Struck By Living

Coping with depression and living life to the fullest.

Dump the Shame, Not the Pills

Where is the divide between bad fit and mental illness?

Monk's Hood from Holy Ghost Trail near Pecos, NM
Marsha Linehan's Dialectic Behavior Therapy for Borderline Personality Disorders got me looking at the wildflowers in New Mexico through a different eye. Specific types of wildflowers tend to cluster in areas where they do best. Monkshood prefer stream front locales; fireweed thrive in spots of sun. On my hike along the Holy Ghost Trail last week, it seemed as though the flowers segregated themselves, sunflowers in one field, Aspen daises in the next. As my brown thumb has proved more than once, plants can be unbending in their requirements. With the right sunlight and water a violet thrives; under same conditions a cactus withers.

Linehan states "'goodness of fit' or 'poorness of fit' of the child within the environment is crucial for understanding later behavioral functioning." A good fit, where the child's talents and style are appreciated, leads to optimal results. A bad fit (where unrealistic expectations, abuse or cultural norms crush the spirit of the child) can lead to later behavioral nightmares. For example, Linehan cites that in numerous studies 75% of people with borderline personality disorder reported childhood sexual abuse. At a time when the seedling person is developing, abuse works like a drought. Abuse weakens roots, impedes future function and leaves the person less resilient.

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Inherent in Dialectic Behavior Therapy (DBT) is an idea of acceptance. We don't look at a cactus and rate it good or bad against a violet, rather we create the right environment for the plant. Linehan applies the same thought process to people and behavior. She doesn't judge behavior, but rather presents consequences of behavior.

Holy Ghost Trail near Pecos, NM

So this got me wondering, where is the divide between a bad fit and a malfunction of the brain called mental illness? Behaviorists might argue that bad fit leads to unproductive behavior, not a broken brain. I would argue that these two are so closely intertwined that it's hard to know which comes first: a malfunctioning brain or a bad fit that leads to dysfunction and eventually a broken brain. We don't have the tools available today to measure accurately the extent of psychological abuse on the brain, but it's easy to imagine a misfiring of brain electricity and chemicals due to a steady stream of negative experience. In the same way, a validating environment can cause positive physical changes to the brain.

Why does this matter? Some patients believe that all problems can be corrected by behavior modification. Medication is for wimps, those lacking the self discipline to change their behavior.  I fight this bias myself. I stopped taking my antidepressant medication in 2005 against my psychiatrist's orders. Despite the fact that I was high risk, I felt I'd changed my behavior and could beat the odds. Without informing my psychiatrist, I stopped my medication. I relapsed in 2007, requiring hospitalization.

My medication had no side effects. Why did I go off? Reason one: I believed I'd cured myself with behavioral change. Reason two: I didn't want my depression to be a lifelong management issue. Many people applauded my drug-free decision, all of us hoping I had my depression licked. Those cheering (including me) underestimated my genetic predisposition. Perhaps if my psychiatrist had a way to show me why my brain works the way it does - a brain scan - a blood test - something, I might have accepted his argument. Instead, I charged into the world without the protection of medicine and relapsed.

Aspen Daises
Holy Ghost Trail near Pecos, NM

Unlike plants, humans have the capacity to change their environment and the way they think. A violet can't erect a shade to avoid the afternoon sun. Our capacity to change allows us to use tools to create hope and harmony in our lives. Psychiatric medication is one of those tools.  If used well, meds can allow a person to thrive. Take that tool away, and some people shrivel.

If we place a violet in a desert expecting it to sprout needles and don a thick outer shell, we've overlooked the essence of being a violet. True acceptance requires an open mind, with the ultimate goal of patient wellness. I had to learn this lesson the hard way; perhaps I can spare you the trouble. Take the medicine. If medication works for wellness, don't dump the pills.

Cactus from Pecos National Monument

 

Julie Hersh is the author of Struck By Living: From Depression to Hope.

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