NOT WAVING, DROWNING
Reading Sarah Krasnostein’s beautiful, sick-making Quarterly Essay, Not Waving, Drowning, in a local park beneath dappled autumn light, I was reminded how much of my relatively good mental health now is simply the product of time, money and language.
It wasn’t always this way.
When Orygen’s director of clinical services, Dr Andrew Chanen, tells Krasnostein that “a lot of the problems associated with BPD [borderline personality disorder] are not part of the diagnostic criteria,” it made me sit upright, leaning into the revelation of those words.
The constellation of confusing presentations to emergency departments, the “difficult” behaviour of people seeking help – none of this is necessarily inherent in BPD, as Chanen says, but in “things that we create.”
“They’re diagnostic of the mental health system,” he says.
And, as the essay addresses, these harms are inflicted well beyond the mental health system silo. They are all around us.
During the promotional run for My Year of Living Vulnerably – a book I wrote to make sense of my recent diagnosis with complex post-traumatic stress disorder (cPTSD), a condition with very close links to the BPD of Krasnostein’s impressive case study Eliza – I spoke offhand about the seven or so psychologists and psychiatrists I had seen over the course of a decade in a bid to get better. Because I had initially been diagnosed with depression and an anxiety disorder all the way back at university, this was the label that stuck. And that, apparently, would have been the end of the matter if, at age thirty and armed with hard-won knowledge, I had not finally demanded a reappraisal.
After one radio interview, I received an email.
“I was that uni psychologist that stuck those very sticky and unhelpful labels on you. At the time, as a CBT [cognitive behaviour therapy] therapist, that’s all I could really see to fit with our brief discussions. How much more I know today,” the psychologist wrote.
“Anyway, I just felt compelled to say I’m sorry I didn’t know or have the time to help you understand that little seven-year-old Rick, that vulnerable little boy, was still showing up, and we needed to work together to help him feel safe and connected.”
To be clear, I have never once blamed this person. They, too, were the product of an inelegant system designed to spit out inelegant solutions. And they are, through this kind of eternal curiosity, a force for good. But it is true, too, that those original sticky labels produced something of a tunnel for my own treatment. I have been on medication – SSRIs, once daily – for seven years, although it is now clear they were not needed. These pills produce terrifying withdrawals. The CBT so favoured by Medicare is not particularly well suited to treating trauma-related conditions: there are better options. In my lost decade, I didn’t even know to ask for them. Like Eliza, there was no language available to me for what had happened and nobody, in all my frenzied interactions with the system, who could speak it.
What is maddening about all of this, as Krasnostein correctly observes, is that we have arranged our collective social mind to hide away the uncomfortable truths about mental illness. It feels too big, I suppose, to stare down the role of poverty; family dysfunction; the harsh illogic of the justice system; chronic pain and physical ailments; the stress of being any kind of “other”; physical or emotional traumas; and government systems meant – at least in our conception of them – to provide support but which come booby-trapped by negligence or, worse, malicious intent (Robodebt, anyone?), such that they can grind the very objects of their attention into paste.
Yes, it all sounds very hard.
So we open a new Headspace, launch the 874th awareness campaign and double the number of Medicare-rebated psychological sessions in a given year to twenty. More of the same, with the same results. Of course, some of the approaches that will make a difference are not very “hard” at all. It just takes money. Not only in mental health but to pay people enough through the safety net that they are not destitute. That is, payments above the Henderson poverty line. Housing that is affordable and accessible; services in justice that do not, as Krasnostein writes, “mistake the last note for the whole song.” So much of our public expenditure is, in the old parlance of health bureaucracy, sending ambulances to wait at the bottom of the cliff. It has become fashionable to frame these moral truths in the language of ideology. Unemployment benefits, according to some, are not meant to be “easy” to live on because then people might actually manage to live on them. But if you’re not inclined to believe the bleeding hearts, ask the hard-headed economists and researchers at the Productivity Commission whom Krasnostein quotes at length. Loath to use the terms of neoliberalism though I am, this argument from conservatives and reactionaries is lost even on the doctrines of their sacred economic temples.
What we continue to ignore is making us sicker.
I think of all this when I am reading Krasnostein’s QE in the park on an afternoon when, despite recently living through one of the most multidimensionally stressful periods of my adult life, the earth does not threaten to swallow me whole. The ground does not tremble, precisely because I am lucky. To have work that I am able to do, that I enjoy doing and that pays me well. Work that allows me to look after my family and preserve their dignity in the face of otherwise diabolical circumstances. My being here, reading this clarifying essay, is pot luck. Still, despite working myself raw in fear of losing the only thing that afforded me a skerrick of agency in my own life – my job – there were so many months where it almost all came undone. Months where I spent every last cent I earned on out-of-pockets, running the roulette of bulk-billed GPs wherever in Australia I could walk in when needed. One of them kicked me out of his office when I asked for a new mental healthcare plan, because that would have taken fifteen minutes and he hadn’t had lunch.
On paper I was income middle class, albeit with none of the structural advantages of those born into this category, and still I was drowning. What hope the millions of Australians with fewer resources? With deeper and more complex layers of hurt?
Instead of offering them a hand in the churning water, we’re commenting on their stroke. Lazy, defective, morally culpable perhaps. This kind of thinking is baked into public life.
A little love, in the sense that love is a way of saying I see you, would remove at least some of this degrading nonsense. But as anyone who has ever loved anyone in any way knows, it can be difficult to inhabit the lonely chambers of that place.
“Ignore words and look at outcomes,” NSW Hunter Region GP Adrian Plaskett tells Sarah Krasnostein. “For the health system, have a think about areas that work really well. Emergency – you have a car accident, you have a heart attack – we have extraordinarily good outcomes in Australia. Intensive care – does a wonderful job.
“Any sort of emergency surgery – public health is great. Cancer is pretty good – my sister had breast cancer last year and it all went pretty smoothly. And then ask yourself: what are the parts of the hospital that the middle class uses? There it is. What are the parts of the hospital that poorer people use? There it is.”
This is a shameful state of affairs when we know, in our sinew, that people help create governments, and governments can help engineer a little luck. When we and they manage to do this, however, we call it something else.
We call it help. We call it love.
This correspondence featured in Quarterly Essay 86, Sleepwalk to War.
ALSO FROM QUARTERLY ESSAY