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Mental Health / Mental Illness

PTSD and the remnants of Cartesianism in psychological practice

11th January 2019 by Finn Gardiner Leave a Comment

The view of trauma adopted in the DSM-V is a reflection of the Cartesian dualism that still permeates mainstream psychology. The diagnosis of post-traumatic stress disorder, or PTSD, requires that a direct, physical threat to someone’s life occur; emotional abuse doesn’t seem to count, despite research studies indicating that emotional distress can exert the same effects as physical abuse. If emotional abuse results in the same biochemical responses as physical abuse or life-threatening accidents, then it should be included as a criterion for PTSD or other psychiatric disabilities that arise from stress or trauma. Limiting the aetiology to direct physical threats prevents survivors of emotional abuse or other forms of sustained maltreatment from receiving the help they need.

Drawing a bright line between the two seems entirely predicated on the idea that the mind and body are two separate entities. This kind of crude dualism reflected in the DSM is not in keeping with current neuroscientific findings. Rather, the states of the mind and the rest of the body work in concert with one another. For example, anxiety and depression lead to the increased production of stress hormones like cortisol and adrenaline, which can ultimately overload the body and lead to a variety of adverse health consequences like stroke and heart disease (McEwen, 2005). The idea of a mind wholly separate from the rest of the body is an epiphenomenon of our cognition, not a tangible reality; while we may feel a separation between our thoughts and the rest of our body, the brain is still inextricable from the rest of our flesh, blood and bones. Our selfhood is immanent within the corporeal; it neither transcends it nor is reducible to it.

Admittedly, this frustration is deeply personal; I myself have PTSD symptoms from surviving years of emotional abuse and neglect, but if diagnosticians adhered strictly to the DSM, I couldn’t even be diagnosed with it. There is no official name for what I’ve gone through, even though the effects of this maltreatment still linger. Some psychologists and psychiatrists have suggested adding complex PTSD, or C-PSTD, to the DSM, but it hasn’t been added as of 2013. Leaving the scars of emotional trauma unnamed creates the potential for gaslighting, denial, and manipulation. While I’m not an unalloyed supporter of the medical model to name and identify trauma, I do think that we need ways to discuss what we’ve gone through as survivors in a systematic way. I hope the DSM-6 actually catches up with the literature and recognises the effects of long-term emotional trauma.

References

McEwen, B (2005). Stressed or stressed out: What is the difference? Journal of Psychiatry and Neuroscience 2006, 30(5).

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) (2013).

Filed Under: Disability, Mental Health / Mental Illness, Philosophy

The slipperiness of “I”: emergent properties, personal mythos, and co-creative development

21st November 2018 by Finn Gardiner 2 Comments

I’ve talked before about having psychiatric disabilities and being an abuse survivor. Today, I’m going to go into a bit more detail. This hasn’t been easy to write, but I think it’s a story that needs to be told.

It’s honestly a misnomer to say “I” in the first place; it’s more for your convenience than it is an inner truth. There are a lot of ghosts in this machine. I have a complex, intricate personal mythos; though I am very private about what that entails, it’s still a central component of my experience. I don’t feel comfortable with any of the “official” diagnostic labels that come close to what I experience, but there’s some similarity to Internal Family Systems. I’d say that the experience is more complex than that therapeutic model encourages, but it’s vastly better than anything that immediately evokes thoughts of Sybil and Three Faces of Eve.

I said this when I was 19:

It is difficult to define me in a few words; I see myself as a fissiparous, separate collection of ideas consolidated into one whole, forced to work together because of physical unity. In my mind exist multitudes of plots, characters, turns of phrase, denouements, orchestras with rousing crescendos and subtle diminuendos, the decisions and revisions of daily life, and the constant analysis of information. I’ve likened my brain to a large music-box or production factory; the ideas and influences of this world enter me, and I take them and combine them through my perception and interpretation, and take the universe and make it into [my own].

So many “psychiatric disorders” are extreme responses to a disordered, chaotic, and often mean world. To imply that the person experiencing psychiatric disability is the one who is “disordered” lets abusers, dictators, and warmongers off the hook. Our lives are intricately linked with others’. It’s important to understand individual factors, but it’s also vital to remember that we exist within systems: families, towns and cities, friend groups, countries, Earth at large. My lack of a contiguous “I”-narrator is in part a response to the circumstances in which I was brought up. I don’t—can’t—believe anything with absolute certitude, because I know my entire universe can be ruptured at any moment. It gets even more intense when you add in generational trauma: slavery, the Middle Passage, Jim Crow, and centuries of tilling the land without being able to reap the results of one’s own handiwork. This is not a stable foundation on which to build a singular sense of self, but my brain mitigated this problem by allowing for varied and co-creative senses of self to exist instead. I’m not anti-psychiatry, but I am vehemently against seeing people’s mental health as something extricable from the contexts in which people grow, live, work, and play.

