I'd really like to talk with some people who don't categorise their afflictive mental states as "illness" or "chemical imbalance", if you're here.

[working9while5]

Nervous about this because what's in a name, hey? But it's something I increasingly feel strongly about.

I will not for one second dispute that when I was in the depths, it felt worse than any physical illness I've ever had in my entire life. I can read "I had a Black Dog" and I recognise it all and then some.

I just don't think I was ill or that it was caused by a chemical imbalance. I think that my brain was chemically imbalanced in that state because I was dwelling so much in the regions of the brain that store dark thoughts and memories that my brain was bathed in those neurotransmitters. I have no doubt if you hooked me up to a machine my brain would have looked all depressed. I also needed - and need - medication.

My experiences relate to my father's severe alcoholism and watching a man who was once really charismatic, caring and inspiring become an abusive good-for-nothing screaming drunk, my mother's absent presence, being raped in university and other such events which sucked all my faith in the future out of my life bit by bit. I think I just had no skills to support me in not spending my entire life in my head rather than with my feet on the ground and the whole thing short-circuited when I was pregnant and lacked the meagre resources I'd been using to keep it all at bay. I think I had learned to relate events in ways that predicted catastrophic outcomes through virtue of experience.

I've had a year and a half of weekly therapy, groups, psychiatrists, CPNs etc and I just feel so pissed off that this journey and its pain and where its brought me is categorised as being the same as diabetes or a broken leg when for me, it was a product of my life... and not only my life but what other people brought into it.

It just seems to me that the emphasis on the medical model in relation to this is sometimes just another sanitisation and another way of shutting up those who have been abused. I appreciate it's great that people get sick pay and I know it certainly manifests as illness so perhaps it is semantics.

yet when I went to the supervisor of midwives to tell her I'd had a dissociative state during my first forceps birth because of the rape, she said that she wouldn't want any of her staff to know this because it wouldn't be appropriate but it was fine to write OCD/Depression all over everything. The implication to me is that the causes of depression are still pushed into the category of "deeply shameful".... but in that case it wasn't the OCD or depression that was creating my fear, it was a bodily memory that had been triggered. Categorising this as illness just seems to me to be a way of making it be something intrinsic to my brain rather than something arising from human experience of suffering.

Does anyone else feel this way? I think I had a particularly medical model type of team which didn't help - there was constant reference to how ill I was and how I needed to recuperate and how disordered my thinking was and every time I tried to say, I don't think this is illness, I think this is about something that happened and a fear of similar trauma happening again, it was put in a box like "you MUST accept this is illness". I was never disputing I needed meds or therapy... I just didn't find the metaphor of chemical imbalance helpful. I had enough suffering because of what happened, I certainly didn't want that bastard to be responsible for my fricking brain chemistry!

Didn't want to read and run but quick reply to say, absolutely! The more I read- from the history of madness through to Buddhist psychology and mindfulness, as well as the current psychologists v psychiatrists' debate re medical model, value of DSM etc etc, the more I'm convinced that the chemical imbalance theory does not apply In most cases. Oh, bit random, sorry, bedtime here! Be great to discuss further though!

That is such an interesting post OP, so i am marking my place (hate it when people do that!) for when i am less busy so i can come back and see what others have written and have a think about it. I am on meds at present, i am depressed and anxious, im not sure if i am ill or not.

That's a really interesting post, and I can identify with it. I've been diagnosed with reactive depression, which as I understand it means that my brain has had enough to cope with, and is now permanently a tad wonky. It means that I'm on antidepressants for the long term, but I don't need counselling. gp wanted me to, but i had it in the past, it did what I needed it to, but don't feel I need it again). My diagnosis came after severe pnd after my second child, I'm not ill as such, I'm just not quite right either!

OK, so i may have had a few too many s

I think it is a very fine line, is it an illness? reactive depression is a reaction to shit that has happened to us in our life, it all mounts up and it gets too much, we shut down and everything is not "quite right" This is what happened to me - lots of bad shit, all at once, probably had these things happened separately, i would have coped, but it was like somoene was pushing, just to see how much i could take. I broke down, my already slightly anxious personality took over to the point i couldnt function. I needed medication. It helped. But did it help because i was "ill"

I think the issue here is the definition of illness. I was not well, but was there pathology? If i dieted excessively and took too much exercise i might put my body into a state where i get totally run down and make myself "ill". The imposed starvation could mimic a diabetic state. The cause is different, the effects the same. Only one of those conditions would be considered an illness.

