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jadedmusingsWhat's included in quotes is not attributed to any single individual. I have heard these arguments made time and time again from more people than I care to count, and the problems with such statements are discussed on a variety of feminist and progressive blogs. You are quite welcome to disagree with me, to dismiss me, whatever, but again, this is my life and my opinions will not change because I've experienced this and I've spent a lifetime learning so much about this. This is something I'm passionate about, but at the same time it's difficult for me to discuss without becoming emotionally involved, so chances are I'm not going to engage in debate much over this. I'm putting this out there not to argue, but to offer my experience and to maybe help others understand why just getting help isn't as cut and dried as doing. In short, I've said my piece with this and the previous post and I'm done for the night, perhaps for a long time. I won't fight anymore than this.
I've talked about the idea of whether a person chooses to be happy or unhappy and how such a notion is wrong in the context of mental illness. Now I want to expand on that and address the concept of choosing happiness or misery in the form of choosing to get help and how sometimes that's just not an option for some people.
Some reading this are going to claim I'm naive, that I'm ignorant of the fact that there are people out there who are just miserable assholes who live to suffer and don't get help because they're selfish/spoiled/whatever.
No, I'm not naive. I'm compassionate. At thirty years old I have spent the past twenty-six years witnessing the effects of mental illness on others and on myself. I also have had quite a bit of experience in the realm of psychiatric care as both a patient and a family member of a patient. I've also realized that we don't all live on an equal playing field and I have had the privilege of access to decent care. I do know a little bit about which I speak, so don't waste my time and yours if all you can say after this is that I'm just being a stupid idiot or a bleeding heart who just doesn't understand the reality of life. No, this is my reality. I have lived it.
"I can't understand why zie doesn't get help!"
It's a lot easier to be on the outside looking in when dealing with any situation. You can spend all day going, "Well, if that was me, I'd do X, Y, or Z!" But to a person who is actually living through it, the solutions to their problems aren't always so clear. Sometimes, you don't know you need help. You don't want to know how long I spent believing that suicidal thoughts were just a normal part of being a teenager, how I thought I was supposed to feel miserable because I was a teenager. Because it's really impossible to have someone else's life experience as a frame of reference, you think this is how it's supposed to be since this is all you know. Sometimes it takes a loved one pulling you aside and telling you there's a problem before you suspect something's wrong. Then again, you might not want to admit there's a problem and you live in denial a little longer.
There is a huge stigma surrounding mental illness in this country. Admitting you need help is often a shameful experience, something I know first hand. If you need therapy, you're weak or worse, you're someone to be avoided (and mocked too). In my family it was very clear that we didn't discuss mental illness with others. Sure, talk about that medical procedure you need, or talk about what it was like that time you had to pass a kidney stone, but you don't talk openly about your struggles with your own mind, otherwise people might think poorly of you and it could affect how your friends treat you and how potential friends receive you if they know you're different. Trust me, when this is the message you receive throughout much of your life, you're not exactly eager to jump up and get help even when you realize you need it.
There's also the chance that someone does try to reach, to get help and zie is dismissed by a therapist/psychiatrist/doctor. Just because a person has a license to practice medicine doesn't mean they should be, that they're qualified, or that they're incapable of misdiagnosing or making mistakes. Finding a medication that works can take time too. For anti-depressants, it can take anywhere from two to four weeks before you know if a medicine will work or not, and there are times when medications stop working or a patient becomes allergic. It can become very discouraging and easy to give up if you can't find someone to listen to you and/or find a medicine that treats your illness. Then you have to factor in the cost for some of the newer medications on the market. Once my mother was on a medication that cost $200 for a thirty day supply (yes, it was prescribed by a psychiatrist). We were lucky to have prescription coverage, but it was still around forty or fifty dollars, and that's just one medication out of several.
If getting help requires hospitalization, that's another hurdle to overcome. I have seen good psychiatric hospitals and I have seen bad. I have heard horror stories that are believable only because I know that it actually happened. Tell someone you've been hospitalized for reasons other than physical ailments, and they start wondering if you're going to chop them up with an axe while they sleep. In fact, most people I meet think people in hospitals must be violent/have violent tendencies. Either that or they're just pathetic "emo kids" who need to "get over it." I rarely admit I was in a children's psychiatric ward in grade school because people start assuming I was some horrible kid when the truth was that I've never been violent in my life (and no, I wasn't suicidal then either). I was there because of a combination of home life and school-related bullying and I needed close monitoring since I was prescribed a medication to help me, but very few care about that. Can you imagine another parent wanting me around their child if they heard rumors that I was in a child psychiatric ward? You can pretend all you want that you'd be above keeping your child away, but the hard truth is that people did want to keep me away from them. People treated my mother differently and cruelly after her hospitalizations. Add into it how the media portrays psychiatry in general and you can understand why most anyone would do all they could to avoid hospitalization.
