In this case, though, form obviously trumps content. The beauty of this campaign is that it’s transformative. The literal message implies a static present, but the act of reaching out, of making these videos, itself shatters that illusion.

These videos prove that people have been moved already. They allow us to see a changing landscape in bloom. The point isn’t really that things will get better; it’s that – look! – they are getting better…

And that sharing our pain makes all the difference.

Bless you, Dan Savage.

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[This is a gorgeous essay. I hate to excerpt it at all. -Ed.]

More on Andrew Solomon

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[A fun read on the benefits of mental unrest. When hypomania looks like an asset, can we call it a "disorder"? (After all, it's in the DSM-IV.) This question is a bit of a red herring; it poses a dichotomy where none exists (i.e., you're either sick or you're not). The trickier and truer question is, if illness has its benefits then how should we treat it? Hopefully no one would want to "cure" a successful entrepreneur like Seth – except, perhaps, his future wife and family. According to the article, he sleeps at the office and works every waking hour. He doesn't even bother with friends.

This may work for him now, but will it always? That's up to him, I suppose. But a determination to avoid hypomania's drawbacks, in this case anyway, can be seen as a drawback itself. It's understandable why Seth doesn't pursue relationships – he sounds terrible at them. But life demands a certain kind of mental flexibility. It's nigh impossible to avoid change, even in the realm of our own desires.

I hope I don't sound like I'm pathologizing Seth. Barring the violently ill, treatment only belongs to those who seek it. What I'm advocating for, really, is a more fluid concept of "mental illness" in the first place. Illness needn't be a burden or an albatross. Often, as in Seth's case, we may prefer to think of it as a "condition" instead. However we classify them, though, states like hypomania should be recognized as such. Hypomania may be a gift to Seth right now, but – like all gifts – it may come to feel like a curse in other arenas. Such is the nature of reality itself, not just mental illness. -Ed.]

photo: Man & Wifey

I mention this in light of an ongoing debate: what is the best approach to mental illness?  This question has plenty of stock answers – too many, perhaps. When we boil down a complex issue to just two sides, it helps us to digest subsequent arguments. Making a simplified choice at the start of a debate (pro or con?) gives us a footing for grey area. But human beings don’t like grey area right off the bat.

Unfortunately, mental illness is grey area. In its most extreme forms it may not be – everyone agrees that John Hinckley was a sick man – but extreme forms of illness are just that; they’re rare. Most of the time, mental disorder expresses itself within a vast spectrum of behaviors that we can and do normalize. Sadness, emptiness, anxiety, fear, compulsion: these aren’t just symptoms.

The inherent “greyness” of illness makes it a difficult topic. We can reduce it to black and white, but that never does justice to our cause. Take, for example, this recent bit of news:

The level of Americans’ prejudice and discrimination toward people with serious mental illness or substance abuse problems didn’t change over 10 years, a new study has found… [Sociologist Bernice Pescosolido] and her colleagues compared the attitudes of people in 1996 and 2006. During this period, there was a major push to make Americans more aware of the genetic and medical explanations for conditions such as depression, schizophrenia and substance abuse… People who believed that mental illness and substance abuse had neurobiological causes were more likely to be in favor of providing treatment. But these people were no less likely to stigmatize patients with mental illness or substance abuse problems. [my emphasis]

First of all, this is progress. If more people support treatment, that’s a huge plus. Nonetheless, these researchers sound disappointed: “It’s time to stand back and rethink our approach,” said Pescosolido.

Really, guys? Obviously doctors are going to take a medical approach. But I’m a bit astonished that doctors, of all people – the ones who have the most direct experience with illness in all its various forms – think that purely medical explanations are going to satisfy us. Yes, it is absolutely crucial for people to understand illness as a medical problem. As I’ve written in the past, classifying something as a “mental illness” is just a way of acknowledging that treatment exists. But reducing these woes to brain chemistry in order to make illness more approachable?  It’s almost comic. I’m not suggesting that brain chemistry is too complicated for the average person (the fundamentals are easy to grasp, actually). It’s deeper than that. No one wants to think of their emotional life, no matter how unbalanced, as chemical soup.

First of all, this robs us of agency; it suggests a lack of free will. Second of all, it’s an obvious over-simplification. It’s not a distillation of the issue; it’s reductionist. (From a recent post: “It is time… to wonder deeply in and about our gifts, rather than reduce ourselves to primitive urges and selfish genes.”)  Everyone feels in their bones the reach of illness, that illness itself is wrapped up with fundamental things. Even if mental disorder is “just” errant neurons, we know from experience that our psychological development is a feedback loop – that our thoughts, feelings and actions inform our future selves (i.e., our neuronal development). By definition, sufferers can’t control their illness, but invariably they will make decisions that affect its course.

What does this have to do with stigma?  Everything. The premise of my efforts here and elsewhere is that stigma makes illness more difficult to bear – and that whatever exacerbates mental illness is actually part of it. Mental illness is simply too amorphous, too expansive and too rich to reduce to molecular biology alone. People may not articulate this in my way, but this argument is at the heart of a lot blowback against a medicalized view of mental suffering. People do believe, and they want to believe, that when it comes to mental illness, everything matters – not just science.

