Perhaps the key difference is whether you find the thought distressing. I remember discussing this with my brother (who doesn't have OCD) about having the random thought of throwing a crying infant off the bus and having the image in my head and feeling sickened by it... and he said that's the kind of thought that pops into his head too but he finds it funny because he knows his brain is random.
Definitely with intrusive thoughts, the more you try to resist thinking about them, the worse they get. When younger, it was very much images vividly in my mind's eye - violent images from the news for instance or brief clips from horror films.
That seems accurate to me... sometimes it definitely is externally triggered, but otherwise it feels incredibly random. Like, walking along and a graphic image of a multilated body pops into my mind's eye... thanks brain! It is still very distressing at times, but I've grown much better at not ascribing meaning to the images or thoughts. OCD is rightly classified as an anxiety condition - I've generally found the obsessions way harder experientially and emotionally than the compulsions; though the latter could be intense when I was younger they were largely comfort rituals (about trying to control my environment), albeit sometimes unhealthy ones that could take up a lot of time. I used to do the stereotypical handwashing until my hands bled as a child, whereas that's not something I do anymore, for instance.
Also - no need for apologies - Freddie's openness about his own mental health struggles definitely encourages me to do the same on his blog when I feel it's useful to do so. I'm thankful to have never suffered with full-on psychosis.
There's some fascinating data that response rates for SSRIs and other antidepressants are way higher in more severely depressed cohorts, because a lot of people get diagnosed with mild-moderate depression who don't have a biologically based mental illness.
The frustrating thing is (as someone who's had manic psychosis from bipolar disorder) is that actual mental illness hasn't been destigmatized at all. As far as I can tell, the only thing that's been distigmatized is labeling normal life struggles as mental illness. But, not being able to function or being legitimately paranoid/delusional and the various interpersonal and life sequelae of that are still heavily stigmatized, for somewhat understandable reasons.
This has only ever been about status. To be blunt, the stigma is alive and well when no one accepts that mental illness might cause behavior they don't like. This entire project has never been about reducing stigma, only expanding the definition of mental illness to let the maximum amount of people claim special status with all the privileges that come with it nowadays: community, lowered expectations without lowered stature, and the sense that they're more magical than the normal, which is about the worst thing you can be right now.
I have family members who aren't psychotic but anti-depressants make a significant improvement to their lives. For some its a matter of being able to feel joy instead of constantly seeing themselves as a piece of shit. Others have debilitating anxiety and without the meds they'd be hermits, unable to leave the house.
None of them buy into the special status that seems popular now. We do talk about it openly in the family the way you would talk about any health issue. They take their happy pills and get on with life. It isn't an excuse for being a jerk.
Some mental illnesses do make people jerks or even violent and that's something that's increasingly missing from our public understanding of mental illness. It's still their responsibility to take care of their health as best they can, but mental illness can and does make people act horribly, even to the level of murder. Freddie's pieces on the Kanye antisemitism situation and the Colorado movie theater massacre discuss this at length.
As the image of the mentally ill has shifted to being professionals with depression/anxiety/ADHD, we've lost the understanding that mental illness does cause horrible symptoms and behavior for many sufferers. Sure, moderate depression may not be an excuse for being a jerk, but losing touch with reality and being utterly convinced you're being spied on often leads to socially unacceptable behavior.
"It's still their responsibility to take care of their health as best they can," Someone who is a paranoid schizophrenic with delusions doesn't have control over the situation. If they think they're a machine, it makes perfect sense to have to have gasoline to breathe. It even makes sense to light it up in your bedroom. When the zombies are after you it makes sense to walk around in a ski mask and carry a knife to protect yourself.
Your brain is the controller and when it's telling you lies, you're in deep shit and can't get out on your own. The delusions are insidious and creep up.
In general, I am frustrated by the inability of people to view these things on a spectrum. It's true that no one achieves the perfect level of happiness and function you describe. It's also true that plenty *more* people may benefit from treatments like antidepressants and stimulants than just those who suffer truly debilitating illnesses, because I'm sure there are plenty of people who don't deal well with "normal" amounts of stress (esp given the levels and kinds of stress that people are expected to just deal with) but who aren't so debilitated that they can't, say, hold a job (they will just underperform their potential their entire life).
I think the ends of the spectrum can look like a binary - "very healthy and stable person" versus "people who believe that they must kill their neighbors to silence the aliens in their brains". But in truth people exist at every step along that spectrum, and I think it's very difficult to create a bright line where one side is "mentally ill" and the other side is "fine". (I say this as some who truly suffers from depression - but have never considered taking my own life, hold down jobs well, etc).
I'd wager a guess that *most* people perform better when they take, say, focus enhancing drugs. Which is why perfectly healthy, highly competitive people often take them. So we can certainly often benefit from drugs, even if we don't have some kind of "illness"; the question is if we want to. There are often immediate side effects and poorly-understood or totally unknown long-term effects. My take is generally that drugs should be reserved for serious debility.
But that's not really your take, is it? "Drugs" is a big category - I doubt you believe that aspirin should be reserved exclusively for debilitating pain. Tons of people believe that cannabis is wildly dangerous and addictive (because that is the official position of the US federal government) when it is demonstrably not. Drugs have short- and long-term effects, sure, but so does lack of treatment. Who gets to decide when someone's benefit outweighs the risk? Who gets to decide whose condition is "real" enough to warrant treatment? And, why are we fixated on who "deserves" ADHD medication when the entire adult population is taking caffeine every day for the same purposes?
I think there's a strong tendency among people to assume that taking drugs is always worse than not taking drugs. And sure, it's better if your body can function in the way that you want it to function without drugs. But I think *far* more people tolerate minor dysfunction in ways that they don't have to because of a vague "drugs are bad" mindset, than people who medicate to gain a 5% edge or whatever and then later regret it.
And, again, I say that as someone who resisted getting any kind of treatment for minor depression because I didn't think I was "bad enough" to warrant those scaaaary drugs, when all I was doing was intentionally making my life worse for decades.
I have ADHD and avoid mentioning it to people not because of any shame or stigma, but because saying I have it tells someone almost nothing due to discourse like that, as I've found out the few times I've actually done so thinking it might help people understand a couple of the things I struggle with.
