A world full of people who genuinely view free will as an illusion, and who are committed to maximizing well-being is a world without shame. It’s a world without egotistical pride. It’s a world without revenge–a world without hate of self or others. It’s a world full of people being compassionate, loving and grateful.

Recognizing that we may have already extracted as much utility from the likely fictional idea that human beings are autonomous agents consciously controlling their thoughts, feelings, and actions and therefore their lives, is an important conversation that I don’t hear many people in suicide prevention and mental health advocacy having. I’m committed to changing that reality. Recognizing the likelihood that free will is an illusionary creation of humanity is a silver bullet capable of piercing the heart of the stigma surrounding “mental illness.”

It’s evident to me that Einstein would have said that believing in free will is a major risk factor for depression and becoming suicidal.

It’s time to seriously consider Einstein’s conception of what it means to be a human being. This guy was clever enough to notice that humanity was grossly misperceiving the foundational building blocks of our reality–time and space. Is it so incredible to fathom that Einstein might have had profound insights into the illusory nature of the “self” and free will worthy of our attention and consideration?

Einstein’s conception of what a human being is and how reality works would suggest that we reconsider how we approach describing the problem of human suffering, including the suffering that leads people to die by suicide.

Einstein thought shame arose from a gross misunderstanding of the human condition

Kevin Hines is a suicide attempt survivor whose efforts to try to help people struggling with self-destructive thoughts and behavior have inspired me.  He recently posted a video on Facebook about his #mysevenbucksmoment in response to Dwayne “The Rock” Johnson.  In his video Kevin talks about the shame he felt after his suicide attempt.  As a fellow suicide attempt survivor, I’m familiar with how people who live through suicidal behavior feel guilt, embarrassment and shame as a result.  I was watching the final moments of the Obama presidency draw to a close after watching Kevin’s video, and I was inspired to share the following thoughts with him.

Regarding the shame you mentioned…

Albert Einstein (and many other thinkers) believed that emotions of shame and guilt arise from a gross misunderstanding of the human condition. Einstein said that a belief in free will results from a “delusion of consciousness.” There is a growing pile of evidence being amassed by scientists to back this claim up.

I’m compelled to suggest that Albert Einstein’s free will skepticism–his belief that a person is mistaken in thinking that he or she could have done other than he or she did–is an unheralded prescription for peace that this insightful genius left for the benefit of humanity.

I’m compelled to champion this idea within the suicide prevention community. We have GPS technology and many other modern marvels because of Einstein’s genius insights about reality. It’s time to consider leveraging Einstein’s apparent genius insight into the human condition too.

A world full of people who genuinely view free will as an illusion, and who are committed to maximizing well-being is a world without shame. It’s a world without egotistical pride. It’s a world without revenge–a world without hate of self or others. It’s a world full of people being compassionate, loving and grateful.

Recognizing that we may have already extracted as much utility from the likely fictional idea that human beings are autonomous agents consciously controlling their thoughts, feelings, and actions and therefore their lives, is an important conversation that I don’t hear many people in suicide prevention and mental health advocacy having. I’m committed to changing that reality. Recognizing the likelihood that free will is an illusionary creation of humanity is a silver bullet capable of piercing the heart of the stigma surrounding “mental illness.”

It’s evident to me that Einstein would have said that believing in free will is a major risk factor for depression and becoming suicidal. The Buddha would agree as would Nietzsche. So too would neuroscientist Sam Harris and professors Bruce M. Hood, Thomas Metzinger and Thalia Wheatley.

It’s time to seriously consider Einstein’s conception of what it means to be a human being. This guy was clever enough to notice that humanity was grossly misperceiving the foundational building blocks of our reality–time and space. Is it so incredible to fathom that Einstein might have had profound insights into the illusory nature of the “self” and free will worthy of our attention and consideration?

Einstein’s conception of what a human being is and how reality works would suggest that we reconsider how we approach describing the problem of human suffering, including the suffering that leads people to die by suicide.

Looking forward to talking to you.

Best,
Francesco

Are people who die by suicide or attempt suicide selfish?

Thoughts from  about selfishness and suicide via TheMighty.com.

thinkstockphotos-497517286-1280x427

When a Friend Said ‘Suicide Is Pretty Selfish When You Think About It’

“Like… I get that it’s not the person’s fault really but… suicide is pretty selfish when you think about it.”

Flash.

Instantly, it was like somebody lit that spark in my mind that never fails to ignite my passion for mental health advocacy. For me, there’s something about stigma that turns an ordinary passion into the sort of fire you can just see in someone’s eyes.

The above sentence was said to me (paraphrased, of course) a couple of years ago. I was tabling with a fellow Active Minds member and a friend of hers had joined us to hang out. I think we were tabling about suicide, which is why the subject came up.

My immediate reaction when she said this was to be offended. Did she really have the nerve to say that while we were tabling about suicide prevention? Once I took a step back from my emotion I realized that she didn’t mean to insult anyone. She probably didn’t understand how stigmatizing it can be to label suicide as “selfish.” How could I expect her to understand when the topic of suicide is so seldom discussed in our society?

“The thing about suicide is….” I paused, not wanting to offend her or make her think she offended me, “Even if we can call the act of attempting suicide selfish, the person behind it is not acting out of selfishness… if that makes sense.”

