Mental Health History

Marketers today are obsessed with “branding” which, in the most general of terms, is the mental picture a prospect or customer has of a company. For example, when you say “McDonald’s” I think of a diabolical clown whose red shoes skate across a smear of grease. Others might think of inedible food in bright red boxes served up by awkward, angry teenagers dreaming of their next tattoos. Companies may project any brand they like, but their actual brand is the image and opinion others have of them.
Much has been written about mental illness among human beings, but almost nothing about mind maladies among those of the canine persuasion, aka man’s best friend, or, more popularly, dogs.
Ours is an age of scientific marvels where the distant fantasies of yesterday have been productized, packaged, and delivered to customers remotely before they even realized they wanted them. It leaves one breathless. Science, traditionally a discipline devoted almost exclusively to the enterprise of capturing insects, applying Latin names, then cutting them in sections, continues its ascent. Today, as society’s moral center erodes and the values traditionally associated with organized religion crumble, we observe that science has supplanted religion as the new sociological belief system – ironic, really, since there are no beliefs in science as such – only facts, or so the guys in lab coats remind us. Whether or not science, as an entity, actually reflects values, it is certain that society has put its faith squarely in science, relying on it to cure social ills and flatten barriers to the orgy of self-indulgence that characterizes contemporary life. And why not? Wasn’t it science that put men on the moon? Wasn’t it science that split the atom and teased open the mysteries of nature when nature wasn’t looking? Of course it was.
When you get to be my age you start asking yourself questions like, “What time is it?” and “What am I doing in Tijuana?” and “Where are my teeth?” If you are about to celebrate a birthday, (if celebrate is the right word), you may be tempted to gaze across the seemingly endless succession of impulsive decisions, high-speed car chases down cul-de-sacs, and manic spending sprees littering the ravages of what you generously describe as “your life” and wonder how you managed to squander the cornucopia of opportunities strewn at your feet as a child. Or not.
Those with an interest in the history of American medicine will recall how the delivery infrastructure has evolved through the years, from careless care to poorly managed care to mismanaged care to the paradigm currently in vogue, managed care. Seems simple enough, and yet, there are as many definitions for managed care as there are for quincunx, so let’s cut through the clutter and have a look at what it actually means, especially in a mental illness/mental health context. Historically, care could only be denied on a case-by-case basis, which was very time consuming for care providers. Insurance companies struggled with tremendous overhead because it was necessary for them to maintain large departments staffed by professionals skilled at denying claims one at a time.
According to a study released recently by the American Association of Associated Americans (AAAA), insanity may soon be out of reach for all but the super-rich, if current trends continue. Chumley Throckmorton, PR Liaison for AAAA, explained the findings at a recent press event. “America was founded on democratic values,” he began, “our constitution guarantees specific freedoms like speech, religion, and the pursuit of happiness. Happiness means different things to different people but one thing is certain, for many of us it means embracing our inner whackadoomian and smiling shamelessly as the cheese drifts slowly off the cracker. “If one quality has helped to shape this nation more than any other it is the enthusiastic celebration of personal insanity,” he smiled. “Madness was no mere colorful side road of the American experience, oh no, looneytude carved Main Street out of a hostile wilderness, tied the sky with wire, clogged the air with carbon monoxide and made the racing rivers glisten with mercury. Toxic levels of greed, ambition, and aggression drove a long parade of pathologically disturbed explorers, industrialists, bankers, bookies, assassins and interior decorators to ravage a utopia of incalculable natural wealth and beauty.
Most professions develop technical jargon so rarified as to be virtually incomprehensible to outsiders. However, their impenetrability is simply an unintended consequence of the function served. Other enterprises deliberately employ coded slang so that insiders can secretly communicate with one another in the presence of clueless outsiders. Many of you are familiar with “Cockney rhyming slang” – an amusing grab bag of odd phrases used by English shopkeepers when they want to discuss matters of concern in the presence of customers without letting on what they’re saying. Entertaining snippets include “plates of meat” for “feet” – “trouble and strife” for “wife” - and “boils and blisters” for “sister”. I know what you’re thinking, something like that could never happen in the United States where people are direct, open, and honest all the time.
It’s been a long time since I had a manic episode, but I certainly remember them vividly. One of the hallmark components was an intense sense of urgency. I lived entirely in the moment, a state of being at once exhilarating and terrifying. It was as if I had been cut loose from the restrictions of time; I had no past or future. My existence resembled the reality described by William Blake – infinity in a grain of sand and eternity in an hour. When one is strapped to the nose cone of a rocket one does not think much about time – one thinks about each instant as it happens. An essential element of living successfully through every manic moment, for me at least, was the ability to move wherever, whenever, I wished. Boundaries of any sort were anathema to me. I was always ahead of the moment, faster than reality, pushing life along so it would catch up with me. I was ready for whatever came next even though I had no idea what that might be. I flicked the ashes off my cigarettes before there were any. At bars and restaurants I always paid in cash – using exact change – so that I was free at the exact moment anxiousness set in. To fully embrace the feeling of absolute freedom I felt it was necessary to believe I was already prepared for what was to come. I was hyper-vigilant.
Let me preface this by saying that I’m a strong advocate of what is called “talk therapy”, whether conducted with a psychiatrist or psychologist. Today’s mental health care community likes to throw pills at problems because insurance companies prefer it that way – for obvious reasons - but real mental health recovery occurs over time as the result of a careful blend of professional guidance, pharmacology, and personal will, labor, and fearless commitment. Talk therapy, when done properly, is the greatest emotional and spiritual adventure anyone could ever embark on. Compared to talk therapy, the much-discussed boating expedition of Columbus was simply a hop, skip and a splash down to the corner newsstand for a pack of smokes. But, it is dangerous and scary, and only works if the traveler is in the hands of a skilled guide.
When you live your entire life with mental illness your relationship with the particular nemesis tormenting you goes through a long, evolutionary arc. What do I mean by this? Let’s find out. At first there is the glorious warm bath known as victim-hood, in which we indulge as long as possible until at last the water turns cold, grimy and inhospitable. At that moment we must look directly into the pitiless, unflinching eyes of reality’s rubber ducky. We fantasize about having ourselves dry-cleaned. Our lament of how unfair this all is must finally be returned to our children, where it belongs. Fairness, as we have told them so many times, is not of this world. Stuff happens. Deal with it as best you can but please, no whining.