Invisible Handicaps

Disability Studies is a nascent field of interdisciplinary approaches to understanding and making meaning of disability. Though the field itself does not declare any class of disability more or less deserving of academic scholarship, it has been noted that an over attention to physical disabilities has haunted the field. Intellectual and mental disabilities are gaining more interest, however, but this presents some difficulties. Ideally, the scholars in the field of studying disabilities would be disabled themselves. This is the general attitude towards ethnic studies as well, like American Indian studies, where those physically foreign to the subject matter, i.e. Caucasians, aren't given the same validity as would a Native scholar. In Disability Studies, the disabled are encouraged to become involved as their life experiences are unique to the human experience and lend a kind of authenticity to the work.
The movement towards inclusion of the non-physically disabled, or mentally disabled, presents natural barriers as the production of knowledge becomes hindered by the disability. Intellectual disabilities, developmental disabilities, like Autism, and Schizophrenia, hereafter "mental disabilities", present seemingly insurmountable barriers to higher education and the knowledge economy. Seen below, this logo does not make clear whether mental disabilities are included in their initiative.

I tread lightly here. Disability is still stigmatized in our society and while physical disabilities get a lot of visual attention and are an obvious target of affirmative action, the collection of disabilities that originate, and remain, in cognitive functioning are more difficult to integrate into the ADA movement due to their seemingly elusive and low-profile characteristics, i.e. it is easier to acknowledge someone's physical handicap than an abnormal frontal lobe. Any efforts towards integration and accommodation risk discrimination and exclusion for any disability but this is never truer when it comes to mental disabilities. Another major factor in this problem is the spectrum aspect of these afflictions. Research has shown that many mental and intellectual disabilities are "spectrum disorders"or spectrum conditions (I don't want to define here what is a disorder and what is a condition as these labels deserve an entirely independent analysis). So, the levels of disability in these fluctuate, which renders problematic the disabled label. This produces a sense of unease among those with mental disabilities in the Disabilities Studies field. Many simply don't reach that level of contribution to the community because their disabilities inherently disrupt or limit cognitive functioning, something that just doesn't fly in academia. While there are exceptions, a favorite of mine being Elyn Saks, who has Schizophrenia and happens to be a tenured professor at USC, they don't represent the critical mass of the mentally disabled who remain not just outside of the academic community but at times outside of their own local community as well.
I saw Dr. Saks speak at a conference last spring in Santa Monica. She had a relatively flat affect,or lack of facial expression, which is a symptom of Schizophrenia, among other mental illnesses. It was a physical sign of her disability but the tip of the iceberg of what Schizophrenia entails. Also of note, Temple Grandin, an Autistic scholar of animal sciences at Colorado State, has been very outspoken regarding her disability and credits her unique view on life to her deep understanding of animals.
In sum, I appreciate the difficulty our society has in dealing with and understanding those with mental disabilities. A malfunctioning or malformed brain is hard to group with physical handicaps such as deafness or loss of a limb. They take intensive treatment and therapy and can never be completely overcome, much like many physical disabilities. Contributions to Disability Studies can still occur from the mentally disabled, as a disabled mind can still have flickers of brilliance and insight and these perspectives are sorely missing from academic literature.

