Notes on Mental Conditions

The Periodical Weekend Edition

The Macbook zombie class that drives the current narrative around mental health insists that you will be heard and that someone will be there for you. They litter their articles and twitter threads with suicide hotlines, disclaimers, and other mental health resources, to show that they care, of course, unless you try and make sense of what’s going on in your head on your own. “Take the meds” is the most condescending, obtuse sentence that could ever be said to someone with mental issues that isn’t an outright lack of acknowledgement that there’s an issue in the first place.

Psychology and psychiatry as they relate to mental health fall into a category I call “best-guess” fields. Unlike math, where formal logic rigorously underpins the whimsy of theory, the core unit of the psychs is self-reporting. While we obviously collect statistics and build literature through the scientific method and effectively accruing sample sizes, as I’m fond of saying, “statistics do not apply to individuals in a population.” On an n=1 scale, virtually anything can happen. This isn’t an argument against the unreliability of human recall — rather, I want to highlight that we sort of have to take anything reported by an individual at face value, otherwise you have no direction at all. By nature, this would mean the individual reporting the condition is the most important source material for treating any mental condition medically.

To be clear, any rational person should and would heavily weight the opinions of established research and the individuals who have dedicated their lives to studying it heavily. But they cannot see inside your head, nor do they even operate with perfect information. We have literally no idea how one of the most common first-line treatments for bipolar disorder works. We don’t even know what exactly causes depression! (Chemical imbalance theory seems to have, well, just been made up and taken at face value.) It is pretty callous to deign any individual’s thought about their own mental health as unworthy of driving a course of action in favor of “trusting the experts”, because the model the experts use to medicate mental conditions is sort of a crapshoot. There is no “objectively right” drug to take — rather, there are “effective doses” that have helped some subset of people with some subset of conditions a certain percentage of the time, so perhaps under close supervision, you can find relief too. This, of course, is noble! The experts are trying to help. However, there is an individual receiving the treatment — in a sense, they have to let themselves be helped. Susceptibility to medical relief from a mental condition requires the individual to come to terms with a course of action.

I have generally seen two archetypes of people’s reactions to going to the doctor or shrink and being told they might have a mental condition. The first kind of person identifies with their diagnosis — something like depression, for example, becomes a core part of the identity of Person A. The receptability to treatment is high for these people, as the inclusion of the condition into their unique makeup itself implies a sort of “coming to terms”. I would say that most people fit into this category — psychiatry and therapy work and are highly useful institutions. There are innumerable success stories. However, the media in particular treats everyone like they should fit into this category, which is why there’s so little nuance in the discussion of hot topics like Kanye West’s mental health. It’s unfathomable to the laptop class that someone wouldn’t treat a condition, like how Steve Jobs still (justifiably) draws derision for his own actions regarding his cancer. Jobs’ case differs because treating mental conditions is much more esoteric — you can get rid of (some) cancers, but what exactly is “solving” bipolar disorder? The self-defined nature of mental conditions makes this a philosophical question. “There is no chemical solution to a spiritual problem”.

The second kind of person identifies against their diagnosis — particularly talented, intelligent, creative, or successful people. The receptability to treatment is much more volatile for these people, as it ranges between “needing to get help” versus “not feeling like yourself”. The ability to just “take the meds” is constantly in flux, as they feel like they’re fighting the medication on some level. It’s a battle against your own condition — it’s a dark thought to think that your own brain can set off a flywheel of behavior that is out of your metacognitive control. Furthermore, these conditions might not even be leading to primarily negative outcomes — mania can correlate with utterly incredible levels of output and achievement (though sometimes the results are a little haywire.) I wouldn’t be surprised at all if My Beautiful Dark Twisted Fantasy was the result of a manic recording binge. To these individuals, especially those who have driven themselves to incredible heights off their own mindsets, medication can utterly ruin your ability to operate as you’re used to. In my own case, the last time I was taking medication, my ability to generate words completely disappeared. To anyone who knows me, this is absurd — I’m well-known for constant conversation, prolifically writing emails, chat messages, and, of course, blog posts. The longer term followers of this Substack can probably deduce that this is what led to the months-long lack of output. I felt like I was consistently operating at 75% capacity. Was I “mentally healthier”? Perhaps. Is it healthier long-term to not be overclocking yourself mentally? Almost certainly. Was this palatable to me to remain medicated? Absolutely not. And I’m just some random individual — I don’t even have 22 Grammy’s or a now-destroyed billion-dollar fashion line. Do any of us have any real inkling of what it would be like to be gated from utilizing your own creative ability on that level? “Just take the meds” lacks nuance to the point of being smug, pompous, and utterly flawed. Yes, Kanye is clearly mentally unwell and said many awful, irredeemable things. But the way his mental health situation was paraded around and used as evidence of the perils of not taking medication was suffocating.

The medical model has helped me identify and process my own metacognition heavily over the years, and I fully believe that as the process gets more refined, it’s the best way to manage mental conditions going forward. At the same time, it has to be kept in mind that the only person who can acknowledge what’s truly going on in your head is you. Without a sense of self, we are nothing. Let’s have a little sympathy for individuals acting of their own volition.