The Mental State of the Union

I wrote this article about eight years ago, but it’s still relevant, in fact more relevant than ever–the stats haven’t changed that much.

1. I’m Okay, If You Say So

I’m sane, no, really, I am.

I’m not insane. No, really, I’m not.

Except…I’ve struggled with clinical depression and drug addiction, and these are both diseases of the brain. For a long time I made the same mistakes in life over and over, knowing better each time — but doing it anyway. I was married and divorced four times before I figured out that I was giving in to relationship-wrecking compulsive behavior.

But since I don’t rave on the street, I don’t stalk people or have delusions of grandeur or hallucinate or hear voices, let’s pretend I’m not crazy.

When I was young, I was in a mental hospital because of an overdose of a powerful street drug. The drug that put me there made me temporarily psychotic.

Thanks to that horrible street drug, I was temporarily able to experience full psychosis, artificially induced-hence I know what one form of psychosis is like, and have a sense of what the psychotic endure: the sense of being strapped to an evil carnival ride going ten times too fast, everything nauseating, everything terrifying, and it never seems to stop. The feeling of being utterly subjected to forces outside of your control. All that you have left is the part of you that experiences the nightmare.

But it was all over in 48 hours or so, and I was able to wake up from the nightmare. Some people are born into it; some people never wake up from it. It’s so easy for the “sane” to shrug off the suffering of a psychotic. If only they knew…

I was luckier than a relative of mine, who’s bipolar — or schizophrenic, depending on which doctor you ask — and whose life has been hellishly undermined by it from the time he was a young man. The road of his life capriciously turns to quick sand under him, all of a sudden, as the voices and the paranoia and the hallucinations begin. He once spent all night talking to “Bob Dylan” in an alley in Sacramento. Perhaps there was no one with him in that alley, or perhaps it was some street alcoholic amusing himself babbling to a handy schizophrenic.

I used to sometimes take care of that relative when he was a baby: a sweet, affectionate, bright toddler. Twenty years later that baby was waving a knife at cops on the street and warning them that he knew exactly who they were really working for.

We deal with mental illness in different ways in our society. One way is, we make it a joke — “They’re coming to take me away ha ha they’re coming to take me away ha ha to the funny farm where life is beautiful all the time and I’ll be happy to see those nice young men in their clean white coats…”

But we also romanticize madness. By calling it madness instead of sickness-the word madness has a melodramatic, Roderick Usher sort of sound to it. Usher, in the Poe’s “The Fall of the House of Usher,” spoke of being hypersensitive to sounds and impressions, his consciousness constantly under bombardment until he was driven to madness — he was Poe’s Poster Boy for the overwhelmed, the anxiety-raddled, and even now he could symbolize our dysfunctional relationship with our media, our technology and frantic lifestyle addictions; our ravening hunger for input that’ll keep us one step ahead of having to live with ourselves…until we overload from it like modern Roderick Ushers.

Sometimes kids can’t deal with all the input of their lives, media, schools, family anxieties; then there’s the toxins we’ve let them ingest (encouraged them to ingest, with fast foods), and the low-attention settings we’ve given them through our media conditioning…and their ability to concentrate is eroded from all this. So they are perceived to have Attention Deficient Disorder. Perhaps some of them really have something of the sort. But do the enormous numbers of kids who get a powerful amphetamine-related medication really have the disorder? Are those vast numbers of kids genuinely, definitely, truly in need of drugs like Ritalin, which permanently alter their neurological makeup? And is it a coincidence that Ritalin vastly enriches the pharmaceutical industry, an industry which makes, no exaggeration, twice the profits of other Fortune 500 companies?

One day a few years ago we were suddenly confronted with mechanical voices on the telephone, menus and automated responses, press one if you want a recording to explain about this, press two if you want a recording to explain about that, and having pressed three, press four if you want an explanation of the explanation. You literally had to go through a maze to talk to the phone company about a problem with the phone — and it’s that way with most businesses now. Suddenly there was a new technology that was part of our lives and nobody asked us if we wanted it there. It was another maze to go through besides the mazes of streets and personal conflicts.

Everyone is Roderick Usher sometimes. We love the drama, the romance of madness-as opposed to mental illness. We love to imagine tortured artists wrenching the pearl of their genius from the tortured oyster of their suffering: Van Gogh half mad and all genius, never understood or appreciated. We all feel inadequately understood and under appreciated.

We romanticize insanity or we ridicule it, or we put it in the room where we keep the objects of our pity, a chamber we rarely enter, we toss some coinage through the door and dutifully look through the window at times, at the raving icon of human isolation on the street, the homeless and insane. Sure, it’s understandable: we can only carry so much burden. So we compartmentalize life and people and ourselves to make it easier. And in that compartmentalization we methodically build mazes and then we complain we’re lost in a maze.

