At Somatosphere, "Liz Oloft" (heh) writes about the dilemmas of "coming out" as a user of psychiatric meds while being an academic who researches them: Prozac In The Closet.Liz is a social scientist, while I'm a card-carrying neuroscientist, but like her I also take antidepressants while studying them, and I identify strongly with her thoughts.
One sentence in particular struck a chord -
Depending on who you ask ... to engage in Lacanian psychoanalysis for neurotic problems of living might be cool, to take an antidepressant for depression without psychotherapy is less cool, and to take a cocktail for bipolar might be even less so (although bipolar disorder may be more legitimate than depression because it seems to be more widely accepted as a “real biological disease”).This is something which isn't much talked about, but it's absolutely true. Some mental illnesses are just cooler than others. Cool is a famously elusive concept, maybe undefinable. Either you got it or you don't. But some diagnoses certainly have more of it than others. From most cool to least the pecking-order seems to be:
1. "Issues" – problems of living and/or "stress", rather than illnessThis list is, of course, subjective - "cool" inherently is – and it goes without saying that I’m not endorsing this hierarchy, just reporting it as I perceive it. I’m no slave to cool as a glance at my iTunes library would verify.
2. "Physical" conditions with psychiatric symptoms, such as thyroid problems and PMT
3. Anxiety, phobias, panic attacks
4. Substance abuse & addiction
5. Bipolar disorder (manic-depression)
6. Eating disorders
7. Unipolar depression
8. "Personality Disorders"
9. Schizophrenia
What does it mean for one thing to be higher on the list than other? Amongst much else it means - that people are more comfortable talking about it and being in the presence of it; that people will tend to prefer it as a diagnosis for themself or a loved-one; and that it's easier to think of "cool" people who have it. And, simply, it means it that it’s easier to “come out” as having it.
Some of the rankings may surprise at first glance. If you read the textbooks, you'd think that bipolar disorder is generally speaking "worse" than unipolar depression. And in many ways it is. But it's still cooler, I think. Cobain sang about "Lithium", the quintessential treatment for mania, not "Imipramine". Hendrix sang "Manic-Depression", not "Depression". Lots of cool, or at any rate famous, people, are bipolar, or are widely believed to be. By contrast, try to think of a famous unipolar depressive, and you'll come up with Winston Churchill with his Black Dog and... who else?
The key factor behind psychiatric coolness seems to be the degree to which a problem is seen as internal to the self. There's little shame in being "stressed" due to things that happen to you, because then the problem is external. You're "normal", it's the situation that's screwed up.
Likewise, as Liz says, bipolar disorder is in an important way cooler than depression, because it's seen a closer to being a "physical” illness that happens to you, like a thyroid problem. That’s as opposed to a weakness or failure of you as a person, which is the most damaging and most persistent stigma of unipolar depression.
The one apparent exception is schizophrenia, which is profoundly stigmatized despite being widely viewed as a biological disease. But isn't this because schizophrenia is seen as a disease that disturbs the self, leaving someone merely "mad" or "insane", no longer responsible for their actions and therefore no longer really a person?
10 comments:
Nice post! It would be interesting to have a research on the coolest psych disorder :)
cheers!
Good post --- funny and thought-provoking.
Much of your list surprises me, though. While I'm not surprised to see bipolar disorder and eating disorders on it, I am surprised by the low placement of unipolar depression and the very high ranking of generic "issues," stress and physical problems that also affect mental health. I'd expect the latter not to be very "cool" since so few people have heard of those problems, and stress happens to everybody and thus seems like it should be unremarkable.
I also wonder if there are UK/US differences at work, as well as differences in the circles in which one moves. I've found that in progressive, radical and hippie-ish circles, there can be a strong prejudice against taking drugs for depression.
(And autism's just not cool at all, eh? ;P )
I'd put bipolar and Asperger's at the top of the list, and I am not sure anyone thinks addicts are cool.
