spare the crutch and break the rod

[kaigou]

In the past two months (or so), it seems like a lot of us on my flist have been hit with some heavy-duty changes, difficulties, and just plain wake-up points where we knew it was time to Do Something. Which is all well and good, but in some changes there's a definite stigma (whether we get it from outside and have accepted this, or fight against it), and rather than run around saying it elsewhere, I thought if I said it here, that might be better.

Let's take the most common (if equally one of the most debilitating) illnesses that can hit your brain: depression.

I've seen a lot of fussing about 'dependence' on taking a medication, reluctance to take it, and the usual (and I see this in myself) hope that eventually it will 'be fixed' and the medication can be ended. Depression may end, or just lighten, or come back full-throttle, but it's not like taking antibiotics to get over strep throat. First, that analogy only works if you had to go through anywhere from one to eight different types of antibiotics to find the one that works for your strep throat (if any), and second, if by having strep throat you increased your risk of having it again.

Right-o. Let's compare two people, one, non-depressed, the other, suffering a (first-time) major bout of depression. The second person has double the chance of the first for a (second) depressive episode. For each additional cycle of depression, the chances of another increase, until it's pretty much guaranteed that you'll end up neck-deep in it again, and again. I don't know why this is; it seems most doctors don't, either. But it just is.

There are a lot of people out there who will call medication -- especially long-term medication -- a crutch. Used to be, a crutch was a perfectly acceptable, neutral term that meant 'an aid to healing', because obviously you don't want to be walking about on a broken leg with your full weight. But from my rather random and spurious readings, it seems that 'crutch' may have gotten its negative connotations from London beggars, whose favorite begging form was...the crutch. Simply: you stumble onto your corner with a crutch, turn your leg just so, get sympathy. After the marks have left, you put your crutch under your arm and walk off.

The crutch itself -- and as a term -- became associated with use of something unneeded, often to garner sympathy, provoking an unspoken attitude of 'if you'd get off your duff' -- get a job, grow up, accept responsibilities, etc. Alcohol as a crutch, smoking as a crutch: 'you're using this to avoid doing/facing something', to avoid handling reality's stress, pain, discomfort, much as some might argue beggars are just lazy people who don't want to get a job.

I'm clarifying that because we need to separate the cultural connotations of 'it's something used/done as a means to circumvent handling a situation' from the original (and more honest) 'it's something used/done to stabilize a situation.' In the latter, the neutral medical version, you need a way to stand upright when you can't put all your weight on one leg; you need a medication to put your brain in the right gear while you're tilted mentally to one side.

But don't stop there, okay? This is the point: a crutch may not be the end of it, but it may be the end of your apparent injury.

Let's say you're in a horrendous car accident, and your leg is smashed all up. Bone-settings, casts, crutches, wheelchairs, physical therapy, all these are going to be as identifiable to the outside observer of 'that person is healing from an accident' as much as more perceptive observers may notice a change in your behavior when a drug starts kicking in (and working, or half-working, or whatever). This is the crutch-period of the healing. You get therapy, you and your doctor fiddle with the prescription levels, you make progress, you have bad days, and hopefully make more progress rather than less.

At some point after that accident, the final surgeries are done, with a rod inserted into hip or bone or knee or ankle. The smash-up damaged the body, and while it has amazing abilities to repair itself, it can't do everything. That invisible metal rod is going to let the person get up and walk around, maybe even play golf again, walk the dog, climb the stairs -- the key is that no one will know the rod is there... because it's doing its job.

Long-term medication is not a crutch. It is not something that will be branded on your forehead as a sign that you are slacking, that you're avoiding doing the work of growing up or accepting responsibility or whatever other bullshit people say or think. It is an acceptance that the damage done to your brain is a permanent part of you. It is acceptance that this long-term medical-rod will remain to stave off reoccurances and/or symptoms -- and that, when the medication is working, no one will ever know.

I have met people who are calm, centered, pleasant and successful, and discovered they've taken Ritalin regularly for nearly fifteen years now, like clockwork. I never, ever in a million years would've guessed it. Same for people who take anti-depressants, or lithium for bipolar disorder. When the medication works, it's not a crutch. It's a rod that's been placed inside you to strengthen something that got weakened, somehow, and that bolsters you so your own muscles and behaviors can heal, can keep going -- and no one will ever know just by looking.