This is the society that thinks Celebrity Boxing is normal and…funny.

2. Sicker-Than-Ever Society?

Now hear this, an estimated 22.1 percent of Americans ages 18 or older suffer from diagnosable mental disorder in a given year — and that’s not just someone who’s a little troubled and neurotic and goes to a therapist. I’m not counting myself. In 1998 that was 44.3 million Americans. Four of the ten leading causes of disabilities in the United States are mental disorders — major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder. Many people suffer from more than one of those at a time. For the multiply-stricken, life can truly be a bitch-a hag, a harridan riding your shoulders and tearing at your skull with a serrated beak.

About 18.8 million Americans have a depressive disorder. That’s almost ten per cent of the adult population. Nearly twice as many women as men are affected by a depressive order each year. Why, because they have to live with American men? That’s 12.4 million American women.

Depressive disorders seem to be appearing earlier in life in people born in recent decades. Clinical depression often co-occurs with anxiety disorders and substance abuse — and with substance abuse, clinical depression only gets worse, since narcotics damage the brain’s ability to make mood regulators, endorphins, and serotonin.

Whatever the cause, “Major depressive disorder” is the leading cause of disability in the USA and established market economies, worldwide.

Bipolar disorder affects approximately 2 point three million American adults or about one point two per cent of the us population age 18 and older in a given year. Men and women are equally likely to develop bipolar disorder.

In 1997 30,535 people — that we’re sure of — died of suicide in the USA. It’s probably more than that. More than 90 percent of people who kill themselves have a mental disorder or a substance abuse disorder. The suicide rate in young people increased dramatically over the last few decades. In 1997 suicide was the third leading cause of death among 15 to 24 year olds. Four times as many men than women commit suicide — but women attempt suicide two to three times as often as men. (Ladies — was it drama all along or was it inefficiency? Cut to the chase and see a therapist.)

Approximately two point two million American adults — apparently a lot of them attracted to San Francisco — are schizophrenic.

Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder and phobias. About 19 million Americans (13%) have diagnosable anxiety disorder. Many people have more than one anxiety disorder.

Not all of them know it — they just think they really need to drink a case of beer and watch six hours of television a night.

Women are twice as likely to have an anxiety disorder, post-traumatic stress, generalized anxiety, agoraphobia and specific phobias. Of course those specific statistics don’t point out that at least some of that — especially post-traumatic stress — probably does come to women after they’ve been abused by men: raped, beaten, or psychologically raped and beaten.

Others are just neurologically prone to anxiety — and there are imponderable causes having to do with the fact that, generalize as we might, every person is exquisitely individualized, having their own individual experiences from the moment of birth. It stuns me to look at a big crowd anywhere and think that each person– if you could turn time backward for them and follow along — would follow an individual path through millions of experiences in millions of places, each one with their unique joy and suffering and misunderstanding and understanding; each person in a kind of winding tunnel of personal experience. Try psychoanalyzing that vast accumulation of experience; try finding clear psychological causation in thousands of miles of experiential tunnel.

About two point four million people have panic disorder… which often leads to agoraphobia. About three point three million Americans have OCD: Obsessive-compulsive disorder. Five point two million Americans have some form of serious post-traumatic stress disorder, usually after personal assaults such as rape, vicious muggings, parental abuse, or encounters with terrorism — as in Oklahoma City, as in the 9/11 attacks — or due to natural disasters, car accidents, and so forth. And the above statistics don’t even venture into the terrifying world of Alzheimer’s patients.

So besides all the depressives grazing on Prozac (I used to be one), and all the children getting their attention spans chemically tweaked, we have this huge population of people with mental disorders. We raise money and we get help for all kinds of charities and sufferers — but when did anyone last do a “walk for the mentally ill”? It might happen, but not very often.

Maybe because we can’t bear to imagine all that unjust suffering, we somehow cling to the idea that in someway mentally ill people have brought it on themselves. Not all mentally ill people are always just victims — many of them may indeed collaborate with their own diseases, or succumb when they could fight.

But that’s easy for us to say. Those of us who don’t hear voices in the electric toothbrush, don’t go for days without sleeping because of fear of what’ll get them when they sleep. For the most part the mentally ill, and not just the ones on the street, are the abandoned-and it’s easier for us to assume that there’s nothing we can do to help and in some obscure way it’s all their karma.

Notoriously — most readers will know this — this is the one major industrialized nation with laughably inadequate socially-provided health care and that goes big-time for mental health care. If little is done for the uninsured poor with physical problems even less is done for the uninsured poor with mental problems. And what is done is under funded, hackneyed, saddled with uneducated health care workers who don’t care because they’re not paid enough to care — I don’t mean the doctors and nurses; I mean, for example, the generic “mental health workers” now found in mental hospitals.

