Hiding in the Backwaters Just one more blog on the net.

New Freedom Commission on Mental Health

One of my assignments for my practice class is to keep a journal of things that come up for me during the semester. I haven't been very good about it and I'm trying to catch up.

In my policy class, we have been discussing Bush's New Freedom Commission on Mental Health. From the opening letter:

On April 29, 2002, you [Mr. President] announced the creation of the New Freedom Commission on Mental Health, and declared, “Our country must make a commitment. Americans with mental illness deserve our understanding and they deserve excellent care.” You charged the Commission to study the mental health service delivery system, and to make recommendations that would enable adults with serious mental illnesses and children with serious emotional disturbance to live, work, learn, and participate fully in their communities.

Generally, the recommendations are a good start toward better policy and don't pull too many punches about the current state of mental health care. However, I find that I have real issues with the premise on which the commissions findings are based: "After a year of study, and after reviewing research and testimony, the Commission finds that recovery from mental illness is now a real possibility." It seemed that I was the only one in class who took issue with the use of the word recovery.

How exactly does one reduce or remove stigma from mental illness if official policy states that recovery is possible? What exactly constitutes recovery? My instructor suggested the definition of recovery is being able "to live, work, learn, and participate fully in their communities." Really? That's an interesting definition. Do you think if you talked to someone with diabetes who has their symptoms under control with insulin shots and dietary restrictions if they had recovered from diabetes they would say, "Oh, yes." Do you think if you asked someone with schizophrenia who has learned to manage their disorder with medication and counseling if they feel they have recovered their answer would be yes? Of course not. They would both tell you they have learned to manage their illness. Recovery is when you can stop taking pills and you don't have to worry about symptoms returning, like, oh, gonorrhea. Ten days of antibiotics and you're good to go. Otherwise, if the cessation of pill popping precipitates a return to a prior dysfunctional state, it's not recovery. It's managing your illness. Redefining recovery to mean "symptom management" doesn't do anyone any favors. It only muddies the waters and complicates and already complicated issue.

Someone in class said they were offering hope. I'm sorry, but what good is hope if it's a false hope? Do you think a client who has bi-polar tendencies is going to be just a tad disappointed when he learns that your definition of recovery includes taking pills daily for the rest of his life that may also make him feel lethargic and interfere with little things like his libido? By stating that recovery is possible you're still saying it is not okay to have a mental illness. How many of you balk when the person you're dating reveals they're on psychotropics? Why? They're recovered, right?

Policy makers and insurance companies are so enamored of the medical model of disease for mental health. They want it predictable and measurable. Like the medical world has all the answers for it's own domain of problems. The ultimate goal is to find a pill for all that ails you. None of that costly long term therapy. "Do you find yourself boiling your paramour's pet rabbits? Do you spend hours hiding in the bushes near the home of your latest obsession? Have you ever come completely unglued and beat your child with the forbidden wire hanger that found its way into your child's closet? Then ask your doctor about antifatalmominase, our new anti-borderline pill. Side effects include nausea, vomiting, anal leakage, migraines and high blood pressure. If you find yourself having hallucinations contact your doctor immediately as this may indicate a rare but serious side effect that could lead to a murderous, psychotic episode."

Of Gender, panties and knots

This semester my practice class is focusing on issues related to children and adolescents. We've spent a little time talking about sexuality and gender. It is interesting to me that we as a society are slowly getting to a place where the sex of the person you sleep with is less an issue, but woe unto the individual who doesn't conform to gender stereotypes.

The APA dropped homosexuality from the DSM (Diagnostic and Statistical Manual) back in the 70s, but Gender Identity Disorder is still on the books. Congress is set to pass an ENDA that includes sexual orientation in the list of protected classes, but Congress still can't stomach the idea of someone who is transgender or transsexual and gender identity has been removed from the version that will go to the floor of the House for a vote.

These days I tend to believe all prejudice toward women, homosexuals and other sexual minorities is rooted in the rigid definition of gender roles. I'm sure it is my place in a sexual minority that colors my thinking, but I don't quite understand why gender bending is so threatening to society. If someone born male would rather dress as or be a female why do you care? What possible threat does that pose to you as an individual? Doomsday predictions about the disintegration of society don't carry much weight with me. There is absolutely no proof for such dire prognostications. They rely heavily on mountains of dubious assumptions based on dogmatic declarations and have little real evidence to back them up.

It seems to me that Gender Identity Disorder is a social construct. It's very existence is based on the existing definitions of masculine and feminine. Were the definitions different, so would be the definition of the disorder. The fact is our society can't handle a continuum of gender identity. Men who are not athletic, aggressive and well muscled are disdained in our society. Just ask any shy, skinny, awkward fifteen-year old. Such men obtain some reprieve when they marry and demonstrate their ability to impregnate a woman, the ultimate marker of manhood that trumps all others. Women who are muscular, athletic and aggressive are met with equal disdain, again until they demonstrate their ability to birth a child, the ultimate marker of femininity. In our brave new world of more latitude when it comes to sexuality, society is grudgingly giving ground on the impregnation front. It's increasingly okay if an individual has no desire to impregnate or be impregnated, but by God that person had better toe the line on other gender identifiers.

The other aspect of Gender Identity Disorder that leaves me wondering is the taboo doesn't work equally for both sexes. Females are allowed to venture into male territory, but males are absolutely forbidden to venture into female territory. I am reminded of the words from "What It Feels Like For A Girl" by Madonna: "Girls can wear jeans, cut their hair short wear shirts and boots, 'cause it's okay to be a boy, but for a boy to look like a girl is degrading because you think that being a girl is degrading." Biology suggests that both sexes are equally vital for the survival of the species. Both serve necessary functions. Whence the unequal attitudes about gender roles?

I gave a short presentation on sexuality a few weeks ago and did my best to present facts since I have one or two biases when it comes to sexuality. Yesterday C gave her presentation on gender and C made no bones about her biases and laid them out there for everyone. I find the contrast interesting and am forced to wonder what, if anything, it says about me and my comfort level with my "other" status. I guess I'm just used to minds slamming shut when the subject comes up. I did (deliberately) present some statistics and recommendations regarding masturbation, sexual play in children, and gender identity that I'm pretty sure made some in the class uncomfortable. The point, I guess, is I was hoping they would have to deal with facts and not be able to dismiss them as rubbish from the radical homosexual.