I am leaning away from mainstream thought on the differentiation between mental illnesses in some respects, and very much into it in others.
It was not my reason when I wrote my paper on resources for people with depression, but it occurs to me that I focus on psychiatric interventions because at bottom, much about psychotherapy is natural, intuitive, and governed by simple principles. Don’t hurt your client. Help your client become empowered. Teach your client how to manage her illness, whatever aspects are troubling her. At all times act with benevolence and even love, because we do suffer for lack of genuine human caring, all of us.
Psychiatry requires a sharper eye: which behaviors are happening under what circumstances? I watched my father have a panic attack out of the blue. I know he has anxiety. I also know he’s recently been started on an SNRI, which gives the brain a chance to soak in extra noradrenaline. I know that patterns of chemical dysfunction are heritable, and that the noradrenaline and dopamine aspects of previous medication have aggravated my anxiety disorder. Further, I know that unlike me, my father consumes at least two cups of coffee a day, sometimes three, and the odd cola. My total intake is, at most, 63mg (when I’m drinking the full 20 oz bottle of Pepsi).
I think, based on my experiences with all-in-one drugs, that my father needs a separate SSRI from any stimulant medication. I suspect this is a situational, anhedonic sort of fatigue: he has lost interest in activities he once loved. Only last summer his passion for archery knew no bounds. Now he can hardly be stirred. He thinks his only talent is for breaking arrows. He has lost all confidence and enthusiasm. A trial of stimulant medication is appropriate, but I don’t feel it’s right to combine that trial with his serotonin balance, which when he feels validated is actually not so wrong. When he has been beaten down so completely, of course his impulse is to alternate withdrawal with lashing out. He’s furious and hopeless by turns.
Writing that paper, I saw that in fact, the medications we use for many types of mental illness control the same neurotransmitters, and later I discovered that psychotherapy is largely conducted according to the comfort of the practitioner with a certain method, not because any specific diagnosis calls for it. If these things are true outside my observations, then it is not according to the diagnosis, but to what works for each person, that we ought to tailor treatment.
. . .
I have learned a great deal about mental health from my cats.
You are allowed to laugh. They’re cats, right? Not humans. They might as well be deaf, dumb, and blind for all we can communicate with them. But they’re creatures. They have brains. Presumably they have neurotransmitters, too. They can develop mental illnesses. I read an account once of a cat who had to be put down because the owner could no longer manage her fits of aggression, and I wish I could find it again so I’d know what was tried. How do psychotropics function in the veterinary context? And if we do behave toward animals as we might toward humans with whom we cannot effectively communicate by verbal means, then what is left is to observe behavior in context and try different responses to that behavior.
Trixie (not the midwife) is anxious. She can only be held when she feels utterly safe. Otherwise her limbs go stiff and she flails them in order to get free. When met with something outside her comfort zone, her urge is flight, not fight. If it were fight, she would be trying to injure whoever had her trapped, and she has never once tried. She only slices me with her back feet because I’ve been careless and she’s got her claws out in an instinctive defensive maneuver. When she is comfortable, she will make overtures and settle in for a cuddle, but it must be her choice. Positive reinforcement for Trixie is acknowledging her need to initiate affection and never to trap her or corner her. She feels safe on my bed, and she will interact more with humans in that environment than in any other.
Contrast with Adalyne. I suspect Addy gets overwhelmed. Sensory overload, maybe? Does she hear real sounds and startle at them, or are they in her head? I am the only person who can comfort her. She’ll sleep on my parents’ bed, but she’ll curl up on me or right beside me when I’ve got my laptop out. She settles in and drinks up gentle affection. I speak quietly to her. I scratch behind her ears and under her chin. I know when she is safe to approach, what physical cues she gives, and when I might come away bleeding. When she’s alert, with her ears twitching and a certain look in her eyes, the best approach is respectful of her personal space. Under no circumstances is it a good idea to tweak her tail; it was broken somehow in two places, and while the injury has healed, she does not tolerate touch in that area. My father once stroked all the way down her back and up her tail in a loose grasping motion, and she turned around and bit him. That was only to be expected.
A good mood can turn into overstimulation fast. As long as I know that, I know when to back off and let Addy center herself.
Bodie needs attention. Neglected for a great deal of his early life, he’s the most openly affectionate of my three. He kneads, drools, and wipes his nose on us. He curls up beside whoever’s dozing on the sofa. But if he wants something and he’s not getting it, he will come looking. If he comes looking and we ignore him, he escalates his misbehavior because he knows we’ll eventually stop him, and that may be his goal: attention at any cost. A raised voice is better than no voice at all. A kiss with a fist is better than none. If we could figure out how to meet his needs, he might stop piddling everywhere. But he’s a cat. We can only do so much.
So I am fascinated with the idea of feline neurodiversity, and all it entails. On the one hand, we are far slower to pathologize their every foible; on the other, when those foibles overtake our coping skills, it is not considered unreasonable to put a cat down. They’re our dearest companions until they inconvenience us. Then they’re our pets and we can get shot of them if we please.
. . .
There is no longer any such option when human foibles leave us fumbling for answers. Institutions were impractical at best, so we stopped using them. But families cannot be the sole source of care and support. Professional help comes rationed: by managed care, by the time professionals have to spend with us. Can there be an intermediate solution?
Small group homes would be nice, five beds or so in quiet places. Naturally, no community wants these group homes. I cannot understand why. If my parents and I weren’t related, we would be the same as a group home for two, with one staff member. I get pretty loud in my pain sometimes. We are more functional than many adults, but not by much. Nobody would know it, passing our house. They wouldn’t have any idea about hiding bolts and razorblades, and making emergency plans in case one of us is overtaken by suicidal ideation.
Where’s the problem in providing housing for people who need support? It cannot be the people. No community would dream of asking a foster mother to stop taking in so many disabled children, for example. Where, then, is the problem with staff acting in loco parentis? Is it the spectre of grown men who might escape and, oh God oh God, do Something Rash? We don’t want our kids wandering into Unsafe Situations.
Not in My Backyard, or My Village, My Cul-De-Sac, My Bedroom Community, My Posh Suburb.
Nonprofits alleviating the burden on the taxpayer by five-odd residents at a time, providing them somewhere safe to live and maybe to get a trade, and we’re upset at the notion? I could understand the need to house pedophiles away from children, but where there’s no such problem, what is the problem? They’re just people who want to enjoy the smell of lilacs in a proper backyard, bacon and eggs cooking on the stove of a morning, and real human companionship, the same as you or I.
Bring them to me. House them in my neighborhood. Let them be my neighbors in all ways, and let us enjoy passing each other while we’re out for a spring stroll. Let me bring over soup when someone’s ill, a casserole for a death, a present for a special day. Let’s spend time gardening at each other’s houses. They’re not prisoners. They’re disabled. And if you’ve got a problem with that, then ask yourself why it’s okay for me to be your neighbor, for my dad, but not for someone like them.