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Wednesday, April 21, 2010

Committed to Free Will

I recently watched The Soloist, and it really expanded my view to the homeless. Subcity, by Tracy Chapman also illustrates a good point toward the homeless:

"They say we've fallen through the cracks
They say the system works
But we won't let it
I guess they never stop to think
We might not just want handouts
But a way to make an honest living
Living this ain't living"
     The first assumption most people have towards the broken is that they want to be fixed. It is natural to want to help disadvantaged people; however, no matter how unbroken we may seem in comparison, it does not give us the right to tell another person what is best for them. For example, if someone told you that your religious beliefs were entirely irrational, leads to violent and unstable behavior, causes conflict and degradation of other human beings; therefore, We in our Right minds are obligated to make sure you take this medicine. If you do what we tell you, you'll be like us, you'll be better. Your life will be much improved to the barbaric ways and ideals you've adopted.
      Of course, that sounds rather radical, doesn't it? "Healthy" society often dictates what is proper and improper for mentally unhealthy individuals, tell us how to behave, coerce us (sometimes against our will) to imitate healthy society, or to go against our own judgments. Often, we are expected to act against behavior that might, in fact, be good for us.
    For example, it would seem on paper that allowing a mentally unwell person to engage in behavior that would encourage poor distinction between fantasy and reality (such as roleplaying games). Allowing a person with clinical depression, fairly severe anxiety, and complex personality quirks (such as trust issues) to throw themselves into roleplaying games, writing, or reading might appear like enabling addictive or isolating behavior... on paper. However, gaming requires a comfortable amount of healthy social interaction, but where it really *sings* to help the clinically depressed is engaging higher intellectual thought processes with imagination. I have personally seen how roleplaying games help a handful of people who are clinically depressed, and over a matter of years, such a hobby provides more than just a distraction.
    Well-meaning individuals would assume a regular schedule imitating "healthy" society would be the best medicine for steering the clinically depressed towards positive behavior. Many people would assume getting up early in the morning, a strict exercise routine, regular meals, set sleep schedule, etc. would be ideal therapy for the clinically depressed, but I strictly believe imitating a healthy schedule only serves to exaggerate how mentally unwell I am. While others seem to cope to such a schedule well, I feel more alienated by it.
     Now, I'm not saying the clinically depressed should enable their own illnesses to rule their lives, but there is a delicate process involved-- a balancing act, if you will-- between working with depressive symptoms and finding the right schedule and activities that actually do help the individual person.
    Roleplaying games offer one scheduled activity that a clinically depressive person can engage in like the typical poker night, but it is better than the typical social activity because of the research involved. RPGs have plenty of research involved that enables a person to dedicate attention and imagination to between scheduled gaming sessions. RPGs engage technical and critical thinking, imagination, storytelling and reasoning skills as well as provide a comfortable social activity. Close-knit gaming groups encourage forming healthy social relationships with others, which feeds back into the benefit of RPGs to the mentally unwell because gaming sessions become "socially safe" environments, where fellow gamers are unlikely to judge and micromanage another person.
    A part of having a mental illness is that it interferes with your life, and a huge aspect of learning to manage one's illness to improve one's own quality of life is learning what works for the individual. This process cannot and should not be micromanaged, because there is no "one" path to wellness, and micromanaging a mentally unwell person strips them of understanding the illness and separating symptoms of the illness with one's personality traits-- with who they are as a person foremost. The reason why it is morally wrong for anyone to micromanage or coerce a mentally unwell person into another's understanding of the illness and treatment is that it robs the unwell person of their freewill. Not only is it almost impossible for an unwell person to fight the illness for the approval or requirements of another, this gives a false sense of wellness for the individual sufferer. It robs them not only of their understanding, but interrupts and distracts from the individual's own progress. A shattered sense of trust can not only interrupt and distract from this progress, but encourages isolation and unhealthy behavior.
     Most mentally ill persons are not a danger to themselves or others. Speaking with personal experience, there is a great amount of trust involved in taking an unknown mind altering substance at the request of a stranger, who may or may not have your best interests in mind. Such a concept may sound paranoid, but it is still true. Even well-meaning doctors find it hard to accept they are morally obligated to fully explain medications and therapy to their patients under the mindset of "Well, they want to get better, don't they?".
Wanting to be "well" is different from being able to trust others. Wanting to be "well" is a complex issue for the mentally ill. Fear of drug-related illness, flat affect, and prejudice is overwhelming (at least for myself).
     Despite the advances in humane care for the mentally ill, prejudice and wrongdoing still exist. Doctors at understaffed and severely overbooked clinics might not be as dedicated to finding what's best for a patient, and are often unable to take the time to get to know a patient's needs if that patient cannot communicate them effectively. Not to mention, there is a long-standing history of abuses towards the mentally ill. Many people, even some of the mentally ill themselves, are poisoned by the idea that a desire to do better or fight off "less severe" illnesses (such as clinical depression and anxiety/phobias versus schizophrenia and bipolar disorder) is all it takes to enable and empower a mentally ill person to get on the road to recovery.
      Fighting off depression is like fighting off an addiction to cocaine, or severe alcoholism; except there is no set "trigger behavior" to steer a depressed person off the path of "wellness". Depressive persons who happen to fall into certain misfortunate socioeconomic classes also have the burden of poverty. "Getting better" requires a vast change in lifestyle for a poverty-stricken depressive. Often therapy and medication is required, and how can anyone expect a person to go through rigorous paperwork (to get assistance), the struggle to get back and forth between doctor's appointments (especially if homeless, without transportation, or with a job where you might be fired or have your hours reduced by taking necessary time off, regardless of what the Americans with Disabilities Act declares). The lowest paying jobs are often surrounded by immoral and illegal acts, and since the poor are not likely to be in the position to sue an employer (much less get a job after suing an employer), these acts go under the radar and unregulated.

