Archive for November, 2010


Dear you,

Simple human decency – that’s really all I insist on in relationships.

I am a low-maintenance kind of partner.  I do not expect text messages at every possible work break, gifts, constant reassurances of love and my own self-worth.  My sense of self-worth does not reside in anyone else’s opinion of me.  I don’t freak out if you’ve been talking to your ex, I don’t fly off the handle with jealous fits, I don’t resent time spent with other people who aren’t me, friendships, family obligations, hobbies or interests I don’t care about.  I don’t care if you are dating somebody else if you are being honest about it, not when we’re not living in the same state and aren’t going to be anytime soon especially.  I don’t ask if these jeans make my ass look fat, and even if I did, I wouldn’t then punish you if the answer wasn’t what I wanted to hear.  I don’t need anybody to pay my bills, bail me out, or prop me up.  I understand work and life obligations.  I don’t have unrealistic expectations that a partner is going to “complete me,” nor that a long-distance relationship is going to magically not have any challenges, up to and including the dreaded “I’ve met somebody else.”  I’m not needy, I’m not passive-aggressive, I don’t expect people to read my mind and punish them for not doing so, and I strive to be a clear communicator.  Furthermore, I’m not all that bad looking for my age, I’m of higher than average intelligence, I have a sense of humor, and I’m reasonably skilled, responsive, and attentive in bed.

In sum, I’m not some histrionic psycho who needs to be handled with kid gloves, I’m not some piece of trash you picked up on the side of the road, and I’m not some idiot who begs to be lied to.  I am – or thought I was – your friend, and I expected that friendship to mean something even if the more-than-friends part of it were to end.  All I ask is simple human decency, and to be accorded the same respect and honesty that you would accord to any friend of twenty years, whether or not that person had also been your lover.

How, then, in your eyes, do I deserve the treatment I’ve received at your hands?  How do I deserve to be lied to? How do I fail to rate a heads-up that our relationship is over (and given that your new partner has issues with me on account of our having been together in some romantic and sexual capacity for several years, therefore our 20 year friendship is over too)?  How do I fail to rate even a phone call before you publicly announce your new relationship status, and the fact that you are about to have a child with this person you’ve known for a few months, to your facebook?  How does that math come out, exactly?  I can’t figure out if you’re incredibly heartless and inconsiderate, or just incredibly stupid.  I can’t figure out if you think I’m some dangerous psycho who needs to given bad news at arms length, or if you simply think that two decades of friendship and several years of more than friendship are just worth that little.  I can’t figure out if this is a reflection of your real feelings towards me, which you did an excellent job of actively deceiving me about for some unknown and unwarranted reason, or if you are just that big of a selfish, cowardly asshole and it’s nothing personal.

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As I mentioned earlier in a post that is probably too long-winded to actually be of much use to anyone skimming for info/resources, there is some controversy over the existence and diagnosis of complex PTSD.  That post outlines part of why the complex PTSD diagnosis has come to exist: the DSM manual has a list of symptoms and things to look for that inquire about and search for “the event.”  Thus the intake checklists and questionnaires, and thus the diagnosis, and thus the treatment that follows, often vary depending on whether or not a psych professional and/or a person looking for help can point to “an event.”  I have had PTSD ruled out before. I have ruled it out myself.  I currently have a t-doc and p-doc who concur on the diagnosis.  I personally don’t know what I believe, but I can tell you that the treatment strategies that are or can be on the table now are a lot more helpful for me than any of the strategies I’ve tried before.  Right now that’s good enough for me.  And because a psych doc will sign a piece of paper giving me a Proper Categorical Description, my insurance will pay for me to go to a t-doc and a DBT group.  If that psych doc didn’t “believe in” complex PTSD – in PTSD without the single defining “event” — then my insurance wouldn’t pay for my therapy (it would be happy, however, to keep paying for my drugs.  I happen to not want to be on drugs, though, and therapy costs them more more, so I can’t tell you how relieved I am to have finally found a p-doc that listened to me when I said that Prozac made my life unbearable and that worked with me to find some alternatives).

