Cognitive Behavioral Therapy is designed by white, upper middle class, non-disabled people. The further you are from this demographic the worse you will fare.
The changes one is expected to make in order to better themselves are more likely to be met with roadblocks when one is far from privilege. Most changes one makes to their life involve a social dynamic. A person without privilege generally faces a harsher social environment so change is stunted. There is also the issue of a success percentage. There is a threshold (different for each person) that when dipped below the changes one tries do more emotional harm than good. Naturally those without privilege will have a lower success percentage.
Those without privilege generally can call the therapist’s self-worth bluff. They know worth is not innate, it comes from privilege. It’s asinine to hold someone of non-privilege culpable for their poor self-image. Their self-image is theirs, not yours, and it comes from life experiences.
Non-Privilege is a singularity. A white therapist generally isn’t going to reach a black teenager who has seen his brother get twice the sentence a white person did for the same stupid crime.
They generally don’t have access to positive influences. There’s this idea that people can find edifying friends. For those without privilege this is more often untrue. Addiction-oriented people are all they have to choose from.
They often cannot afford therapy. This means that therapy might only be sought after issues have gotten so bad that it is of less help than if the issues had been dealt with earlier.
It always ground my gears hearing chapel speakers wax romantically about suffering while I was in eye pain and serious depression. I’m sure there are a lot of reasons I don’t have the historical knowledge to grasp but here is my speculation:
Those who have come through suffering with their articulation intact represent a biased sample. People who haven’t weathered suffering so well generally aren’t readily able to put it into words. And when they do it often comes out incoherent.
Suffering weakens people to the point where the most adaptive thing for them to be is virtuous. Christianity lifts up virtue so when it sees people who suffer exhibiting more of it it jumps to the conclusion that the suffering was what made them better.
Suffering makes some people more reflective. This can cause them to produce better art/writing and we value good work so we say the suffering that led to it must be a good thing.
Suffering makes some people more empathetic. The fact that someone’s suffering makes your life better doesn’t mean it’s a good thing.
Romanticizing suffering comes from a premodern view of the mind. There is this dualistic notion that there are limits on what the corporal self can do to the inmost being. This is shown to be false by modern psychology. Once you have suffered past a certain threshold your mental health starts to degrade. And in the realm of mental illness there is actually something called a negative symptom—parts of you the mental illness takes away.
Painting suffering in a positive light assumes the ideal that those around you will support you instead of pull back or drop out of your life entirely. More often than not people drop out of the lives of those who experience serious suffering (which compounds the suffering). Those doing the romanticizing are unwilling to take the step of romanticizing the desertion.
Ultimately romanticizing suffering is a way for those who suffer more to make those who suffer less (who generally have more power) comfortable, insulating them from the senseless evil and chaos the world offers those without power in good measure.
See Part 2
Christians, both Evangelical and Liberal, are united in that they hate the idea that one’s experience of God can turn on them. That’s part of the reason why they don’t engage individuals with mental illnesses on a deeper level. Some thoughts:
This idea calls into question God’s power. You would think if a god was as just and powerful as he is advertised the least he could do is get communication right. Christians are quick to point out that hostile voices coming from God are from the devil or one’s mental illness but if these voices so easily overpower positive things God is trying to say it says something about his sovereignty.
Saying experiences of God can turn against you erodes the child-like trust in God. Second-guessing everything God tells you is not a recipe for a healthy faith. Christians know this so they make trusting God fully the default state. Only a tiny minority of Christians will have these negative experiences so there is no point in sacrificing the majority’s trust experience for an often-scorned minority.
Calling into question the “personal relationship with God” paradigm makes the faith a lot less attractive. One of the most beloved aspects of the Christian faith is the idea that a loving god will walk beside you and guide you. The idea that this experience can turn against you begs the question, are positive experiences from God really from God in the first place or are they just windfall from one’s functioning mental health? Mentally healthy people have voices in their head as well but they generally tell them to do positive and pro-social things. Is “experience of God” just beautifying these voices? And once you realize it’s all in your head (and subject to the vagaries of your mental health) your Christian experience will likely become more hollow.
The idea that one cannot trust their experience of God throws a rod in the idea of seeking God’s direction. If you have veto power over everything God says doesn’t that make you—not God—the one ultimately in control? And what do you fall back on when you override “God’s voice”? The church? Your church’s interpretation of the Bible? A helping professional? These options are better but you might be seen as making a mistake by pursuing them instead of “God”.
The idea that your experience of God can turn against you runs counter to the idea that God will never leave you or forsake you. Christians say it just “seems like” God is forsaking you but he really isn’t. Unfortunately what “seems like” it’s true is often based on eons of actual experience while what “is” is based on dogma. People with mental illnesses are often marked by their experiences—for them there is no pie-in-the-sky “is” any more.
