spare the crutch and break the rod
6 Jan 2007 03:25 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
kaigouIn 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.
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.
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no subject
Date: 8 Jan 2007 08:20 pm (UTC)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. :)
no subject
Date: 9 Jan 2007 03:27 am (UTC)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. ;-)