Bootstraps

One of the major themes when apologists for the current system diagnosis and treatment get going is that people struggling with mental illness cannot be expected to just “pull themselves up by their bootstraps,” that you can’t just “decide” to get better. Back when I believed in my diagnosis, I would take deep offense to even slight suggestions that I should just “buck up.”

But what if you can? In some ways that’s exactly what I did. I also believe that I was misdiagnosed, and maybe that’s an important point. Maybe if I was “really” mentally ill, I wouldn’t have been able to get to those bootstraps. I don’t believe I ever met criteria for bipolar disorder, even by a generous reading of the DSM-IV, but I certainly met criteria for depression. I’ve had times when I couldn’t get out of bed, when my life felt empty and meaningless. Who hasn’t? What I’m getting at here is that even though I was misdiagnosed (and have significant doubts about diagnostic practices in general), I wasn’t necessarily substantively different than your average semi-functioning patient seeking out mental health care. Well, maybe I was substantively different in one way. I’m god-awful stubborn.

When I first withdrew from zyprexa, I did so motivated by fear of diabetes and metabolic side effects. At that point, I truly believed that I was ill. But once I was off (thanks in large part to that stubbornness), and I felt so much better, I started to doubt my remaining drugs, and also the story that I had been told about these more difficult aspects of my personality. At that point, I started to see how much my own behavior, behavior that I could control, played into how I perceived myself as ill. Because I was bipolar, I let myself get out of control and panicky at the slightest stressor or provocation. Every time I cried publicly over something trivial, I had an easy explanation. By telling my whole social circle about my diagnosis, I created an environment in which I had special dispensation to act outside usual rules of social interaction. I got to be extra demanding and extra dramatic, because, after all, I was sick.

I began to see how much of this bipolar construction was molded by my own behavior, and to experiment with changing that behavior (A short round of CBT really helped me to get going on this). And what do you know? It turns out I actually could behave reasonably. I could act like I wasn’t bipolar. What if I wasn’t bipolar? It was hard work to change my behavior, to retrain old habits, and some of them still crop up. All of that bootstrap pulling wasn’t exactly comfortable, especially since I was having to shed old ideas that I shouldn’t have to work. The psychiatric world had told me for years, in essence, that I shouldn’t have to try. I would just magically be happy and get along with everyone, as long as I took my medicine. This is not to say I wasn’t trying really hard even when I believed my diagnosis. If there’s one dominant feature of my personality, it’s that I always “try hard”, maybe too hard sometimes. But what I didn’t have was any faith that I actually could truly change my behavior. I had been told I was permanently disabled and would be like this forever. For me, the medications themselves destroyed my resilience and made true change even more difficult.

Not everyone has access to their bootstraps. I get that. I know there are depressions that are so deep there is no clear way out. But even in the worst times, I think most of us have at least one or two things we can control. When we are told over and over that we just shouldn’t bother because the drugs are doing the work for us, how can we really find a way to move forward towards recovery? Belief that change is possible, in and of itself, can help that change to happen.