I think it’s very healthy for people—especially those with mental illness—to never take God’s voice seriously but many of us have been brought up in religious environments where we were told to do the opposite.
Being at the right end of the power structure, therapists make up terms that cast the sufferer in a pejorative light.
Social Anxiety Disorder: Most people are anxious in social situations for a very good reason. They get rejected and even picked on. By calling it social anxiety disorder you are painting the condition as a deficit of the sufferer while failing to acknowledge the hostile social environment’s role. A better term for it would be snub sensitivity.
Co-dependence: Wow, having just one good friend is considered a disorder? Shouldn’t having no friends be considered a disorder? I would think having zero friends would be considered a worse disorder than having just one. I’m not trying to paint co-dependence as healthy but I think it’s very often the lesser of two evils.
Social Skills: Again this term does a poor job of describing what goes on in the real world. Take the term woodworking skills. It describes someone’s ability to form good things out of wood. The point here is the wood isn’t resistant, it is pliable and always stays the same. In social interactions there are all kinds of feedback loops going on. If there is something wrong with you the loop generally starts out negative and continues along on that path (as an individual with a physical disability and mental illness I experience this daily). A better word for “social skills” would be social traction because that is a more accurate and holistic way of describing what goes on.
Being an Enabler: We don’t like people who love unconditionally so we have to come up with fancy denigrating names for them. We do this because we know, despite what any significant other says, we are not loved unconditionally. So when we see someone who is we want do demonize the one doing the loving. I’m not saying there isn’t a place for “tough love” but from what I’ve seen people use the excuse of not being an enabler to withhold support from people who need it.
Social Independence: What social independence really means is you have enough social worth for others whose social interaction you depend on to come in to your life on their own free will.
With some people who are mentally ill, life, in itself, isn’t really worth living. What makes life worth living is the good things in that person’s life (generally relationships). When these things are taken away life is no longer worth living and suicidal thoughts and actions might take place. When someone with a mental illness threatens to kill them self if you leave them you can take it as a back handed compliment. They are living for you! It might not be healthy or right but it’s true.
The experience of being mentally ill (particularly with regards to the elements within your life making it worth living as opposed to life being worth living in and of itself) is a singularity. It’s like those video games where you can reverse the whole gravity of a world and all the elements move in the opposite direction as they were before. Relationships mean a lot to you but they mean so much more to us. Our internal monologue is a cesspit—being alone is more like death to us. What other people say may be bad but it generally isn’t much worse than what we are already saying to ourselves. On a more practical note, relationships counter the self-absorption/rejection vicious cycle which is no good for anyone. And friends who knew you before your mental illness started/worsened (who have stuck) help you relive a healthier version of yourself through shared memories. Just them being there connects you to a part of yourself that was lost through mental illness.
Below are some reasons I think Evangelical Christianity is ableist (prejudiced against individuals with disabilities).
Biblical portrayals. In the Bible, individuals with disabilities are portrayed as objects of pity who are broken. This is particular true in the gospels. After a cursory reading you come away with the idea that the only way to be accepted in society is by a miracle of healing. This kind of thinking trickles down to the churches where modern notions of individuals with disabilities as people OK the way they are generally haven’t taken hold.
False hope of healing. Some churches believe if you just pray hard enough and have enough faith, your disability will be healed. This adds a whole new layer of hurt on a life already burdened by disability. Suddenly your faith is being called into question because you didn’t have enough to receive healing. Miracles rarely, if ever, happen.
The Pollyanna effect. There’s this current within Christianity to try to focus on silver linings and try to use them to justify the clouds because, after all, life is supposed to make sense backwards. It’s easy to have a romantic notion of suffering when you observe it from afar. After all, life is a story and there are challenges but those who suffer learn something won’t be worse for the wear. Unfortunately a disability actually makes your life worse in ways that cannot be romanticized, partly because of all the relationship and vocational opportunities you’ll lose out on. Also, there is this idea that individuals with disabilities are supposed to put on a happy face, despite the circumstances and are supposed to somehow overcome and do something heroic with their challenge (like the guy with no arms and no legs who pulls himself up in front of a crowd). Individuals with disabilities are just people like you and me. They aren’t heroes and they aren’t wallowing in self-pity and despair their whole life.
Intolerance. Christians generally have an aversion to people who are different (which individuals with disabilities definitely are). Part of this makes sense because if you look different that means you might think different and thinking different is frowned upon (especially when you think differently about God). Another part of it is just xenophobia and the fear of the unknown. It’s easier to function in a comfy little bubble and pretend brokenness doesn’t exist except in third world countries. Christians want to be happy and upbeat—there’s almost an aloofness in the whole thing.
Experience of God. Following the voice of God to me is just beautification of intuition. But to Christians (particularly Evangelicals) it is a way of life. It works well for the mentally healthy, God tells them what drapes to go with the new carpeting and stuff. Once you start telling mentally ill people to heed the voice of God things get very different. You are just giving them fodder for their next psychotic break. It’s a sad state. I think it has to do with the fact that religion wasn’t made to survive every test case (like when you engineer a car battery that has to work in a huge range of temperatures). Religion was just made to appeal to the experience of the dominate majority.