Here’s part of the deal: complex PTSD is not in the DSM.  This leads some people to say it’s a non-existent thing.  But the DSM is prescriptive, not descriptive.  Diagnosis starts with matching symptoms to checklists, and continues with the differential (and that is a shaky spot for psych stuff, and an honest psych doc will admit that).  But we aren’t talking about a liver whose enzymes we can measure with a test and a machine. We are talking about people who are big complex dynamic combinations of nerves, organs, feelings, memories, attributes, temperaments, etc.  We are talking about a profession that insists it is scientific and that things are quantifiable at the very same time that our only data points come from self-reporting and subjective experience (and the descriptions of p-docs who aren’t sitting in the skin of the person they’re categorizing).

And diagnosis has a big part in shaping how we conceive of and categorize stuff.  Once upon a time, there was “no such thing” as PTSD, if its inclusion in the DSM is the criteria for something being a “real” disorder.  Right now, there’s a “disorder” in the DSM called “Gender Identity Disorder” and another called “Transvestic Fetishism.”  Now, as far as I’m concerned, this is 17 shades of fucked up and what we *ought* to be treating as pathological is a society that can allow the sort of bullying and institutional prejudice and abuse it allows towards transgendered people.  To me, the cultural and scientific perspectives that produce the DSM are what’s in need of treatment, with its authoritative pathologizing of affect and desire and identity of non-white, non-middle-class, non-first-world, non-hetero worldviews.  The DSM prescribes based on deviations from the norm. But the norm is itself a construct that the DSM itself helps construct.  It’s a big serpent-eating-tail phenomenon.

But one of the good things that comes from Gender Identity Disorder existing as a diagnostic category for the psych profession is that it validates the experiences and feelings of a lot of people who might otherwise be dismissed, electro-shocked, shamed into repression or suicide, ridiculed, etc.  Does that mean “yay, hooray for pathologizing difference!”  No.  but there is very much a way in which its inclusion in the DSM makes it “real.” I don’t just mean in people’s heads.  I mean in ways that are tied to reforming laws, to allowing access to therapy and surgeries, to making some lives tolerable that were intolerable before (because something that isn’t “real” can’t be responded to as if it’s real, and like it or not, inclusion in the Holy Scientific Tome of the DSM-IV makes things “real” on some levels, in some areas of life and politics and medicine and praxis and ethics).

(Of course, this shades over into very real concerns about the potential for abuse of fuzzier or more labile diagnostic approaches, and a real concern is that changing the DSM will mean allowing for more disability claims fraud and courtroom proceedings bullshit.  “It’s not my fault I murdered my wife because my daddy used to spank me.”  I’m aware of this problem.  But even this should underscore just how “real” the DSM can make something, what I mean when I talk about the power of this manual and the power of Prescribing.)

(Of course, there are some people who believe that entire concept of the DSM is flawed and people would all be better off if we returned to good old-fashioned family values, but those people are not my audience here. I’ve done enough trying to teach pigs to sing to waste my time with those folks.)

I bring up Gender Identity Disorder in the DSM by way of example (though if you ended up here because you want to know more about that, here’s one place to start.)  In a way, *everything* in the DSM is “made up.”  The psych and med professions are constantly modifying the damned manual. And they should be – our categories and vocabulary should adapt as we learn more shit about more shit.  The DSM should be a tool, not holy scripture.  And the psych professionals who are talking about complex PTSD are doing so from a good place – from a place where they see how some aspects of trauma reaction are formative in a person’s psyche but how the PTSD checklist doesn’t quite apply.