I had a lot to deal with, it caused a lot of stress hormones to be produced over a long period of time, i had also had a baby etc so already hormones off kilter (this of course is what happens when people have PND, a recognised illness) and it built up. What built up was adrenalin which suppressed my seretonin levels which in turn reduced the amount of receptors for the seretonin, so there were less receptors to mop it up, as a result of this less seretonin is produced and it becomes a bit of a vicious circle - so all the things that happened to me made me ill. I didn't have a mental illness like schizophrenia or Bi-polar, but it made me ill nonetheless. I was physically ill, i wasn't producing and processsing seratonin at the right levels. Just as someone with diabetes isn't producing and processing insulin and glucose receptors at the right level. The cause of the diabetis may be genetic or this could be due to being overweight and not being able to produce enough insulin.

OP - it may be hat the all the shit that you have had to deal with has knocked the biochemistry of your brain off kilter but you say "i certainly didnt want the bastard to be responsible for my fricking brain chemistry" I get this, but just because there is a change in brain chemistry it doesn't mean this is permanent change, this sort of thing changes daily. Even being "pissed off" or happy changes our brain biochemistry. The thing wiht depression is that the brain biochemistry takes a bit longer to put right.

I understand where you are coming from, you are not bi-polar, you are not schizophrenic so don't suffer from a "mental illness" per se, but your mental health has been affected by the things that have happened to you.

As it happens, my anxiety has reared its ugly head recently in a big way and i realise that i have always had this issue, why? i dont know but it does affect how i process every day things. The things that have happened to me, probably happen to everyone and you have had some serious crap to deal with, don't estimate the effets of this on your health

Sorry if this iswaffly and nonsensical, i have had too much wine xx

I found your post both moving and thought provoking. It makes me so angry and sad to see how convenient it is to stick a medical label on us. You seem to have a lot of insight OP,sounds though you have been through harrowing times. I've always struggled with anxiety (I was terrified of my dad's violent tempers) and later eating disorders, yet it was only after difficult birth of DS1 that I needed professional help and eventually saw psychiatrist.

He couldn't have been less interested in my life story, just prescribed meds and labelled me as cyclothymic (?) - a milder sort of bi polar disorder to be treated with AD's. One GP suggested my depression was due to lack of moral strength!

About seven years ago when I was totally swamped by anxiety I saw a very helpful psychologist. She helped me draw up a time line of my life story from 0-48 years and when I looked at it I could see how events and other people had affected me and how lacking I was in the most basic emotional skills. I discovered compassion centred therapy and the role of shame in chronic depression, pioneered by psychologist Paul Gilbert and that was the beginning of a new understanding of myself. I'm still on AD's but I now see my bad days as part of who I am and try to simply 'weather' them. Thanks for starting such an interesting thread.

Op, i thought you might be interested in dxsummit.org (sorry i can't link from my phone). It tends to be professionals who contribute, but there's some brilliant discussion.

It's frustrating to hear how the midwife's attitude made you feel. from her perspective i imagine she felt she was protecting your privacy, but the result was that you felt that you were stigmatised rather than the rapist.

I don't doubt that life experiences can contribute to depression and other MH conditions like some of the PDs. I've met people with terrible depression because their lives have been tough, unsupported and in places extremely traumatic. That's why I believe that in a lot of cases therapy and medicine has to go hand in hand.

In my case it doesn't though. I had a loving, stable and supportive home life and no traumas apart from those caused by my MH. In my case stress can trigger manic or depressive episodes in me, but if I didn't have bipolar then it wouldn't. I've always found therapy difficult as when I'm well (or manic!) I don't have anything to talk about as I don't have anything to get over IYSWIM.

Really interesting post. There is a quote from Peter Shaughnessy a Mad Pride activist who died about 10 years ago which I often think of:

'It's almost like walking up to the nurse wearing wet clothes, and the nurse treats you for a cold. The nurse then lets you walk out without changing your clothes. When you return the next day, the nurse wonders why you still have a cold. Similarly, I'm walking around a product of emotional and physical abuse, broken relationships, no meaningful employment, stressful housing - and I'm taking a tablet for the symptoms.'

It doesn't quite relate to what you say because you found the treatments helpful even if framed as medical. But it does capture why it is a lot more than semantics...

This is a really good blog post from a woman who felt the same as you OP, where her life experiences and abuse was what was behind her MH problems. You may find it interesting.

Mental Health and Me

Hi working this is a really thought-provoking post - thanks. I've been suffering with depression since the beginning of the year and many a time wonder about the ADs/medical model and what I'd be like now if I hadn't taken them.

