The NAMI Papers

 The seven blog entries below are all contributions on mental health/mental illness issues originally asked for by Indianapolis NAMI, the leading mental health advocacy organization in the U.S., which, unfortunately, is not as effective an advocate on behalf of mental health consumers as is needed.  These articles were submitted to national NAMI for publication, and were all rejected, I think because they were just too damn good for NAMI's low-middlebrow standards.  What NAMI wants, unfortunately, are breezy, facile, feel-good articles that are essentially akin to the non-professional writer contributions to the Reader's Digest, leavened with a good dose of the superficial Power of Positive Thinking "philosophy" associated with Norman Vincent Peale and Robert Schuller.  However, as an extensively published actual writer and poet, including at the national level, I was not about to lower my standards to produce for NAMI such superficial, breezy pabulum.  Yet, my articles below definitely deserve publication, as any judicious reader will plainly see.  Hence, I have posted them on my "Politically Incorrect Leftist" blog in hopes of their finding the wider readership they deserve.     

NAMI and Parents

 

My late parents wouldn’t have been caught dead joining NAMI or attending a NAMI meeting.  Their attitude on mental health, mental illness, and seeking psychiatric help was made clear in their attitude toward me when I voluntarily sought psychiatric help—in doing so I brought shame upon the family!  My relatives had the same reaction.  My parents were clearly what psychologist Dr. Susan Forward called “toxic parents”—parents who were abusive, who were abusers.  Though my parents never physically abused me—they didn’t have to, they intimidated me by their constant screaming at me.  That is, when they weren’t ignoring me completely.  The noted Kaiser Permanente ACE (Adverse Childhood Experiences) study of 1995 delineates this clearly:  abusive parenting can cause lifetime mental health, relationship and addiction problems for the children involved.  And there are four particular classes of parents for whom this is notably true:  parents who regularly denigrate or belittle their child; parents who themselves suffer from mental illness; parents who have serious drug or alcohol abuse problems; and parents who are jailbirds, former jailbirds, or who are engaged in illegal activity.  My parents clearly fit into the first category, and possibly into the second category.  Although I had, according to the latest psychiatric research, a 55% genetic propensity to inherit the personality disorder I suffered from, my parents’ abuse made it certain, I believe we could say, that I had a 100% chance of having psychiatric problems.  Which I did for literally decades.  As I’ve written poetically, it takes only one thing to become a natural parent: “the ability to fuck”!  Biologically, sperm meeting egg produces a child.  Period.  Even when the parents involved are utterly unfit for parenting.  As were mine.  I realize this goes against the grain of official NAMI, but, frankly, Freud was really onto something when he posited that mental illness has its origins in parental failure.  He was indeed at least half-right, and the ACE study confirms it.  NAMI needs to reform its facile view that mental illness is entirely genetic and can’t be helped, and its naïvete about toxic parents and toxic parenting.  Bad, toxic, inappropriate parenting does play a key role in gestating mental illness.  Lest we forget or ignore.   

“Stigma” is not the problem; bigotry against the “mentally ill” is!

 

“Stigma” is just the symptom, the effect of open societal and individual bigotry against those deemed “mentally ill.”  It’s just like the “stigma” of being black in the South during the period of Jim Crow segregation.  Being a black person “stigmatized” one by the color of one’s nonwhite skin, but the underlying cause of the “stigma” was the open societal bigotry against those deemed “colored,” even to “one drop of Negro blood”!  As with blacks then, we “mentally ill” are deemed “inferior” simply because of who we are; and if we seek professional treatment for our “mental illness,” the bigotry follows us, follows us with the false “Aha!”:  “See, I told you he [or she] was one of those people!”

 

I suffered this bigotry openly from my family, for whom I allegedly brought shame upon the whole family for undergoing psychiatric treatment.  I also suffered this bigotry openly here in Indianapolis, where I’ve lived since late 1979, because one person, of whom one of her friends said “She had a narrow conception of mental illness,” badmouthed me publicly for twenty-six years, and which badmouthing still haunts me to this day, despite this person now being dead for over a decade; because, as a Quaker “saint,” she was believed automatically and uncritically, but none of those who believed her ever questioned me about it!  No, instead, they just shunned me, which is what this person wanted.  To her, I was more crippled because of “mental illness” than if I had been confined to a wheelchair!  And yet—this person worked as the head nutritionist of a well-known local hospital.  And had a Master’s degree.  Yes, even the educated and supposedly intelligent can hold onto truly infantile bigotries.  One of her friends even told me, “I avoided making your acquaintance for three years because I had heard you had ‘mental problems.’”