Among people of the same or younger generation, the response to saying I have it is often "oh, me too", despite the people I'm talking to not appearing to have any problems in their life because of it and often e.g doing just fine working away at a degree in school.
Not that problems are always visible or that you can't succeed in school in spite of having ADHD, of course, so I don't like to assume or guess who really may have it, but I really don't believe there's any way everyone I've heard say that they do possibly could, even if due to overdiagnosis (which is somehow a thing despite many who actually have it also struggling to get diagnosed) I wouldn't be surprised if some have good reason to think they do.
A lot of the time, I wonder if they just confuse what is basically Internet or smartphone addiction and its effect on their attention span as "ADHD" to avoid trying to improve on it, often relying on medication instead. Again, not that there's necessarily no casual connection with those things or those can't worsen ADHD, but by themselves they seem pretty different to me, considering I *wish* reducing screen usage made a major difference for any of my ADHD symptoms and that it wasn't something that actually majorly affected my life and made everything way more difficult.
It's relieving to at least have advocates for mental illness like Freddie, and to see so many with similar understandings in the comments here.
"even if due to overdiagnosis (which is somehow a thing despite many who actually have it also struggling to get diagnosed)"
It's a thing *because of* the overdiagnosis. Much like anti-biotics which are now much harder to get, even for legitimate cases, because they were overprescribed for so long.
I have these particular intrusive thoughts, that I know are wrong and have never thought to act on-they are deeply rooted in childhood experience and I am not mentally ill. So I think its an overstatement that only the mentally ill can have such intrusive thoughts.
True, intrusive thoughts are not always an indication of mental illness, but in this case the mental illness obsessive-compulsive disorder has a very common symptom of pathological intrusive thoughts. As is so often the case the important criterion is whether the behavior/experience obstructs your ability to live a healthy and adjusted life.
I watched someone in the middle of a true mental health breakdown, where she was so convinced that her hair was growing back into her skin that she shaved half her head and stopped going to work. I had to make the call to the person who could finally get her the help she needed. Its clear to me that the illness part of intrusive thoughts is the inability to understand what isn't real and that its controlling your life.
No one has the ability the look at anything with nuance these days though so immediately if you have an intrusive though I find "gross" you are psychotic but also my mental illness makes me cute and quirky.
I have a mentally ill father. Started in his late 20s and now he is in his late 80s. He had been violent, beat up his parents and broke his brother’s arm. Fights with strangers. Thankfully my mom divorced him early and he never was out of control violent with his kids. But he also split and lived on the streets of Honolulu for 40 years so he wasn’t around to do violence to us. But otherwise he is a sweet old man that is bright and does well enough taking care of himself even though he “knows” bad people read his mind and control some of his actions.
I have empathy for mental illness just like all illness and advocate care and treatment. Except that I draw the line when it manifests in acts or even impulses to physically hurt other people. Then I advocate involuntary institutionalization to protect everyone else. Sorry, “my brain does not work” is not an acceptable justification for freedom when it materially risks harm to others. I don’t support the insanity defense either.
Your last sentence makes no sense. You advocate involuntary institutionalization because security is more important than freedom, OK, sure, but then if someone commits a crime you think that the government shouldn't have discretion on how they institutionalize the criminal? Like you switch, in what seems to me a bizarre way, from 'I think the mad should all be locked up' to 'and also every social misfit should be in the same building.' I'd rather have the mentally ill in spaces that are built for them, personally.
Wait. Doesn't *everybody* have socially suicidal intrusive thoughts? Wow, maybe I am a Very Interesting and Special Person after all. I need a TikTok !
Somewhat tangential, I find it unfortunate when people become reactionary over discussing thoughts and experiences that generate emotions and perspectives that are likely confusing or uncomfortable for the holder themselves to navigate or express. It doesn’t make psychological comprehension or healing any easier for the person trying to understand themselves and their own rationale, especially if it regards sexual development.
I see this, like most things, as another example of how the post-colonial theory of the "subaltern" has become de rigueur among academics and progressives in the last 20 years. While such theories can be helpful in framing the world, when taken as orthodoxy the "marginalized other" becomes more precious than the "evil, privileged majority." So, in this case, people will first look for who's marginalized (the mentally ill), then, defend them against ANY implication of badness or wrongdoing. Usually this has nothing to do with the mentally ill person and everything to do with the person doing the finger wagging wanting to appear smart, current, and morally upright by the rules of their peer group or tribe.
No, I think it is exactly right to say that the perverse situation we're in is
people have mental illness -> stigma for mental illness develops -> activists want the mentally ill to not face stigma -> activists insist mental illness is not bad -> people have mental illness that is materially and indisputably bad -> those people become inconvenient to the claim that mental illness is not bad -> the people with the most unpalatable mental illnesses are slowly written out of the category "the mentally ill" -> mental illness now belongs to people with self-diagnosed anxiety, not schizophrenics who live in the streets
If you sell medical interventions to people who don't actually need them, you expand your market of potential customers and your interventions are much more efficacious, because they don't really have to do anything to "work".
Most of the anti-depressants are off patent and cheap. I do believe that pharmaceutical industry likes it's profits, but I think the biggest driver is that the drugs actually make people's quality of life better. I just know way too many people who were miserable before and fine after. If it's placebo...hooray for placebo.
I’m definitely with you here. One of my biggest concerns with recent (past ~15 years) large-scale social and cultural developments is how pervasive and pernicious the spread of Postmodernist philosophical though, and all of its other post- offshoots including some Critical Theory, have been.
One of my fields of study in academia was political science, and i think theories that seem or present themselves as “radical” to frustrated progressive laymen are often taken completely out of context and further bastardized by ignorant commentators beyond the fundamental criticisms of these theories within academic circles.
There's a certain Manicheanism in human nature. Previous generations lauded the brave white people standing against the swarthy savages; then decolonial thought realized this was bullshit and tried to revise it. But instead we find that it's been turned into evul white oppressors vs oppressed noble savage indigs. Or maybe it's cultural Christianity; the view that "if you're suffering, you're righteous" elevates martyrdom/victimhood to a virtue.