Stimulating Conversation

It is no surprise that the US is a breeding ground for stimulating drugs. The American Dream is one of hard work; long hours and a “pulling oneself up from one’s bootstraps” mentality that suggests even an average person can be successful if they work hard enough. If every average American can have a piece of the success pie then competition flourishes. This competition drives energy drink, caffeine and supplement sales and is a suggested contributor to the widespread psychopharmaceutical use that many lament over. Working long hours or excelling academically, for the average American, takes concentration, alertness, good working and long-term memory and rarely is conducive to an otherwise health lifestyle of sufficient sleep, exercise and fresh air. Stimulant drugs, and here I mean stimulating psychopharmaceuticals like stimulants and anti-depressants, nootropic and neuroprotective compounds as well as consumables like coffee and Red Bull are allies in the fight for the American Dream. They help college students pull “all-nighters” to study for exams, long-haul truckers make deadlines, medical residents get through 24 hour shifts and those working well over 40 hours a week to make ends meet fair reasonably well on very little sleep.
The ubiquity of them in the knowledge economy and higher education is something that has long been of interest to me.
I grew up in a Folgers drinking, blue-collar household and saw my father get up at 5am daily, sometimes 7 days a week, to provide for us. He taught me a good work ethic and was the quintessential American success story, working hard to eventually own his own company. This brought us financial stability but I only saw him work more. This painted the American Dream, blue-collar work and indeed, instant coffee, in a poor light for me. To me, less family time but more money was the short end of the stick. This life lesson is what drove me to be the first in my nuclear household to go to college, drew me to the “knowledge for knowledge’s sake” approach to education and in general took away any inclination and motivation towards being wealthy. What did stick though, interestingly, was my parents’ coffee habit. I grew up smelling coffee at 5am and then again a few hours later when my mom woke up. I found caffeine a necessity to the working adult, especially the working college student, and sometimes favored buying a latte over lunch with what little money I had. Stimulants like caffeine are so prevalent because, I argue, all classes can benefit from the alertness and sharpness of thought it brings. I find significant importance in phenomenon that transcend class boundaries as such.
Here we see a vintage satire of this effect coffee has on the American Dream mentality.




Caffeine itself, without even any consideration of the other chemicals we use to need less sleep and stay alert, deserves ample discourse alone. The workingman’s stimulant, the remedy for Monday mornings, the study aide and the cubical companion.

I don’t want to discount the global usage of coffee in focusing on usage in the US. We are the world’s biggest consumer culture of coffee however we are not the first to make it part of our daily routine. Americans tend to take things to the level of abuse quickly and I feel we are particularly fiendish about our caffeine. Rightfully so, as our culture praises those who can function at optimal levels with little sleep or food. This pride in productivity is something we created and still have ownership over although the nations in the process of full industrialization and development, like Brazil, China and some areas of the middle east, are showing signs of a similar culture unfolding.


Global consumption aside, domestically, we are showing pathological signs of caffeine abuse and overuse. Has anyone seen the extra-caffeinated coffees at gas stations, claiming to be the equivalent of multiple cups of coffee in one? And I’m sure you’ve noticed the original 8.4 oz. can of Red Bull has ballooned to a 20 oz. option as well? Coffee pots are even spotted at banks, mechanics and car dealerships, anywhere an adult may be waiting at for more than 5 minutes. Specialty websites even sell caffeinated foods, gums and mints. Given this rampant consumer culture, there is virtually no excuse for anyone to be running at less than high octane. It puts an implicit pressure on every American to succeed, despite any and all odds.

Many anthropologists find this problematic. Not only can this mentality nurture unhealthy habits, it encourages an artificially high level of functioning that few have naturally. Coffee, and now energy drinks and other consumables, is now synonymous with "fuel" to get you through your day.

See below: to-go cup at local Seattle coffee house. We are candid about our coffee addictions.


While certainly not the most sustainable method of coping with the pressures of the American culture of hard-work and success, it remains a method that has formed new spaces for social congregation, new ways to connect with people and new ways for Americans to make money.

Call for Papers

I will be submitting an abstract for the Second Annual Western Michigan University Medical Humanities Conference, September 27-28, 2012 in Kalamazoo. As I delve into my past in literature and philosophy to provide theoretical grounding for my proposal, I find myself missing the intellectual coziness of the humanities. They say, "ideas of all kinds are safe here, every idea deserves to be expressed". I miss the ancientness and the nobility of them. If they were sweets, the humanities would be English toffee; a refined concoction of various textures and tastes while anthropology would be honey, a viscous glaze with which to see the world through. Anthropology is truly a beautiful discipline and I feel, pairs well with many others. When they mix, stickiness ensues but what is left is so utterly perfect! This conference will be exciting indeed!

The Power of the Pomme

Regard below; a young Steve Jobs. I have to say, after watching a few of his keynotes, including the one for the original iPhone, he was as close to an anthropologist as a developer could be. Jobs' keynote speeches were more about our emerging culture than the emerging product.