 

So, the “stigma” of seeking psychiatric help comes from the bigotry so prevalent out there; we are literally damned if we do, and damned if we don’t.  And it’s institutionalized, and in high places.  Such as, after a horrific mass shooting a couple of years back, President Trump proclaimed publicly that guns don’t kill people, the mentally ill kill people!

 

So, my NAMI friends, focusing on “stigma” doesn’t get to the root of the problem: the open societal and individual bigotry against those deemed “mentally ill,” and our damnation whether we seek or forego seeking professional help.  It is that bigotry that must be firmly extirpated, not simply its accompanying “stigma.”

 

Indeed, the “stigma” of being labeled “mentally ill” is far greater than the “stigma” of having an STD.  After all, the “stigma” of coming down with an STD can give one bragging rights:  “Well, if you had such an active sex life as I have, where not only do I get all I can handle and then some, you’d realize that sooner or later it was inevitable that I’d catch an STD.  Just the cost of doing the business of getting all the sexual pleasure I can.  And boy can I!”

 

Then there are those mental health consumers themselves who try to fight the “stigma” of seeking truly professional help by indulging instead in all kinds of New Age nostrums and pseudo-sciences.  Such as one mental health consumer I knew who was telling all her fellow mental health consumers, “Go off your medication, and let God heal you.” (By the way, she and her husband went off their medications and did thousands of dollars’ worth of property damage; and had to be ordered by a court of law to stay on their medications!)  Though, to be honest, the ofttimes horrific side effects of psychotropic medications make going off them seem a very attractive option to those who are on them.  But these are but two more “adverse side effects” of what is a wrongheaded approach to the “stigma” of “mental illness” in the first place!

 

Then there is the problem of wrongheaded, inadequate, and often just plain malfeasant psychiatry and psychotherapy.  This, too, results in, and feeds, “stigma.”  But the answer to that “stigma” is better, more affordable, more accessible, psychiatry; which means more good alternatives, not simply consignment to often wrongheaded, inadequate and malfeasant CMHCs, especially for those who lack private incomes, rich families, or strong insurance.  Money, and its lack, also feeds “stigma.”  But again, I must emphasize, it is not “stigma” as such that is the problem; it is the underlying bigotry that fuels the “stigma.”         

 

Mental Illness: It’s Not Just the Big Three

 

The Big Three being, of course, schizophrenia, bipolar disorder, and depression.  There’s also, as a major category of mental illness, personality disorders, which are now viewed as far more prevalent than before.  Though psychiatrically ignored for the most part prior to 1980, where they were simply regarded as “untreatable, their recognition in DSM-III changed that.  They can also be successfully treated psychiatrically, though not by medication, which can bring significant symptomatic relief to schizophrenics, those with bipolar, or depressives.  Treatment of personality disorders requires long-term psychotherapy of a year or more, to undo the false mental narratives in the minds of the sufferers.  Fortunately, ever since the late 1980s several types of psychotherapies have been developed that successfully treat personality disorders:  though they start from different theoretical assumptions, in practice they all embrace certain similar methods and techniques of treatment.  Among them are Cognitive-Behavioral Therapy, Dialectical Behavioral Therapy, Mentalization, and others, as well as hybrid approaches that draw from more than one school of therapy.  Unfortunately, these successful therapies are not generally available in CMHCS; they often require therapists in private practice, which can be a financial obstacle for many seeking treatment.

 

The individual and societal costs of untreated personality disorders are myriad and costly:  in unfilled and unfulfilling life chances and choices, in employment and schooling failures, in relationships and interpersonal interactions, and are often comorbid with other disorders notably depression.  But since successful treatment now is substantially available, it’s high time for NAMI do advocate for and demand awareness of personality disorders, and for treatment of such to be readily available and financially accessible for all who need such.  We who suffer from personality disorders have been neglected far too long; it’s time to reverse this.  And that time is now.

Wondrously Gifted

 

This article, "Wondrously Gifted," is a digest and expansion of my 2004 speech, “Wondrous Gifts: The Contributions of the Mentally Ill to Human Society,” which has been reprinted four times.  "Wondrously Gifted" was published in the Circle City Clubhouse newsletter.

 

Truth is, many great, accomplished people in history and contemporary life have suffered mental illness, addiction, or both, yet achieved anyway.  Mental illness, “mental health issues,” need not hold back such sufferers from achievement and accomplishment—history and lived life is replete with positive examples.

