This is a reprint from an earlier blog. I thought with Thanksgiving and other holidays so near, it would be the perfect time to highlight the work of so many that goes unnoticed so often. —Katy
As the nation held its breath, waiting for news about health care, violence has occurred to caregivers of mental health and from them. The psychiatrist in Fort Hood who shot military men and women was pre-ceded by a more intimate tragedy. At Mass General Hospital a bi-polar man, in an outpatient appointment, attacked his psychiatrist, a female doctor and was killed by a security guard who happened on the scene. The following day I sat in my office and wondered, not for the first time, if I might get killed by a patient or have a death on my hands. And I thought, how amazing it is that these events do not happen daily.
Mental illness shows no prejudice: It is invisible and slippery. Progress is difficult to measure and the care is given by people who are tired, severely underpaid, suffer compassion fatigue, and vicarious traumatization. We live in two worlds—often at the boundary of madness. Then we walk back onto the bright well-lighted rooms of our homes or children’s school and try to forget what we know.
But at such an important moment of change, as we contemplate our American “system,” we need to review the state of mental illness. Thirteen years ago I began treating young women who were dying from eating disorders. I was tremendously optimistic, then, about change in my field. Taboos were lifted and therapy became widely acceptable as did new and effective psychotropic medication.
Yet, in fact, the opposite has happened. I see more and younger women, succumb to eating disorders. We know what treatment is but there are fewer places for this treatment. I also see the power of our culture, as it speeds up its demands and feeds us less.
Mental illness, the invisible dark cloak of depression, the shaking hands of the anxious, the rude voices of schizophrenia are one of America’s untouched frontiers. We believe that people with cancer are due every bit of bone marrow they can find. Yet we leave our ill to sit in squalor with demons in their heads and no one visits or calls. Loneliness is the chief complaint of most of my patients. Something in us still dares not name mental illness when we see it. Others of us trust everyday that the relationship we have formed with our patients—the web of connection thrown over an abyss, will hold. The anxiety, depression, and psychosis caregivers metabolize is staggering. We do it because we are curious, compassionate, and believe there we are not doing hospice work. I remain deeply troubled as to why this profession goes undervalued when it is lifesaving and life-affirming. Our country is still adolescent, We believe death will not happen to us. We believe that unattractive aging is optional. We believe there is an ‘us’ and a ‘them.’ Until that prejudice is dropped and we understand that mental illness is often a cruel accident of birth, we will never provide adequately for mental illness in those we care for or those who give care. The valedictorian of the class, the doctor’s wife who seems a bit ‘off,’ the college roommate who kills himself writing and in love … all of these are just the a few cracks in the pavement away from us. There is nothing especially ‘other’ about mental illness. Perhaps that is why it scares us so.
Quizzes abound: What Disney princess are you? Which Downton Abbey character are you? These questionnaires are found everywhere. This new fad of quizzes tells me that we yearn for rules and definition the more we feel unclear. Books on mothering and motherhood are everywhere. As an academic (lapsed) and a haunter of libraries, there’s no better way to master a situation, I thought, than research. So, when I realized I was going to be a mother, I started reading.
I started out with What to Expect When You’re Expecting. In about 10 weeks, that book was obsolete. I was on bed rest and nothing went as “expected.” My reading also went far off the beaten path. I roamed about in fiction, poetry and mass market self-help. I have emerged 11 years now, with 5 books that are my guides. I turn to them and recommend them to others with the eagerness of a zealot or a convert:
1. Perfect Madness, by Judith Warner
2. I Don’t know How She Does It, by Allison Pearson
3. Operating Instructions, by Anne Lamott
4. The Bitch In The House, by Cathi Hanauer
5. Mothers Who Think, by Camille Peri
None of them, in fact, are self-help books. These are decidedly anti-selfhelp books. I prefer books which repeat passionately that predictable rules just won’t help in this sort of situation. These authors are the women who “get it,” get me, get the whole “wow I’ve really got this thing down … whoops, I have no idea what I’m doing” feeling, and shore me up. Thank goodness that women who write and reflect are as baffled as I was by the strange careerist role of being a mother in this time.
