#diagnosis

You don't exist unless you're actively on fire, suffering as your brain burns down to ashes that all hate your guts, and treating all of that as a horrible disease that needs curing to make you normal again. And if you are diseased, then "you really need to stop having symptoms, it's not good for you. Get some help. Go to therapy. You're too crazy to understand yourself accurately."

It's not just us. I see it happen time and time again, played out the same way across a dozen different websites, slowly driving us all mad as we rip each other to shreds to appeal to strangers who see all of us as broken murderer stereotypes. It doesn't matter why you exist. It doesn't matter what you deal with or how happy you are. Someone, somewhere, is going to find a reason to punch down and go for the throat. Someone is going to justify it using psychiatry's medical model of the mind.

In a community so centered on medicalizing every little experience, no matter how mundane or common, I look around and get really fucking worried about some of what I see: the sheer amount of sucking up to people who think we don't exist in the first place is disturbing.

My friends get asked if they want to kill people when they open up about being plural. We get threatened with incarceration, eviction, and the loss of our livelihoods. People like us get their kids taken away from them, get denied the ability to enter other countries, have their autonomy taken away time and time again for the crime of being a little too different. We're called imaginary, insane, violent, confused, and a thousand other words that all add up to, "we don't see you as worthy of the same respect as us."

And yet, we're all stuck on this idea that some of us are more acceptable than others, and that casting off the people you disagree with will save you from the people who see all of us as exactly the same level of crazy and dangerous.

Appeal to nitpicky strangers all you want, but someone out there is going to hate your guts for existing in a way they disagree with, and they're not going to see you as being on their side if you join in and beat up your friends. Sanitization just kills us from the inside instead of the outside.

So screw whatever fears we had of being a little too unhinged on this blog, I'm opening up the can of "honest thoughts about psychiatry" to talk over some thoughts around the mental healthcare industry. Want to go off in our inbox or comments about how much I suck for having opinions? Skip it and block us. You'll save us both time.

Psychiatry is a Mixed Bag

I'll start by porting over some thoughts from a conversation we had today that sum things up decently well:

I'll make the argument that decisions about what's best for someone's life aren't always best left up to a professional who does not live that life or necessarily share their values about what makes a life rewarding, worthwhile, and meaningful. Some people seek mental healthcare because becoming more normative fits their ideas of living a good life. Other people feel harmed by that pressure to outsource their decisions about their life and identity to mental health systems, or they may fundamentally disagree that one has to be "normal" to be happy and successful in life. The psychiatric system can be very helpful to some people, very harmful to others, and anything in between to plenty more folks. I don't think that psychiatric care should be forced on someone just for having unusual ideas about themselves that aren't causing them or other people concrete harm in their daily lives. I think that as much as possible, it should be left up to them whether they want to seek that kind of support, and that even in cases where there is a risk of harm to self or others, it needs to be handled a lot more respectfully towards that person than it often is. There's a reason that there are movements of people speaking out against psychiatric abuse and mistreatment- the industry has its problems, just as it has its merits, and those problems have hurt people just as much as not seeking support has hurt other people.

We approach a lot of things from a vaguely psych-abolitionist perspective, especially me. This shit needs reform at minimum. Keep that in mind.

Sometimes Western psychiatry helps people. Antidepressants saved our life in high school by giving us just enough of an emotional prop to work on fixing the root cause of our depression at the time. Antipsychotics let our friends work and live independently. Therapy helped us learn how to process a shitload of trauma and fear around things as mundane as blue rubber bands. We've picked up some tricks from clinical textbooks.

Sometimes psychiatry's absolute dogshit. A psychiatrist suggested taking the door off our bedroom and never giving us a moment of privacy as part of treatment. Another one told our mom that we just needed to play outside more when the problem was that we were self-injuring to cope with trauma (nevermind that we spent all day outside already). A therapist told us to "just stop thinking bad thoughts" instead of helping us figure out why we were in pain.

We know people who called emergency services, then were handcuffed, sedated, and institutionalized during a crisis. We know people who were medicated against their will, had their trauma dismissed as a factor in their pain, had their actual concerns ignored in favor of what the clinician wanted, and had psych wards deny them human contact or companionship when all they wanted was a hug. We know people who were diagnosed, then had those diagnoses weaponized by everyone in their lives to take away their autonomy, credibility, and independence. We know people pushed to use modalities that weren't available to them, or that did concrete harm to them in the past.

Psychiatry isn't all bad. But some of the shit that goes on isn't right.

Psychiatry isn't Universal

Even if psychiatry didn't have its issues, it's not universal. Some folks live in areas that do have Western mental healthcare, but they lack the means to access it. This shit isn't always free or cheap. Even if it's available, some folks can only access mental healthcare based on paradigms now considered to be harmful or unhelpful under the Western model.

Some folks have access to different takes on mental healthcare that aren't "take Prozac" or "talk in a therapist's office for an hour a week". Different medications, no medications, physical interventions, understandings of mental illness that look nothing like the DSM. The Western model of mental illness isn't the only way to make sense of suffering.

Some folks have access to healing modalities, spiritual and cultural interventions, and other approaches that don't pathologize their experiences as "diseases" or "disorders" in the first place.

Some folks have no access to any form of mental healthcare whatsoever.

Despite that, the internet's first response to someone struggling is to toss them, "you need to see a therapist", "get diagnosed or you're faking it", or suggest that they go on meds to get rid of their suffering like any of that is a readily-available magic cure for all suffering and abnormality. Every weird experience is pathological. Every pathology should be fixed with Western treatments and understandings.

Sanity isn't Universal Either

Of course, there's one true standard of what's sane and what's insane, and symptoms never happen outside of disorders. Everyone knows that. (Immense sarcasm.)

Yeah, that shit isn't universally true at all. Weird shit happens to people all the time outside of a diagnosis. Even in Western countries:

6-15% of the general population hallucinates without meeting criteria for a diagnosis

Millions of people believe in ghosts, and a sizeable portion believe that they've directly encountered a ghost at some point in their lives

Some writers hear the voices of their characters and find that they can act with autonomy

An ACE score of 1 or more is typical in the United States, and a full quarter have a score of 3 or more. If you're curious what an ACE score corresponds to, here's a questionnaire. Most people do not see themselves as traumatized despite this.

I could pull more examples of "normal" people being crazy (conspiracy theories, anyone?), and I'm sure you could too.

If all of these people have the right to understand their experiences outside of the medical model, then why don't we? Why the insistence that a subjective experience has to be diagnosed to be real to you in the first place?

What if you don't live in a culture that treats your experiences as a disorder in the first place? Even if you do, what if you'd rather use another paradigm to understand your life? Where's the space for that on an internet that assumes that the only truth is a diseased and diagnosed one?

There are other ways to understand your "weird" experiences that aren't in the DSM. Even if you do make use of the DSM or ICD, you still have access to these other paradigms.

Things to Think About

The medical model didn't appear out of thin air. Diagnoses in the DSM and ICD didn't manifest in isolation either. Have you ever asked yourselves who decides what's normal? Why do they get to decide that, and who benefits? Who suffers? Who is disproportionately affected by the concept of diagnosis, and why is that the case? Where do we get these diagnoses from, and what value do they offer? Who do they offer it to? Who is it denied to, and why?

Take a minute, think on it. Work out how the medical model helps you, how it hurts you, and how you want to relate to it. It's worth your time to get both sides of your story around the medicalization of your experiences.

If you find it useful, great. Roll with that. But don't assume everyone else feels the same way.