I know the arguments for resisting complex PTSD as a category.  Some of them are better than others.  This blog post and the comments on it introduce you to a wide array of positions and thoughts on the issue.  But the point here is, in my opinion, it’s not so much a question of “right” and “wrong.” We can’t say “here’s the definitive proof that this is the right diagnosis” in the same way that we can say such a thing of leukemia (and in many cases, the “proof” that something is the wrong diagnosis comes because the “proper” medications for that diagnosis did not do the expected thing.  SSRIs do not do what they are supposed to do for me, which has led at least one person to say “Oh, you must not be depressed then- you must be bipolar.  And the reason you don’t have x, y, and z from the bipolar checklist is because [fill in the rationale].”  Lo and behold, now there are different types of bipolar to account for people who don’t have the textbook symptoms of “classic” bipolar.  Bottom line: this shit changes all the time.  Psychiatry may have plenty of science in it – but there is some stuff about it that isn’t and can’t be measurable and provable in the same way things can be in the other sciences.  And if it’s changing in response to more knowledge and if the center of those changes is helping individuals instead of making everybody fit neatly into a rigid box, then those changes are good from where I’m calling them.)

Do I have PTSD?  Complex PTSD? Is there a real difference?  Beats the everliving shit out of me.  I know a hell of a lot of people who have it a hell of a lot worse than I do.  I’ve never been one of those people who’s been comfortable defining myself in terms like that anyway, because I think the whole concept of this kind of diagnosis has some inherent problems.

But. Are the treatments that I have access to now that I have a PTSD diagnosis helping me more than the treatments for “Depressive” and “Anxiety” helping me?  You bet your ass they are.  Are they helping me understand and find a way to change some of the things about me that have never made any sense to me before?  Hell yes they are.  At the end  of the day, I don’t really care what label I have.  I just want to improve my quality of life and not live in a body, with a brain, that I sometimes don’t have any control over.  So I personally advocate the separate existence of complex PTSD as a category – because the DSM’s current checklist for PTSD leaves some people out who maybe shouldn’t be left out, because the DSM is not the freakin’ Inspired Word of God, and because the psych profession and the people who seek help from it are fallible human beings who are ideally doing the best they can with what they’ve got.

I’d rather modify the shoe than cut my freakin’ toe off to fit in it.

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Here’s a discussion of proposed changes for the DSM-V.  It touches on a few hot topics I bring up briefly above, and it also touches on some ways that treatment and models might change without subsuming everything under the heading of PTSD.

Pete Walker on multi-modal approaches to PTSD and trauma treatment

My page on PTSD resources.

 

 

Written Saturday at noon:

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Railroad Bill

I’m putting up some  collections of folk tunes I’ve been working on for a while – they’re going up as “pages” rather than posts – but I think this one deserves its own actual post, not only because hearing “Railroad Bill” being picked on the guitar is one of my earliest memories, but also because my great-grandmother, who spent most of her life in Lowndes County, AL, wrote about Railroad Bill in her memoirs.  She writes,

Railroad Bill was a young black man that could board a train without being seen until he stepped out of nowhere and robbed the baggage coach and sometimes the passengers of the train and then vanish completely. It was said that he was invisible. Posses would be close on his track and all at once they would lose him. Even the blood hounds could not track him down.

This was in the gay nineties when the young people were happy and singing “After the Ball,” “Two Little Girls in Blue,” and other popular songs of the day. Then someone would ride up and announce that Railroad Bill had just robbed the North or South bound train and had vanished with the loot. Everyone began trembling and wondering if he would come by and harm them. Railroad Bill had become notorious.

I was a small child about 8 or 10 years old and hung around Papa’s store and post office. Men would gather from miles around to meet the mail which was due at eleven o’clock from Claiborne by way of Perdue Hill and Monroeville, from Beuna Vista by way of Burnt Corn and from Evergreen by way of Belleville. The heaviest mail came from Evergreen as the only railroad came through there. It was interesting to hear the news from surrounding communities, and every week or so, the mail carrier would come with the news that Railroad Bill had thrown loot off the train. One time it was a box of meal that weighed a hundred pounds, other times it would be a barrel of sugar, a barrel of flour or other goods. At times someone would get a glimpse of Bill as he dropped from the moving train.