I could tell she was truly listening to what I was saying, so I continued. “When someone is so far into that dark place they want to end their life, they might not be thinking about who their actions are going to hurt. Maybe they are in too much pain to think about it. And even if they are aware of how it might impact their loved ones, the desire to end their pain may have become too great to bear anymore.”

If I remember correctly, that’s about all I said. I could’ve gone in-depth about the known risk factors for suicidal behavior. I could have explained how feeling like a burden (a common experience of those contemplating suicide) might make someone think they’re doing their loved ones a favor by taking their own life, which might completely negate any feelings of selfishness or guilt that they might have had. However, I could tell she was really considering what I had just said, and I didn’t want to go too far and overwhelm her.

The notion that suicide is selfish is something I had spent a great deal of time thinking about.

When I was 14 I felt so incredibly guilty for wanting to die, because I knew if I killed myself my family would be devastated. For years, that guilt and the selfishness I felt for thinking about suicide kept me from reaching out for help. All of the stigma about suicide — much of which I had internalized — had me convinced it was better to suffer in silence than to have someone else think what I did: that I was selfish for wanting to die. I’ll never know for sure if that guilt had pushed me closer to the edge or further from it, but I do know that I’m grateful to be alive.

Make no mistake, I didn’t lose any respect for this acquaintance because of her statement, and there was no animosity created between us. In fact I’m glad she said what she said, because it reminded me that the stigma we need to face is not just in the media and our larger social systems, but in the people around us who don’t even realize these ideas are stigmatizing.

It’s one of the things that make the work I do as an Active Minds member or in other advocacy settings that much more important. I also realized that it was important for me to listen and understand where she was coming from too, because a one-sided conversation is not a productive conversation, especially in the pursuit of social change.

Being part of the social movement against mental health stigma can be difficult and discouraging, especially with the seemingly endless sea of misinformation and disrespect shown in various media outlets, but it’s worth it. Thinking back, it makes me happy to remember how respectful and thoughtful that conversation was. It gives me hope to know that “fighting” the stigma doesn’t have to be a fight —sometimes it’s as simple as a conversation.

I wanted to share this story here because I hope to see a day in which we can completely put to rest the idea that victims of suicide are selfish, weak or otherwise bad people, and think instead with empathy by making an effort to understand what someone might be going through if they are contemplating suicide.

My thoughts on the subject:

As a fellow suicide awareness / mental health advocate, I think it’s important to have conversations like the one you describe in this piece. I shared some of the same feelings of guilt regarding my own suicidal intentions and behavior when I nearly died as a result of untreated depression in 1998.

I think the conversation around suicide and selfishness is an important one. I think it’s important to acknowledge the pain and suffering experienced by suicide loss survivors. I think it’s a completely normal reaction for a suicide loss survivor to wonder: how much consideration did my love one give to me before dying by suicide? I think it’s equally “wrong” to blame someone for being suicidal as it is to blame a suicide loss survivor for wondering about the thoughts and feelings of their loved one prior to their death.

I often turn to the dictionary definition of the word selfish in conversations like the one you had: (of a person, action, or motive) lacking consideration for others; concerned chiefly with one’s own personal profit or pleasure.

It seems apparent to me that some people who die by suicide may not give very much consideration to the impact of their actions on others. They do not see themselves as a burden to others, rather their suicidal crisis stems from feelings of shame, embarrassment and guilt. Sometimes simply for feeling and acting suicidal.

I know that some suicidal people go through a series of desperate mental gymnastics to try to think of anything else besides the impact of their death on family and friends. This is part of a process that some suicidal people go through to work up the nerve, to work up the courage to take suicidal action. I know this because I did it, and I don’t believe that my suicidal crisis was unique.

Here’s how I’ve described my thinking in the past about why it doesn’t make sense to think of suicide as a selfish act:

Many view suicidal people as selfish cowards, but I believe it takes courage, massive amounts of courage to turn suicidal thought into suicidal action. Trying to cause your heart to stop beating, while knowing, to some degree at least, how much pain and suffering your death will cause for those who love you requires a special kind of morbid audacity. I won’t claim that there has never been a person who has died by suicide who lived selfishly during his or her life, but I insist that anyone who thinks those two words: selfish and cowardly — about the suicidal act itself, has no first hand experience with the macabre deed. The biological instinct for self-preservation is an almost insurmountable force to overcome. Death is the greatest unknown and fear-inspiring phenomenon facing each of us, which explains why possessing an enormous amount of courage is a prerequisite for dying by suicide.

Suicide can’t be accurately described as selfish either, although it’s understandable why people are prone to do so. The dictionary defines selfish as: lacking consideration for others; concerned chiefly with one’s own personal profit or pleasure. I think it is unavoidable for survivors of suicide, the friends and family of people who die by suicide, to wonder how much consideration was given to them by their loved one or friend, prior to their suicide. Regardless of how much time and consideration someone who died by suicide gave to those left to deal with life after their death, the end of physical and psychic pain resulting from suicide can not bring pleasure nor profit to the deceased. So the suicidal act, by definition, cannot accurately be described as selfish. Suicide extinguishes any notion of the self. An act that causes the sense of self to no longer exist is inherently not selfish.