Tag Archives: mental illness

Why I don’t have to be offended by the same things as somebody else

29 Jun

 

offending people

 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the American Psychiatric Association’s (APA) classification and diagnostic tool. In the United States the DSM serves as a universal authority for psychiatric diagnosis.

A friend of mine sent me a public tweet listing the DSM 5 criteria for one of the borderline personality disorders, with the wry observation that Tony Abbott’s public behaviours seemed to fulfil them all.

I thought this was pretty good on several levels, the most imaginative being that I know both my friend and I regard the DSM 5 as a frightful load of bollocks, and using its criteria to categorize Abbott, whom we also think of as a frightful load of bollocks, made a satisfying little irony.

However. Within hours we were set upon by two blokes who stridently accused us of using mental illness as a political tool against an opponent, and in so doing, being unbelievably disregarding of other people’s pain. One of them was a psych student. The other said we had no right diagnosing Abbott when we hadn’t ever treated him. Which is true, of course, except that my friend wasn’t diagnosing Abbott, she was pointing out the self-evident truth that the DSM 5 criteria bore a striking resemblance to Abbott’s way of being in the world, a way of being we can all daily, even sadly hourly, observe.

I am very sorry that I have never treated Abbott. I would give my right arm to treat Abbott, and to what, I will not, at this point, say.

I should say here that both my friend and I have our battles with mental ill-health, and we both feel comfortable with finding certain characteristics in the DSM 5 that seem to scream at us: Abbott. I do not feel using such criteria to describe Abbott is a personal insult to my mental health or lack thereof. That everyone will not share my view is inevitable, as I pointed out to the angry blokes, and I see no reason why they should. However, I insisted, I do have the right to express a differing opinion without incurring abuse, as do they.

What I understood afresh after the increasingly abusive exchanges we were treated to on Twitter, is that there is apparently an expectation that everyone with, say, a mental illness, will feel the same as everyone else with a mental illness, react to stimuli in the same manner, be offended by the same things, and that if you don’t you either aren’t really suffering mental illness, or you are a traitor who cares nothing for the suffering of others. In this mindset, there appears to be little distinction between mental illnesses: they’re all the same, apparently.

This, to my mind, is offensive. The assumption that there is a stereotypical mentally ill person offends me profoundly.

It doesn’t matter to which situation this totalitarian perspective is applied. I’ve heard it used about survivors of child sexual abuse, and  survivors of all kinds of trauma. If this has happened to you, you will think, feel, and behave in these ways. At its source, it is a typical right-wing nut job argument, and Tony Abbott employs it better than anyone: if you don’t think like we do you aren’t one of us, ergo you are bad because we are good.

The totalitarian mind cannot bear variation: what offends it must offend everyone.

Defending against the mindless stupidity of this argument is what got me embroiled in the Twitter fight in the first place: one cannot, in this zeitgeist, pass up any opportunity to take on these hive minds who believe that if you do not think as they do, you are a very bad person in urgent need of re-education. These minds turn up in the most unexpected of places: they are as common amongst the so-called Left as they are amongst the Right. They are why the victorious revolutionaries always become the bourgeoisie.

While there are definitely characteristics common to certain human experiences, reactions to those experiences are as individual as the human beings involved in them. Even within the individual reactions to trauma will change over time, and what brings us to our knees initially will, hopefully, lose much of its force and its ability to hurt.

Everyone has, to my mind, the inviolable right to deal with their mental illness, or trauma, or physical illness in ways that best suit them, within the parameters of everyone’s safety. So I sat in a cafe with my friend who’d just lost a testicle to cancer and we told one another cancer jokes someone else might very well find extremely offensive: does this mean we can’t tell them, even though for us, black humour is a central part of how we cope with our circumstances?

I understand you are offended by my friend’s tweet, I told one of the angry blokes. I am not offended. I do not have to be offended to please you. Are you intending to attempt to bully me into pretending offence, because I will not do that. I have the right to not feel offended. I have the right to be true to what I feel, and I do not feel offence.  Would you like to shoot me, because this is where the continuum you are on eventually leads.

We have a terrifyingly secretive government, and a useless opposition. We are, as citizens, being controlled and silenced to a degree many of us have never before experienced. Our freedoms are being eroded, bit by little bit. There is no freedom without the freedom to offend. There is no freedom without the freedom to decide what is offensive to you, and what is not.  I can imagine a future in which if we are not overtly expressing offence at circumstances the government decrees we must find offensive, we could well find ourselves in all kinds of trouble.

There is no I in team, yet without I, the team is nothing more than a herd.

 

 

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Drugs and Depression

30 Mar

 

drugs two

 

 

Andreas Lubitz, the co-pilot believed to have deliberately guided Flight 4U9525 into the French Alps killing all 150 people on board was reportedly suffering from depression, and possibly taking anti-depressants to treat his illness.