The party line is cognitive behavioral therapy combined medication will do a whole lot of good for people with mental illness. I’m sure it works for some people but not me. A large part of that reason is I’m bipolar (cue sound of career being destroyed) and a dirty little secret of any mental illness worse than depression is they often can’t give you the most effective depression medications because it will trigger psychotic episodes. Add to that the fact that a lot of the things therapists say make no sense to me at all. Some follow below.
You have innate worth. Yes, in a paid helping professional’s office you have innate worth, but once you walk out their door things are different. You can lay claim to self-worth but nothing will come of it unless others recognize this claim as legitimate. What exacerbates self-worth issues is the disparity between claimed and effective self-worth. You may think you’re worth something because your mom and your therapist think you’re so great but in the world where what car you drive and how you look are what matters your claims of self-worth won’t be recognized. Then there is this cognitive dissonance because you have been primed to think you are entitled to self-worth. This is a result of two systems, the helping professional’s and the real world’s, both working the exact opposite of each other.
You need to compartmentalize. This is a curious thing to say as one of the symptoms of someone with a mental illness is the inability to do so. If the underlying depression and OCD is not effectively treated (which it isn’t with me) than this is a useless thing to say. People with mental illness are generally self-absorbed and take things personally so training them to be otherwise is difficult if not impossible. Take rejection for an example—the rejection should not be taken personally, it just represents the sentiment of the rejector at that particular time. Just taken as a single event ignoring everything else one could take this view. But in the aggregate, once you compare the amount you are being rejected by that particular person verses how much others are, things get different. Add to this the fact that culture has gotten nastier and personal attacks are more common and you see it’s hard enough for mentally healthy people to compartmentalize not to mention those with mental illness.
Go out of your comfort zone. Once again for this advice to be helpful depression and OCD have to be way under control. If you dare go out of your comfort zone and things turn out not OK or bad you will be reminded of it constantly for a time proportional to the amount of discomfort the risk took. For example if you tried asking a girl you liked out and things went bad you will be reminded of it constantly—the more you liked her the longer you’ll be reminded of it. Therapists will tell you the reward of going out of your comfort zone is worth the risk but for people with depression and OCD the risk is a lot greater and more immediate.
Advertisers relish at the thought of their work washing over mentally ill minds. This is because mental illness is fertile ground for their messages to take root.
Depression: Studies have shown that people who value material things highly are more depressed than those who don’t. What we don’t know is if the depression is fueling the consumerism or vice versa. What is clear that people who have poor self-image (which advertising itself tends to exacerbate) are more likely to try to compensate for it by consuming things. Advertisers are in a win-win situation today because most people crave relationships and need them to not be depressed but most places you have to buy things that the advertisers are advertising to fit in and be accepted.
Obsessive Compulsive Disorder: A mind with OCD is like a washing machine that turns the same things over, over and over again. A mind like this is fertile ground for advertiser’s messages. In a normal mind an advertiser’s message will come in, be analyzed a little, and brought up when necessary (for example a fabric softener ad will be recalled when one is in the laundry aisle of the supermarket). In a mind with OCD the advertiser’s messages get stuck in the tumble cycle. For example the new Gilette shaver that supposedly “glides” and has “less tug and pull” gets stuck in my mind because shaving wiry hair is a pain in the ass. I think the campaign is full of crap but that doesn’t stop it from entering my mind. The key here is things proven to be patently false (like most advertiser’s claims) will cycle in people with OCD’s minds. This is good news for advertisers.
Anorexia/Body Image: When was the last time you saw a fat person or an individual with a disability on a TV commercial (besides diet or wheelchair ads)? You don’t see these people because they don’t fit the ideal. We are a very looks-based culture–you live or die by what you look like. Prescient people internalize this and some starve themselves. It’s a disorder but it’s also a real rational response to cultural forces albeit a sad one. Advertisers love this demographic because they are particularly absorbent of the consumeristic culture around them and have poor self image, both things that make for an easy target market.
Anxiety: If you can create fear and offer some product or service that supposedly “cures” said fear you are in business. If someone is already anxiety-prone they are more susceptible to these pitches. Think how advertisers sell home security systems and even how the government sells war. In both cases it’s about some “they” that is going to attack us and destroy our way of life. Another example is how people afraid of impending economic collapse will buy more gold so you advertise gold places where anxiety-prone people are (Glen Beck, religious programming, etc..).
Many people who are mentally ill put a premium on how something makes them feel. It’s more about the sizzle than the steak. Interacting with a comfortable brand can be therapeutic. For example Tylenol may work better than the same medication with an off-brand label because there is something comforting about interacting with a strong brand.