Yes, Christianity is nominally on the retreat, but people have yet to free themselves from its assumptions. Or maybe those assumptions speak to something in human nature; a desire to believe our enemies are Evil and can be freely ignored/mistreated. Or, more likely, that guilt is an exploitable emotion; can't do anything about racism, but making white people kowtow and confess their unworthiness in order to be considered One of the Good Ones is at least gratifying.
One of the main differences I've seen is the "conversation piece" vs "I don't want anyone to know about this" The father who has spent the family vacation money on drugs or the the woman with OCD from Freddie's mental illness vignettes a view months back are not broadcasting their situation. The "stigma" is there for a reason, it implies expectations, or a quality of life one feels everyone is entitled to achieve (and yes, it is also a comparison tool we use to feel better abojt ourselves). The stigma should be removed from the person as it usually dissuades from pursuing help, but stigma around behaviors or conditions are helpful when they keep perspective for those in chargeb of helping and allocating resources. (The word stigma is everywhere, but it seems now to be portrayed almost exclusively as a representation of oppression as opposed to a positive awareness that some "ways of being" aren't good
My meaning around stigma was that stigmatizing a particular 'person' for most mental illnesses is unhelpful and unecessary and often a result of someone searching for superiority or protecting themselves (demonizing an alcoholic father because of the pain they've caused the rest of the family). The tendency to downplay or refusal to "stigmatize" in the sense of disapproving strongly of certain behaviors I think makes it less likely people will be invested to help appropriately. Could be semantics, but I have found people throw the word around to shut down dialogue or protect themselves from self-reflection, or because they do not want to be responsible for making a decision that affects other people (involuntary commitment).
They can be hellish, and are exactly the kind of mental illness that is both a) minor in the grand scheme of how destructive mental illness can be and b) harmful and deserving of medical care and compassion. The trouble is that the endless casualization of mental illness in our culture has made it harder and harder to maintain that balance. People think I don't "believe in" ADHD. No, I absolutely do, and it can be really difficult to deal with. AND ALSO there's a lot of people who claim to have ADHD because they want community and access to stimulants.
I may as well let you know that I actually unscheduled this post after scheduling - it just didn't seem meaty enough to be worth posting - but something is up with Substack where it's not registering some changes to posts after you initially schedule them. Monday's post is missing some significant edits I made, for example. Trying to figure out what's going on.
I can tell you right now what's going on: Everyone is burned out and terrified because it's been a generation since this industry last had to cope with a real economy and no one believes things have finished shaking out. The pressure on "big bets" is unreal at every level and I don't think anyone's handling it all that well, not that I can really blame anyone for that.
Expect things to get a lot more weird in the software world before they start getting less so.
Most of my intrusive thoughts are about donating to charity. The other day I was on the subway and started having intrusive thoughts about letting the old lady standing near me have my seat.
This gentrification of mental illness has helped lead to shameful neglect of those who most need treatment. If mental illness consists of only quaint and vaguely endearing symptoms, then it's not so bad that mentally ill people are not getting treatment and are being repeatedly released from observation onto the streets. Unfortunately, that's not the reality. It is very dangerous for both the patient and the people around them. Not to mention profoundly miserable and terrifying.
I believe we need to bring back mandatory treatment for those who suffer. But also, most mental hospitals need to recommit to actually helping people who they have so obviously given up on. A person who is deeply psychotic can be admitted for observation and not given a single medication during that 72 hours, determined to be low risk whether they are or not, and then dumped on the street to fend for themselves. It's shameful, and yes I do blame people who have the mental health equivalent of a hangnail for normalizing things that should not be normalized. I realize this is a bit uncharitable, but dang. It's annoying and leads bad directions.
Some of the institutions are really good. They have lots of activities and positive outcomes. They also are under attack. There aren't enough less restrictive places for the "hard core" who need monitoring and assistance especially in taking their meds. WE NEED BETTER MEDS. The meds for major psychotic illnesses are debilitating and make those who take them feel bad. But they're better than the alternative.
Most institutions aren't treatment centers; they're dumping grounds and containment facilities. And even getting someone into one of those takes work, let alone keeping them there (assuming it does them any good).
Yet another person was pushed on the subway tracks in NYC yesterday by an "emotionally disturbed" person. And of course the transit police reveal immediately that this person is "known to us in the subway system". Great system we have for the severely mentally ill. Wait until they are dead or try to kill somebody else before intervening.
Always spot on regarding this subject. But you might burn yourself out reacting to the presumably legion uninformed and moronic dialogues/exchanges on Twitter and TickTock. I closed my Twitter account weeks ago, and apropos of better mental health, I’ve never felt better.
In the early 2010s I was writing a lot about campus politics. And people always said the same thing - oh, what do you care, they're just college kids, it doesn't matter. And then by 2020 the entire national political conversation was proceeding according to the terms dictated by those college students. I just find this constant reversion to "oh hey those people don't matter" to be so bizarre, at this point. The internet has shown again and again that it can empower small populations of motivated people who have social capital and education.
"The internet has shown again and again that it can empower small populations of motivated people who have social capital and education."
As a person who isn't and hasn't been particularly connected, this seems a good explanation for a lot of what appears to me to be delusional and destructive.
Maybe you've addressed this already, but is there a conflict between this view and the view, expressed in a couple more recent pieces that the evidence for pro-hamas/anti-israel/whatever sentiment at universities is "a few dozen dopey college kids at a handful of small rallies?" I tend to agree with your assessment of this as a nothing-burger of a phenomenon that doesn't have any real impact. But on the other hand, I thought "oh hey those people don't matter" for the longest time about the post-modern/woke/whatever phenomenon as well and look at us now.
Is there a more principled rubric for evaluating these things besides my sense that US moving meaningfully away from Israel is far-fetched? If I pointed out the small support to these groups, and my jewish friends responded by pointing to the woke movement and said "see how small silliness in universities can take root," I'm not sure what counter-argument I could make. I don't think it is likely but that would seem to be a fair argument on the surface. Thoughts?
I think he was annoyed that he had already addressed this in the comments... (Posted an hour before your comment)
Freddie deBoer
2 hrs ago
Author
I may as well let you know that I actually unscheduled this post after scheduling - it just didn't seem meaty enough to be worth posting - but something is up with Substack where it's not registering some changes to posts after you initially schedule them. Monday's post is missing some significant edits I made, for example. Trying to figure out what's going on.
