What/when change is possible

My therapist often deals with bosses, spouses, church leaders, probation officers, etc. who inquire as to whether and how fast behavioral change is possible with someone who suffers from mental problems. He tells them that change is almost always possible, it's just not often possible in that moment. For example, someone who struggles with rage issues may be able to learn to control their temper through years of training and self knowledge and growth, but they may be completely incapable of controlling their temper in any given moment. He says that this restricted ability to control behavior, where mental hardwiring meets a deficit of willpower or skill level, is really hard for people to understand who don't suffer from similar deficiencies in those areas. First, it feels like the person is cheating, coasting through life on excuses while the rest of us have to try so hard. Second, it's difficult to understand how someone couldn't just be able to make a choice in that moment to do something differently, e.g. "just relax".

A lot of people have experienced this frustration with me over the years,. Recently, though, I've had extensive experience with it myself from someone else who has a very entrenched personality disorder, but also has started suffering from major depression symptoms. For various reasons, I am to a large extent responsible for this person and must interact with him various times a week. And every week there is some new flavor of dysfunction going on in his life, despite a comprehensive cocktail of medication and weekly therapy. This week, it's an inability to get out of bed for anything but work. He is already suffering pretty serious health consequences from a lack of exercise, for which he is taking another set of medications. All of his doctors, mental and physical health, tell him to keep trying to exercise. He knows that it will improve not just his physical health, but his depression as well. He knows that he enjoys getting out and walking in nature. But it is just very difficult for him to do it, so difficult that he doesn't quite go to the trouble of trying. I have a very tough time relating to this, and after years of dealing with nearly limitless levels and varieties of dysfunction, my frustration levels can get pretty high.

The crazy thing is that I would have never had this experience at my most sociopathic self. There would be a snowflake's chance in hell that I would have continued to deal with someone like this for longer than a few weeks, maybe a few months in exceptional circumstances. So I've never actually had to confront this type of frustration at someone's inadequacies. The one great thing that has come out of it is that I now have much more cognitive empathy and understanding for what people have to deal with on the other side of the mental health problem equation -- the people without the seemingly intractable problem, but still have to deal with it on a regular basis.

But I think of a parallel -- my grandmother, who suffered a stroke and had to undergo a sequence of physical therapies. She did get better over time -- better bladder control, speech, decreased paralysis, etc. There were also some things that she didn't get appreciably better at -- lack of inhibition, sense of decorum or propriety, respect for the privacy of others, demonstrating an adult level of patience, and certain types of emotional regulation. She had in many ways the mind of a child to her death, but I bet that even in those things she could have seen further improvement -- too bad she didn't live 50 more years to reach that point in her trajectory.

And I know that as much as I have improved over the past few years -- almost no manipulation, more in touch with my emotions, stronger sense of self and identity -- there are still things I probably won't ever be able to do -- affective empathy, strong emotional theory of mind, understanding subtle emotional cues, conforming more closely to social norms and expectations, etc. Or maybe I will, it will just take some future brain surgery and/or 50 years of training. We'll see. 

The cruise ship story

I know this post is going to sound random to most people and morose to some people and everyone can agree it probably belongs in the category of navel gazing. But there is one story (probably not true, because I think I heard it at like a cousin's graduation or something) that I have heard that inexplicably haunts me. In fact, I'm surprised I have never said anything about it because I feel this strange compulsion to re-tell it to people, like the movie The Ring (which I thought was such a great metaphor for so many things in life, by the way).

The story: some lady wants to go on a cruise, but she is not financially well off. So she saves all of her money for years and finally has saved up enough to go. But she doesn't have a lot of money to spend on the cruise, a budget of $20 a day. So she figures she'll just bring along some food with her (saltine crackers and cheese) to save money. Now for whatever reason, this story makes me cringe. Because I haven't even cruised before, but my impression is that the standard cruise is all-inclusive. Some more upscale restaurants may charge additional fees, but at least the entry-level restaurants meals are included in the price of the cruise ticket. And of course this is true of the cruise in this story, except the lady doesn't realize it. Instead she has a great time, participates in the activities and goes to the different locations. The last night of the cruise she decides to treat herself and dine in the restaurant. She orders whatever she wants and she loves it. At the end of her meal, she waits for her server to bring the check. After a while, she flags someone down and asks for her bill. The server, surprised, tells her that there is no separate cost for her meal, it's included in the price of the cruise.