A contiguous sense of self is an epiphenomenal emergent property anyway, not a concrete reality that can be used as an absolute benchmark of sanity or insanity. Because it’s all people know, they act as though it can be used to delineate what is beneficial and what is harmful. That’s not to say that there aren’t consistent tendencies, traits, and behaviours I can label as mine, but they’re the traits of a microcosm. There are plenty of other creative people who “contain multitudes,” pace Walt Whitman.

On a meta-level, it’s already pretty fucking weird that a collection of atoms can perceive itself at all. Thought itself is an intangible process generated by electrical impulses and chemical baths washing over our brains. I could continue the reduction to the sub-atomic levels: quarks, photons, and the like.

If it weren’t for the way my cognition is arranged, I don’t think I’d be alive to be telling you about this today, or if I were still alive, I think my quality of life would be greatly diminished. Having an internal support team has allowed me to pull through difficult traumas and create a better life for myself. This is deeply important to me and I am horrified by narratives that pathologise, flatten, and diminish my interiority or its positive effects on my external presentation. It’s especially galling when those judgements come from other neurodivergent people who seem to think that only some forms of cognitive difference are acceptable. Anxiety, autism, and depression are OK to talk about, but nothing else is. This is not OK. There is no point in trying to win the Oppression Olympics. Some animals are not more equal than others.

I don’t typically talk about it publicly because I have no interest in ontological debates, especially when people drag in the medical model. I’m also profoundly uncomfortable with having people apply inaccurate, minimising, and hurtful narratives to my experiences, turning a complex, multi-dimensional topological space into a two-dimensional figure or stripping it into non-contiguous pieces separate from the context in which they originally existed. It’s particularly painful to see people who know me well do it. I don’t want people to delve into extensive analyses of my personal mereology. I just want them to listen and not try to create their own—ultimately inaccurate—stories that they think supersede my own.

I refuse to allow people to denigrate me for having internal mechanisms that allow me to survive and even thrive after years of abuse, discrimination, marginalisation, and oppression. It’s time to take my power back by telling my story. Our story.

Filed Under: Disability, Mental Health / Mental Illness, Philosophy, Sociological Hyperawareness

Too Much Space

29th June 2018 by Finn Gardiner 6 Comments

Content warning: bullying, emotional abuse, food/weight talk

I am constantly beset by the worry that I take too much space. That my entire existence is a nuisance. Because of this, I often find myself consigned to the margins, either by my own reticence or through others’ behaviour. Ironically, I feel profoundly marginalised in communities that are supposed to address and dismantle the systemic marginalisation of those of us who have been pushed to the periphery of society. I am on the periphery of a periphery. Sometimes I wonder if it’s because I don’t sound right, or that I’m not ‘woke’ enough to fit in, even though I’m no Clarence Thomas. I often feel as though I’m in middle school again, being accused of acting white or failing to perform the correct kind of blackness for my peers’ benefit. I feel like an intruder in spaces in which people look like me, but don’t see me as one of them. I worry that I’m not pure enough. Not radical enough. Not loud enough. Not cool enough. I am terminally uncool. Square, nerdy, congenitally awkward. I feel constantly overlooked in discussions about disability and race, even though I have not shied away from discussing the relationships between them. I feel, despite my isolation, that I am somehow taking too much space simply by being there and having inconvenient opinions. I see ‘cooler’ voices amplified before mine. This is not limited to my work in advocacy; as a master’s student, I avoided applying for fellowships and other opportunities within my programme. After all, weren’t so many of the others younger than I was, and therefore more deserving of opportunities? Better for me to withdraw, to focus on my advocacy outside campus instead of intruding. It didn’t help that some people thought I talked too much in class during my first semester. I grew comparatively quieter. I didn’t shut up entirely – it’s not in my nature to do so – but I did feel some pressure to hold back. While I was able to build cordial relationships, there was always the knife-edge fear: I take up too much space. I’m not cool enough. I should just back off and let real people get involved.

I’m 32 years old. I finished junior high eighteen years ago, but I still feel I’m there sometimes, though the consequences are severer.

