I'm laughing so hard it's killing me

I know I've been writing a lot about my Broken Brain recently, and I'm on the fence as to whether or not this belongs on a blog which I try to keep focused on social justice stuff. Mental health issues are social justice issues, but my own personal breakdown - not so much. That said, I think a personal account of depression/BPD/anxiety can be a powerful tool in breaking down stigma. So on the fence I remain.

But then I got hit by a one-two set of news stories which reinforced exactly why I talk about this as openly as I can: because it matters, because one in four people will have mental health problems in their lifetime, and because so few people will talk about it, and because this stigma is literally deadly.

1. Asda has been selling a "Mental Patient Fancy Dress Costume".

Because we're not real people! We're just horror movie staples!

Because we're so dangerous! We fucking love running after people with meat cleavers! It's not like we're no more likely to commit violent crimes than anyone else, and actually significantly more likely to be the victims of violent crimes! (I know I drag this stat out a lot, but apparently this has not revolutionised social attitudes to mental health yet!)

Because people with mental health problems are Other, surely a teeny tiny minority of the population, so massive supermarket chains don't need to worry about pissing us off!

2. People with mental health problems are significantly more likely to die from preventable illnesses.

There's a lot of reasons behind this, and I don't pretend to know all of them; but I do know that an overwhelming majority of the medical professionals I've dealt with since developing depression have had serious tunnel vision: whatever it is I seek help for, I inevitably end up answering questions on self-harm or suicide attempts or anxiety. Remember Dr Dickface McBullyo? I sought help for a problem with my heart; without doing a single diagnostic test or asking any further questions, he told me I was having a panic attack. Turns out I had supraventricular tachycardia. This isn't actually life-threatening, but these stats suggest a lot of people aren't so lucky.

Of course doctors have to make decisions very quickly and it makes sense to take a person's medical history into account, but this shows, with terrible clarity, that those decisions are being dangerously coloured by social stigma.

The belief that persons with mental illness are dangerous is a significant factor in the development of stigma and discrimination (Corrigan, et al., 2002). The effects of stigma and discrimination are profound. The President’s New Freedom Commission on Mental Health found that, “Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders - especially severe disorders, such as schizophrenia. It leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking and wanting to pay for care. Responding to stigma, people with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment (New Freedom Commission, 2003). (From the Violence and Mental Illness link.)

  Funny-ha-ha mad people Halloween costumes don't seem like so much of a giggle now, huh?

Undermedicalisation: taking mental health seriously

When I was tentatively diagnosed with Borderline Personality Disorder, the first thing I did was get on a bus to my old house to ask a friend if I could borrow her copy of Girl, Interrupted. (The second thing I did was seriously consider getting my hair cut off again like Winona Ryder in the film. Perhaps "Looks really fit with a pixie cut" should be one of the diagnostic criteria.)

This was after ransacking Wikipedia and WebMD and NHS Choices and any other source of internet information I could get my hands on. I mean, it makes sense: someone tells you that you are something; you want to know what that something is. Movies are probably not the best source of information on any mental health condition, but they have one thing that dry medical websites don't: they can try to tell you how it feels.

Susanna Kaysen: [reading from a book] "Borderline Personality Disorder. An instability of self-image, relationships and moods... uncertainty about goals, impulsive in activities that are self-damaging, such as casual sex."

Lisa Rowe: I like that.

Susanna Kaysen: "Social contrariness and a generally pessimistic attitude and often observed" Well, that's me.

Lisa Rowe: That's everybody.

This was actually a really common reaction when I told people: "So, I have an exciting new diagnosis! I have a Borderline Personality! It means I have no idea who I am or who I want to be, and some other stuff!" "Isn't that just being in your 20s?"

Well, yeah, but let me ask you this, Unsure About Your Future Twentysomething: does it make you want to die? Are you so horrified at the gaping vacuum at the centre of yourself that you frequently find yourself curled into the foetal position on the bathroom floor digging your fingernails into your arms to stop yourself howling with fear? Are you suicidal because the idea of figuring out what you want to do with the rest of your life seems like a task you're just not capable of? Does the prospect of getting hospitalised for your insanity sound like a blessed relief?

No?

Then you are probably "just in your 20s".

I think people have this impression that psychiatrists are roaming the streets with nets, cackling madly as they spring upon anyone who displays mildly unusual behaviour and diagnose the crap out of them. "In my day, some kids just had more zip than the others, we didn't call them ADHD and pump them full of drugs." Yeah, and those kids were called troublemakers, underperformed in school, and were denied the chance to deal with their neuroatypicality in a way that suited them.

The idea that we're Overmedicalising Normal Behaviour and Looking For Problems Where There Aren't Any sends people too far the other way, denying the reality of Problems That Are Actually There.

Because these fears are based on genuine issues: yes, the pharmaceutical industry exists to make money, and can best do this by creating medical conditions out of perfectly normal symptoms and patenting drugs to "cure" them. But that doesn't mean illness doesn't exist.

And yes, there are genuine problems with definitions of mental health; BPD is especially contentious because of the disproportionate numbers of women who are diagnosed - hmm, do we possibly think this is because "promiscuity" is only deemed a problem in women?

Reading definitions of mental health conditions, even the healthiest and happiest person can diagnose herself with six different disorders before breakfast. I mean, look at the DSM-IV criteria for Generalised Anxiety Disorder:

A. Excessive anxiety and worry (apprehensive expectation), occurring more-days-than-not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more-days-than-not for the past 6 months).