When the medication works, really works, there may be the chance that your doctor may say, this isn't something you can leave behind. Maybe you can, in which case you're lucky. But if it's looking more and more like you can't, like this is some kind of 'life-sentence', then maybe you need to ask yourself this: how many people do you know have survived major accidents, gone through significant healing, and now live with metal or plastic bits in their body somewhere, that let them get back to enjoying life? Find those people and ask them if they'd willingly have those bits removed, on the principle that these bits aren't 'them', are a 'crutch', are 'preventing' them from dealing with the repercussions of their injuries.

I worked, in the past five months, with three people who'd gone through accidents that severe, and I can pretty much promise they'd all look at you like you were crazy for the notion. Why should it be any different just because it's a chemical rod, instead of a metal one?

There's the analogy: first you suffer/recognize the injury, then you go through the major healing, and then you have the maintenance.

A medication is a life-sentence only in that it can give you back your life.

Comments

[buymeaclue.livejournal.com]

Very, very good post.

[kaigou.livejournal.com]

Thanks. I've tried to incorporate this mindset into my life over the years, but I thought some friends could use the positive analogy.

[annotated_em]

Thank you.

Right now, I'm lucky. I'm in a place where I don't need that rod to keep me upright, but if I ever go back to the hole... anyone who has the nerve to disparage me for needing medication should expect to have their spine removed, by way of their stomach.

[kaigou.livejournal.com]

...and then wear it as a hat!

(ahem, sorry, obscure reference there.)

It's possible that most people aren't willing to be honest about their private feelings (even with themselves) when it comes to medication, anymore than they'll admit sexism or racism -- that's my suspicion, at least -- and so there are few people who will say, outright, "oh, you shouldn't take that, you should be able to do it on your own."

Instead, what's more often expressed is, "well, you're all better now, so you need to stop taking that before you get addicted." Which was my point, as well, about the idea of a chemical-rod: if the medication is doing its job, there is no addiction, either.

[sevun.livejournal.com]

Any method that allows you to actually feel like you're in the living world is positive. Thank you for that post. Especially in recognizing that it is an illness, and not just a passing mood swing.

sev

[kaigou.livejournal.com]

It's just a phase, it'll pass, it's just part of stress, yeah, I've heard plenty of those. I've also gotten my share of anti/ignorant ADHD comments, mostly from professors, like the one who -- when I asked if I could do the final in the hallway, a broom closet, anywhere other than in a crammed classroom with seventy people -- yelled at me that I was an adult now and I was just going to have to grow up and learn to deal with stress, that everyone did, and I couldn't be expecting special treatment.

Irony is, looking back at her lectures, I think she was probably as ADHD as I am.

Only way to change people's attitudes towards mental illness -- because illness it is, and thus can be treated -- is one person, one day, one bit at a time. Sigh, but there it is.

[sevun.livejournal.com]

After having battled severe depression alone for years in both elementary and HS, without any drugs or diagnosis, and then having someone come up to me and say I was weak and should snap out of whatever it is I'm dealing with...kinda gets my blood boiling. In any case, I've learned that unless a person has felt it, they most likely won't understand it. Especially the need to take your time, and find a space or action that allows you to deal with yourself at that moment.

So here's to taking care of yourself and knowing that one step at a time, and test-taking in broom closets, is a healthy and strong way of dealing with the roadblocks in life.

sev

[kythiaranos.livejournal.com]

Thanks so much for saying that. It's really important for people (read: me) to think about medication differently. Your conclusion is so, so true.

[kaigou.livejournal.com]

You're welcome, and thank you, too.

[difrancis.livejournal.com]

medication can be an absolute gift. But one thing you should add to this--that long term heart medication or long term medication for blood pressure is perfectly acceptable to most people. The muddy area seems to come when someone (whether the patient or some outside idiot) decides that they somehow caused or otherwise are responsible for the illness--like depression, or any other mental illness. Like they could just stop if they . . . behaved right, ate right, did good deeds, whatever. Which is ironic, because often it's the other kinds of heart related illness that CAN be helped with diet and exercise, but I digress. My point is just that there is a certain level of blaming the patient associated with the guilt or embarrassment or whatever the fuck it is that people feel when taking certain medications. But the fact is, it's a gift. Because you get to be you and you get to have the life you want and you get to be happy.

My two cents, babbling probably.