These feelings have deep roots that extend much further than my involvement in public activism or advocacy. As I previously intimated, it goes back to childhood, back when I grew up feeling as though I were an inconvenience for being neurodivergent. When I was bullied at school, my parents routinely took the side of the bullies unless they were actually inflicting physical pain on me. When I cried out in emotional distress, I was met with ridicule, stonewalling or punishment if they didn’t blame it on Satan. If I felt excluded, I was not to question it; for my parents, it seemed self-evident that I should be excluded, and that my protesting against my exclusion was tantamount to wanting to be the centre of attention for no good reason. Disputing this exclusion was clearly a sign of my being vain and self-centred. My being good necessitated my being a marginal figure. I was not to question, not to feel, not to exist in any substantive way that required that they address my humanity. I take up too much space.

I’m also fat. Very fat. I’ve been fat since I was ten years old, back when I literally Ate My Feelings, pace Mean Girls, because I didn’t know what else to do when I was depressed and dealing with my parents’ emotional abuse and neglect. Ironically, my being mistreated for taking up too much space led to habits that would cause people to believe I took up too much space in other ways. While I no longer binge-eat in the same way, I spent about twenty years dealing with disordered eating as a form of self-treatment when all the pills, prayer, therapy and meditation couldn’t banish the self-destructive demons dominating my thoughts. Doctors berate me about my weight, treating the effects of my self-medication as an individual moral failing. I take up too much space.

I have a hard time initiating conversations, even with friends I’ve known for over a decade. Even though they’ve managed to put up with me for that long and somehow don’t find me repulsive, I feel my initiating contact is an intrusive act. That I am intrinsically repellent and should wait to be approached first. I feel the same way about job applications. I take up too much space.

Even now, nearly twelve years after I have had any direct dealings with the people who inculcated this into me in the first place, I feel compelled to fold myself small and to be marginal for others’ benefit. If others approach me with opportunities, I’ll accept, but I am less forthcoming about seizing them for myself. For doing so requires that I place myself at the centre, rather than consigning myself to the margins and allowing others, who are always more important than I am, to take up space in my stead. For I take up too much space, and always will. The current political climate doesn’t help, either; far-right politicians and their acolytes actively say that those of us who do not fit the mould of an ideal citizen should be eliminated, whether by actively killing us or by persecuting us out of existence through the continual curtailment of our civil and human rights.

I’m trying to convince myself that I deserve to be here, too, but there’s a lot I have to work through before I get there.

Filed Under: Activism and Advocacy, Disability, Family, Mental Health / Mental Illness, Race and Racism

Parents, do not infantilise your teenage and adult disabled children

17th June 2018 by Finn Gardiner 5 Comments

If you’re a parent of a teenage or adult child with a disability, it’s important to avoid infantilising them. What is infantilisation? It’s treating people who are no longer children like children in a way that restricts their ability to be fully integrated with their age-peers. It’s talking to them in a condescending voice, dismissing their ideas and opinions, acting as though you will always understand them better than they understand themselves, or going out of your way to shield them from everything you think may be even slightly dangerous. It’s treating your child as though they will always be a child, no matter whether they’re 5, 15 or 35. Infantilisation is different from recognising that disabled people have support needs. That’s part of what being disabled means: being at a relative disadvantage compared to non-disabled people because we require specific supports to help us live within the community, whether that disadvantage is related to physical health, cognition, mental health, sensory processing or perception, mobility, or something else people find disabling.

It doesn’t matter what kind of disability your child has. This applies to people with chronic illnesses and intellectual, mobility, psychiatric, learning, developmental and sensory disabilities, or a combination. People with all kinds of disabilities deserve to be taken seriously and treated with respect. A teenager or an adult with an intellectual or developmental disability is still a teenager or an adult. Accommodating the support needs of an autistic 17-year-old or a 30-year-old with Down Syndrome does not mean that you should treat them as though they’re younger than their actual age. You can support people without condescending to them.