For me, a lot of what LEM says rings true. Two years with lots of stress, change and difficult situations seem to have melted my brain. I think I've always had a susceptibility to depression and anxiety (always depressed premenstrually and to a milder degree in the past). But this time its different - severe - and physically incapacitating as well as mentally horrible. So what LEM says about receptors and serotonin makes sense (in as far as I can understand it!)

In your situation, I can understand why comparing your depression to something like diabetes is not helpful, when yours has been longer in the making and significantly determined by really tough times in your life.

I do also think there is a genetic (nature) and/or nuture element. Both my parents have been depressed in the past and don't have a very positive outlook on life which will clearly have affected me growing up. Perhaps a genetic predisposition too - or how else to explain those amazing people who have awful times but get through them OK?

A very interesting area for which there seem to be no sure answers.
Also came across this today which was an interesting view on the fairly recent reporting on AD effectiveness.

Take care x

One of the strangest things for me was that the symptoms rapidly escalated once I put a label on how I was feeling. To a certain extent, I've always had a certain acceptance of down days and of the grief and anger and even flashbacks, I thought they would come and they would go... yet about a year and a half ago, I was on a thread on MN in AIBU I think and someone started talking about OCD... and I started to think "oh my God, this isn't just how I'm dealing with this situation, I'm actually mentally ill..." and somehow that little seed just grew and grew.

Now here I am having been told to come full circle with it, back to Acceptance and Commitment Therapy which was sort of how I was before I suddenly labelled myself as "mentally ill" and landed in services and was told I was ill and suddenly viewed all sorts of things I had considered normal as deeply pathological. This is reducing it but in my case I certainly found that the whole experience of being labelled and the reactions I got from some professionals and the way in which I was spoken to quickly escalated things.

Things like:
"well all women want to keep their baby safe, that's a natural thought... but you are of course at the very severe end of the spectrum and definitely disordered"
"I can imagine you were hilarious to watch in a driving test"
"Hi [CPN], this is Working and you'll have to take what she says with a pinch of salt, she has a bit of a perfect patient complex" (!!!!!)
"Oh the GP was so surprised when we told him you were OCD, he thought you seemed very competent this morning!" (this is because I'd had a freak out after a GP visit where my baby was described as "wasted")
"Clearly you view your thoughts as being very important and that is the root cause of your suffering"
"You will benefit greatly from paying less attention to your thoughts"
"Sweetheart you are afraid of birth because you are ill and not seeing clearly"

And reports saying that I was "ruminating" on the birth/previous sexual trauma etc. Ruminating? I wasn't. I didn't even want to think about it.

Babyheave, I'm sort of relieved to here there ARE people for whom it is just brain chemistry because of course it makes sense that there would be, just as there are people who have issues with mobility or speech or learning or what have you. I was beginning to worry.

I've benefited greatly from having a pretty on-the-ball CBT therapist throughout all of this who helped me to see without really putting words in my mouth that some of how professionals in the mh service spoke to me was not appropriate.

I just think there's something deeply sad that it would be deeply shaming to say to someone "I was raped/abused/I feel dreadful because of the suffering I've endured recently" while everyone says there's nothing to be ashamed of in being ill. Of course there isn't... but why is it still so shameful to admit that you find certain things hard because of particular experiences? People are bad enough around mh issues but telling someone you've been raped seems to me like you've slightly knifed them in the stomach or something. I've only done it with a very few people in my life and I often feel that they respond to it with much greater shame than I feel. I have had extensive counselling about it.. it's just not the case that those memories and feelings go away, they are part of who I am.

Do you think it's because people generally believe that it's a bit of a soap opera type thing with mental illness e.g. oh I felt dreadful and I was sobbing and sad and couldn't get out of bed and then the lovely doctor gave me pills and sent me to a therapist and now I am all better and will never feel a sad feeling again I am now so wise and enlightened about the irrationality of my depression and anxiety?

I agree with the memories being part of who you are - I find people are shocked but then after seeing me a couple of times after that, and not talking about it, they realise I'm just me, and treat me the same as they did. It's been ok. I think with telling people it's as much about how you think they may react that makes it hard. I don't think others are shamed, more just shocked, and it makes them think how they would feel if it happened to them, which they then find hard, which means they react, which makes you feel bad etc... I just carry on being my usual flippant Bolshy self and that makes them break into a different way of thinking, and I've ended up with some deeper friendships as a result. Mind you, I'm choosy about whom I tell...

It is hard work though!