“Hi how are you. Good? “ The answer comes right after the question. I don’t need to speak. That’s how many of my days begin when I drop my daughter off at school. Parents cluster in pools of light, nursing coffees and trading gossip about vacations, teacher choices and new policies on parking.
I love that light- but I don’t live in it for long. Like New England spring- happiness is elusive and luxurious. I move in and out of those pools of sun with friends and family. But I don’t live entirely in light or even in sanity. My real life happens elsewhere, at work shuttered behind the city streets.
Last week I saw a man running with a long steel leg. He loped through his morning run in the suburbs like a mysterious creature. Half man and half steel. Miraculous and brave. The centaurs have come back.
A woman cycled past me on Brattle Street this summer while I waited for the camp bus. Crouched low on her bike, half an arm tattooed to the stump. My daughter observed ”she must have lost it in the marathon bombing. Otherwise the tattoos would have continued down her hand.”
Survivors are among us in all forms. Some with wounds, some amputees. Some with wounds that are invisible and harder to tend.
I treat invisible wounds. Scars on the soul largely go unseen. Who stops a passerby and says “You look sad. How was your day?” Who sits down with the person alone on the bench?
How can we tend the strangers among us? Cutting and burning, even tattooing, show me how much we all want to be seen. Internal pain must be transformed into something recognizable, demanding immediate care and attention.
No wonder that so many patients beg for a scar- a broken limb- the psychic equivalent of a scarlet letter on their forehead. No wonder they talk loudly to themselves.
How else is darkness, as William Styron, said to be “made visible?”
My father, an oncologist, taught me early on “The most serious wounds don’t look bad. They grow inside you until you die from them.” Doing psychotherapy is like doing neurosurgery in the dark. We feel our way along, making connections.
I try to decode the dusty Braille on the inside of a wrist. The one word that flies up like a gleaming fish out of a sentence and sinks down. The pearl inside the oyster’s slime.
Yesterday in the middle of a few things I stopped on-line for a coffee. From behind I felt a hand like a shaking butterfly, descend on my arm.
“I don’t know if you are aware, but your purse is open?” It was an older woman, speaking with care. A few years ago I would have brushed her off politely.
But now I thought- perhaps this is her one conversation, her only touch for the day. I turned and talked about the wait and the line.
EM Forster said,” Only connect.”
Do you talk to someone unsolicited? Can you listen? Can you hold that thin thread of connection and ask them next week: : “How are you now?”
Ask them to step inside your circle of sun?
These days most children are labelled specially gifted or have a learning disability. It’s easy to ignore this data as the heightened gaze of baby boomers on their child.
But the increase in documented LD, e.g. slowed processing speeds, dyslexia, and other non verbal learning disabilities, demands the attention of teachers, therapists and healthcare professionals.
As a psychologist who spent years testing teens, I was humbled by how robust the cognitive and psychological findings were. Early on I realized how sensitive these tests were.
Years later I spend much more time than I anticipated unravelling anxiety and depression from a possible cause of an untreated or undiagnosed learning disability.
The anxiety a bright child feels who cannot express them selves quickly—in words or on paper, builds in them with the force of a nor’easter. By middle school children can announce they feel “stupid.” They and their families are darkly embattled with homework every night.
Performance in school and comparison with others is a natural part of self esteem and intellectual development.
As a professional who struggles to administer Block Design I remember the words of a doctor and mentor:
“the three most powerful words you can say are: I don’t know.” Encouraging parents and their children to admit to areas of struggle is part of my job.
If we make thinking about thinking easier for kids, the relief is palpable. They feel lighter and less alone. Children and parents can feel empowered when they are released from a dark inchoate battle over homework.
“I don’t know” can even be replaced with “I can figure it out.” Cognitive testing is much like Harry Potter’s beloved cloak of invisibility: We can use it for good or for evil. But ignoring power to help children thrive is simply naive.