Disabled teenagers and adults are just that: teens and adults. Teens and adults may be interested in relationships, sex, college/university, dating, alcohol, parties, mature subject matter in films, TV or books, and other activities and experiences that other people their age are interested in. Pretending that disabled teens and adults don’t have these interests does them a disservice. If you don’t recognise their autonomy, they may seek out predatory people who pretend to respect them and may lead them into more danger because you didn’t talk to them about sex or drugs or relationships and realise that they, like other people their age, may want to try things out. I’ve seen other disability activists, like Cal Montgomery, talk about allowing disabled people the right to experience ‘dignity of risk’, or allowing them to try new things and potentially fail at them or learn from their mistakes. I think that’s important. Young people of all ages should have the opportunity to learn what works and what doesn’t work for them. I understand the desire to protect one’s children from harm. If I had children I would want to avoid them from being harmed too. Unfortunately, you can’t always control what happens to people throughout the lifespan as much as you may try. The inherent uncertainty of life requires that parents allow their children to adapt and respond to that uncertainty. There is no such thing as a permanent cocoon, and you’ll find that your teenage or adult child is probably more resilient than you may expect. We deserve the right to try.

Infantilisation is very familiar issue to me. I myself have a developmental disability and my parents—my father in particular—infantilised me as a teenager and as a young adult. I wasn’t allowed to do what many of my peers were allowed to do; my parents claimed that I ‘wasn’t ready’ for many of the things everyone else my age seemed to be allowed to do, like going to school dances. My parents restricted what I read, thinking that I wasn’t mature enough to handle heavier themes in books, TV and films despite encountering similar subject matter in my assigned readings at school. They would force me to attend church even when I’d told them clearly that I was no longer religious; they justified this by claiming ‘in our house, we serve the Lord’, even though I was only going through the motions of practising Christianity. I was also a legal adult when this happened; I didn’t tell my parents explicitly that I was no longer Christian until I was eighteen. The appearance was what mattered, even if it was clear my beliefs had changed. When I was nineteen years old, my parents installed parental controls on my Windows account. (I found a way to disable them a few days after they installed these controls without their noticing, but that doesn’t excuse the fact that they still treated me like a small child even though I was an adult.) I was old enough to vote. In fact, I had voted when I was eighteen; I distinctly remember being eager to vote against George W Bush in 2004. My parents didn’t always give me the right to try, or if they did, they would do it begrudgingly and blame me if whatever I tried didn’t work out, instead of listening to me and working with me to identify strategies that did work for me. For them, supporting me entailed controlling me.

I should also add that recognising that your teenage or adult child with a disability is, in fact, a teenager or an adult is different from using their age as a weapon against them. You can respect their autonomy and recognise that they may need support in certain areas. Just because somebody struggles with housework and certain kinds of planning, as I do, doesn’t mean that you can tell me ‘why, you’re 32! If you want to be treated like an adult, you should be able to muster up those non-existent executive functioning skills!’ Yes, I’m an adult. That doesn’t mean that I don’t have support needs. Rather, it means I should be able to share what my support needs are and direct the means by which I receive support. Autonomy in adolescence or adulthood is about being able to make decisions about one’s own life and enlisting support to make those decisions and implement them. It is not about having to do every single thing by yourself if your disability prevents you from doing so.

Again, teenagers and adults with disabilities are still teenagers and adults. We have the right to make decisions about our lives and receive support to help us make and carry out those decisions. Having a disability doesn’t mean we’re children, or that we don’t have the right to learn by trial and error. We should be allowed to learn and grow from our experiences. Your children are not an extension of you; they’re autonomous human beings who will eventually develop their own goals and priorities in their lives that may or may not coincide with yours. Your job is to help guide and support them, not to use them as proxies for your own desires. Respecting disabled people’s autonomy helps us live healthier, more fulfilled lives.

Filed Under: Disability, Family, Mental Health / Mental Illness, Relationships

Worst Practices: The Discrediting of Autistic Narratives through Pathologising Constructs

14th May 2018 by Finn Gardiner 1 Comment

The one positive of my neuropsychology horror story was the series of existential, epistemic and personal revelations that proceeded from it. I knew that after that experience, I had to move forward in rejecting the politics of shame and pathologisation and move towards a more holistic framework to understand myself and the way I gather and express knowledge. Since that incident, I’ve been thinking about how professionals’ ideas of autistic epistemology (people’s relationship with knowledge, how it is gathered, and the validity of that knowledge) and ontology (ideas about existence and what it represents) are rooted in the idea that marginalised people’s self-perceptions and -knowledge are intrinsically invalid because of who we are.