Hell, even outside of psychiatric care, show me a person who genuinely wants to spend time in any hospital for any reason. Go on, I'll wait.
Still another factor is being able to afford to get help. From an American's perspective, decent mental health coverage, if you have insurance, can be a crap shoot. Some plans only cover a handful of days in a psychiatric hospital if you need it (let's not think about what happens if you have health insurance through your job and you lose your job because you're getting treatment and can't work), others only cover a very limited number of visits to a psychiatrist or a therapist, and they might not cover a therapist or pyschiatrist not on their network. And some practices won't accept certain insurances at all and make you file your own claims, which can then be denied. And assuming you can afford it, finding a decent therapist or psychiatrist takes time and money and requires access to reliable transportation.
"But there's Medicare/Medicaid!"
Oh how I wish everyone who needed it qualified for Medicare/Medicaid, I really do. Even Medicare/Medicaid won't pay for everything, and, as my mother recently learned, even with Medicare supplemental on top of excellent health insurance, some practices still charge you money that you have to pay out of pocket.
And again, you're not figuring in transportation costs and medication costs even when you do have Medicare/Medicaid. As I said, my mother has an excellent health insurance on top of Medicare supplemental. Often she winds up owing nothing when it comes to doctor and psychiatrist visits, but last year she spent over $2500 on medicine and that's with prescription coverage. We know she spent that much because $2500 is her deductible she has to meet before Medicare pays for her medicine outright and thus it becomes "free" for her for the month of December (as she usually meets her deductible by the end of November). Granted, that's not solely pyshciatric related medicine, but she's not the only person in America living with multiple physical ailments.
And sometimes, medications offered at a discount one year aren't offered at the same price the following year. One of Mom's medications this year has gone up to $60 from $30 per month and when you live on a budget, those extra thirty bucks have to come from somewhere, often the food budget.
Re: Transportation: "But there's shuttles/buses/cabs that go to hospitals/doctor's offices!"
In highly populated areas with decent mass transit, yes. In rural areas like where I grew up or where I'm living now, this isn't necessarily true. It's only been within the last six years that my hometown started offering low-cost transportation options via a large van, but you have to schedule pick up 24 hours in advance. Their service is spotty and...well, it's pretty crappy from talking to at least one person who had to rely on it. The drivers weren't always very nice, and while I think they don't have to be cheerful and fully of sunshine, but there's no excuse for being outright rude to people who are depending on you to get them where they need to be.
Also, where I'm from, you often have to look out of town for decent care, especially for mental health. It's not unheard of to travel two hours for a doctor, and those local transporatation places don't drive anywhere out of town.
"BOOTSTRAPS BOOTSTRAPS!!! But I have [X] and I got treatment and got better!"
I'm glad that you were able to get help, that you could afford it, that you had the support network in place to get you through it, but not everyone has those options, and what worked for you might not work on the next person. Medicine in general has never been an exact science, and especially in the realm of psychology and psychiatry, the treatment has to be tailored to the individual. Some people can get treatment for an illness and go on to live great lives and function well. Other people, like my mother, can get treatment and have a number of years where they function pretty well and then something changes and their life is altered (i.e. needing to go on disability because she can no longer function at her job). And still other people spend years trying to find something that works well enough that they can at least keep their head above water.
Your experience cannot speak for everyone, and your results will not happen for everyone.
"But once a person does have a good doctor and medication, that should be it, right?"
No. Doctors retire, get burned out, or, as happened in a really weird case for my mother, disappear off the face of the earth. (No, seriously, we still don't know what happened to her last psychiatrist. He just...stopped going into work it seems. According to the licensing board he's still licensed, but no one knows what happened to his practice.) A new doctor might change your diagnosis, and it might be the wrong thing for hir to do (happened to my mother). Insurance coverage changes and practices have to change with them, which might mean sending patients to other places, places where they don't get the same quality of care. People lose jobs or hit financial trouble and can't afford to continue treatment or have to change/stop medication, which means they have trouble functioning at the same level.
One more thing...
When I say "afford" care, I don't mean only in terms of finances. If I'm ever in a spot where I require hospitalization, there's a lot of people around me who will be impacted. My son will need care, my pets will need care, my mother relies on me for various things, and there's my properties I still own. I have finances to worry about, and while there are people in my life who might be able to step in as far as child care and pet care, they'd only be able to do this for a very short term because they have their own families and lives they have to tend to as well. Other people aren't as fortuante as I to at least have that option should they need it, and so I guess my final thought is that it's not just money or bad insurance coverage/lack of insurance, but there's many other "costs" to getting help and to getting better that aren't even considered by most people.