I feel like I should tell my therapist this story because maybe there is some deep seeded psychological issue behind the story for me (read here for a similar real life experience). Or maybe I should email my brain doctor, because he's good at dream interpretation and this seems similar. But I actually thought about it again tonight possibly in connection with the reason I keep thinking about it -- I thought about it in relation to my general lack of attachment to life or this world. I've simply never found life to be that compelling. Kind of like a tv show that maybe I might find myself stumbling upon on Netflix and watching the first season or so, but ultimately not getting that caught up in it. Like I don't hate it, and I like it well enough to sit through it and enjoy it, just not enough to keep wanting a bunch more of it. It's oddly a family trait. My brothers would also say that they welcome death, or at least that they have no fear or dread of it and that it will have elements of release or relief to it. (One of my sisters-in-law used to complain about it, worry that it would mean that he would abandon his kids by not trying hard enough to survive a disease or other injury. Interestingly, now she feels the same way about take-it-or-leave-it life and can't remember how she ever could have felt any other way, so maybe it's contagious). But even though I've always had a friendly stance towards death, I think I've always wondered if I wasn't just eating saltine crackers and cheese in my closet of a room rather than dining at the all-you-can buffet. And I think that more than anything else has been a secret wish or hope of mine. But I feel a little funny admitting that now because I've been in therapy with a great therapist for over two years now and have made a lot of reconnections to emotions and letting go of some of the more problematic personality disorder thinking patterns, have actually started finding fulfillment in my career, have better relationships with my family the last few years than I had in any other few year span in my life. But if anything, I feel even less thrilled about life than I ever have. Maybe it was the cutting back on the shenanigans. Maybe feeling my emotions more really and deeply is making me overall less satisfied with life. Or maybe I thought that I'd have found the way to the buffet by now if it existed, but the fact that I'm still here eating cracker sandwiches suggests that maybe this is it and I have to get better at appreciating what I have? I don't know, it's kind of hilarious because I feel like for the first time I am starting to have problems that only normal people have, but I haven't yet learned all of the coping mechanisms that go along with them.

Better than before

I thought this article was interesting (interesting enough to re-tweet the quote "We are frightened by people with mental illness." a few days ago) for its discussion of stigma and heritability of mental illness. But what has stuck most with me was the section where author Jenni Fagan talks about trying to get better by just paying attention to herself, her reactions to things, and making fine adjustments that seemed to put less stress on her brain or give her outlets:

[O]ur bodies want us to heal. My injured brain was telling me I had to change how I thought.

So I did. I bought a record player. I made a vow to brush my teeth each morning and not check emails until after I had breakfast. I decided to go out to dinner during episodes of severe derealization. I said I would not wait for my illness. I took train journeys where I thought I would not be able to stand at the end of them because my exhaustion was so severe it seemed I would have to just go to sleep on the floor. I told people.

Am I well? I am better than I was before.

A lot of people have asked me what I find most helpful in dealing with my mental issues. I tell them what has worked for me: gardening, playing music, writing the blog, therapy that is focused on helping me be more in touch with my own self (especially the origins and progressions of my thought processes), alone time, exercise, fish oil, a diet high in protein and fiber, excessive amounts of sleep (induced by sleep medications), not being around strangers for more than a couple of hours a day, being around family, writing, masturbating, being religious, listening to music when performing mental tasks to help me think more linearly, calling people by their titles to remind myself of both who they are and who I am to them and to treat them appropriately, finding relatively harmless mind games to indulge in instead of doing them with people I love, etc. How'd I figure these things out? I don't know, I just tried them and they helped (or tried stopping them and they hurt). 

Maybe I'm just self-medicating with some of these, and maybe in a way that simply masks problems instead of helping them to get better. Maybe some of these things are a crutch that I really don't need. But I don't think the only criteria for whether or not something is a crutch or perhaps an excuse to engage in bad behavior is just whether other people seem to find it distasteful. Some people might disagree with the way that I am religious, say that it is an opiate of the masses and ultimately contributes to my delusional thinking and megalomania. Others (probably not the same people) might take issue with the masturbation or the antisocial or selfish tendencies. And I'm sure a sizeable portion of people reading this will think that playing mind games with people is bad and I should stop doing that right away. But will those same people believe that I can keep exercising and playing music? Probably so, because somehow those are more popular/common amongst people aspiring to live "better". 

Here's the thing: I currently don't think that playing music and exercising are necessarily better or more noble or even more wholesome than masturbating and mind games. Or at least, I haven't yet learned to distinguish between those. Maybe I will eventually. Maybe I will come to see that some of those really are crutches/placebos and should never be indulged in by nobody ever. I am not ruling out the possibility. But I probably won't believe it just because you say it. Because maybe I will eventually learn that music and exercise are actually bad for my mind but mind games are good. Or maybe I should start taking long train journeys. I'm pretty willing to try whatever might help. And maybe I am doing wrong things. Maybe some of you care enough about me to tell me how/why. Or maybe some of you don't care at all about me and hope I get worse and then die.

Relatedly: medicinal marijuana? Legal farce contributing to social and moral decay? Or godsend to suffering souls?