Gosh really interesting thread. I agree that there is alot of 'conveniently' pathologising of perfectly natural reactions to events. Not sure how vocabulary of illness fits in though, in my own mind.

I think society labels nearly all negative emotions as illnesses as its part of a very warped world view our culture propagates...

I dislike the medical model of MH because I find it reductionist - you cannot separate yourself from what is going on in your head in the same way you maybe can if you have a broken leg.

I think it can be useful model because it has helped to make MH issues more accessible, and there is maybe a bit less of a stigma to it?

I have a PD and I guess I consider myself to have MH issues but I am not mentally ill. I have definitely noticed a huge difference in the way MH professionals treat my more psychotic symptoms compared to my more PD symptoms.

Sometimes it feels like the MH problems that fit the medical model (schizophrenia/bipolar) are treated as more valid, as more real. I have been told that I just have behavioural problems, that I am a grown woman and should be able to control myself, that maybe I am just having a spiritual awakening. I have also been sectioned and spent time in a secure unit and so I suspect, it is a bit more than me not being grown up enough to manage!

I think this is where the medical model falls down, it should not exist to invalidate problems that cannot be primarily medication managed. Denying or invalidating someone's problems because they are not hearing/seeing things and they are behaving in a certain way does not help, it just alienates.

I also think that there is still a perception that MH issues are like obesity or smoking related diseases, they are real problems, but they are somehow caused by not being careful or healthy enough. We (or the medical professionals) need to understand that our lived experiences, our reactions to stress, our reactions to unusual thoughts or feelings are not our fault. There is no blame there, it just is.

I think a holistic approach is needed to MH, I think medication can play an important role but emotional support is important too. Whether it is analysing your childhood (and actually IME therapy focuses very much on the here and now) or helping you process the impact of what you did when you were manic.

This is long!

I'm interested in this as well, but am too tired and raw to read in depth or post much. My summary contribution is this: I feel the problem is not the labels we use for our conditions, but other people's interpretation of them. In a very global sense, I'm more in favour of coming out about it (I do) with the aim of improved understanding & appropriate compassion.

I think what the hospital staff did to you is more like "Does she take sugar?" to the wheelchair-pusher, than a considered response to your condition as stated.

"some of how professionals in the mh service spoke to me was not appropriate"

Ya think???? It is the 'perfect patient complex' comment that annoys me. I can't imagine a universe in which that is an appropriate comment to say about someone, or indeed a helpful contribution to make. What did this person expect to achieve by saying what they did? It merely undermined your position without actually communicating anything useful. It might be true that you understate your symptoms/distress at times (don't know you not suggesting this is the case) which might mean that people trying to help you need to gently explore if they are hearing everything you have to say. There will be reasons why you do that which go to how much you trust services (and whether they have earned it). No one has the right to presume the reason is you have a fucking 'perfect patient complex'. Sheesh.

Rant over.

"telling someone you've been raped seems to me like you've slightly knifed them in the stomach or something. I've only done it with a very few people in my life and I often feel that they respond to it with much greater shame than I feel."

That really matters. I did not know that happened. I have had people tell me they have been raped and I hope I have not responded in a way that implies shame.

I wonder if it is simply that people are projecting their own feelings about the term on to you. That may be what happened with the Supervisor of Midwives. For you the forceps delivery was experienced as a rape and caused you to experience a dissociative state to get through that. That is a straightforward description of a traumatic event. But for her it involves using a highly emotive term that might imply to the staff involved that they had metaphorically re-raped you and she wants to protect them from the implications of that. I think she was wrong to use a euphemism when you were being straightforward but it isn't necessarily an evaluation of you. It is an evaluation of rape and how horrific a crime we find it. Look at the way whenever someone 'respectable' is accused of rape the first strategy the media employs to restore their image is to imply that the rape was not a real rape. 'Real' rape (yeah I know) is too unimaginable for most of us to contemplate so cannot be associated with anything safe or normal or that might once have presented a television show...

"Do you think it's because people generally believe that it's a bit of a soap opera type thing with mental illness e.g. oh I felt dreadful and I was sobbing and sad and couldn't get out of bed and then the lovely doctor gave me pills and sent me to a therapist and now I am all better and will never feel a sad feeling again I am now so wise and enlightened about the irrationality of my depression and anxiety?"

Oh and hell yes. But to be fair people who have recovered from mental illness/distress contribute to this because one of the things we do is try and simplify these massive events which have disrupted out lives and our families lives and generally screwed everything up by transforming them into a simply story. I was ill. I'm well now. The end. And in the screwy bit in the middle when we are messed up and distressed most of us are not communicating what is going on to a wide audience and the rest of the world isn't hanging out in psych wards or day centres absorbing all the gory details.