Some people actually have been diagnosed with 5 mental illnesses though?
Or to make this a more substantive point, I think Freddie sometimes assumes that his experience of mental illness is the only one. But, Freddie, trust me that other people have different experiences. It is possible to get X diagnoses and still not be seriously mentally ill, still not to feel that the supposed mental illness has had a major negative impact on your life. You can say "well then those diagnoses were wrong," and maybe, I'm not going to defend the DSM, but still there are people with real official diagnoses who don't find them to be a big deal.
In almost any case that's terribly diagnostic and therapeutic practice and I promise you that this person who's clearly able to operate in the communicative environment of Twitter without any limitations. I am very happy to say that he does not have five diagnosed mental illnesses.
"I think Freddie sometimes assumes that his experience of mental illness is the only one."
On the contrary I have always said that I am high functioning and far less debilitated than many.
Some people are REALLY FUCKING SICK. They receive almost no attention in our culture, thanks to the self-obsession of people like this. And it's time to stop humoring them. The gloves have to come off.
People looking to medicalize their shit life syndrome seem to pick up a lot of labels and pills and then use those labels and pills as a cudgel to say "I'm so mentally ill and oppressed," without having any understanding of what actual moderate-severe mental illnesses look like.
By some counts you could say I have 3 mental illnesses, and one of them has included psychosis, but I am nowhere near as severely impacted as people with "only" one mental illness who have, say, treatment resistant depression/OCD, or most people with schizophrenia. Or hell, even someone with "just ADHD" who is unable to function at all in a classroom setting and doesn't graduate high school.
“medicalizing their shit life syndrome” perfectly describes someone I know (in my opinion, anyway.) thank you for these words.
I am often torn by the understanding that this person really does objectively have a large boulder to push uphill right now, and wanting to have compassion for that, but that also they seem to believe there is a Magic Answer That Will Just Fix It All and maybe another therapist, another med, another round of complaining (to me) will do the trick. I’ve had to distance myself, it’s just too much.
When the dominant messages are platitudes about "ending stigma" and unscientific myths about "chemical imbalance" then it is hard to have a sober conversation about what mental health services can and can't do.
I really want to give all of those people Marsha Lineman's "Building a Life Worth Living." It's a memoir about DBT and borderline personality disorder, but even for people who don't have BPD, the basic idea of how to build a life that isn't shitty is very powerful. The basic idea is that working on healthy human connection, mindfulness/spirituality, and finding meaning in putting in effort and work can make life better for even the most unhappy people.
There's definitely a spectrum of severity of mental illness, and it goes all the way from people whose lives are destroyed by their illness to people whose lives are very little affected. If the point is that severely mentally ill people exist, and that we should pay attention to them, and even that their voices should be given more priority than those who are very mildly affected, I completely agree. But I have to keep pointing out that people like me exist, and that it's very possible to have real diagnoses without suffering very much or not at all from them.
Yes, I agree some people are really sick! But people like me, who have diagnosed mental illnesses and who are not really sick, also exist. Being on Twitter is not at all proof that a person does not have diagnosed mental illnesses.
Yeah, while I'm very much on the same page as Freddie with this post's thesis and on the general issue, I'm a little uncertain about the range of what it can mean to have five diagnosed mental illnesses. So much has to do with degree and severity of each diagnosis.
Tons of people are diagnosed with depression and anxiety nowadays while generally being functional (if not optimally functional), so that's two right there. People with mild cases of OCD are typically able to operate on Twitter, I would think? Someone could be diagnosed with PTSD and not have it flaring up at the moment and be active on Twitter? Certain personality disorders, like Borderline, don't seem to particularly hamper one's ability to use social media? Then (if we're being sloppy, as people often are) throw in mild neurological conditions that shouldn't really be classified as mental illnesses, but which someone might implicitly in a throwaway tweet.
If they had said something like "five *severe* mental illnesses" my reaction would also be, "Yeah, no you don't." Just "five mental illnesses"? I genuinely don't know how plausible this is.
For the sake of argument, let's take Mr. 5 Undiagnosed at his word. Doesn't this seem like it should be a "there but for the grace of God" moment? (Is there a good secular equivalent to this phrasing?) I'm not gonna say my own anxiety and Asperger's are a great time, but I do appreciate that my manageable experience is not the only one.
I can't believe I'm saying this, but this is exactly the time where "check your privilege" is actually appropriate. Maybe not in that tiresome phrasing, but the basic idea fits.
I have bipolar 1 and have been in a couple of nasty hospital wards for it. There's nothing like a locked psychosis unit to give you an appreciation for whatever slim stability and connection to reality you have. I might have been ill enough to be in the hospital but at least I wasn't catatonic.
I'd say that's the ungenerous interpretation. I liked Hitchens, but he liked to take the worst possible view of humans at times. I'd say how most people mean it is, "that person could have been anyone, including me or someone I love." To me, it's essential for recognizing our precarious situation as humans, and it helps to assuage the "othering" that can happen when someone suffers from a stigmatized situation. It's a first step, not the complete picture of compassion.
Perhaps the key difference is whether you find the thought distressing. I remember discussing this with my brother (who doesn't have OCD) about having the random thought of throwing a crying infant off the bus and having the image in my head and feeling sickened by it... and he said that's the kind of thought that pops into his head too but he finds it funny because he knows his brain is random.
Definitely with intrusive thoughts, the more you try to resist thinking about them, the worse they get. When younger, it was very much images vividly in my mind's eye - violent images from the news for instance or brief clips from horror films.
That seems accurate to me... sometimes it definitely is externally triggered, but otherwise it feels incredibly random. Like, walking along and a graphic image of a multilated body pops into my mind's eye... thanks brain! It is still very distressing at times, but I've grown much better at not ascribing meaning to the images or thoughts. OCD is rightly classified as an anxiety condition - I've generally found the obsessions way harder experientially and emotionally than the compulsions; though the latter could be intense when I was younger they were largely comfort rituals (about trying to control my environment), albeit sometimes unhealthy ones that could take up a lot of time. I used to do the stereotypical handwashing until my hands bled as a child, whereas that's not something I do anymore, for instance.