Di

[difrancis.livejournal.com]

Speaking as a long term taker of heart-related medicines in heavy doses. Which I will be taking the rest of my life and for which I thank the universe because it means that my oddly-behaving body will hopefully last awhile. And I should add that had my grandmother been given anti-depressant medicine much earlier, she would have lived a much happier life.

[kaigou.livejournal.com]

Back when the doctor tried Ritalin on me (in HS), I recall my mother asking the pharmacist about addiction potential. His response was something along the lines of, "I would no more worry about a diabetic becoming addicted to insulin than I would about your daughter becoming addicted to stimulants. These are chemicals lacking in their bodies, and taking the medicine at the proper dosage creates a stable level."

Of course, then I got a huge lecture about never ever letting anyone else have any of my pills. *rolls eyes*

I think part of the stigma with mental illness (other than the long-term stigma from centuries of just not really understanding some of the more radical and complex disorders), is that it's not like you can hook someone up to an xray or mri and say conclusively, yep, you're depressed X amount, or have a blip here so therefore you are definitely diagnosed with A and complications of B.

It's using behavioral and self-reporting analysis to apply a medical solution, unlike the strictly medical analysis of most other illnesses to apply a medical solution. That 'self-reporting' aspect, of "I don't know, I just feel down in the dumps and can't stop crying," or "I just can't stop my brain from going a mile a minute and I feel jittery all the time," makes some folks suspicious, as though you're exaggerating.

I've never met anyone who'd tell someone with a congential heart defect, or clogged arteries, "look, stop whining, there are days when my heart aches, too." Or for a herniated disk, "yeah, well, my back hurts sometimes, too, get over it." But I do hear it a lot when someone's depressed, and otherwise well-meaning people tell them to "buck up" or some other nonsense.

Any of us who take long-term medication are going to get it, whether overtly or subvertly, from outside. We don't need to be doing it to ourselves at the same time, which is the whole reason I wrote the post.

You're not babbling, woman, remember, I'm the one with ADHD here, not you! Ffffttt.

[kraehe.livejournal.com]

Do you think it's partly a generational thing -- as in, maybe younger people are more accepting of the idea that it's a chemical imbalance, not a character flaw?

Just thinking of the analogy with, say, being gay. I think people of our generation (GenX) are more likely to accept that gayness is a function of how one's brain is wired, rather than a choice. People in my mom's generation aren't (generally) quite so willing to believe that. (There are many who are, of course, but just going on general social observations here.)

And my grandparents' generation thought that people who got cancer were angrier or somehow had a flawed character (which belief still pops up, much to my amazement) (http://www.huffingtonpost.com/murray-waas/the-wag-time-pet-spa-cons_b_36927.html); and my maternal grandpa never did believe there was such a thing as allergies ("it's all in your head").

Be that as it may -- there's just no excuse, given the amount of medical information out there, for stigmatizing people who take medications to help with depression. Your analogy is a good one & I'll have to remember it for future reference.

[kaigou.livejournal.com]

I think there's been a shift over the past two hundred years, from seeing all illnesses as aspects of our spiritual state -- sinners (iow, people who lived unhealthy/immoral lives) were more likely to demonstrate that internal unhealthy state with external symptoms. Frex, crazy behavior indicated demonic possession: external bad indicated internal bad.

What kept things in balance was that the majority of Western civilization also believed, thank you xtianity, that everyone was a sinner, to one degree or another. That made it a great deal harder to thwack a neighbor for a bum leg or bad eyes or constantly getting the flu, or blame someone for having galloping consumption or diabetes or whatever.

But as our comprehension of medicine grew, the old 'illness = sin, everyone is a sinner' became 'illness = abnormality' and medicine could create normality. It created a line between normal and abnormal, and that if you worked hard enough, went to ex-gay treatments, were a better person, whatever, you too could be Normal Like The Rest of Us.

We seem to be slowly coming around to the "everyone is born with some kind of imperfection, some more visible than others", thanks to DNA testing and further scientific advancements. But it's still an intriguing course for western civilization to take, IMO.

[kraehe.livejournal.com]

Indeed. Maybe the "Everyone Must Be Normal" thing is particular to the 20th century, from Kellogg and associated health crazes through similar health fads today. I dunno.

I sure hope there is increased tolerance, but am not that optimistic -- I hope that DNA testing doesn't lead to a sort of eugenics revival.