Thanks for the posts, they are really helpful. PenelopePipPop, you are exactly right that the "perfect patient complex" was about.. there was lots of talking about me minimising etc... but actually, my desire to be a "perfect patient" was NOT to win their approval etc, it was because I frankly would have done ANYTHING to feel better because I felt I was missing these precious times with my baby. If they had asked me to walk on hot coals I would have. I was so raw and open and vulnerable. I couldn't have given a shit what they thought of me except in so far as I needed to protect myself from deep feelings of inadequacy for the task, feeling I would be overwhelmed. It was undermining my whole coping strategy.

When I challenged the CPN on this she said, "but you had said you were worried you were trying too hard to be a perfect patient, we have to take you at face value" when I said NO, love, you need to be a professional and act like one... I said to you I was deeply worried/obsessed that I wasn't trying hard enough and I was just putting on a front and that this was delaying my recovery. I also said to her, if I'd said to you I felt weak and selfish and disgusting, would you have introduced me in that manner? I had specifically told her I was afraid that I wasn't engaging as well as I could because I thought this was what my father did... disguised compliance... and yet she took it as though this was what was happening when this was such a straightforward obsessional thought, it is classic OCD in terms of hyperresponsibility and perfectionism.. she played right into my OCD's hands as it were. I had signed up to every thing going, was reading literally book upon book and spending every waking moment in a sort of ongoing therapy exercise which I was basically obsessing constantly about, I had every second of every day scheduled with therapy activities... I was totally candid about this... and this became me being "the perfect patient" instead of being desperate to be well. I know now that this was basically an avoidance of my deep fear and depression and a desperation to get well and to have it spoken about like that was the very worst and most mindless thing that she could ever have done.

Your comments about the forceps make sense too... I had never considered that.

As for the soap opera thing, I am guilty as charged.. but it is lonely as hell to not be able to share the reality of it with people. I made a passing reference to it on a facebook group I'm on where I know the rl people the other day and the silence was DEAFENING. Stigma is alive and well and living in the UK.

"I also think that there is still a perception that MH issues are like obesity or smoking related diseases, they are real problems, but they are somehow caused by not being careful or healthy enough. We (or the medical professionals) need to understand that our lived experiences, our reactions to stress, our reactions to unusual thoughts or feelings are not our fault. There is no blame there, it just is."

^^

This, exactly. It's not just a wee grumble because I didn't get enough sleep ffs.

"
I think society labels nearly all negative emotions as illnesses as its part of a very warped world view our culture propagates..."

^

This too.. I think it has become the new "sin" or religion in some ways with some seen as okay, others seen as reprehensible. Very little considered understanding and mainly everyone just wants you to bog off and take your untidy messy humanity well away from them and certainly from the workplace. How very dare any of us experience any suffering unless we are able to keep that upper lip nice and stiff, it's just not cricket.

Hi, great thread and I am nodding away in agreement. I am a trainee clinical psychologist so am predisposed to being critical of the medical model though. I really hate to hear about the crappy ways people have been treated in hospital/under medical care.

I too am interested in this. Working, your insight into mh issues makes a very refreshing read and I am so grateful for your input on my thread.

I think the point made about other peoples perception of labels is a good one. As you know working, I recently gave birth. There was a lot of confusion over my ante natal care as I was deemed high risk but the consultants who I saw in clinic knew nothing about bipolar or the medication I was taking. After a few mishaps on their part I was invited to meet the head of midwifery and lead consultant of the trust for an apology. When I met him he argued that the mishaps in my care were inevitable because, "I looked normal and seemed very pleasant and articulate." I was so shocked and this is from a very well trained medical professional! I have been guilty of using the label to deflect from the years of chaos I have gone through as it is an easy option. However I am more aware of people's perception of mental illness especially bipolar which now makes me reluctant to say anything. I don't think the media coverage of celebrity illness has helped at all.

My psychologist is very much against the medical model. I find her approach less intimidating and it gives me hope that if my difficulties are a product of things in my past that their is hope for a happier future.

Thanks for informing me of that website. I found this article very interesting. dxsummit.org/archives/197

I have to say that in my experience the inpatient units and the community team have places great importance on holistic care. I have been told lots that I need medication for my thinking but therapy is the main thing that will help me to recover. They have always been very clear that medication is not the solution and that my own motivation to recover is what is important.