Also - no need for apologies - Freddie's openness about his own mental health struggles definitely encourages me to do the same on his blog when I feel it's useful to do so. I'm thankful to have never suffered with full-on psychosis.
There's some fascinating data that response rates for SSRIs and other antidepressants are way higher in more severely depressed cohorts, because a lot of people get diagnosed with mild-moderate depression who don't have a biologically based mental illness.
The frustrating thing is (as someone who's had manic psychosis from bipolar disorder) is that actual mental illness hasn't been destigmatized at all. As far as I can tell, the only thing that's been distigmatized is labeling normal life struggles as mental illness. But, not being able to function or being legitimately paranoid/delusional and the various interpersonal and life sequelae of that are still heavily stigmatized, for somewhat understandable reasons.
This has only ever been about status. To be blunt, the stigma is alive and well when no one accepts that mental illness might cause behavior they don't like. This entire project has never been about reducing stigma, only expanding the definition of mental illness to let the maximum amount of people claim special status with all the privileges that come with it nowadays: community, lowered expectations without lowered stature, and the sense that they're more magical than the normal, which is about the worst thing you can be right now.
I have family members who aren't psychotic but anti-depressants make a significant improvement to their lives. For some its a matter of being able to feel joy instead of constantly seeing themselves as a piece of shit. Others have debilitating anxiety and without the meds they'd be hermits, unable to leave the house.
None of them buy into the special status that seems popular now. We do talk about it openly in the family the way you would talk about any health issue. They take their happy pills and get on with life. It isn't an excuse for being a jerk.
Some mental illnesses do make people jerks or even violent and that's something that's increasingly missing from our public understanding of mental illness. It's still their responsibility to take care of their health as best they can, but mental illness can and does make people act horribly, even to the level of murder. Freddie's pieces on the Kanye antisemitism situation and the Colorado movie theater massacre discuss this at length.
As the image of the mentally ill has shifted to being professionals with depression/anxiety/ADHD, we've lost the understanding that mental illness does cause horrible symptoms and behavior for many sufferers. Sure, moderate depression may not be an excuse for being a jerk, but losing touch with reality and being utterly convinced you're being spied on often leads to socially unacceptable behavior.
"It's still their responsibility to take care of their health as best they can," Someone who is a paranoid schizophrenic with delusions doesn't have control over the situation. If they think they're a machine, it makes perfect sense to have to have gasoline to breathe. It even makes sense to light it up in your bedroom. When the zombies are after you it makes sense to walk around in a ski mask and carry a knife to protect yourself.
Your brain is the controller and when it's telling you lies, you're in deep shit and can't get out on your own. The delusions are insidious and creep up.
In general, I am frustrated by the inability of people to view these things on a spectrum. It's true that no one achieves the perfect level of happiness and function you describe. It's also true that plenty *more* people may benefit from treatments like antidepressants and stimulants than just those who suffer truly debilitating illnesses, because I'm sure there are plenty of people who don't deal well with "normal" amounts of stress (esp given the levels and kinds of stress that people are expected to just deal with) but who aren't so debilitated that they can't, say, hold a job (they will just underperform their potential their entire life).
I think the ends of the spectrum can look like a binary - "very healthy and stable person" versus "people who believe that they must kill their neighbors to silence the aliens in their brains". But in truth people exist at every step along that spectrum, and I think it's very difficult to create a bright line where one side is "mentally ill" and the other side is "fine". (I say this as some who truly suffers from depression - but have never considered taking my own life, hold down jobs well, etc).
I'd wager a guess that *most* people perform better when they take, say, focus enhancing drugs. Which is why perfectly healthy, highly competitive people often take them. So we can certainly often benefit from drugs, even if we don't have some kind of "illness"; the question is if we want to. There are often immediate side effects and poorly-understood or totally unknown long-term effects. My take is generally that drugs should be reserved for serious debility.
But that's not really your take, is it? "Drugs" is a big category - I doubt you believe that aspirin should be reserved exclusively for debilitating pain. Tons of people believe that cannabis is wildly dangerous and addictive (because that is the official position of the US federal government) when it is demonstrably not. Drugs have short- and long-term effects, sure, but so does lack of treatment. Who gets to decide when someone's benefit outweighs the risk? Who gets to decide whose condition is "real" enough to warrant treatment? And, why are we fixated on who "deserves" ADHD medication when the entire adult population is taking caffeine every day for the same purposes?
I think there's a strong tendency among people to assume that taking drugs is always worse than not taking drugs. And sure, it's better if your body can function in the way that you want it to function without drugs. But I think *far* more people tolerate minor dysfunction in ways that they don't have to because of a vague "drugs are bad" mindset, than people who medicate to gain a 5% edge or whatever and then later regret it.
And, again, I say that as someone who resisted getting any kind of treatment for minor depression because I didn't think I was "bad enough" to warrant those scaaaary drugs, when all I was doing was intentionally making my life worse for decades.
I think that's a fair response. I think I overstated my case considerably.
I have ADHD and avoid mentioning it to people not because of any shame or stigma, but because saying I have it tells someone almost nothing due to discourse like that, as I've found out the few times I've actually done so thinking it might help people understand a couple of the things I struggle with.
Among people of the same or younger generation, the response to saying I have it is often "oh, me too", despite the people I'm talking to not appearing to have any problems in their life because of it and often e.g doing just fine working away at a degree in school.
Not that problems are always visible or that you can't succeed in school in spite of having ADHD, of course, so I don't like to assume or guess who really may have it, but I really don't believe there's any way everyone I've heard say that they do possibly could, even if due to overdiagnosis (which is somehow a thing despite many who actually have it also struggling to get diagnosed) I wouldn't be surprised if some have good reason to think they do.
A lot of the time, I wonder if they just confuse what is basically Internet or smartphone addiction and its effect on their attention span as "ADHD" to avoid trying to improve on it, often relying on medication instead. Again, not that there's necessarily no casual connection with those things or those can't worsen ADHD, but by themselves they seem pretty different to me, considering I *wish* reducing screen usage made a major difference for any of my ADHD symptoms and that it wasn't something that actually majorly affected my life and made everything way more difficult.