To sum up.
No one chooses to be miserable, and the person who actively avoids getting help in order to find/achieve happiness is an exception. More often it's a complicated issue of ability to get care, availability of care, and access to care. It's harmful and cruel to dismiss a person as lazy or as being "happy in hir misery" when you simply can't know everything that is going on in a person's life/know what factors limit or impede their desire/ability to find care.
I've talked about the idea of whether a person chooses to be happy or unhappy and how such a notion is wrong in the context of mental illness. Now I want to expand on that and address the concept of choosing happiness or misery in the form of choosing to get help and how sometimes that's just not an option for some people.
Some reading this are going to claim I'm naive, that I'm ignorant of the fact that there are people out there who are just miserable assholes who live to suffer and don't get help because they're selfish/spoiled/whatever.
No, I'm not naive. I'm compassionate. At thirty years old I have spent the past twenty-six years witnessing the effects of mental illness on others and on myself. I also have had quite a bit of experience in the realm of psychiatric care as both a patient and a family member of a patient. I've also realized that we don't all live on an equal playing field and I have had the privilege of access to decent care. I do know a little bit about which I speak, so don't waste my time and yours if all you can say after this is that I'm just being a stupid idiot or a bleeding heart who just doesn't understand the reality of life. No, this is my reality. I have lived it.
"I can't understand why zie doesn't get help!"
It's a lot easier to be on the outside looking in when dealing with any situation. You can spend all day going, "Well, if that was me, I'd do X, Y, or Z!" But to a person who is actually living through it, the solutions to their problems aren't always so clear. Sometimes, you don't know you need help. You don't want to know how long I spent believing that suicidal thoughts were just a normal part of being a teenager, how I thought I was supposed to feel miserable because I was a teenager. Because it's really impossible to have someone else's life experience as a frame of reference, you think this is how it's supposed to be since this is all you know. Sometimes it takes a loved one pulling you aside and telling you there's a problem before you suspect something's wrong. Then again, you might not want to admit there's a problem and you live in denial a little longer.
There is a huge stigma surrounding mental illness in this country. Admitting you need help is often a shameful experience, something I know first hand. If you need therapy, you're weak or worse, you're someone to be avoided (and mocked too). In my family it was very clear that we didn't discuss mental illness with others. Sure, talk about that medical procedure you need, or talk about what it was like that time you had to pass a kidney stone, but you don't talk openly about your struggles with your own mind, otherwise people might think poorly of you and it could affect how your friends treat you and how potential friends receive you if they know you're different. Trust me, when this is the message you receive throughout much of your life, you're not exactly eager to jump up and get help even when you realize you need it.
There's also the chance that someone does try to reach, to get help and zie is dismissed by a therapist/psychiatrist/doctor. Just because a person has a license to practice medicine doesn't mean they should be, that they're qualified, or that they're incapable of misdiagnosing or making mistakes. Finding a medication that works can take time too. For anti-depressants, it can take anywhere from two to four weeks before you know if a medicine will work or not, and there are times when medications stop working or a patient becomes allergic. It can become very discouraging and easy to give up if you can't find someone to listen to you and/or find a medicine that treats your illness. Then you have to factor in the cost for some of the newer medications on the market. Once my mother was on a medication that cost $200 for a thirty day supply (yes, it was prescribed by a psychiatrist). We were lucky to have prescription coverage, but it was still around forty or fifty dollars, and that's just one medication out of several.
If getting help requires hospitalization, that's another hurdle to overcome. I have seen good psychiatric hospitals and I have seen bad. I have heard horror stories that are believable only because I know that it actually happened. Tell someone you've been hospitalized for reasons other than physical ailments, and they start wondering if you're going to chop them up with an axe while they sleep. In fact, most people I meet think people in hospitals must be violent/have violent tendencies. Either that or they're just pathetic "emo kids" who need to "get over it." I rarely admit I was in a children's psychiatric ward in grade school because people start assuming I was some horrible kid when the truth was that I've never been violent in my life (and no, I wasn't suicidal then either). I was there because of a combination of home life and school-related bullying and I needed close monitoring since I was prescribed a medication to help me, but very few care about that. Can you imagine another parent wanting me around their child if they heard rumors that I was in a child psychiatric ward? You can pretend all you want that you'd be above keeping your child away, but the hard truth is that people did want to keep me away from them. People treated my mother differently and cruelly after her hospitalizations. Add into it how the media portrays psychiatry in general and you can understand why most anyone would do all they could to avoid hospitalization.
Hell, even outside of psychiatric care, show me a person who genuinely wants to spend time in any hospital for any reason. Go on, I'll wait.