 Things get more complicated if that depressive person is a single mother, who has children to care for.

As a good friend of mine pointed out, "And never forget the price tag on those medications. Provided they eventually find one that doesn't make you worse, or give you a new condition, or turn you into a completely different person (that one most likely when the patient is an introvert, as many of the anti-depressants 'fix you' by massively increasing extroversion, even if unnatural for... See More the patient), there is the perpetual terror that then, you will be forced to choose between your medicine...and food.

You can't always predict the direction that choice is going to go, either."

I agree entirely. More often than not, government or organizational assistance does not cover psychiatrist visits (rather leaving it to clinic physicians). More often than not, assistance programs covering prescriptions only cover a select number of medications, and might not cover the medicine an individual would prefer. Giving the mentally ill in poverty access to good care (rather than basic care), where an individual can select professionals not desperately overburdened by an overpopulated clinic, take the time to get to know and trust a professional, gain the tools necessary to understand one's illness and the full range of treatment options, and gain affordable access to a wider range of treatment options might actually break the cycle of depression and poverty. But the key really comes from the individual's understanding, willingness, and free will.

Having a mental illness already takes away certain freedom of choice, and no one wants to be forced or coerced into a way of life that isn't right for them. No one has the right to tell another person how to live.

The answer isn't as simple as asking for help.

    Many mentally ill people refuse to take medication NOT because they don't know it will "make them better", but because it doesn't actually help improve their lives or fear of radical behavioral modification, abuses or oversights by medical professionals, etc.
    No one has the right to tell another human being they must live a certain way. Copying the behavior of "healthy" people does not improve the mental health of "unhealthy" people.
Bipolar disorder or depression alone are common ailments of artists. As an artist, I firmly believe some of the chemical imbalances in my brain are good for some functions, such as giving a range of perception and insight to the physical, political, and spiritual world around me. It does "expand my mind", and if I were to take the wrong medication, I fear trading one set of familiar symptoms with a new set of foreign ones. I also fear flat affect, but most of all I fear getting worse.

I have experienced what it is like to have a medication make a person want to commit suicide and self-harm. I know it is a different experience than my lowest of lows.
I also know it is wrong for people to tell me I don't know what I am clearly aware and informed of, that I don't know what's best for me.

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