Crazy Maybe, But Not Insane

March 29, 2019

“Our society is becoming increasingly perfectionistic. Falling short of complete happiness or failing to have a worry-free life is too often translated into mental illness. Our goals are set to high and our expectations are unrealistic—especially when it comes to our kids,” wrote Dr. Allen Frances in Saving Normal: An Insider’s Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life.

I finished the above book by Dr. Allen Frances a few weeks ago, and I can’t stress enough how important it is. Saving Normal is a must read for anyone who (1) struggles with mental health, (2) has been prescribed psychotropic medication, or (3) is raising children.

We as a society are in too much of a hurry to find immediate solutions to our problems. We look to medications and “gurus” of all kinds to provide us with instant relief. We hand over our trust to unvetted and undereducated doctors every single day.

I have worked in and around the field of western medicine long enough to understand its benefits, but also see its appalling deficiencies and misappropriations, especially when it comes to mental health.

“Eighty percent of prescriptions are written by primary-care physicians with little training in their proper use, under intense pressure from drug salespeople and misled patients, after rushed seven-minute appointments, with no systematic auditing,” Dr. Frances wrote.

I am certainly not a doctor, nor have I played one on TV, but I do know what it feels like to be depressed, anxious, and desperate for relief. And to those considering psychotropic medication to feel better, I would say: try everything else first. Examine your alcohol intake (drinking doesn’t eliminate sadness or stress, it just saves it for later), read a book, mediate, take a walk, take a cold shower, cut back on social media, et cetera. And if you find an approach that brings you any solace, do it again, and again, and again.

Because, in the not-too-distant past, we as human beings faced down a range of life’s problems with nothing more than grit and time. But these same problems are now being diagnosed and treated as mental disorders. And “because of diagnostic inflation, an excessive proportion of people have come to rely on antidepressants, antipsychotics, antianxiety agents, sleeping pills, and pain meds,” Dr. Frances wrote. “We are becoming a society of pill poppers.”

According to a November 2017 analysis from the National Center for Health Statistics, 12.7% of the U.S. population over the age of twelve (somewhere around 40 million people) took an antidepressant medication during the month prior to the study’s publication.

We seem to have forgotten how stable and resilient human nature really is. The uptick in the diagnosis of mental illness is not due to some unforeseen epidemic, but just a much looser definition of sickness. The “worried well,” who are regularly stable and content, are being caught in the widening net of vague mental disorders.

“Our ancestors lived through wars and privations unimaginable to us—without resorting to an overdose of labels and an overuse of pills,” Dr. Frances reminds us.

Along with fortifying our innate will to live, we also need to cut ourselves some slack. Being human is hard and a burdensome responsibility. We are the keepers of the most complex organism in the known universe, and it sits right between our ears. The existential joke is, though, we do not have a clue how it works.

But don’t worry, you aren’t missing out on some secret. No one truly knows how the mind works. “Our thoughts, emotions, and behaviors are the final result of an indescribably complex coordination of billions of cells firing off in a carefully tuned, exquisite equilibrium,” Dr. Frances wrote.

Yet, we still believe we have a map of the mind’s wanderings. And in the rush to heal ourselves from the absence of perfection, we forgo time-tested treatments for nearly every physical and mental ailment known to man. Treatments like: exercise, proper diet, and moderation of or abstention from alcohol, tobacco, and drugs. Which, as far as drugs and alcohol go, all tend to “hit the brain with a huge wallop that can mimic virtually all the psychiatric symptoms in the book.”

After reading Frances’ book carefully, I got the strong impression that the best advice you can get from your doctor is: don’t do anything.

“The best way to deal with the everyday problems of living is to solve them directly or to wait them out, not to medicalize them with psychiatric diagnosis or treat them with a pill. Prematurely resorting to medication short-circuits the traditional pathways of restorative natural healing.”

The imperativeness for us as individuals to become active participants in the betterment of our own lives cannot be understated. It is hard enough to understand how we feel and why, without the meddling forces of government and for-profit organizations. As with so many other problems in the world, diagnostic inflation is exacerbated by greed. Money is not the only cost to us as the unwitting consumers of misinformation and receivers of mistreatment. 

“The most senseless driver of diagnostic inflation is the way medical insurance works in the United States. To get paid, the doctor must make an approved diagnosis,” wrote Dr. Frances. And the “premature rush to a reimbursable psychiatric diagnosis often results in unnecessary, potentially harmful, and often costly treatment for problems that would have disappeared on their own.”

Or as Hunter S. Thompson once said: “Quacks are a part of our culture, and we all fall prey to them. Who among us can say, for sure, that even our own personal physicians are honest and competent?”

As imperfect humans, our emotional resolve is tested daily and hourly. We can be as sensitive to the slights of others, as we can be insensitive to the needs of others. Harsh words sting us, but no words defeat us.

But rarely is our mental metal tested so acutely than by the death of a loved one. But, as Dr. Frances wrote, “To mislabel grief as a mental disorder reduces the dignity of the life lost and of the survivors’ reactions to its loss.” When you lose someone, it’s going to hurt like hell. Rushing to get over a tragedy, through medication and avoidance, only saves the real work for later. “Most people will recover just fine after the loss, without medical meddling and pill popping.”

Shout it out, cry it out, talk it out, or as a very last resort, drink it out—it really makes no difference. Just don’t blot it out or wash over it with medication. Wear your grief like a badge of honor. To have loved someone so much that when they are gone you go a bit off the rails, is not weakness or sickness, it is a special kind of beauty. We should all be so lucky. 

Our emotions ebb and flow like the tide. Riding out whatever storm you’re facing takes courage and hard work. But to give up control of your struggle to medications and shortcuts is to take the easy passage home. But I warn you: the lighthouse you’re aiming for is surrounded by enormous rocks, sitting just below the surface.     

I’m probably repeating myself at this point, but when it comes to grief, depression, anxiety, et cetera, Dr. Frances tells us, “People should have more faith in the remarkable healing power of time, natural resilience, exercise, family and social support, and psychotherapy—and much less automatic faith in chemical imbalance and pills.”

With all that being said, certainly do not go off and join the Christian Scientists, or some other group who believes “that sickness is an illusion that can be corrected by prayer alone.”

Pretending to be fine is just as dangerous as being over-treated. “Be skeptical, but not cynical,” Dr. Frances wrote. “Used correctly, medication can be very helpful and sometimes curative.” He also reminds us that “it is equally dangerous at either extreme—to have either an expanding concept of mental disorder that eliminates normal or to have an expanding concept of normal that eliminates mental disorder.”

Ultimately, from his book, Dr. Frances wants us to take away two very important lessons about the dichotomy of mental illness, treatment, and diagnosis.

  • One: “Don’t jump to the conclusion that you are sick just because you are sad or anxious. Give yourself time to sort things out and see how nature takes its course.”
  • And two: “Real mental disorders need attention from a mental health clinician. Don’t be shy about getting professional help when you need it, but avoid it when you don’t.”

Or as Hunter S. Thompson also said: “‘Crazy’ is a term of art; ‘insane’ is a term of law. Remember that, and you will save yourself a lot of trouble.”

When all else fails, just act normal.

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