Sunday, February 22, 2009

So much of our lives are closed books to one another. I see you everyday, but I don't know your secret dreams, your hidden desires. Hell, I probably don't even know how you take your coffee. I am phenomenally good at keeping secrets; my own and other people's. I wonder sometimes how people feel who are professional secret keepers (who would those be? You ask. Priests. Doctors. Nurses. Therapists. Lawyers.) feel about this. What is it like to carry the secrets of not one or a dozen or a hundred but thousands and thousands of people? If you're a member of the Cabinet, what is it like to keep the secrets of an entire country? If you're a cardinal or Pope, what's it like to keep the secrets of an entire religion?
What would happen if we--not the professionals, bound both my law and ethics, but the everyday men and women on the street--told one another our hidden stories? What if we opened our shells just a little? Are we so afraid of being crushed that we'll cower behind walls of our own making forever rather than risk that soupcon of freedom? And some secrets are secret only because they aren't told, not because they're horrible or uncomfortable to share. Let someone know a little more about you. It's much more interesting to talk about real life than to hash over last night's Grey's Anatomy. Some secrets, both mine and others':

I know several women who have had abortions. One of them I held and massaged through her cramps and tears afterwards.

I know someone who actually won a red convertible from the McDonald's Monopoly instant-win game.

I know at least a dozen women who have been sexually assaulted--by friends, fathers, uncles, strangers, husbands. In no way did I think less of them after I knew. In fact, I was inspired by their fortitude and courage in surviving, and in telling me.

In middle school, I went to the national spelling bee in Washington, D.C. I was eliminated on the word "indefatigable."

I know a lesbian nun.

I started smoking with some regularity when I was 13.

I knew someone who died in a plane crash.

My second college roommate was Susan Sontag's niece.

In high school, someone scratched "Dyke" into the paint on my locker. I suspect it was the same kid who later called me "Lesbo" and hit me in the stomach. No one ever did anything about it.

One of my high school friends killed himself right after he loaned me Mark Twain's "Stories from Earth." I still have the book; I don't have Josh.

One of my friends found out she had 'dysplastic cells' from HPV in high school. Two years later her mother died of cervical cancer. I know she must be frightened, but we've never talked about it. Maybe we should...

Of my med school class, I know at least 4 of us have eating disorders, and that many more than that have what might be termed 'alcohol problems.'

Sharing a secret with another human being is one of the quickest ways to diminish its power. It also forges a bond between you and that other person. It doesn't have to be your deepest, darkest desire; it can be that you were the 'weird kid' in elementary school, or that you make your own kim-chi, or that you've always been afraid of dogs. Face your secrets, then share them.

Saturday, February 14, 2009

Psychiatric Diagnosis--who decides?

The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed.--Thomas Szasz (a psychiatrist himself!)

So, I've been reading a lot about PTSD (post-traumatic stress disorder) recently, and noting some interesting things. Yes, psychiatric diagnosis is useful to the extent that it guides treatment, helps someone understand themselves (or others) better, or provides insurance benefits. When is it not beneficial? When it's used as Szasz describes, of course, or when it becomes the sole focus of the therapeutic endeavor--ie, the psychiatrist begins to treat a diagnosis rather than a patient. But the very process of diagnosis can be biased and inappropriate to the particular circumstances. For instance: who is primarily diagnosed with PTSD? Yes, soldiers, but who else? If you guessed sexual assault survivors, good job.

So, what are the symptoms of PTSD? Some are arguably pathological, yes, and to the extent that any of these symptoms cause suffering it may be appropriate to approach them as treatable dysfunction, BUT I think it is essential to recognize that these are not pathologies inherent to the individual, but to the traumatic situation itself. The patient is having a normal reaction to a profoundly abnormal situation. Labeling with a psychiatric diagnosis may cause undue stigma and further suffering in addition to the "condition" the patient is perceived to have. So what about PTSD symptomatology, particularly as it pertains to rape survivors? Some of the symptoms seem not to be pathological at all when viewed from a female perspective (yes, I know men can be raped too, but roll with me here--I guess what I mean by the 'female' perspective is the 'constant awareness of being a potential target' perspective).For instance, 'hypervigilance' is one symptom of PTSD; being victimized DOES make a person more aware of their surroundings. Once bitten, twice shy, as the saying goes--and who decides what constitutes HYPERvigilance anyway? I would think being traumatized would make you pretty effing vigilant, to try and keep it from happening again (even though, of course, it wasn't your fault), and who the hell am I to tell you how vigilant you should be? Irritability--hell yes. Trauma and suffering tends not to bring out the best in anyone, and if I've been raped and you tell me I'm being excessively irritable, you're suddenly going to have a whole lot more irritability to deal with (and possibly head trauma). Intense psychological distress at reminders of the event, and subsequent efforts to avoid such triggers--well, if you have a panic attack every time you smell cigarette smoke, you're probably not going to be hanging out at a lot of bars. I mean, it doesn't take a Mensa member to figure that one out. And intense psychological distress at reminders--well, isn't that kind of a given? Does the average person, who has undergone much less acutely traumatic events, not have similar reactions? Who likes being reminded of their messy divorce, the time they broke their arm, their first car accident when they were sure their parents were going to kill them and bury them in the backyard? Yes, of course, it's a matter of degree; but it's also a matter of perspective. I wouldn't go out for a run at dusk; if I were a man, that might be considered hypervigilance. Since I have a vagina, it's just business as usual, and a man who tried to give me a psychiatric diagnosis based on my desire to protect myself from potential pervs in Forest Park would earn himself either an impromptu lesson on gender sensitivity or, failing that, a swift kick to the groin.