Tuesday, October 28

Fetishizing Insight

Linda Holmes and Stephen Thompson from NPR did a sweet conversation remembering Robin Williams and Linda got me thinking about how culture in the United States "fetishizes insight."  Yet mental health isn't about being the smartest.  Some reflections, after the jump.
On my beloved podcast, which is the only way I refer to Pop Culture Happy Hour, Linda and Stephen discussed the loss of Robin Williams and just how sad it was.  Part of the conversation moved to when Williams was on Marc Maron's WTF podcast (Episode 67 and released again in August 2014) and how it was difficult to listen to because Williams appeared to be doing so well.  Linda had this to say about how Williams was addressing his mental health:
We are in a culture that sort of fetishizes insight and believes that if you are-- if you understand your problems you are 99 % of the way to solving them and that's just I think part of what was really heart breaking for people about his trajectory and ultimately learning that he had died is understanding that it doesn't really work that way. And that he's an incredibly wise person and when you listen to him talk-- I kept catching myself-- it's impossible not to keep catching yourself thinking you're glad he's doing so well, because of the way he talks about it, because he's so smart about it and it's such a good reminder that that's not the issue.
It's the Pop Culture Happy Hour Small Batch from August 12, 2014 if you want to listen (and you should and also every Pop Culture Happy Hour).
     Linda is right.  We (I'm speaking of the collective culture in the United States) do tend to assume that understanding the problem is what is (often all that is) required to fix the problem.  Admitting or acknowledging is the first step in many philosophies of healing.  There's certainly some truth there; for many people, a deeper understanding of the problem does help and people can plan, problem solve, and pull themselves up by their bootstraps.  Many evidence based practices in counseling use that idea as a primary tenant.  For example, being able to understand triggers to anger or depression means being able to plan for when they happen and theoretically mitigate the negative reaction.  We all do various versions of this from time to time: cutting out the toxic friendships which are too taxing, using time management to avoid becoming overwhelmed, and not scheduling a stressful meeting first thing Monday morning are all examples of how insight can help a problem.
     Counseling is often working towards insight.  Sometimes insight needs additional education before the light is found, other times people need to be shown a different perspective or to hear something a new way, and sometimes just taking a dedicated time out of one's day can lead to valuable insight.  Insight can be immensely valuable, like I mentioned above, and counseling tends to start with increasing the client's insight.  On one hand, it makes perfect sense because if you don't know what's wrong, it can difficult, if not impossible, to 'fix it'.  (I think there is also a woeful problem with people assuming there is something which can or needs to be fixed, rather than adjusted for.)  When there is a problem, there's a direction to strive for solution and that feels great.  But on the other hand, that's not the way the human brain is understood to work (at least not yet).

     So what of these people who have tremendous insight and still cannot 'fix' the problem?  That's the most terrifying part of mental illness, both for the person who is directly impacted by the disease and by those who are indirectly effected.  Think about yourself for a moment, most people have something they wish they could change and know they should, but it remains unchanged.  Eating danishes for breakfast? Smoking? Getting in the car and not buckling your seat belt?  Forgetting to brush your teeth at night? Biting your nails?  You know you should, intellectually you completely understand why it isn't healthy to drop danishes down the hatch in the morning and you should, at least sometimes, eat some raisin bran.  Yet, day after day, here you are, eating those danishes.  And maybe some days you do make the effort to change and eat something else, but a few days later, the danishes creep back.  Now, likely if your doctor told you that you have to stop eating danishes or you would have a heart attack, you would at least cut back-- reaching for the box of raisin bran at least a little more often, consistently.
     Severe mental illnesses don't always give people a choice to reach for the other option.  We wish they did.  It's almost worse that some people can reach for the other options, because society tends to then blame the people who can't.  Mental illnesses are still often thought of as weaknesses and if the person would buck up and suck it up, they would function fine.  That's not true.  They may be able to skate by and fake it, but that doesn't mean they are well or happy.  Addictive behaviors and depressive disorders (like depression and bipolar disorder) especially fall into this category and you don't have to listen hard to hear someone remark something to the effect of, "I don't understand, why doesn't she just stop drinking!?"  Some people truly can't.  Some people know they are depressed and that it is bad and that they should do something about it.  Depression changes the brain and sometimes that option to get off the couch or out of bed isn't an option.
     Imagine what that's like, you know that you shouldn't be afraid to go and order your food at a restaurant, but you are. Your brain and your body are filled with so much anxiety that you are incapable of ordering your food.  Logically, you understand that there is no reason for your fight or flight response to kick in while trying to order food at a restaurant.  Still, you're paralyzed.  That's what it is like for some people with anxiety and it is made all the worse because it doesn't make objective sense.  Again, all the worse for psychotic disorders where the brain processes information like it does make sense, but scary things continue to happen.
     That's where other counseling strategies or pharmacological methods come in.  Sometimes both of those things together.  If you are someone who has been able to use insight and introspection to solve mental health problems, you deserve a medal.  If you are someone who hasn't been able to use insight and introspection to solve mental health problems, you deserve a medal.  Don't give up on yourself, don't give up on your kids, your friends, your family... whoever it is.  Linda Holmes made an excellent point, mental health doesn't care how smart you are.  Being intelligent and not being able to vanquish mental health problems with insight isn't weakness, it's a reality.  Please know that there are other options to help.  Please don't disparage those who haven't found insight or those who have insight and haven't yet encountered change.  In a medical model people are much more forgiving of the person who has lost the ability to control a limb-- respect mental illness the same way: Sometimes the functioning returns, sometimes it doesn't and everyone needs to adapt to that.  Be kind to one another, and for the love of what's what, be kind to yourself.

If you're looking for support for yourself, someone else, or as someone who cares for someone impacted by mental illness, I highly recommend the National Alliance on Mental Illness and particularly this guide which includes great questions to ask professionals involved in treatment.