4

The "System" Is Made of a Bunch of Organizations That Don't Communicate

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Mental Illness Has a Lifetime Membership

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While many physical illnesses are recurring, most mental illnesses last forever. No matter your treatment, you never get to slay that final boss and teabag his smoldering corpse because there are no cures for mental illnesses. That pill you take? That therapy? Whatever it is, there's no solution you're working toward -- you're just trying to make it as easy as possible to live with and manage your affliction. It's part of your life now. Forever, like a bad case of "I'd like to hear some funky Dixieland" echoing in your thoughts until the day of your sweet, mortal release. Even after your symptoms disappear.

What sets this apart from most recurring physical illnesses is that the stigma stays with you, too. That difficulty finding a job we mentioned earlier? That's not something that goes away once you get treatment -- you just learn how to manage it so you don't end up rotting away in your apartment as, one by one, the utilities disappear. The best you can hope for is going into "remission," but since "the lack of symptoms alone is not an adequate gauge of remission," lots of people will never feel like they have any control over when that remission happens, or what it even is. You're just waiting for someone else to tell you that your brain is working again. Forever.

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"That'll be $4 million."

So what does that mean in terms of the system? Well, with regular physical health care, unless your problem is ongoing like diabetes or terminal like the self-punch virus, patients will show up, collect their cure, and then disappear for the next half a year. It's why physical doctors can take on so many patients. It's in-and-out.

Mental health care, however, is oftentimes a lifelong commitment involving not only medication, but counseling and psychiatric evaluations that require more frequent trips to the doctor and close personal interaction. Treating a cold is easy because the symptoms are always the same and it goes away on its own. Treating any of the five types of schizophrenia is an ongoing process that requires constant medication and professional monitoring. Just getting a correct diagnosis of the problem can take months. Sometimes, years.

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"Just relax and breathe deep. We're going to remove your brain to see what's wrong."

2

Misdiagnoses Are Everywhere

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In the 1970s, Dr. David Rosenhan was wondering if we were any good at identifying crazy people, so he launched an experiment. He had eight totally healthy "pseudopatients" admit themselves to a psychiatric hospital and then proceed to act completely normal. The answer he quickly discovered was no, we kinda suck big ol' floppy balls at it. All but one of his patients were quickly diagnosed with mental illnesses, and some were forced to take antipsychotic medication before they were allowed to leave. Rosenhan concluded that the doctors in the ward had conditioned themselves to see insanity in totally normal behavior. In one case, they labeled a guy who seemed obsessed with lunch as exhibiting "behavior ... characteristic of the oral-acquisitive nature of the syndrome." In reality, he was just "showing up to lunch early because there's fuck all else to do in a psych ward."

But that was 40 years ago, and that study was hugely influential -- things are better now, right? Not especially. One guy in England spent 20 years bouncing around different parts of the "mental health care system," including prison, while having every antipsychotic under the sun crammed down his throat like loading a Pez dispenser. But instead of the super-schizophrenia everyone assumed had afflicted him, someone eventually figured out that he had Asperger's syndrome.

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"Have you considered that you might just be an asshole?"

Many diagnoses have more to do with the doctor's personal theories than the patient. Bipolar disorder, one of the most common disorders in the country, is initially misdiagnosed in 69 percent of cases, and one-third of those aren't figured out for a decade or more. One-third of people diagnosed with depression may actually have bipolar disorder, a disorder that needs entirely different medication. At this point, it wouldn't be surprising to walk into a grief counselor's office after your mother's funeral and walk out labeled a werewolf.

1

No One Knows How These Medications Work

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I've known people who go through different kinds of psychiatric medication the way sensationalist news organizations assume kids go through video games: try one out to silence the raging voices in my brain, get bored, get a new one a month later, repeat forever. It's like chasing the dragon, only instead of the perfect heroin high, people with mental illness are hoping to wake up with a feeling that can be described with actual words instead of a long, tortured moan. And figuring out which medication works is a hell of a grind: 30 to 40 percent of patients won't respond to any given antidepressant, you won't know if something's working until you've been on it for six weeks or so, and some of them actually make symptoms worse. It's like playing a long, slow game of Russian roulette with your brain.

The reason picking an antidepressant is so much tougher than choosing a decongestant is because doctors have no idea how these medications even work. The explanations from antidepressant ads aren't just dumbed down marketing; they're actually not that different from what the scientists actually know.

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WARNING: May cause eye explosions.

Am I saying that you should stop taking your medication, or not seek mental health care because it's too fucked up? No. Jesus Christ, no. Don't ... is that the message you got from this? If so, I ... suck. Listen: If you need medication, go take it. It's good for you in a lot of cases. Talk to your counselor, if you're lucky enough to have one. Do whatever the hell you need to do to keep control of your life. And avoid taking any life advice from me in general. My life's a wreck. I don't even own a car.

What I'm saying is that when your doctor prescribes you medication and it turns out to not work or make you worse, you can't just label him a dumbass and give up. Taking medication for mental issues is far beyond tricky, to the point that they literally have to guess which one you need and then eliminate it if it doesn't work and try the next one on the list. Yes, the actual real life treatment path is like an episode of House. If they tell you it's lupus, just run away. Bad things are about to happen.

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"Give him 12 ounces of mercury and punch him in the face. It's the only cure."

I wish I could offer some smart, helpful suggestions for fixing the mental health care system. But the truth is that if people much smarter than me with master's degrees and Ph.D.s and decades of experience can't get a handle on it, I'm pretty sure I'd crash the whole system and get genuinely sick people diagnosed as "just an asshole." But recognizing the problems is a good first step. I just hope they get it fixed soon, because it's kind of a ridiculous clusterfuck as is.

JF Sargent has a ridiculously pulpy sci-fi adventure story about space mechanics that you can read for free until he decides he wants people to have to pay him for it. And who knows when that'll happen! Also Twitter and Facebook.

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