It's relieving to at least have advocates for mental illness like Freddie, and to see so many with similar understandings in the comments here.
"even if due to overdiagnosis (which is somehow a thing despite many who actually have it also struggling to get diagnosed)"
It's a thing *because of* the overdiagnosis. Much like anti-biotics which are now much harder to get, even for legitimate cases, because they were overprescribed for so long.
"That's psychotic" YES THAT'S THE POINT MY MAN
yeah that part floored me too
I have these particular intrusive thoughts, that I know are wrong and have never thought to act on-they are deeply rooted in childhood experience and I am not mentally ill. So I think its an overstatement that only the mentally ill can have such intrusive thoughts.
True, intrusive thoughts are not always an indication of mental illness, but in this case the mental illness obsessive-compulsive disorder has a very common symptom of pathological intrusive thoughts. As is so often the case the important criterion is whether the behavior/experience obstructs your ability to live a healthy and adjusted life.
I watched someone in the middle of a true mental health breakdown, where she was so convinced that her hair was growing back into her skin that she shaved half her head and stopped going to work. I had to make the call to the person who could finally get her the help she needed. Its clear to me that the illness part of intrusive thoughts is the inability to understand what isn't real and that its controlling your life.
No one has the ability the look at anything with nuance these days though so immediately if you have an intrusive though I find "gross" you are psychotic but also my mental illness makes me cute and quirky.
I have a mentally ill father. Started in his late 20s and now he is in his late 80s. He had been violent, beat up his parents and broke his brother’s arm. Fights with strangers. Thankfully my mom divorced him early and he never was out of control violent with his kids. But he also split and lived on the streets of Honolulu for 40 years so he wasn’t around to do violence to us. But otherwise he is a sweet old man that is bright and does well enough taking care of himself even though he “knows” bad people read his mind and control some of his actions.
I have empathy for mental illness just like all illness and advocate care and treatment. Except that I draw the line when it manifests in acts or even impulses to physically hurt other people. Then I advocate involuntary institutionalization to protect everyone else. Sorry, “my brain does not work” is not an acceptable justification for freedom when it materially risks harm to others. I don’t support the insanity defense either.
Your last sentence makes no sense. You advocate involuntary institutionalization because security is more important than freedom, OK, sure, but then if someone commits a crime you think that the government shouldn't have discretion on how they institutionalize the criminal? Like you switch, in what seems to me a bizarre way, from 'I think the mad should all be locked up' to 'and also every social misfit should be in the same building.' I'd rather have the mentally ill in spaces that are built for them, personally.
Wait. Doesn't *everybody* have socially suicidal intrusive thoughts? Wow, maybe I am a Very Interesting and Special Person after all. I need a TikTok !
My condolences for whatever you went through.
Somewhat tangential, I find it unfortunate when people become reactionary over discussing thoughts and experiences that generate emotions and perspectives that are likely confusing or uncomfortable for the holder themselves to navigate or express. It doesn’t make psychological comprehension or healing any easier for the person trying to understand themselves and their own rationale, especially if it regards sexual development.
Imagine trying to destigmatize mental illness while stigmatizing mental illness.
"Stigmatizing" =/= "removal from the Officially Sanctioned Victim List".
I see this, like most things, as another example of how the post-colonial theory of the "subaltern" has become de rigueur among academics and progressives in the last 20 years. While such theories can be helpful in framing the world, when taken as orthodoxy the "marginalized other" becomes more precious than the "evil, privileged majority." So, in this case, people will first look for who's marginalized (the mentally ill), then, defend them against ANY implication of badness or wrongdoing. Usually this has nothing to do with the mentally ill person and everything to do with the person doing the finger wagging wanting to appear smart, current, and morally upright by the rules of their peer group or tribe.
Or, maybe I'm reading too much into it.
No, I think it is exactly right to say that the perverse situation we're in is
people have mental illness -> stigma for mental illness develops -> activists want the mentally ill to not face stigma -> activists insist mental illness is not bad -> people have mental illness that is materially and indisputably bad -> those people become inconvenient to the claim that mental illness is not bad -> the people with the most unpalatable mental illnesses are slowly written out of the category "the mentally ill" -> mental illness now belongs to people with self-diagnosed anxiety, not schizophrenics who live in the streets
If you sell medical interventions to people who don't actually need them, you expand your market of potential customers and your interventions are much more efficacious, because they don't really have to do anything to "work".
Most of the anti-depressants are off patent and cheap. I do believe that pharmaceutical industry likes it's profits, but I think the biggest driver is that the drugs actually make people's quality of life better. I just know way too many people who were miserable before and fine after. If it's placebo...hooray for placebo.
Same goes for the main stimulants. Adderall and Ritalin are also no longer patented.
I’m definitely with you here. One of my biggest concerns with recent (past ~15 years) large-scale social and cultural developments is how pervasive and pernicious the spread of Postmodernist philosophical though, and all of its other post- offshoots including some Critical Theory, have been.
One of my fields of study in academia was political science, and i think theories that seem or present themselves as “radical” to frustrated progressive laymen are often taken completely out of context and further bastardized by ignorant commentators beyond the fundamental criticisms of these theories within academic circles.
Elite production gonna overproduce.
There's a certain Manicheanism in human nature. Previous generations lauded the brave white people standing against the swarthy savages; then decolonial thought realized this was bullshit and tried to revise it. But instead we find that it's been turned into evul white oppressors vs oppressed noble savage indigs. Or maybe it's cultural Christianity; the view that "if you're suffering, you're righteous" elevates martyrdom/victimhood to a virtue.
So much of the cultural conversation smacks of the doctrine or original sin, repurposed - only with no mechanism for salvation.
Yes, Christianity is nominally on the retreat, but people have yet to free themselves from its assumptions. Or maybe those assumptions speak to something in human nature; a desire to believe our enemies are Evil and can be freely ignored/mistreated. Or, more likely, that guilt is an exploitable emotion; can't do anything about racism, but making white people kowtow and confess their unworthiness in order to be considered One of the Good Ones is at least gratifying.