Winston Churchill was claimed as a bipolar posterchild - literally. http://bit.ly/N5IZS
Why is bipolar cool? Top ten reasons: http://bit.ly/3Egz2s
Sandra - not sure addiction is 'cool'? Do you follow rock and roll music, in all its glorious coolness? ;)
Only if you're a rock star and not breaking into cars to feed the habit. I guess it depends on the substance they're addicted to, also. Heroin = cool, crack = not cool, or something like that.
The list is relative, of course. Addiction isn't cool, but it's cooler than depression, I think. Rock stars get addicted - it's hard to think of a single one who's gone on record as "clinically depressed" although there must be many. I bet a lot of celebritys who go into "rehab" for "drug problems" are in fact suffering from a mood disorder and addiction is the acceptable face of it.
Unipolar depression is very low on the list, but I think that's right. At least in my experience people are much less willing to talk about depression than they are about, say, anxiety problems, or even eating disorders. Both of those are seen as being external problems - things that happen to you - whereas depression isn't quite accepted in that way.
Autism - heh - I didn't know where to put it, so I left it out (same with OCD, PTSD and others.)
Heh, yes, perhaps we need a sub-ranking for "addiction" with the order of addictive substance coolness...
I am a community psychiatric nurse who also takes regular medication for depression (Prozac). The medication has always worked for me in the past and after my last serious depressive episode in 2006 I have stayed on it upping the dose from 20 to 40mg to stave off another episode.
Since being on regular medication I have suffered one down turn in my mood which was not as severe as I think it would have been had I not stayed on medication.
All this puts me in an interesting dilemma when advising patients that I see. I work for a crisis and home treatment team and often am responsible for monitoring patients who are at times acutely suicidal.
I recently saw a patient, M, who we were handing back to the CMHT. M had experienced a depressive episode during which he had become acutely suicidal.
M had recovered and was keen to peruse what he described as a more holistic approach to his illness. One based on counseling, hypnotherapy and regular physical exercise. In fairness he had tried three SSRI's and had become acutely suicidal on three. An outcome he was at pains to attribute to the medication rather than his illness.
All of which placed me in a bit of a dilemma. I am sure we will be seeing more of M but at what point do you stop using medication or combinations of medications and why when people talk of a more holistic approach do they inevitably mean one that does not involve pharmaceutical medications but will often include herbal remedies, vitamin supplements and or homeopathy?
Great post and interesting comments. Neuroskeptic, you are spot on when you talk about how stigma or uncoolness increases the more disorders are perceived to be internal to the self. Medicalization in that way has been a real gift to sufferers, but at a cost as well.
Lindsay, many of my over-educated, progressive friends and colleagues in the US also have a strong prejudice against treating depression with meds. This is partly because they want to resist medicalization--they want to preserve and retain certain domains of suffering as inherent to the human condition. They fear we are medicating away the anxiety, grief and melancholy of life. As a big fan of existentialism and psychoanalysis, and an apprehensive witness to widespread medicalization, I can understand this perspective. However, it can become too ideological and thus does not account for the complexity of individual suffering and meaning-making.
I also have found, like E., interesting contradictions in people's beliefs about substances. Antidepressants might be bad, while other chemical interventions are OK. This goes along with recreational drugs--smoking pot is fine, but its not fine to do antidepressants.
In terms of ranking, bulimia is less cool than anorexia. Stress, I would agree, should be at the top. As a big follower of celebrity gossip, I believe Neuroskeptic is right, and that many celebs are hospitalized for depression or other emotional problems and not addiction or "exhaustion."
Personally, I think a critical factor in coolness rating is association with creative output and productivity. This also means that a coolness ranking is going to be misleadingly over-general: who you are and what you do is critical to whether some conditions are 'cool' or not.
Unipolar depression robs you of the ability to work, for example, but it's not (at least in popular consciousness) associated with a productive upside - unlike bipolar, which is thus 'cooler'.
Addiction should fall both high and low on the list, imho, and so should stress and exhaustion. An artist or any kind or a high-powered businessman who suffers from addiction can derive coolth from these conditions, but there's little cool about being an addict single mother - or, indeed, about suffering from exhaustion from a lifestyle that others seem to handle just fine.
This does tie in with the victim thesis: it's all part of the mythology of the muse...
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