I’m inclined to agree. Part of my discussion with the students this summer included a brief lesson in neurology, showing them how SSRIs actually work in the brain. This is an essential piece of my attack on stigma, but it’s just a piece. I spent much more time talking about the stigma itself: how it arises, why it’s damaging, and how to combat it. I also talked to them about life in general, and in particular feelings of failure and/or hopelessness: how to recognize them, how to address them, and why they’re okay – why they’re essentially, actually, to a life well-lived. This can be abstract stuff. Brain chemistry is more concrete. But if we don’t acknowledge that our attitudes matter, then why change them?

“And yet it seems to me that the process itself, in its very commitment to interiority — its attempt to ferret out prime causes and pivotal events from the psychic rubble of the past and the unwieldy conflicts of the present — can be intriguing enough to stand in as its own reward.”

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[This is a doozy of an article: long-winded, self-involved, not entirely pleasant to read. The obligatory horror stories of pathologically insensitive therapists make me cringe; I believe them but feel they're sensationalized and unbalanced. With the utmost sympathy, Daphne Merkin does seem like a person destined for therapy. I don't mean this as an insult – I wouldn't be featuring this article if I did. (I wouldn't be here if I did!) Merkin's struggles are real, and she's honest about them. As a result, she doesn't offer up the most likable self-portrait. I don't know if that's her objective, but in any case she bravely illustrates a core tenant of therapy: we evade the truth of ourselves at extremely high cost. If you read this article, read it with an open mind. Daphne Merkin may not be "your kind of person," but the sympathy that she feels for herself in the face of obviously frustrating emotions is, I'm sure, a consequence of her life in therapy – a consequence and a great accomplishment. -Ed.]

I love this cartoon. The joke works because we want to pay for inner strength; it should feel difficult, like a triumph – something deeply reached for.

But I don’t read it as an outright critique. As much as this cartoon questions the legitimacy of drugs, it also pokes fun at modernity. The joke works, too, because reaching for the medicine cabinet is so utterly unromantic. Where once there were shaman, vision quests or holy insight, now there’s Rite Aid, $10 and a ’scrip for Paxil.

Nonetheless, is it so far-fetched to find strength in the act of helping oneself? How much humility does it take to crack open that white bottle cap for the first time? It’s easy to conceive of “pill-popping” as a shortcut, an easy way out – until we’re the ones faced with the choice. We may have a hard time admitting it, but inner strength isn’t always there. Sometimes, we need to reach out.

And that’s an act of courage in itself.

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[I have a friend in medical school – a psychiatrist in training – who tells me that AA gets tremendous credit for being the most effective addiction recovery program in existence. This surprised me, because a) I didn't know that AA's success rate is the gold standard, and b) I thought that many of AA's strategies were at odds with certain classic, psycho-therapuetic mores. The latter appears to be true, although this article suggests a welcome shift in attitude. If AA offers the best chance for recovery, than psychotherapy should follow its lead. Therapists, say the authors, should break out of their comfort zones when the failure of addiction looms; the successful treatment of alcoholism may require more communion with patients than is commonly advised.

This makes a lot of sense to me. In my own treatment (not for addiction, admittedly), my therapist never shared her own stories. I knew next to nothing about her life, and I assumed it would stay that way. But in one instance, she shattered this well-established practice – it was shocking to both of us – by sharing an incredibly intimate story about a death in her family. I could see this made her nervous. Clearly she was going out on a limb, defying her own notion of "best practices." Yet her intuition paid off. Her story changed my life, not because it made me feel any closer to her, but because it made me feel closer to others (certain others at first, and then more generally). I went from feeling confused and frustrated to feeling sympathetic and forgiving.

She told me her story, she said later, in an attempt to give me facts that she never thought I'd get, i.e. I wanted explanations from people who couldn't give them to me. The revelation of her family's secret became a stand-in for the experience I'd been missing, both literally – she told me something I never thought I'd hear – and figuratively – her story gave shape to the actions of people in my own life. She drew a parallel, but she also broke a boundary. Both helped my treatment; I can't say which helped more. This is the art of psychotherapy: the acknowledgment that, despite an appropriately clinical approach, any rules-based system is bound to fall short in the face of us. -Ed.]

This pending law in Nebraska correlates abortion with mental weakness; it suggests that women who are pressured to have an abortion should be handled with kid gloves. First of all, women face all kinds of pressure from all sides at this juncture: lovers, friends, family, and even circumstances themselves. Making a choice under pressure doesn’t mean that it’s a bad choice. Most important choices in life are made this way. Second of all, if we’re honest about these pressures, then we can see this law for what it is: an attempt to use the stigma of mental illness against women considering abortion.

As you probably know from reading this blog, I’m all about de-stigmatizing mental illness. This stigma leads to suicide all the time – every day. It killed my sister, who took her own life before she was willing to take an anti-depressant (even after she filled a prescription). So the thought of using this stigma, reinforcing it, for political victory makes my blood boil. Whatever your position on abortion, we must do better than this law.

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[A wonderful follow-up to this post. Props to Cathy Horyn, who really hits all the bases in writing responsibly about a suicide.]