1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

If there is an adult human on the planet who does not meet those criteria, I want their secret. The point is that there is an unwritten addendum to all of these definitions: that these symptoms must be resulting in dysfunction; that they are making it difficult for the person to live a "normal" life. It's unwritten because no one goes to a mental health professional unless they're actually suffering. Unless it hurts, it's terrifying, it's too much effort to get outside your front door in the morning.

The mental health system, for all its myriad faults, is not trying to make problems where there aren't any. (The NHS, in particular, hardly has a vested interest in creating extra patients.) It's trying to give names to problems that are already there, and have a bash at making them less awful.

...

The third thing I did was collapse in horrified tears because I've always known I was fundamentally defective as a human being, and now this assessment had been confirmed by a qualified medical professional.

The fourth thing I did was tell my self-proclaimed GBF. He instantly dubbed me his BPD-BBFFF (Borderline Personality Disorder Bi Best Fucking Friend Forever) and promised to get that on a t-shirt.

Arctic Monkeys vs Kaiser Chiefs on class and chavs

This post would have been so relevant if I'd written it in 2006.

They might wear classic Reeboks
Or knackered Converse
Or tracky bottoms tucked in socks
But all of that's what the point is not

Arctic Monkeys ~ A Certain Romance

So much chav-hated is focused on clothes, isn't it? You say, "Please don't use that word, it's hate-speech against working class people" - or, you know, a slightly less pompous version of same - and they say, "But what about people who really are chavs? Who wear Burberry and caps and tracky bottoms and Croydon facelifts? It's okay to hate them, right?"

The point is there in't no romance around there.

Kaiser Chiefs' I Predict A Riot is in the peculiar situation of being held up as the epitome of the wave of chav-hatred that's been rising in this country for years - at the same time as being an anthem to the very people the song derides.

Girls scrabble round with no clothes on
To borrow a pound for a condom
If it wasn't for chip fat they'd be frozen

"I don't find you sexually attractive, therefore you shouldn't wear revealing clothing" / "I don't want to look at your body, therefore you shouldn't show it in public" / "I don't want to listen to you, therefore you shouldn't exist". (I'm paraphrasing slightly.)


The difference between A Certain Romance and I Predict A Riot is like the difference between you gently taking the piss out of your mum, and your stepmother viciously sniping about your mum. It's the difference between my sister, 15 years ago, railing against the townies who made her life a misery every day at school - and my sister virulently bitching about "chavs" (on benefits, in council houses, in Burberry) who she's never met. Back then they had the power, and she was the underdog; now she has a degree and secure white collar work and the ability to code-switch to Received Pronunciation for job interviews, while the objects of her disdain are struggling to feed their families on ever-dwindling benefits, unable to work because childcare costs are too fucking high and the minimum wage is so fucking low.

I tried to get to my taxi
The man in a tracksuit attacks me

While A Certain Romance laments the cultural wasteland of Sheffield estates - there's only music so that there's new ringtones - it also has the close-up view which shows individuals (don't get me wrong, there's boys in bands), rather than the alarming uniform army conjured up by I Predict A Riot.

Over there there's friends of mine
And they might overstep the line
You just cannot get angry in the same way

That's the difference, isn't it? A Certain Romance is full of exasperation at people who you've grown up with, who you love dearly, but who want different things and go about them in different ways. It's feeling apart from your friends because you're into books and music and get good marks in school, but knowing that those things are prized in the outside world. I Predict A Riot is full of anger: frothing hatred, disgust for a faceless mass of people you don't know and don't want to know.

...

With thanks to Greg L. Rose for mulling this over with me while we were doing the washing up, and for making me finally listen to Arctic Monkeys seven years later than I should've done. Now that, my friends, is a certain romance.

There be dragons

Why is it that -

1. We are taught to fear attack by trans women ("but if we let THEM use OUR bathrooms how can we protect ourselves against being raped by the hypothetical penises we show a creepy amount of interest in??") when a) there is not a single case I am aware of where 'bathroom panic' has been justified, and b) trans people are exponentially more likely than cis people to be the victims of violence, and
2. We are taught to fear attack by people with mental illnesses, when a) people with mental illnesses are no more likely to commit violent crimes than the rest of the population, and b) people with mental illnesses are significantly more likely to be the victims of violence and abuse, and
3. We are taught to fear sexual assault from gay people ("don't drop the soap!"), when a) there is no evidence that gay people are more likely to commit sexual assaults than straight or bisexual people, b) gay people are targeted for violent assault because of their sexuality, and c) the vast majority of sexual violence is committed by men, against women.

(An obvious caveat: this is not about individual members of these groups. Trans, mental, and gay (or any combination thereof) people can and do commit horrible crimes, and sometimes their victims are cis, straight people with brains full of sunshine. This is about the net flow of violence between groups, and the popular conceptions of which groups are dangerous.)

I'd love to tell you that this is a calculated program of misinformation, designed by malevolent moustache-twirling policy wonks in the Ministry of Social Injustice (possibly dwelling in the musty basement of Senate House) for the explicit purpose of Fucking Shit Up, but sadly, this is like everything else: it's more complicated than that, and we all contribute to it, every day.

Where the evil happens

I think it's primarily about fear of the unknown. Everyone is scared of things they don't know: that's just how our brains work. But no one wants to think of themselves as being scared of the unknown, because that would make them a bigot: better to fill the threatening blank space with big, hard, concrete REASONS to fear people who are Not Like Us. And if there aren't any, better to make some up.

Because being scared of someone who is 'below' you in the Universal Pecking Order would make you kind of pathetic, right? You're the one with the power, and yet you're quaking in fear.

So to maintain two key beliefs about yourself - that you are not a bigot, and that you are not a coward - it is imperative that you believe that these marginalised populations pose a genuine threat to your safety.