"constantly getting the flu" -- that would be me. Yes, I'm whining. But the antibiotics are kicking in, and I'm beginning to feel better, so I have to get my whining in while I can. :P

[bluefate.livejournal.com]

That's very interesting...I would guess that the evolution of refering to something a crutch might have gotten a more negative connatation as people try more and more to be independent. If you rely on something to keep your health, then you can't do it yourself, and then you'd have to admit that you're not a perfectly healthy individual. No one wants to admit that their friends/family/they themselves are not perfect, or not normal...
Actually, I'm commenting just to ask you about your icon. I've never heard that phrase before. Would you tell me where it comes from and why round cake?

[kaigou.livejournal.com]

I think crutch as a negative term is an external judgment; I've known few people who'll say "I use X as a crutch," and not mean it in either a joking way, or in a strongly self-castigating way. More often it's judgment upon another, declaring the person is just fine, doesn't need X, and therefore is being deceptive to continue leaning on it (but that the observer is wise to this).

I find that attitude both offensive and trivializing, and thus I think it's important people return to the neutral medical term, and recognize that long-term medication is not living a lie but a means to living in a healthy manner. Yes, we all want to be 'healthy' individuals. But I don't see anyone going around telling diabetics or people with bad eyesight that they're somehow deficient for not 'fixing' it themselves. Even those who believe prayer can do it are, in essence, asking for help from outside.

Re icon: the phrase is zen, and is related to the enso (the calligraphy in my current default icon). The koan goes something like: a student asked the master why he'd bother to contemplate such an imperfect thing, and the master simply poured the student a cup of tea and said, "have some tea with your round cake."

Zen buddhism has a rather quirky sense of humor.

[bluefate.livejournal.com]

hm. Thanks.

[no-ron.livejournal.com]

and it's interesting to observe how depression is that special condition that provokes all this controversy.
first of all, it's a psych. disorder and despite it being the 3rd millennium, they are still frowned upon and not understood, accepted or regarded as let's say any which somatic disease byt the wider humanity.
then, depression is special in a way that depressive states (subclinical or reactive in nature) are part of virtually everyone's direct life experience.. hence the comments to "get over it, get moving, grow up, etc."
what people won't understand is the underlying endogenous, very material, biochemical disposition that is present in (not all but) many cases of depression. and that not every depression is the same depression.

biochemical. yet no-one will frown upon a diabetic's life-long insulin supply, or - to get back to the brain and neuromediators - no-one will speak about crutches or dependence to epileptics with regards to their anticonvulsants. and certainly no-one will tell them to "get over it and grow up".

another misconception is the idea that antidepressants are some kind of a "happy pill", some sort of uppers or euphoriant, and many are surprised to learn that they don't have any immediate psychotropic effect on a healthy brain if taken in a therapeutical dose.

on the other hand, i don't believe in the latest trend of an exclusively materialistic approach to the problem, where drugs are seen as the ultimate solution. it smells too much of consumerism and capitalism.
yes, it's so much easier and you can manage that many outpatients per day more, and it takes but a simple prescription. the doctor is happy, the pharmacological industry is certainly happy.. i'm not so sure about the patient.

depression is a very complex thing.
i don't think an antidepressant will solve anyone's internal struggle and psychological issues, though it may put a barrier to their unnecessary amplification by an endogenous process on a molecular level.



oh.. and hi.
i came across your journal through a sequence of links and found you very readable. :) hope you don't mind.
i don't think you'd eventually get any richer from my entries, since there are very few lately and of dubious quality :p .. but i think my comment statistics are good. :)
and i must compliment you on your LJ design. :)

[kaigou.livejournal.com]

Yes, I've had to say that before to folks: "if it were a drug that made you happy, they'd call it a euphoric; it's called an antidepressant because it simply makes you not-sad."

The distinction is important.

I would never argue medication alone is a useful thing, especially not in the early stages of one's diagnosis. Perhaps I just wasn't clear enough that in a physical trauma, you have aid from medication/cast, and physical therapy; in mental trauma (of any sort, born-in or triggered), you have aid from medication and talk-therapy. That would be part of the analogy.

Thanks for the compliment on the design -- was a hassle and a half getting it the way I wanted, but I tend to be a pitbull when it comes to figuring out code and getting it to do what I want. We'll see how long this one lasts before I play again. ;-)