“The tears of the insane bounce like bullets off my brain.” The words of “Country Joe” McDonald about New York City — where I was, as I like to say, “lowered” — still resonate.
The world is too much with us and the mind’s center does not hold. Everywhere we look, the brain is under assault from within and without. Worst of all, we remain at our most primitive when it comes to understanding the organ of our consciousness and humanity. The degree to which we can treat and improve what happens above the neck in our sentient life receives scant funding compared to research in other aspects of health. The National Institutes of Health, America’s largest health research funder, puts twice as much money into cancer as it does mental health.
The mind is everything. If we see suffering as transcendence, a principle upon which major religions are based, even the worst experiences can be borne. Perspective is all. Psychiatrist Victor Frankl in “Man’s Search for Meaning” sought to make sense of survival in the Holocaust. In our own way, we each are searching for a reason for being and doing. In normative times and with a mind functioning to make it through the day with reasonable ease, we think we know what sanity is and where the shadowlands hide in wait.
This, then, is the nonsense we tell ourselves to believe we are chosen for survival. We are the “normal” ones — unless, or until, we are not. If we make it through the traumas of childhood and adolescence, we may get to productive middle years, only to find that senility and erasure of self greet us at the dark end of the street. The death-in-life of my mother’s final decline last year was but one manifestation of the fragmentation of thought that occurs for most of us at junctures in our lives. When those inflection points stretch into lines, we declare “mental illness” and send in the experts. For the most part, we rely on systemic medication. In conversations I have had with insurers, talk therapies are funded below minimum durations needed for effectiveness. Obamacare may have declared parity, but with an abridged calendar.
Big Pharma is its own version of Las Vegas. There are certainly helpful medications, and even life-changing ones, but it is a crapshoot at best, and the trial-and-error can be lethal at worst. With the advent of individualized medicine, we may be on the cusp of slowing that wheel of fortune and tuning treatment — chemical, biological, hormonal, electromagnetic, immunological, digital realignments of neuroplasticity, the list of promising directions swells — but for now we still fall as much as rise. “Stumbling Into Happiness,” as Daniel Gilbert described, is the path of hope led by imagining our futures. Science strives mightily to improve on stumbling.
One day it will. Some say answers are there now if only we would apply them more equitably, accessibly, non-judgmentally, with best practices. It starts with open conversation and an open mind. A provocative piece in last month’s Sunday New York Times Magazine makes a case for no medication at all, choosing rather to accept psychosis into a person’s life, just as other cultures called those visionaries whose brain chemistry announced alternative universes beyond sight. Indeed, all reality is subjective. Who can say what is real or “normal” when murderers are generally not qualified into treatment for “insanity” and the leader of Russia seeks to pillage and destroy Ukraine, while within our own shores an entire political party adopts an Orwellian lie? Is there any basis to what is inside or outside psychopathology?
Small wonder that young people reject societal norms. With each school shooting — Roseburg, Littleton, Blacksburg, Newtown, Parkland, Uvalde — nothing changes or improves, while the pundits on cable news castigate the “mental illness” of the perpetrator, typically a troubled adolescent. Nobody notes that the vast majority of those who suffer psychosis are a danger only to themselves. Artificial intelligence may help us get in front in these cases, but early intervention will also need to navigate the threat of further stigmatization of those who trigger mental illness algorithms. The danger of discrimination looms large in a world in which guns are ubiquitous.
I look around, search family history, peer into the mirror and I see periods of peace and stretches of war. Consciousness of mortality, struggle, suffering, decline, lost jobs, lost love, lost loved ones, is a dark hole with tremendous gravitational pull, while the warming light of distant suns is ever subject to eclipse. Our lives are, as Victor Frankl posited, as livable and upbeat as we are able to make them. There may be choice involved, but all too often choosing isn’t yet graspable. We keep striving to achieve whatever sanity is within reach. Lend me your hand. Here’s mine.