 

Indeed, two suffers of mental illness have been among history’s greatest geniuses:  Isaac Newton (bipolar) and Albert Einstein (severe depression).  Two other suffers of severe depression were two of history’s greatest statesmen:  Winston Churchill and Abraham Lincoln.  Also suffering from mental illness and addiction were the seminal painter Vincent Van Gogh (schizophrenic and suicide) and be-bop jazz pioneer Charlie Parker (bipolar and heroin addict).  Other notable sufferers were actress Patty Duke (bipolar), who also became President of the Screen Actors Guild, as well as “America’s oldest teenager,” American Bandstand host and long-time TV commentator Dick Clark.

 

Many Nobel Laureates in Literature have suffered mental illness, and wrote their masterworks while so suffering—among them, poet T.S. Eliot, and novelists Sinclair Lewis (alcoholic), Ernest Hemingway (schizophrenic, alcoholic and suicide), and William Faulkner (alcoholic). Other notable writers who suffered from mental illness and/or addiction were the father of the short story, the horror story, and the mystery/detective story, Edgar Alan Poe (depressive, alcoholic, compulsive gambler) and Jack Kerouac (alcoholic and binge drinker).  Poet and novelist Sylvia Plath also suffered from mental illness, and ultimately committed suicide—yet she wrote a classic autobiographical novel on her struggle, The Bell Jar.   Pediatrician and Harvard Medical School associate Mark Vonnegut (son of noted writer Kurt Vonnegut, who also had mental health problems) suffered from bipolar, yet wrote a brilliant account of his struggles with it, The Eden Express.  Novelist Susana Kaysen wrote a compelling account of her psychiatric hospitalization, Girl Interrupted, which was even made into a movie.

 

This writer too has a diagnosed mental illness—borderline schizo-affective personality disorder, subject to chronic depression, who also overcame a drinking problem.  Yet I am a college graduate; know a foreign language; am an extensively-published writer, journalist, poet; and stand-up comedian; in addition to holding down a steady job and being self-supporting.

 

On the other hand, neither George W. Bush nor Dick Cheney, architects of the disastrous U.S. wars in Iraq and Afghanistan, as well as of policies that led to the Great Recession of 2008, have ever had their sanity questioned!  Same goes for Ronald Reagan, who, among other things, gutted federal financing for mental health treatment.  And while Donald Trump has been called “narcissistic,” no one has ever questioned his basic sanity!

 

Appropriately enough, the last word was said by a mental health consumer—a former patient at Bellvue who went on to earn a Ph.D. and return to Bellvue—to head its Department of Psychology!  He said trenchantly, “Hey, Normals!  Do you realize what a mess you’ve made of things?”

Dear Psychiatrist/Psychotherapist: Admonitions and Suggestions from a Mental Health Consumer

 

Psychotherapy and dispensing psychiatric advice are easily as much arts as they are sciences, hard science or otherwise, as recently demonstrated by new books by leading psychiatric publisher Guilford Press, which lists three recent books on how to be a better psychotherapist—which basically come down to but one suggestion: listen, really listen, to your client.  That sums it up well, psychiatrist/psychotherapist:  you are, first and foremost, not there to dispense unsolicited advice, much less bark mandatory orders, but to listen, really listen, to that troubled human being sitting across from you; that troubled human being who’s most likely have gone through life’s wringer in ways, and to an extent, you can neither fathom from your own experience, or find automatic guidance for in any standard psychiatric textbook!

 

So, first of all, listen, really listen, to your client, and put this first.  Before dispensing advice or telling the patient who’s before you what to do.  Phrase things such as suggestions and admonitions in an interrogatory way; ask, not tell, your client directly, preface your remarks with, “Have you considered that…” or “Have you thought about…,” for example. And elicit honest feedback from your client!   If your client is unsure of what you are suggesting, if the client has doubts, or thinks what you offer won’t work, and above all, if what you suggest makes your client feel uneasy or uncomfortable, you not only want, but you need, to know about it!  Enforced pseudo-certainly through engineered silence only hurts both you and your client, and detracts from, undermines, the therapy relationship.