It used to be that assistants to doctors and nurses in mental hospitals, so-called Psychological Technicians, or “psych techs”, had to be well trained — but they’re being replaced by the untrained. To save money, asylums and hospices for the elderly stricken with Alzheimer’s are now allowed to use people employed at minimum wage, workers who are untrained or barely trained. These sullen drudges resent what they’re paid — or what they’re not paid — and act out on their resentment by doing as little as possible.

You get what you pay for in health care too, and at that rate of pay you tend to get people who can’t get another job for a reason. That might be partly why at least one of San Francisco’s mental hospitals for the uninsured has a high incidence of mental health care workers making deals with patients for sex — usually the currency is cigarettes. And why that same hospital has a high incidence of mental health workers raping patients, and mental health workers stealing jewelry from patients. (Alzheimer’s patients, by the way, routinely have jewelry stolen from them by minimum wage workers in nursing homes). Yes and this policy may be a large part of the reason that mental patients and Alzheimer’s patients are often left in restraints unnecessarily so that they soil themselves and develop bedsores. Unsupervised, they hurt one another or commit suicide.

3. Racism, Poverty and Mental Health

Racial and religious-minority groups are egregiously under-served by the mental health care system. A constellation of barriers deters minorities from seeking treatment. Language and cultural barriers make them unlikely to get treatment that meets their needs. Because the system is shaped by research on white middle class populations, mentally ill minority groups experience the mental health system as the product of white, European culture. Hispanic and Vietnamese and Cambodian people have problems complicated by their history. How many white mental patients had to escape the Killing Fields or napalm — or life in the inner city ghetto?

In some traditional societies mental health problems are viewed as spiritual concerns. Traditional religious authorities are not heard to say, “You don’t need me as much as you need to see a psychiatrist.” Sometimes having religion helps with stress, makes you less prone to breaking down, gives you a free support system — but if you have a major mental illness, there’s not a hell of a lot your religion can do for you. It might even add to your delusions with talk of demonic spirits.

African-Americans are statistically less likely to voluntarily seek outpatient therapy. Besides cost issues and the stigmas associated with the mentally ill, the short reason is they just don’t trust us. No more explanation is necessary — except for why we don’t do more to do outreach to provide reassurance and outpatient help in the black community.

The overall mental health of Native Americans has barely been studied. What is apparent is that psychological illness is generally higher among Indians than the rest of the population — alcohol abuse, which, of course, is self-medication, is especially prevalent and suicide occurs at alarmingly high levels.

Lower economic status has been strongly linked to mental illness — the poor are two-and-a-half times more likely to suffer from serious psychological problems. Poor women experience more physical danger from men. And of course the poor have less access to health care so they have less access to therapy and medication — so things are more likely to get more seriously out of control. Meanwhile a wealthy matron in Beverly Hills pops another Xanax and wonders how some little woman in Texas can go mad and kill her five children.

The poor are also more likely to be exposed to major environmental toxins. The refineries that keep breaking down and leaking are, many of them, snuggled right up against low-income communities. I stayed at a cheap motel once, in the San Fernando Valley, a block from the Budweiser brewing factory. This place put out some major fumes, sulfur dioxide probably among them, that burned the eyes and hurt my lungs — and I was there only overnight. The factory is right smack in the middle of housing for the poor. They live with those burning eyes and aching lungs, and whatever neurological effects the pollution from the place may generate.

Last time the EPA worked it out, almost two billion pounds of randomly mixed chemicals were dumped into our nation’s water systems. In that same year two-and-a-half-billion pounds of chemicals were released into the atmosphere; with the total chemical attack on the environment estimated at almost six billion pounds. This is only in one year.

Seventy thousand — that’s 70,000 — chemicals in commercial use today have not been tested for neurotoxic effects.

Known neurotoxins that we are most commonly exposed to — these are not from that 70,000 group — are lead, mercury, cadmium, and pesticides. Most of these toxins are colorless and odorless, making sensory detection impossible. Round Up and other herbicides are being quietly phased out after years of vast public use because we’re just now finding they cause serious brain damage in children. The symptoms of those kinds of poisoning may come on slowly due to a gradual build up. The kid gets weirder and weirder and weirder and then one day…

Here is just a partial list of common early subclinical symptoms of toxicity from toxins we routinely allow in our air and water: fatigue, lethargy, depression, headaches, allergies, chronic infection, nervousness, sudden anger, memory loss, and paralysis. Notice how many of these symptoms involve behavior.

Mental illness is more prevalent than ever — how much of it is because we’re routinely poisoning ourselves?