Here we see him enticing us to align ourselves with the Apple brand, something we did with enough zeal to commodify our deepest technological desires. Is the iPad really just another tablet? Or is it a greater symbol of ownership over technology, an emergence from something akin to MaryJo DelVecchio Good's "biotechnical embrace" as we very nearly are becoming biologically linked to our technology. With the iPad, Jobs achieved a closer level of attachment, melding life with device with hardly a seam.

That freshly bit apple apparently speaks to us not just as a culture, but as a species. For humans, the most social creature of all, Apple's logo has brought us into the technologic fold, introducing smart phones, laptops and complex software programs to those with silicon anxiety. I argue that the Apple image carried Jobs' ideology farther than the product itself could alone, and that is saying a lot for the company that portabalized our life management systems so elegantly and taken such an innovative look at form. An image like this, a graphic of and for our anthros, can transfix our social processes with such precision, carve an identifying symbol into our minds and lives and embody whole social revolutions in techno-temporal context.

Ethnography, a method of anthropological research, harkens to the Greek origin of "ethnos", or "the people" and "grapho" or, "to write". While he was not a writer by trade, Jobs knew people and was an unparalleled business mind as well. His days of tinkering with electronics in his garage grew and combined with understanding people and creating an understanding of business, he created an image, intimately linked with a product, that is visibly a part of us. Our glowing apples beam outward from our computers, phones and devices, like a spotlight of consumer desire or a beacon of omniscient circuitry, carrying our tweets, texts, status updates, messages, chats, emails, upvotes, jpegs, docs, images and video to billions of other points of data storage instantly. The Apple breathes with us, gets sick with us and syncs with us. We share out most intimate moments and create the most memorable with it.

Regard below; Steve Jobs in his office circa 1982. If he really was an anthropologist, he would have many more books and much less shelter. Aside from the practical, Jobs thought a lot about people, which is what anthropologists do, when designing Apple's productions and defining its vision. This is the sort of pondering that produces the expression seen below; expressions of intense scrutiny into human behavior followed by the mental equivalent of detective's work. These thoughts have had, and will continue to have, world changing power, as evidenced by the virtuoso above. These thoughts powered the ethos of the PC revolution and are hopefully, going to keep on growing.

Memes of Mental Illness

Here are a few that struck me. I'm not huge on memes because little discourse is visibly peripheral to them (outside of academia). While the comments show appreciation and can reflect popularity, through methods of voting, they rarely delve into the root social commentary. Though simplistic and "off the cuff", they provide a rich account of our culture that can be examined, discussed and dissected and provide unique reflection on higher social processes.
These specialized memes are harder to find and less "liked" on the generalized meme sites however there are a few mental illness specific ones created by and for those who suffer from mental illness. Since they reflect these higher social processes, I've found that they can be applicable to a variety of mental illnesses and are generally well received within the community. For the most part, I find memes overwhelmingly prevalent online and while some are amusing, many are an utter waste of time.
These specific memes share personal experiences of the mentally ill that aren't easily expressed publicly and without the anonymity of this particular form of media (which can broadly be defined as "social-media" however begs for further analysis). Let's view and discuss the following.

This is an accurate expression of the symptomology of bipolar disorder. Now to appreciate these facial expressions, other memes must be viewed. Loosely, the first segment (upper left) reflects the dramatic and sudden shift to a heightened state of excitement. True, everything may seem funnier, "lol", but really I see here a depiction of the adrenaline and norepinephrine that surges when in a manic phase and these really intensify life on all facets. Upper-right, we have the attitude narrowed, that of high feelings of self-worth, feelings of omnipotence and righteousness even. These attitudes can rub people the wrong way and that coupled with feelings of importance leads to interpersonal conflict. Mid-left, we see the subject having the feeling of being able to take on any challenge and the zealous creativity and energy that characterizes mania and bottom, the after-math. Post-mania, a depression follows and true to life, memory of the manic episode is patchy at best. Bipolar disorder is grossly understood and while depictions in media are becoming more accurate, we often are majoritively presented with the extremes of the upper segments while the bottom segment, possibly the most devastating, is left out. Based on my research with bipolar support group outlets, the manic phases are sometimes sought out, induced even, by bipolars so the emphasis on this phase wrongfully ameliorates the imminent depression.