 

Second, ask questions of your client and his/her background.  You, therapist, can’t automatically know everything you need to know about your client, not even from the most extensive psychiatric interview, but you need to find out, because as you and the client go along, ofttimes the must unanticipated, the most unexpected, will make their way to the fore.  And remember always, therapist, there is no such thing as an obvious question, or an obvious answer, so don’t ever assume there are.  What you don’t know, what you are unaware of, you are just ignorant or unaware of, period.  Further, questions to the client also show you are directly concerned about him/her, and not just play the role of an authoritative “expert” who always knows everything.  Because such, even if inadvertent, can seriously not just undermine, but also directly jeopardize, the therapy relationship.

 

Remember always, psychiatrist/psychotherapist, your first duty in therapy or dispensing psychiatric advice is to help the client help him/herself, not transform the client into an obliging robot.  You are a guide, not an automatic “expert” who knows all the answers.  Realize also, psychiatry is forever evolving, new knowledge and techniques of practice are always coming along, so it is important to not only be abreast of these, but to communicate to your client that you, too, are a fellow human being also searching for answers, not some automatically infallible guru.  For even the best of us can make mistakes, mistakes that seriously rouse anger and doubt about efficacy in the minds of the clients.  Such as the psychiatrist who asked me in all sincere honesty, “What did you do to make your parents abuse you?”  (Emphases as they were originally in the psychiatrist’s phrasing.)  The “correct” answer is, of course, “Nothing.”  (I did not answer his question this way, though I felt it.)  I can no more cause someone, even a parent, to abuse me any more than, as a woman supposedly having too much to drink or wearing too short a skirt, cause a man to rape me!  Same way with my most recent therapist, who alleged I was not “subtle” enough in understanding my father who called me “sissy” and “n****r-lover” repeatedly at the top of his lungs when I was a child and adolescent!  These two examples show conclusively that, even if inadvertently, the failure to make good word choices can unravel therapy relations!  For, in both these cases, things were never, ever, the same between me and the therapist.

 

That all sums it up.  These are things I’ve wanted to convey for a long time as a mental health consumer to my “professional healers,” and these are things I think are absolutely vital to a good, constructive therapy relationship.  Summarizing, they are three in number, and are an absolutely needed and vital three:  Listen, Ask Questions, Elicit Feedback.  Remember, your client is an autonomous human being, not just an empty vessel for you to pour into whatever you wish.  For therapy to work, it must be an exchange between two people.  Yes, psychiatrist/psychotherapist, you are “first among the two equals here;” but you are neither a god nor and infallible guru, and your expertise needs always to be tempered with a sense of humility, and awareness of just how fallible you really are. Remember, psychiatrist/psychotherapist, you also make mistakes.

Causes of Mental Illness: Don’t Overlook Adverse Social Environment!

 

It’s now commonplace for psychiatry to credit adverse social environment as a cause of mental illness, even as it slights the social environment in favor of genetic causes, or else concentrates on medication to eliminate or alleviate the outward symptoms of such.  For example, in relation to the mental illness I have, personality disorder, the state-of-the-art research handbook on such, 2014’s Handbook of Personality Disorders, Second Edition (Livesley and Larstone, Eds., Guilford Press), states broadly that personality disorders are 45% genetic, and that hopes for effective medicinal treatment are under research; which implicitly notes that the majority of its roots, 55%, is attributable to social, especially parental, social environment.  This makes a lot of sense, especially since personality disorders are most amenable to long-term cognitive behavioral and other related therapies such as dialectical behavioral, mentalization, hybrid, and other therapies (though these various therapies have differing theoretical premises, they are all similar in the specific therapeutic approaches and techniques utilized).  The Amish and other psychological/psychiatric studies have also demonstrated the importance of social environment in the attenuation or enhancement of basic pathological propensities.  No, adverse social, especially parental, environment must also be considered just as important in causing mental illness as genetics, and that psychotherapy is as needed as is medication (with the proviso that medication is not recommended for personality disorders except to treat chronic outward symptomatic mental illnesses, since personality disorders are often comorbid with depression, substance abuse, and other maladaptive behaviors).  In fact, the last part of the Handbook, Section VII, “Empirically Based Treatments,” is given over entirely to effective therapies in treatment of personality disorders, and how best to utilize them.

 

The role of adverse social environment is especially brought home when we consider the cases of two contemporary notorious individuals.  Serial killer Ted Bundy, for instance, was left orphaned by the death of his parents and was raised by his grandfather, who horrendously abused him.  Bundy was an outwardly charming individual who not only worked in a “Good Samaritan” job, as phone responder to 911 emergencies, but also used his charm to disarm the women in distress he encountered, and then rape and murder them. 

