Mental Health, an oxymoron.

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If people were healthy they wouldn’t be mental…

Ok, before everyone gets offended by my dry and dark sense of humor, let us explore what mental health is or rather is not.

When I was at University in the USA, I was fortunate enough to study biological anthropology with one of the greatest minds of such of all time. One of the things he researched was tribal mental healthcare by South American tribal shamans compared to western psychology and psychiatry. His conclusions? What they do works way better. At least measured by number of relapses, length of disease, and severity of disease.

So aside from the liberal use of cocaine and amphetamine, what have they got that we haven’t got?

Social support.

For them, mental health and disease is a community problem. It is a strain on their local community resources to have non-productive people. So how do they do this? First they identify there is a problem, which due to the fact there is no stigma on mental disease, is not that hard to do. Somebody just cries out for help. The solution is then to have an exorcism. It is believed that it is evil spirits that are at play, and by getting rid of the evil spirits, it benefits not only the person, but the whole community. This is where some rituals, dancing, and of course some “uppers” come into play.

But it is after this that the brilliance of their treatment is observed. They often have a feast, and certainly a big party to celebrate making the afflicted better. Sounds too good to be true right? Except their party is based around the cause of the affliction. For example, if the person had no food, gifts of food are given. If the house was destroyed, the house is rebuilt. No job? What HR manager would not want somebody freshly demon free? A blessed person?

When you observe it through the lens of anthropology, and not religion, or even medicine, here is the basics: They recognize the problem. They motivate the person. They take decisive action to solve the problem.

But I am not here to advocate witchcraft and alternative medicine. (Although I think witchcraft is probably safer and more effective than alternative medicine) So permit me to look at it through the lens of modern Western Medicine?

Identifying the problem. Like any illness or disease, the earlier you identify a mental health issue, the earlier you can treat it, the earlier the treatment, usually the better the prognosis. We call that screening and secondary prevention.

Primary prevention is preventing the disease before it starts. But let’s face it, Western culture just isn’t interested in preventing mental diseases. So treatment it is…

Some people may have noticed that there is an increase in mental disease. Some would claim it was always there and it is just now being reported. As with many medical theories, the answer is probably somewhere closer to the middle.

You see in the past, Western cultures had greater social interaction and support. Whether in a small town or block of a big city, there was a concept of “community.” These people felt they were in life together, they supported each other, looked out for each other, they actually knew each other! Some people had mental diseases no doubt, perhaps less, perhaps the same, but the goal was to help these people within the community or if that wasn’t possible, send them off to a cage somewhere. Surprisingly, many of these people did remain in the community. There were not a lot of cages. That is exactly the goal of modern psychiatry, to help the crazy enough to let them return to productive and independent life. (Don’t get upset over my use of “crazy” either. I am crazy, I just accept and live with it.) This community easily identified problems and took decisive action.

Today though, in the West, there is very little community. It is all about the individual. Many people don’t even know their neighbors. Help them? Out of the question! It is better when you can pretend that only people far away need help and your Facebook selfie or a few bucks can completely change their life. (not possible, but it makes us feel good, like we are doing something) We are living in the time of “me and I.” As such, being “abnormal,” or in any way not super self-sustaining as everyone else carries with it a stigma. We must hide this “defect.” We should be ashamed… If you don’t feel that way yourself, you will be reminded by your peers. “Suck it up,” “everyone has problems,” “get over it.” They make it sound like problems are a choice.

I don’t choose to have problems I cannot fix. Do you choose problems you cannot fix? Who does?

When we have problems this creates stress. You know that old “fight or flight”, sympathetic, autonomous, nervous reaction… We usually think about this only from the acute point of view. But I think that is simply like thinking a myocardial infarction is an acute event, (It is really an acute exacerbation of a chronic disease) flawed at the very core of the theory. How many fire/ems providers break down on their first event ever? How many soldiers? Police officers? Doctors? Nurses? As far as my experience goes, not one. I have not even heard of one breaking down on their first exposure.

We are left with only one conclusion, mental illness is a chronic illness. That naturally means that like any chronic illness, a cure is unlikely. Treatment and palliation is probably the best we will be able to do.

From the physiologic point, we know that when one body system or function is not working properly, the other systems and functions alter themselves in order to compensate. The same can be seen with stress resulting in mental health issues. Under constant endorphin stimulation, other functions are affected, compensatory mechanisms from every system are engaged, I could list things like BNP, cortisol, and a host of other molecules to demonstrate my understanding of molecular physiology and pathophysiology, but I thought I would spare you the reading and just go right for the point, it will be a long enough post as it is. The end result, things are messed up. You heart, your kidneys, your liver, your brain. Emphasis on brain. Contrary to popular opinion, it is an organ, not just a magical consciousness. Like any other organ, it’s functions can be altered, broken. It is interesting that when a person’s heart is broken, or their intestines, they go to the doctor and nobody gives them a second thought, but when the brain is messed up, stigma follows. This is completely asinine.