4. Are Paranoids Right?

If you know any seriously paranoid or bipolar people, you know that they may often fear that they are being poisoned. The irony is of course that they are being poisoned, though usually not as much as they think-

And yet sometimes they are being poisoned almost as badly as they fear. Look at the Erin Brockovich case — whole neighborhoods were genuinely being poisoned by smiling friendly people from Pacific Gas & Electric. The PG & E people were oozingly sweet when they dealt with that community and they knew they were exposing them to toxins and some of the PG & E employees knew they were doing real damage — and they just covered it up. Same goes with the Monsanto case in Aniston.

In both cases, the paranoid were right.

Paranoids are afraid of medication — because they think it’s poison. The irony is double edged. Anti-psychotic medication is somewhat toxic — there are no medications for schizophrenia or related diseases that aren’t rife with nasty side effects. At the same time, most seriously affected schizophrenics and bipolars are even sicker without the medication. Despite its bad side effects, it does make it possible for them to live somewhat rationally in the bizarre civilization we’ve created. Yet they can see it’s giving them permanent tremors and difficulty thinking; they find it makes them drool or lose control of their limbs at times. People have died from not-so-very-large doses of the anti-psychotic drug Haldol.

So the paranoids are trapped — they’re trapped between their own fantasy and the reality of the necessity of taking the stuff that in turn feeds their fantasy by poisoning them for real. This is a nightmarish dilemma to be stuck in.

Medication is sometimes badly selected — people vary neurologically, but the same group of medications are given for most mental patients. Doctors don’t want to take the time to be specific. If the patient feels the medication is making her sicker than it is helping him, and is resistant, the doctor or nurse or psych tech assumes the patient is just being paranoid. And they might be — and yet they might be right! That is their real dilemma, the cognitive dissonance they live every day.

Paranoids are afraid they’re being spied on. Sometimes people are being spied on — I get e-mail and phone calls from people who seem to know what my consumer patterns are, what I’ve bought recently, what insurance I don’t already have, because marketing groups routinely sell information that should be private.

Of course reality is notoriously subjective. And notoriously there were many powerful, effective people, like Abraham Lincoln, who suffered from “melancholia,” or mental illnesses of various kinds. Louis Ferdinand Celine was compulsively anti-Semitic — it was a sickness, not an ideology — and he was one of the best writers of the early 20th century. Some of Coleridge’s best writing emitted from states that are almost undistinguishable from schizophrenic hallucination.

People talk about how this or that public policy is crazy, is insane. Surely it is insane, indeed, to knowingly dump 6 billion pounds of toxins into our food chain. To allow the destruction of forestland and the ocean life that creates the very oxygen we breathe. We still put arsenic and mercury and lead in the air. We take insane risks with nuclear power plants — risks so notoriously high that no insurance company will insure the plants. And these things seem like madness.

At the end of Bridge On The River Kwai the British commander kills t o protect the bridge he worked so hard to build and then deliberately blows up the bridge he killed to protect — and as he does this the doctor says, “Madness…madness…madness…”

When I was watching the Gulf War on television, just like an action-based television show about aerial combat, I was caught up in it — I am opposed to any but the most absolutely necessary wars, but found myself really digging it when those smart bombs zipped from my country — by extension from me — to blow people up in that cross-hair marked building. I enjoyed it — and I was opposed to it, both at once.

I was insanely self contradictory — but then I was just taking part in the collective mass hypnosis. We as a species are far more prone to mass unified behavior than we know. How else to explain what made the Khmer Rouge do what it did? How else to explain the Holocaust and whole towns in the American south partying around lynchings? How else to explain the lunacy of the McCarthy era? How else to explain Jonestown? We have a gift for dehumanizing human beings in our minds and making a sort of mass ritual of it — and that is a form of insanity.

What is insanity? Among other things, it’s the idea that we’re immune to consequences. A madman thinks he’s invulnerable — at times when he’s not being paranoid, as our Sane Leaders were in the McCarthy era. We think we can dump billions of pounds of toxins into ourselves — and not have one in three people come down with cancer and one in five with a psychiatric disorder. We are insane as a society. We are far more asleep, more automatic, more mechanistic in our reactions, our behavior than we know — and that is something psychiatry diagnoses as disassociation.

What if, as a society, we’re far crazier than we realize? What if — and that includes this magazine’s hipster readership, each with his or her own set of conditioned psychological reflexes and insanely overblown vanities — what if we’re all truly — not figuratively, but truly — insane? We happen to be insane in a way that’s functional, like a heroin addict who gets enough dope so he doesn’t start screaming and manages to get through his day. But he knows his addiction in insanity. We’re functional — but insane.

Maybe we really should have more sympathy for the guy who talks to the air in the subway station.

Maybe we should commit more resources to help ourselves.

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(First published in The Thresher, Issue 2, 2002)

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