 

Former President Donald Trump was (and is) frequently, publicly, regarded by mental health authorities as suffering from narcissistic personality disorder (however, psychiatrist Robert Jay Lifton regarded him as “solipsistic,” i.e., sensing no one but himself in interactions with others), and was certainly noted as often publicly unhinged, especially after his defeat in the 2020 election, where he continually blamed his defeat (and in fact, still does) on non-existent “voter fraud.”  But an article on Trump in Politico Magazine by Michael Kruse on December 20, 2020, “Is Trump Cracking Under the Weight of Losing?” contained this telling paragraph on his childhood and parental rearing:

 

Trump is who and how he is first and foremost because of his parents. His  unwell mother couldn’t and didn’t give him the attention he wanted and needed, while his domineering father gave him attention but a wrong and warping kind—instilling in him a grim, zero-sum worldview with the dictate that the only option was to be “a winner.” Ever since, he responded so relentlessly to these harsh particulars of his loveless upbringing—the insatiable appetite for publicity, the crass, constant self-aggrandizement—that he became the president of the United States and arguably the most famous person alive. But from the time he was a boy, the way Trump has coped with the void he’s felt ultimately has been less a solution than a spotlight—it’s what’s made his most fundamental problem most manifest.

 

Don’t these two personality sketches encapsulate much about the importance of a good, nurturing home social environment?  Even over and above genetics, possibly?

 

This is also borne out in the ACE (Adverse Childhood Experiences) study based on questionnaires given to 17,000 patients of the Kaiser Permanente health insurance/medical provider organization in California—which found out that childhood trauma could result in lifelong mental health, relationship, and addiction problems.  Specifically, a pamphlet I picked up free at my medical clinic’s office, “Understanding Adverse Childhood Experiences” (Prevent Child Abuse Publications, 2009), lists four types of parents who, beyond physically or sexually abusing their children, can harm them through other ways:  by swearing at, belittling or insulting their children; being a parent or parents who are mentally ill themselves; abusing alcohol or using illegal drugs; or being a parent who went to prison or engages in illegal activity.  In my particular case both of my parents were of this first type, and may have been of the second type as well—but tellingly, while they accused me of bringing shame upon the family by seeking psychiatric help, they themselves would never, ever, consider it as appropriate for them!  And though they never physically or sexually harmed me, their constant, unhinged screaming at me in 15-minutes-at-a-time raging tirades cowed and intimidated me, especially since their volatility was entirely unpredictable.  But as I’ve written before, it takes only one thing to become a “natural” parent—the ability to fuck!  Even when no other qualification is evident.  So it was for me as a result of such parents, later compounded by the also-negative social environment of abusive Catholic small-town schools and deliberate physical bullying and social ostracism of my classmates, further abetted by inept and malfeasant psychiatric treatment at university clinics and CMHCs, which don’t know what to do with a patient if they can’t drug or otherwise minimally “manage” him/her.

 

But it should be emphasized, as it is in the child-abuse-recovery manual, “Survivor to Thriver” (The Morris Center, 1995), that when  it is this kind of abuse and this kind of parent, when it is, as said in law, “a consistent pattern,” when it is the norm, and  not just the rare, occasional freaking out of a parent who’s having a bad day, that the problems stemming from child abuse  fully arise.  No, it is the “consistent pattern” of the abuse, as it was for me with my parents constantly screaming at me, and the teachers in the Catholic schools I attended not caring at all that I was bullied and socially ostracized.  This prevalent abuse is rightly called by “Survivor to Thriver” “self-indulgence” on the part of parental and other authority figures—and is something to be extirpated, not apologized for; and certainly not to be glossed over or overlooked! 

 

But eventually I was able to grow out of all this to a substantial extent, much considerably due to a very able psychotherapist I had at one particular CMHC, who stuck doggedly yet compassionately with me for over a decade.  In our parting session, he said to me, “Congratulations.  By rights [i.e., by statistical probabilities] you should’ve been institutionalized, incarcerated, a hopeless alcoholic or drug addict, a suicide, or otherwise prematurely dead, but you turned out to be None of the Above.”

 

And yet—since my recovery didn’t come until quite late in my life, I feel (properly, I consider) having been fundamentally robbed by my parents, by my adverse parental and school-system social environments.  Which is why, for the children’s sake, it’s better to deal with parental dysfunctions early in the child’s life, and not let the effects fester throughout childhood, only to be appropriately dealt with when the child has grown to be an adult—with so much vital life and growing lost, in important ways, forever, even with later recovery.  Which may not be, may never be, full recovery.