One of the main differences I've seen is the "conversation piece" vs "I don't want anyone to know about this" The father who has spent the family vacation money on drugs or the the woman with OCD from Freddie's mental illness vignettes a view months back are not broadcasting their situation. The "stigma" is there for a reason, it implies expectations, or a quality of life one feels everyone is entitled to achieve (and yes, it is also a comparison tool we use to feel better abojt ourselves). The stigma should be removed from the person as it usually dissuades from pursuing help, but stigma around behaviors or conditions are helpful when they keep perspective for those in chargeb of helping and allocating resources. (The word stigma is everywhere, but it seems now to be portrayed almost exclusively as a representation of oppression as opposed to a positive awareness that some "ways of being" aren't good
I agree, but I don't think stigma is necessary. We treat strokes immediately and thoroughly without stigma. Mental illness should be the same.
I flagged this post by mistake. Sorry.
My meaning around stigma was that stigmatizing a particular 'person' for most mental illnesses is unhelpful and unecessary and often a result of someone searching for superiority or protecting themselves (demonizing an alcoholic father because of the pain they've caused the rest of the family). The tendency to downplay or refusal to "stigmatize" in the sense of disapproving strongly of certain behaviors I think makes it less likely people will be invested to help appropriately. Could be semantics, but I have found people throw the word around to shut down dialogue or protect themselves from self-reflection, or because they do not want to be responsible for making a decision that affects other people (involuntary commitment).
i have intrusive thoughts constantly. never any upsetting ones though. okay dude.
They can be hellish, and are exactly the kind of mental illness that is both a) minor in the grand scheme of how destructive mental illness can be and b) harmful and deserving of medical care and compassion. The trouble is that the endless casualization of mental illness in our culture has made it harder and harder to maintain that balance. People think I don't "believe in" ADHD. No, I absolutely do, and it can be really difficult to deal with. AND ALSO there's a lot of people who claim to have ADHD because they want community and access to stimulants.
I may as well let you know that I actually unscheduled this post after scheduling - it just didn't seem meaty enough to be worth posting - but something is up with Substack where it's not registering some changes to posts after you initially schedule them. Monday's post is missing some significant edits I made, for example. Trying to figure out what's going on.
I can tell you right now what's going on: Everyone is burned out and terrified because it's been a generation since this industry last had to cope with a real economy and no one believes things have finished shaking out. The pressure on "big bets" is unreal at every level and I don't think anyone's handling it all that well, not that I can really blame anyone for that.
Expect things to get a lot more weird in the software world before they start getting less so.
Most of my intrusive thoughts are about donating to charity. The other day I was on the subway and started having intrusive thoughts about letting the old lady standing near me have my seat.
This gentrification of mental illness has helped lead to shameful neglect of those who most need treatment. If mental illness consists of only quaint and vaguely endearing symptoms, then it's not so bad that mentally ill people are not getting treatment and are being repeatedly released from observation onto the streets. Unfortunately, that's not the reality. It is very dangerous for both the patient and the people around them. Not to mention profoundly miserable and terrifying.
I believe we need to bring back mandatory treatment for those who suffer. But also, most mental hospitals need to recommit to actually helping people who they have so obviously given up on. A person who is deeply psychotic can be admitted for observation and not given a single medication during that 72 hours, determined to be low risk whether they are or not, and then dumped on the street to fend for themselves. It's shameful, and yes I do blame people who have the mental health equivalent of a hangnail for normalizing things that should not be normalized. I realize this is a bit uncharitable, but dang. It's annoying and leads bad directions.
Some of the institutions are really good. They have lots of activities and positive outcomes. They also are under attack. There aren't enough less restrictive places for the "hard core" who need monitoring and assistance especially in taking their meds. WE NEED BETTER MEDS. The meds for major psychotic illnesses are debilitating and make those who take them feel bad. But they're better than the alternative.
Most institutions aren't treatment centers; they're dumping grounds and containment facilities. And even getting someone into one of those takes work, let alone keeping them there (assuming it does them any good).
Yet another person was pushed on the subway tracks in NYC yesterday by an "emotionally disturbed" person. And of course the transit police reveal immediately that this person is "known to us in the subway system". Great system we have for the severely mentally ill. Wait until they are dead or try to kill somebody else before intervening.
Activists have fought to make involuntary treatment harder and harder over time, and they've succeeded, to the detriment of everyone.
Always spot on regarding this subject. But you might burn yourself out reacting to the presumably legion uninformed and moronic dialogues/exchanges on Twitter and TickTock. I closed my Twitter account weeks ago, and apropos of better mental health, I’ve never felt better.
In the early 2010s I was writing a lot about campus politics. And people always said the same thing - oh, what do you care, they're just college kids, it doesn't matter. And then by 2020 the entire national political conversation was proceeding according to the terms dictated by those college students. I just find this constant reversion to "oh hey those people don't matter" to be so bizarre, at this point. The internet has shown again and again that it can empower small populations of motivated people who have social capital and education.
"The internet has shown again and again that it can empower small populations of motivated people who have social capital and education."
As a person who isn't and hasn't been particularly connected, this seems a good explanation for a lot of what appears to me to be delusional and destructive.
I call it the balloon principle; those fullest of hot air rise to the top fastest.
Maybe you've addressed this already, but is there a conflict between this view and the view, expressed in a couple more recent pieces that the evidence for pro-hamas/anti-israel/whatever sentiment at universities is "a few dozen dopey college kids at a handful of small rallies?" I tend to agree with your assessment of this as a nothing-burger of a phenomenon that doesn't have any real impact. But on the other hand, I thought "oh hey those people don't matter" for the longest time about the post-modern/woke/whatever phenomenon as well and look at us now.
Is there a more principled rubric for evaluating these things besides my sense that US moving meaningfully away from Israel is far-fetched? If I pointed out the small support to these groups, and my jewish friends responded by pointing to the woke movement and said "see how small silliness in universities can take root," I'm not sure what counter-argument I could make. I don't think it is likely but that would seem to be a fair argument on the surface. Thoughts?
Eh, love you Freddie, but this standing alone seems like thin gruel for a post on a genuinely important topic. But it’s your Substack.
