throwaway158458

I guess it's only fair that I reveal my bias here: I am deeply skeptical of people who claim to have a philosophical or political "answer" to "mental illness". In my experience, most such people seem to be utterly unfamiliar with the effects of unusual physiological states on the mind, and ultimately find their inspirations in the more flowery and idealistic schools of philosophy rather than in the scientific crucible of rationality and empiricism (neither is sufficient on its own: the two must be joined to make any sense of the world; this is, at any rate, my reading of Kant and his critics).

All that said, I'm a little confused by your invocation of "R.D. Laing etc". Usually, the name I see paired with R.D. Laing is Thomas Szasz, and I am far more receptive to the former than the latter. As far as I understand it, they had some pretty deep disagreements. Perhaps Foucault is closer to Laing than to Szasz, and you meant something closer to Foucault's formulation of mental illness, but I am less familiar with his ideas. I admit a certain reluctance to risk exposing myself to yet another flavor of pontification uninformed by experience (there are so many to choose from, and it seems that they uniformly exhaust my patience; I can only spare so much effort entertaining "learned" people who dismiss my lived experience as utter delusion).

As it happens, I was prescribed an ADHD drug by the same psychiatrist who ultimately urged me to pursue the physiological diagnosis whose treatment I actually found helpful. I found that the drug was only modestly helpful at best, and he was quite receptive to my assessment that I should discontinue it. I actually still have almost a month's supply in my cupboard, have felt no temptation to (ab)use it, and am not sure whether I should turn it in to the DEA (it being Schedule II, which is supposedly accounted with some precision) or quietly dispose of it in the bags of my paper shredder.

(I'm being a little vague here, but given the still-extant stigma around "mental illness" and the amount of data collection that is now commonplace, I'm a bit paranoid about revealing enough to identify myself even under a throwaway account)

After ~20 years of on-and-off psychiatric treatment (some fairly intensive, some not, none especially effective), I found a psychiatrist with enough sense to strongly recommend that I get the relevant lab test. He had to tell me to request it from my primary care doc, because according to the worldview of American health insurance a psychiatrist is not qualified to order said lab test. My primary care doc gave me a questionnaire. My score was just below the threshold where the lab test is considered warranted. He told me he'd figure out how to make it work. I guess he did, because I got the test, got it interpreted by ${DOMAIN_EXPERT}, and got a prescription for treatment that seems to be working pretty well (albeit not perfectly).

Do you think that people who are not clinically depressed (or suffering similar symptoms as part of another diagnosable illness; e.g. hypothyroidism, hypogonadism, inborn errors of metabolism, (pre)diabetes, sleep disorders, Parkinson's disease, dementia) compose a substantial portion of people who experience suicidality? If so, can you identify any empirical evidence supporting that belief?

I think you misapprehend the situation. Based on my experience with suicidality, the "BS" isn't what actually prompts the suicidal thoughts. Rather, it's post-hoc rationalization for the irrational feeling of having no future worth experiencing. In a broader sense, this is something that people do all the time: we experience an emotion, then try to explain it after-the-fact. Our brains are incredibly adept at inventing "reasons" for experiences and sensations that ultimately stem from bizarre defects of biology and other caprices of circumstance. The mythologies associated with sleep paralysis (the hag, incubi/succubi, alien abduction) are perhaps the most vivid examples of this phenomenon.

It wasn't a philosophical problem for me. It wasn't that my value system was distorted, it was that my entire experience of existing was distorted. I could logically affirm that positive experiences are possible all I wanted, but they were somehow profoundly remote, in a parallel universe that I could vaguely remember but no longer existed in. It's not just that I had confirmation bias and fewer positive experiences, it's that my entire perception of everything -- every thought, every experience, every future possibility -- was so warped that positive experiences seemed like an impossible fantasy. More than once, I overcame a tremendous amount of lethargy and pessimism and tried to have a positive experience, and I simply couldn't experience it as positive, no matter how good it "should" have been.

That is the power of having a seriously screwed up brain. My symptoms improved not with antidepressants or psychotherapy or self-help, but with treatment for a previously undiagnosed chronic physiological condition. Despite having a "real illness", I've found validation for most of my experiences in first-hand accounts of people with "mental illness" (which is defined in such a way that the practical definition is "any psychological symptoms not explained by a lab test known to your GP"). Allie Brosh was mentioned by another commenter, and I definitely had a "holy crap, someone else gets it" moment when reading her "Adventures in Depression" comics.

I agree. People talk about "professional help" like it's categorically a good thing. Unfortunately, that's not always the case.

It is incredibly important to understand that many inpatient facilities are profoundly hostile environments for some patients, despite claims of a "therapeutic milieu" (which is somehow exactly the same for both depressive and manic disorders; sure, of course that's credible /s). Based on my experiences at the only two such facilities in my metro area, I would be very, very, very hesitant to ever admit to suicidal ideation in the future. The idea of going back to such a place is enough to make me consider the risk of "going it alone", even knowing that doing so could be a fatal mistake. Comparisons to imprisonment are not exaggerations: it absolutely did feel like punishment, like I had no rights, like the staff merely treated me as a "problem" rather than as a patient or client. Some of the "professionals" were not worthy of the term, particularly the "clinical social worker" types (some of whom expressed, with complete confidence, deeply weird and absolutist "theories" of mental illness that correspond to no credible theory that I've read about in reputable literature).

(punchline: my depression was almost certainly caused by a chronic physiological disorder, one which neither facility screened for; most of the "treatment" I received was probably exacerbating my condition instead of improving it)

I guess if I had to make this venting "practical" I would say this: if you ever have a close friend or family member in an inpatient facility, and they tell you that they really, really need to leave because it's a bad place, believe them. No one else will.