What hasn’t been mentioned so far is that many anti-depressants disclose in their list of possible side-effects a warning that they may trigger suicidal ideation, suicide or attempted suicide, and in some instances, violent and aggressive behaviour. While clinical studies continue into the association between these drugs and certain behaviours, the evidence is sufficient for drug companies to be compelled to disclose the possibilities to potential users.

There is, justifiably, a concern that depression and those suffering from it will be increasingly stigmatised as a consequence of this tragedy.  As the Guardian reports: In a sign of continued nervousness in the light of the tragedy, there were reports on Saturday of pilots offering personal assurances to passengers. One woman tweeted: “Pilot on my @Delta flight announces he and co-pilot are ex-military and ‘we both have wives and kids and are very happy’.” 

Apparently being “ex-military,” male, and with a wife and children is some kind of guarantee against depression which will be news to many people given the astronomic rates of post traumatic stress disorder diagnosed in military personnel, to address just one aspect of an idiotic comment that is a small example of the facile discrimination and prejudice anybody with a mental illness can encounter.

Australia has the second highest use of anti-depressant medication in the world after Iceland, from which we can conclude that depression is a common illness in our society and a lot of us are using drug therapy to help us manage it. Death from drug overdose is twice as likely to be caused by drugs prescribed to treat anxiety, insomnia and stress than by illegal substances, a Victorian coroner recently reported.

And it isn’t just drugs prescribed for depression that can cause mental disturbances. I have beside me a box of Metoclopramide, prescribed for nausea caused by other drugs, with a list of potential side-effects as long as my leg, one of which is “mental depression.” There are antibiotics that can cause anxiety. There are anti psychotics that can cause hallucinations. There are sleeping tablets that can cause bizarre sleepwalking behaviours.  If anything we need more awareness and education about the possible side effects of prescription drugs, and how those side effects can be safely managed.

It would be the worst possible outcome if the tragedy of Flight 4U9525 was used to stigmatise people with depression not only in the airline industry but in every other occupation. There have already been demands that airlines dismiss pilots with depressive disorders, and while no one wants a pilot in the throes of a seriously depressive episode flying a plane, depression can be managed and people do recover.

As usual there’s been a scramble, instigated by the country’s most reliable drama queen Prime Minister Tony Abbott, to ensure such a tragedy doesn’t occur on an Australian airline. Australia’s national security committee met on Sunday at Abbott’s insistence to discuss preventative measures.

Good luck with that. Absolute safety can never be guaranteed, and flying is still a whole lot safer than driving the Pacific Highway, and a whole, whole, whole lot safer than being a woman in a domestically violent situation in Australia. So far this year, the average is two dead women each week. Still waiting for the Minister for Women to call an emergency Sunday meeting about that.

 

 

 

 

 

 

 

 

 

 

How to spot the psychopath in your workplace

23 Feb

Psychopaths rule our world. by Adam Crowe via flickr

 

Get back in the Box: Nurse Ratched is Alive and Well

by Dr Stewart Hase

In the famous book and movie, One Flew Over the Cuckoo’s Nest, Nurse Ratched thoroughly runs the roost. From a Jungian archetype perspective Nurse Ratched represents the dominating and emasculating mother. Her main modus operandi is to manipulate the male patients into believing that their welfare is her primary concern and that everything she does is for their benefit. With this backdrop of apparently caring intention, she holds tightly onto control in the guise of benefactor and protector from the evils of the world. The most mischievous component of her behaviour, however, is to build up expectations for rewards in the form of activities, treats or even positive attention from her as a projection of their mother, and then shatter them at the last moment. It is consummate controlling and deeply obsessive behaviour. When McMurphy (Jack Nicholson in the movie) challenges Nurse Ratched by emancipating the patients and shows signs of winning the battle for control, he is lobotomised.

Ken Kesey’s Nurse Ratched character is based in reality. I actually saw this archetype in the real world when working in a psychiatric hospital in Western Australia in the early 1970s. In my case Nurse Ratched was a male. So, what follows is equally applicable to both sexes but I refer to Nurse Ratched as female throughout to be consistent with the fictional character and, hopefully, not for any other unconscious desire.

by Corey Bond via flickr

Some recent research I have conducted with colleagues suggests that the Nurse Ratched archetype is alive and well in organisations other than psychiatric institutions. It appears in various configurations and degrees but has the same end game, which is to control the inmates: to keep them in their box. This reinforces Nurse Ratched’s sense of power, strengthens the mask that hides a deep-seated insecurity, a poorly developed sense of self and a sense that all is not well with herself, and, hence by projection, the world. Nurse Ratched has developed a set of behaviours that serve to protect her from seeing her true self and the maintain the illusion that others can’t see it either.