A few days after I received the letter from Beth Israel’s patient relations department standing by the neuropsychology department’s poor methodology, I came across some writing by the disability scholar and activist Alex Haagaard about how the voices of people with chronic illnesses are routinely discredited by doctors because these doctors have either consciously or unconsciously adopted an attitude towards marginalised people that renders their words unreliable. Their writing reminded me of some of my own ideas on how medical professionals discredit the self-perceptions of autistic people and treat us as though our self-knowledge is either non-existent or reliable; we are Hans Asperger’s ‘intelligent automata’, even if they may not directly refer to us as robots rendered in flesh in their reports. People who do not feel a fundamental tension between their self-knowledge and the ways others view them—the fraught relationship between the subjective ‘I’ and the objective ‘me’ that George Herbert Mead refers to in his work—will not appreciate the level to which this subjective/objective tension affects people’s lives. For people whose life is blissfully absent of this tension, there is a clear distinction between Normal and Abnormal, between truly human and monstrous. Furthermore, the tension that we feel is inherent to us, a flaw that must be corrected, rather than a reflection of the complex interplay between individual traits and social structures. It is a form of victim-blaming applied to people who find themselves on the wrong end of a power differential; if you’re not powerful enough to matter, your problems are your fault. You are the problem. (Incidentally, this is why I am generally indisposed to refer to neurodivergent experiences as being disorders instead of disabilities except in specific circumstances; being disordered implies that the problem inheres within the individual and exists separate from a broader context, whereas disability implies a more complex state of affairs in which people experience both internal disabling experiences and social disablement. It’s even worse in languages like German, in which disorder is translated as Störung, or disturbance.)

When your clinical standpoint requires that ‘disordered’ people must be discredited, then it is far too easy to reject or distort patients’ experiences. After all, our existence is a flaw in the human design. Anything we produce must be flawed by extension. This is magnified if autistic people also experience intersecting forms of marginalisation, like misogyny, racism, homophobia, transphobia or classism. The discrediting experiences that women, people of colour, low- and moderate-income people, and LGBTQ people encounter reinforce and magnify the disablism we face. People like me cannot be reliable narrators under this framework. The idea, for example, of a black, queer, disabled person being intelligent enough to question the underestimation of their intelligence and to question the idea that the methodology used to evaluate me would accurately describe my cognition, is unfathomable. Recognising that a black, autistic man was capable of being empathic would destroy the very foundations upon which his faulty framework of autism was based. After all, aren’t black men all brutes and autistic people unfeeling robots? Had I come into that office with the same level of education – at the time I was a semester away from finishing my master’s degree and had mentioned being interested in doing a doctoral dissertation – and work experience as a white, non-disabled man with unconditional male privilege, I doubt I would have received the same treatment.

This neuropsychologist had a clear ontological framework of Being Autistic: restricted interests, poor social skills, unable to have legitimate insights into one’s own intellect, knowledge-gathering processes, or background. This pattern of traits was his foundational definition of being autistic within the world. I suspect that he had an absolute, reified version of autism in which it exists as a solid entity with clear boundaries, rather than a socially constructed phenomenon or set of phenomena that is defined primarily for its utility, not its concrete existence.

While I refer specifically to a professional who was immured in a particular kind of thinking and applied it to me, this is certainly not limited to him. It’s the entire foundation of how autism is viewed within traditional medicalised practice. Please note that I’m not a strict adherent of either the social or medical model; rather, I view disability as a combination of social and medical factors. I admit that I am more hostile towards the strictly medical model than I am the strictly social model; I find the former profoundly dehumanising and Othering in ways I do not see the latter. I am generally opposed to models that view people as entities entirely deracinated from the social and cultural contexts in which they live, work and learn.

This systemic devaluation of autistic self-knowledge and existence has real, palpable effects: self-hatred, depression, anxiety, free-floating existential angst. They lead to a construction of an oppositional self-concept that internalises those messages. Whenever I think about my experience with this doctor and and other ‘experts’ like him, I fall into spirals of self-doubt, wondering if my perceptions can be trusted or if my memories are real. I start tearing myself apart, constantly trying to psychoanalyse myself in an effort to find out why I view myself the way I do. I feel a nasty chill running up my spine and a metallic tang in my mouth. I can feel my thoughts starting to scramble and introjected voices taunting me and trying to discourage me from scholarship and intellectual inquiry. I’ve had lifelong mental health struggles because of this kind of devaluation. I know I’m mostly talking about it from a theoretical standpoint here, but it goes beyond that. Remember that even the most abstruse academic theories about identity and selfhood attempt to address internal experiences and social structures that can and do affect real people.

If this happened to me, somebody who does have educational privilege and can engage critically with academic literature, imagine what might happen to someone else who doesn’t have those external markers of credibility.

Filed Under: Autism, Disability, Mental Health / Mental Illness, Race and Racism, Sociological Hyperawareness

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