1. I will post whatever I want whenever I want
2. Read the fucking comments please
Chill. I didn’t suggest that you do anything of the sort.
I think he was annoyed that he had already addressed this in the comments... (Posted an hour before your comment)
Freddie deBoer
2 hrs ago
Author
I may as well let you know that I actually unscheduled this post after scheduling - it just didn't seem meaty enough to be worth posting - but something is up with Substack where it's not registering some changes to posts after you initially schedule them. Monday's post is missing some significant edits I made, for example. Trying to figure out what's going on.
Some people actually have been diagnosed with 5 mental illnesses though?
Or to make this a more substantive point, I think Freddie sometimes assumes that his experience of mental illness is the only one. But, Freddie, trust me that other people have different experiences. It is possible to get X diagnoses and still not be seriously mentally ill, still not to feel that the supposed mental illness has had a major negative impact on your life. You can say "well then those diagnoses were wrong," and maybe, I'm not going to defend the DSM, but still there are people with real official diagnoses who don't find them to be a big deal.
In almost any case that's terribly diagnostic and therapeutic practice and I promise you that this person who's clearly able to operate in the communicative environment of Twitter without any limitations. I am very happy to say that he does not have five diagnosed mental illnesses.
"I think Freddie sometimes assumes that his experience of mental illness is the only one."
On the contrary I have always said that I am high functioning and far less debilitated than many.
Some people are REALLY FUCKING SICK. They receive almost no attention in our culture, thanks to the self-obsession of people like this. And it's time to stop humoring them. The gloves have to come off.
People looking to medicalize their shit life syndrome seem to pick up a lot of labels and pills and then use those labels and pills as a cudgel to say "I'm so mentally ill and oppressed," without having any understanding of what actual moderate-severe mental illnesses look like.
By some counts you could say I have 3 mental illnesses, and one of them has included psychosis, but I am nowhere near as severely impacted as people with "only" one mental illness who have, say, treatment resistant depression/OCD, or most people with schizophrenia. Or hell, even someone with "just ADHD" who is unable to function at all in a classroom setting and doesn't graduate high school.
“medicalizing their shit life syndrome” perfectly describes someone I know (in my opinion, anyway.) thank you for these words.
I am often torn by the understanding that this person really does objectively have a large boulder to push uphill right now, and wanting to have compassion for that, but that also they seem to believe there is a Magic Answer That Will Just Fix It All and maybe another therapist, another med, another round of complaining (to me) will do the trick. I’ve had to distance myself, it’s just too much.
When the dominant messages are platitudes about "ending stigma" and unscientific myths about "chemical imbalance" then it is hard to have a sober conversation about what mental health services can and can't do.
I really want to give all of those people Marsha Lineman's "Building a Life Worth Living." It's a memoir about DBT and borderline personality disorder, but even for people who don't have BPD, the basic idea of how to build a life that isn't shitty is very powerful. The basic idea is that working on healthy human connection, mindfulness/spirituality, and finding meaning in putting in effort and work can make life better for even the most unhappy people.
There's definitely a spectrum of severity of mental illness, and it goes all the way from people whose lives are destroyed by their illness to people whose lives are very little affected. If the point is that severely mentally ill people exist, and that we should pay attention to them, and even that their voices should be given more priority than those who are very mildly affected, I completely agree. But I have to keep pointing out that people like me exist, and that it's very possible to have real diagnoses without suffering very much or not at all from them.
Yes, I agree some people are really sick! But people like me, who have diagnosed mental illnesses and who are not really sick, also exist. Being on Twitter is not at all proof that a person does not have diagnosed mental illnesses.
Yeah, while I'm very much on the same page as Freddie with this post's thesis and on the general issue, I'm a little uncertain about the range of what it can mean to have five diagnosed mental illnesses. So much has to do with degree and severity of each diagnosis.
Tons of people are diagnosed with depression and anxiety nowadays while generally being functional (if not optimally functional), so that's two right there. People with mild cases of OCD are typically able to operate on Twitter, I would think? Someone could be diagnosed with PTSD and not have it flaring up at the moment and be active on Twitter? Certain personality disorders, like Borderline, don't seem to particularly hamper one's ability to use social media? Then (if we're being sloppy, as people often are) throw in mild neurological conditions that shouldn't really be classified as mental illnesses, but which someone might implicitly in a throwaway tweet.
If they had said something like "five *severe* mental illnesses" my reaction would also be, "Yeah, no you don't." Just "five mental illnesses"? I genuinely don't know how plausible this is.
I don't know if it is good that you make me laugh about really serious topics with your humorous bluntness. 😜 ("No. You don't.")
For the sake of argument, let's take Mr. 5 Undiagnosed at his word. Doesn't this seem like it should be a "there but for the grace of God" moment? (Is there a good secular equivalent to this phrasing?) I'm not gonna say my own anxiety and Asperger's are a great time, but I do appreciate that my manageable experience is not the only one.
I can't believe I'm saying this, but this is exactly the time where "check your privilege" is actually appropriate. Maybe not in that tiresome phrasing, but the basic idea fits.
I have bipolar 1 and have been in a couple of nasty hospital wards for it. There's nothing like a locked psychosis unit to give you an appreciation for whatever slim stability and connection to reality you have. I might have been ill enough to be in the hospital but at least I wasn't catatonic.
"There but for Fortune." https://www.youtube.com/watch?v=6lFPIIdud9o&ab_channel=PHILOCHSVEVO
and apropos to this thread: https://www.youtube.com/watch?v=l285bd5aKEs&ab_channel=Hymy
`"there but for the grace of God" moment? (Is there a good secular equivalent to this phrasing?)'
As this reveals the actual self-centeredness of the phrase, it's close enough to secular for me:
"What this apparently compassionate observation really means--not that it really 'means' anything--is, 'There by the grace of God goes someone else.”
― Christopher Hitchens
I'd say that's the ungenerous interpretation. I liked Hitchens, but he liked to take the worst possible view of humans at times. I'd say how most people mean it is, "that person could have been anyone, including me or someone I love." To me, it's essential for recognizing our precarious situation as humans, and it helps to assuage the "othering" that can happen when someone suffers from a stigmatized situation. It's a first step, not the complete picture of compassion.