Still another factor is being able to afford to get help. From an American's perspective, decent mental health coverage, if you have insurance, can be a crap shoot. Some plans only cover a handful of days in a psychiatric hospital if you need it (let's not think about what happens if you have health insurance through your job and you lose your job because you're getting treatment and can't work), others only cover a very limited number of visits to a psychiatrist or a therapist, and they might not cover a therapist or pyschiatrist not on their network. And some practices won't accept certain insurances at all and make you file your own claims, which can then be denied. And assuming you can afford it, finding a decent therapist or psychiatrist takes time and money and requires access to reliable transportation.
"But there's Medicare/Medicaid!"
Oh how I wish everyone who needed it qualified for Medicare/Medicaid, I really do. Even Medicare/Medicaid won't pay for everything, and, as my mother recently learned, even with Medicare supplemental on top of excellent health insurance, some practices still charge you money that you have to pay out of pocket.
And again, you're not figuring in transportation costs and medication costs even when you do have Medicare/Medicaid. As I said, my mother has an excellent health insurance on top of Medicare supplemental. Often she winds up owing nothing when it comes to doctor and psychiatrist visits, but last year she spent over $2500 on medicine and that's with prescription coverage. We know she spent that much because $2500 is her deductible she has to meet before Medicare pays for her medicine outright and thus it becomes "free" for her for the month of December (as she usually meets her deductible by the end of November). Granted, that's not solely pyshciatric related medicine, but she's not the only person in America living with multiple physical ailments.
And sometimes, medications offered at a discount one year aren't offered at the same price the following year. One of Mom's medications this year has gone up to $60 from $30 per month and when you live on a budget, those extra thirty bucks have to come from somewhere, often the food budget.
Re: Transportation: "But there's shuttles/buses/cabs that go to hospitals/doctor's offices!"
In highly populated areas with decent mass transit, yes. In rural areas like where I grew up or where I'm living now, this isn't necessarily true. It's only been within the last six years that my hometown started offering low-cost transportation options via a large van, but you have to schedule pick up 24 hours in advance. Their service is spotty and...well, it's pretty crappy from talking to at least one person who had to rely on it. The drivers weren't always very nice, and while I think they don't have to be cheerful and fully of sunshine, but there's no excuse for being outright rude to people who are depending on you to get them where they need to be.
Also, where I'm from, you often have to look out of town for decent care, especially for mental health. It's not unheard of to travel two hours for a doctor, and those local transporatation places don't drive anywhere out of town.
"
I'm glad that you were able to get help, that you could afford it, that you had the support network in place to get you through it, but not everyone has those options, and what worked for you might not work on the next person. Medicine in general has never been an exact science, and especially in the realm of psychology and psychiatry, the treatment has to be tailored to the individual. Some people can get treatment for an illness and go on to live great lives and function well. Other people, like my mother, can get treatment and have a number of years where they function pretty well and then something changes and their life is altered (i.e. needing to go on disability because she can no longer function at her job). And still other people spend years trying to find something that works well enough that they can at least keep their head above water.
Your experience cannot speak for everyone, and your results will not happen for everyone.
"But once a person does have a good doctor and medication, that should be it, right?"
No. Doctors retire, get burned out, or, as happened in a really weird case for my mother, disappear off the face of the earth. (No, seriously, we still don't know what happened to her last psychiatrist. He just...stopped going into work it seems. According to the licensing board he's still licensed, but no one knows what happened to his practice.) A new doctor might change your diagnosis, and it might be the wrong thing for hir to do (happened to my mother). Insurance coverage changes and practices have to change with them, which might mean sending patients to other places, places where they don't get the same quality of care. People lose jobs or hit financial trouble and can't afford to continue treatment or have to change/stop medication, which means they have trouble functioning at the same level.
One more thing...
When I say "afford" care, I don't mean only in terms of finances. If I'm ever in a spot where I require hospitalization, there's a lot of people around me who will be impacted. My son will need care, my pets will need care, my mother relies on me for various things, and there's my properties I still own. I have finances to worry about, and while there are people in my life who might be able to step in as far as child care and pet care, they'd only be able to do this for a very short term because they have their own families and lives they have to tend to as well. Other people aren't as fortuante as I to at least have that option should they need it, and so I guess my final thought is that it's not just money or bad insurance coverage/lack of insurance, but there's many other "costs" to getting help and to getting better that aren't even considered by most people.
To sum up.
No one chooses to be miserable, and the person who actively avoids getting help in order to find/achieve happiness is an exception. More often it's a complicated issue of ability to get care, availability of care, and access to care. It's harmful and cruel to dismiss a person as lazy or as being "happy in hir misery" when you simply can't know everything that is going on in a person's life/know what factors limit or impede their desire/ability to find care.