Nurse Ratched is a micromanager. Nothing is left to the deliberations of others. Of course there are committees, although one might find precious few of them and they are functionally impotent. This impotence is openly reinforced by Nurse Ratched who frequently overwrites their decisions using an unwritten but thoroughly understood power of veto. All decisions no matter how minute and trivial such as office allocation and travel claims are made by this manager: nothing is left to chance.

The archetype is surrounded by supplicants who have been handpicked to ensure that they do not challenge in any real way. Most importantly they all toe the party line. Dissidents are seen as not being loyal and either micromanaged or managed out. Members of the management group are found on most committees in the organisation. Committee membership has less to do with expertise and more to do with ensuring control. Loyalty is much more important then ability to be appointed as an acolyte. Even the most appalling manager and bully will be supported as long as they are loyal, get the job done and make Nurse Ratched look good.

Nurse Ratched makes sure that appointments are carefully managed. Selection panels are small and consist of herself, a couple of acolytes and a rep from HR. It is important not to have someone on the committee with expertise in the area of the appointment. Lower levels of staff are never involved in the selection process. It is not unusual for Nurse Ratched to veto an appointment and tap someone on the shoulder either within or from outside the organisation. Nepotism is so commonplace that it is taken to be normal. It is one of the rare instances where the manager does not employ a clone of self. There is room for only one Nurse Ratched in an organisation.

Information flow is carefully managed by our archetype. Most critical information is held by the management group and does not filter down: there is a hard communication barrier between senior management and the inmates. The acolytes realise that their survival depends on making sure that only selected information is sent upwards.  Meanwhile Nurse Ratched is fed a diet of misinformation from employees dotted around the organisation that are the result of the nepotistic and political appointment processes. There is nothing like pillow talk to sink an upstart’s reputation.

Nurse Ratched likes to make sure the inmates are busy: extremely busy. Staff levels are kept to a minimum, performance expectations are high and there is little room for diversion from the key tasks of the business. This archetype depends on looking good in front of the board or shareholders and this is achieved by ensuring positive business outcomes no matter what the cost to people or organisational climate. There is a Calvinesque austerity and lack of celebrations of success are rare and token. Nurse Ratched depends on an efficient and well-run ward. In the movie McMurphy’s joie de vive is a major irritant and is finally silenced by reducing him to a vegetable. With such a threat people become malleable.

The result of this archetype’s behaviour is an adversarial, ‘us and them’ culture. The ‘management team’ interpret any discontent as being due to the implicit failing of the inmates and not the result of dysfunctional leadership and a toxic culture. The inmates should be grateful: let them eat cake.

Widespread cynicism pervades the organisation underpinned by powerlessness. Some inmates, like the Chief in One Flew Over the Cuckoo’s Nest, find a way to escape-he throws a water cooler through the window and runs away. In less potent expressions of their disappointment, the more imaginative and stronger personalities soon see the organisation for what it is and fly the coop. There are others who don’t quite understand the culture and innocently push back. But they are soon put in their box one way or another by being micromanaged to death, assigned meaningless tasks, and/or subtly bullied. Many are trapped due to circumstances and suffer the same pathology as Seligman’s dogs, learned helplessness that manifests itself as depressive behaviour. Denial and rationalisation of their situation help maintain a tolerable level of mental health in many.

People being people, they will in even the most adversarial environment find a way to let their creative juices flow and mostly find satisfaction in doing well what they often love doing. This is tolerated as long as the widgets continue to be churned out and there is not too much dysfunction. In fact Nurse Ratched rewards this behaviour with acknowledgement, which is gratefully received from inmates starved of recognition and positive reinforcement. But beware if the light shines too bright or the irrelevance of the activity to Nurse Ratched’s agenda is brought to her attention, the tit-bits are quickly withdrawn. After all, it is for the inmates’ own good.

This is the most toxic aspect of the culture that Nurse Ratched presides over and is the hallmark of the ultimate bully: the manipulation of the human need for recognition. The bully keeps the other in a state of constant desire for acknowledgement by maintaining a high level of disappointment, an air of disapproval. The victim’s diminishing self-esteem cries out for recognition and is occasionally, momentarily rewarded. The rush of pleasure increases desire for more and the person works even harder even as the tsunami of disappointment washes them away yet again.

Such is the dark side of organisations.

Dr Stewart Hase

 

Guest author Dr Stewart Hase is a registered psychologist and has a doctorate in organisational behaviour as well as a BA, Diploma of Psychology, and a Master of Arts (Hons) in psychology.

Stewart blogs at stewarthase.blogspot.com

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