Life was brutally harsh for settlers and outlaws alike, and after many such mysterious crimes committed by Railroad Bill from Mobile to Montgomery, a reward was offered for him “dead or alive.”

A posse was gathered in a store to make plans for tracking Bill down. While they were in the front of the store talking over their plans one man who was late came in the back door with his pass key. There sat Railroad Bill on a barrel listening to the men making the plans for his capture. He failed to hear the man enter, and the man quickly drew his gun and shot Railroad Bill. The railroad company had him embalmed and put him on the train, on a day announced and stopped at every station between Mobile and Montgomery and charged $.25 for each person to look at him. Two of my brothers went to see him.

Railroad Bill was so notorious at that time that a song was written about him, but all I can remember of the song, the closing sentence which said: “and that was the last of Railroad Bill.”

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Crooked Still – Railroad Bill

Doc Watson and David Holt at Merlefest ’08 – Railroad Bill

some guy on youtube picking Railroad Bill, Freight Train, Make Me a Pallet

The Mudcat Cafe discussion on Railroad Bill (if you are into folk tales and folk music and you don’t know this site, go there NOW)

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page links to Shule AgraSt James Hospital, the Trooper and the Maid, Omie Wise

I survived, but it’s not a happy ending. – Tim O’Brien, TTTC

Infection in the sentence breeds / we may inhale despair / at distances of centuries.… – Emily Dickinson

 

I haven’t been writing any fiction.  I’ve been dealing with personal shit (having just hit a fairly noticeable wall, or bump, or tangle of “stuff,” where DBT tactics are not helping and nothing but meds gets me through those bits, and Lord do I hate these meds) and doing day job writing.  But the “mental illness and creativity” post gets more hits than anything else anyway, so I’m using this as a place to dump some stats and figures and sources.

A study of 2525 US Army infantry soldiers 3 to 4 months after their return from a year-long deployment to Iraq showed that of those reporting an episode of mild TBI with loss of consciousness or altered mental status (eg, dazed or confused), 43.9% of those with loss of consciousness and 27.3% of those with altered mental status met criteria for PTSD. (Hoge CW, McGurk D, Thomas JL, et al. Mild traumatic brain injury in U.S. soldiers returning from Iraq. N Engl J Med. 2008;358:453-463.)

In a 1992 survey of 8169 veterans of the Vietnam conflict, approximately 72% of respondents reported a lifetime history and 36% reported a 12-month history of at least 1 psychiatric disorder. (Eisen GA, Griffith KH, Xian H, et al. Lifetime and 12-month prevalence of psychiatric disorders in 8169 male Vietnam War era veterans. Mil Med. 2004; 169:896-902.)

Veterans of the first Gulf War reported a significantly higher prevalence of current anxiety disorders (PTSD, panic disorder, and generalized anxiety disorder) than nondeployed military personnel (5.9% vs 2.8%; odds ratio [OR], 2.1; 95% confidence interval [CI], 1.3 – 3.1).  (Black DW, Carney CP, Peloso PM, et al. Gulf War veterans with anxiety: prevalence, comorbidity, and risk factors. Epidemiology. 2004;15:135-142.)

The military and the VA have both gotten smarter about PTSD since the first Gulf War.  If you are a first-Gulf-War era vet (or pre-Gulf War era), and you are still holding your shit together with beer, bootlaces, and 55o cord, it’s not easy to get help – but it’s easier than it probably was when you got out. The problem is, it’s not always easy to see you could use some help, since military training tends to produce people who are pretty damned good at holding an amazing amount of shit together with beer, bootlaces, and 550 cord.  And at producing a belief that “invisible injuries” = malingering.  Suck it up and drive on, right?

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