So let’s talk about treatment? The first treatment any of us try for anything is to “tough it out.” You don’t go to the doctor the first time you sneeze or cough, or the first time a muscle or joint aches. You do not seek treatment the moment you feel stressed. These self-treatments we refer to as “coping mechanisms.” We all know there are destructive ones and constructive ones, and unfortunately, the destructive ones work better!

Think about it. Smoking didn’t carry a stigma until recently. In fact, nicotine is the only proven anxiolytic and antidepressant. Doctors used to give out prescriptions for smoking in order to relieve stress and depression! (That is kept on the down-low in more modern times) “High risk” sexual behaviors used to not only be acceptable, but even encouraged. “Comfort women,” “horizontal relaxation,” “make love not war” have been documented throughout history by every culture! There wasn’t always a war on drugs. THC, amphetamine, sleeping pills, alcohol, have all been/being used. In fact firemen and sailors used to be paid with alcohol.

I would point out that in the effort to not offend people trying to kill Western soldiers in wars in the Middle East, strict rules forbidding many of these destructive coping mechanisms were put in place at the same time increasing the chronic exposure to stress through extended and multiple deployments. But it is not limited to soldiers. Police Officers, firefighters, paramedics, nurses, and doctors also are in an environment of chronic stress and the negative coping mechanisms have been removed from them too. These civilians will not only be exposed to this stress longer than the average soldier is to combat, but as “representatives” of “the finest” of society, they are expected to live the ultimate puritan lifestyle.

So what should we do? Exercise? You mean between our 3 jobs, hours long commute, overtime, child care responsibilities, house cleaning, shopping, and figuring out our taxes? Perhaps we need to “make time” by working less? That relieves stress right up until it is time to pay the bills. Then it is even more stress. The same with extra time off.

Perhaps we should volunteer some time in order to use altruism to reduce our stress? Most of us do! If it was the magical cure, we wouldn’t be talking about this and there wouldn’t be websites and Facebook groups dedicated to mental health for medical, healthcare, and public safety providers!

Eat right? Well, I guess if you call Red Bull on your 20+ hours on duty “right” it might work, but comfort food is definitely verboten in healthy living. (My triple espresso latte coffee is not comfort food, it is the very liquid that keeps me going when my endorphin rush is wearing down and patient safety and health, or my own life depends on being mentally alert and physically capable.) Let’s call it a performance enhancing drug. I am not a pro-athlete, so it is not a problem.

Now I am not suggesting we shouldn’t do these things, we most certainly should! What I am doing is pointing out the reality of it all. Most of us don’t. Not for lack of wanting.

But lately it has come to my attention, we don’t have social support in the form of camaraderie anymore. When I was a firefighter, you could always count on other firefighters to not only notice something was wrong, but to help you make it right. It was similar as a paramedic, even in the hospital. We were the Emergency Department, an elite group unto ourselves. We strived to be the best of the best, whether it was taking care of chronic toe pain or multiple gunshot wounds. A team united in one goal and supporting and enabling each other to reach it. Police officers, Soldiers, Sailors, Marines all shared similar esprit de corps. Even if we could not relate or get support from society or family, there was always the co-worker, who we referred to as our brothers and sisters. (I’ll spare the incest jokes) But now, even that is breaking down. No more “all for one and one for all” but replaced with “All for me and more for me, not even sorry to hear about your loss.”

This alienation further drives the shame and need to hide mental diseases. It eliminates perhaps our most potent and effective treatments. It sure doesn’t pass the Shaman test.

So what do we do? Go to the doctor and get a pill to try and put our chemistry back in order? Give up that spare time we could be at the gym to get “professional” counseling? I laugh at those “professionals” anyway. Because as we all know, you can read about our lives as much as you want. Study it with the most perfect scientific clarity. But until you have lived it, you really don’t understand it. Whether you are a soldier, doctor, nurse, firefighter, etc. it holds true. There are a few of these professionals out there, but they are very few, and certainly no substitute for the social support from within our group.

Ultimately, I see stress as a cup. Some things add to make it full. Some things help it to empty. When it overflows, you have mental illness, emotional illness, personality disorder, physical sickness, and all manner of badness. If you are not helping empty somebody’s cup, you are helping to fill it. It is not possible for us to help everyone, but maybe we should make the effort for those closest to us? The cup is never empty, and the amount you must take out has to at least add to the amount you put in. Once you overflow, you need to take a lot out and clean up the mess. It may be from that point, you will never be the same again and it will take even more to help stop another overflow. Maybe it cannot be stopped again, only reduced in frequency or severity?

Mental illness is a real illness, no different from a stroke or cancer. It is much easier to prevent than treat. Social support is our best prevention and treatment. Identify people struggling around you. Help them before you are asked. If somebody calls out for help, do not ridicule or trivialize them. Help them. If for no other reason, so others will do the same for you! Attempt to use positive coping mechanisms, because surely if you can’t, negative ones will be your only other alternative.

Bottom line: “Never judge, always help.”                    

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