This meme really hits home the feelings I've seen expressed numerous times during my research. If we are to legitimize mental illness as a biological pathology, like cancer or HIV, we have to move past the elusive quality of it. By definition, mental illness is organically based in the brain, a mostly invisible (outside of the eye) organ. Many medical pathologies are invisible however, so in doing this we risk ignoring its status as an illness, something that should carry no blame, therefore perpetuating stigma. As an anthropologist, I recognize that the bio-psychiatric model of mental illness only accounts for a certain account and certain biological processes and that cultural specificities can adjust these, despite all clinical intuition and diagnostic paradigms. Stigma, however, persists in part because of the invisibility of the illnesses, making them difficult to define discretely. As Andrew Lakoff, professor of Anthropology, Sociology and Communications at University of Southern California argues, "The biomedical model seeks to rescue the person from the stigma of mental illness by treating it as something external to the self"(Lakoff 2005:106). Here Lakoff illustrates how the attempt by the "ignorant" person to find the mental illness in appearance can tie the illness and the self together too completely, taking import away from the biomedical perspective which can help equate mental illness to other "invisible" disorders such as cancer. Mental illness has yet to reach the level of medical respect cancer has and can, in part, vilify its sufferers.

Here we have an observation of what is a popular sentiment regarding current prescribing practices of service providers of mental health care. Over-prescribing and over-medicating are strongly supported claims in the public eye and can be drawn out of proportion. Accounts from actual patients include instances of patients wanting medications but their provider refusing (yes, they can do this). Providers fall into categories where their prescribing practices reflect their personal attitudes towards pharmacological treatment. Many take holistic approaches and give credence to whatever therapy is best suited but there are those who fall to the extremes. Patients often complain about this because the process of switching psychiatric service providers if the suggested therapy is not desired is arduous, expensive and can exacerbate symptoms of certain illnesses. Sometimes providers aren't up front about their pharmaceutical philosophy and this is only to be discovered at the worst time, when you need a medication adjustment. That being said, from my research, I find that while there is certainly complaints about being over-medicated, or at least being suggested to be as the patient ultimately makes the choice for him or herself, there are just as many accounts of patients feeling they need to increase a dosage or add a medication but their providers won't comply. More medication can be good in certain cases or even necessary to maintain a certain level of recovery. There are other therapies that can substitute certain medications, anxiety can be treated pharmacologicaly or through talk-therapy or meditation, but every option has a certain lifestyle it can fit into. When someone is suffering extreme anxiety that is keeping them from leaving the house and working, treating it pharmacologicaly, which is relatively instant, may be preferable to prescribing talk-therapy which can take away time from work and may take much longer for acceptable results. Mentally ill people want productive lives too and pharmaceutical treatments often are the best option to maintain these lives economically and socially.

Unfortunately, lengthy sessions with service providers are still financially out of reach for many and 15 minute "med-management" sessions cost proportionately less however only have one objective. For example, in Seattle, for the uninsured, a med-management session with a psychiatrist is around $75-$100. A full session, which usually combines medication management and talk-therapy is closer to $300 and lasts 50 minutes. These are pretty standard numbers. Insurance is still out of reach for plenty of the mentally ill, especially considering the likelihood of having full-time, insured positions and even with insurance, co-pays and mental health coverage can vary. I see these economic barriers as part of the perceived problem of over-medicating and patient accounts certainly reflect that. Regardless, Peter Kramer, psychiatrist and clinical professor at Brown University, in his groundbreaking memoir of antidepressants, Listening to Prozac, explained that"psychopharmacology (is) an impressionistic art" and this meme reflects the conflicts that can manifest from this.




References:

Kramer, Peter
1993 Listening to Prozac: A Psychiatrist Explores. New York:Penguin Books.

Lakoff, Andrew
2005 Pharmaceutical Reason: Knowledge and Value in Global Psychiatry. New York: Cambridge University Press.