Non-medical crises and struggle severity.
| 10 min read
Note: this writeup mentions and talks openly about suicide and self-harm, although nothing explicit.
“Crisis” isn’t always medical, either, to me.
I was talking to some fellow plural folks a bit ago about some of the bear-in-a-forest philosophy, and noted at one point (somewhat irately) that “problems don't have to be medical to be valid and worthy of care.”
One person responded with essentially agreement that people should be able to get help without being in active crisis, and noted frustration with mental health services not often doing much unless you’re in active crisis.
...while I staunchly agree that lack of more support in non-crisis situations is a significant problem, I did not say anything about not being in crisis, or even the “severity” of the problem in question at all.
The phenomenon of me saying “I don’t think this is medical,” and then some people immediately assuming I am referring to less severe, less threatening, or generally milder cases than "Actual Serious Mental Disorder Crisis" is, to put it very bluntly, a big part of the problem for me. And I don't think it's an individual issue - it's more of a broadly societal one. We as a society have more or less associated "medical" with "more valid/serious" at this point, I think.
“Medical” does not inherently mean “more serious” to me, though. When I say “I don’t think my trauma reactions, which come naturally from millennia of survival evolution that is not built for these situations and is now causing problems because of that, are medical problems,” I am explicitly also including the suicidality, the self-harm, the actual damn suicide attempts, I am including ALL of that. I am explicitly including the crises.
Another friend of mine - who has a biology degree, mind you - a while ago, when I was talking about neurological survival evolution, remarked about how many people incorrectly define "survival of the fittest" as something completely removed from environmental factors. A species that does perfectly in one environment, when taken out of its natural habitat and placed in a totally different one, may seriously struggle or even die. That does not mean that its natural state is diseased or disordered or broken or "not the fittest," actually. It means its survival evolution evolved for its environment, and if you put it in a different environment and want it to be successful, some adaptations and accommodations may need to be made!
I feel like human neurology evolved to handle situations like bears in forests, not things like property taxes and bureaucracy and being held at gunpoint only to survive and be able to drive across the city away from the "bear" (guy with a gun).
“I wish people could get the help they need without being in crisis!” I agree. The fact that if you are not actively trying to hurt or kill yourself then you don’t get support is a massive problem, and actually extremely relevant to a very real problem I’m trying to wrangle right now in my personal life.
But this is not what I’m talking about when I say my mental health is not a medical disease. It’s a bizarre glitch, but honestly, all trauma reactions that don’t match the actual reality are kind of glitched in the same way, in my opinion. The complicated biological Rube Goldberg machine that is my body and brain - they don’t speak logic. They speak, like, viscera, and wild predictive emotion, and weighted averages of everything that has come before this moment. And when there’s a ton of horrible stuff occurring that is exceeding what your biological rube goldberg machine feels it’s able to handle, and there’s a big giant metaphorical button that’s labeled “PRESS HERE AND YOU DON’T HAVE TO DEAL WITH THE HORRIBLE STUFF ANY MORE,” it makes sense that an individual “minimize suffering” evolutionary drive would start leaning toward that button! Even if in the grand scheme of things, it doesn’t quite make full sense with the reality - but then again, things like me getting anxious about a slammed door, even if it was the wind slamming the door and not even a person, doesn’t quite make full sense with reality either. This biological rube goldberg machine does not speak reality logic.
I’m also going to note that when you put a person in a torture chamber for a decade and then put them in a situation where they could either impulsively choose to die, or continue the torture, a lot of people… actually would choose the “way out,” so to speak, I think. Not everyone - I can’t make broad general statements like that, but psychologically speaking, like - when it comes to instances of people being put into horrible situations like literal years-long torture, that’s not an unexpected outcome.
Obviously the common things leading to suicidality are typically not literally being locked in a room for a decade being tortured, but there are a lot of things in current society that are genuinely traumatic that are well beyond any individual average person’s control, and which people very seldom get support for and are left to fend for themselves. I’ve not got this articulated fully yet, but ironically, even though it is obviously a very big problem, I don’t even think feeling suicidal is actually a medical malfunction either. Is it causing problems? YES. Does it need attention and care and support? ALSO YES. Is it evidence of a brain disorder? Mmmmmm, no, in my opinion. (And, frankly, while this is far from the only facet of this, flattening suicidality - and also depression and anxiety - to solely a symptom of a brain disorder can also seriously shift the onus and responsibility of handling the psychological toll of things like racism, ableism, transphobia, food insecurity, labor exploitation, abuse, housing insecurity, and more onto the individuals who are victims of these things, and not the actual damages and a society that is failing to handle them).
Anyway. Struggles do not have to be medical to be deserving of attention and care. I do not know any more plain of a way to put that. And please, fucking hell, do NOT assume that “not medical” means ”LESS SEVERE.” That is not what non-medical means here, that is not what I mean when I say non-medical, and a non-medical crisis is still a crisis and can still be lethal and still needs attention and care.
Because I don’t want to leave this hanging, either, though: Problems having to be past a certain catastrophic threshold in order to “qualify” for help is also a massive problem, it’s just not what I was focusing on in the discussion prior. But to touch on that for a moment, for example, if we’d had support for our genetic disease or heart condition or sleep disorder earlier, BEFORE it got catastrophically bad, we probably would have been able to maintain a job, a career, hobbies, we probably would have been able to continue building our lives.
However. We did not get that. We were told “well, you can still work, because you are still working,” and we were doubted and dismissed, told we were being “irresponsible” because our apartment was an unclean mess because we were having to dedicate all our waking energy to making sure we could get through a work day and also feed ourselves, until we were in situations where we were accidentally ending up in car crashes at stoplights because our brain was so sleep-deprived it was periodically shutting off (microsleeps), having to leave work repeatedly because we were throwing up in the bathroom or passing out or dislocating things, we had to stop doing hobbies, we had to stop having any quality of life whatsoever because everything was dedicated to trying to maintain work and basic survival needs alone with no support because we didn’t qualify for support - even if people believed we were struggling, the number of times we heard “your income is over X amount, you can’t use our services,” “you’ve been working for the past two years so you can’t use our services,” “you haven’t had a hospitalization for this (yet) so you can’t use our services,” was absurd.
There was no midpoint, either - it was “work full-time with no support” or “be ‘bad enough’ to apply for total disability.”
“Why didn’t you get accommodations?” I might hear you say, but here’s the kicker: we really fucking tried. Our former primary care doctor told us she didn’t want us using our cane even though the only reason we were using it was because we wouldn’t be able to fucking take a shower after the appointment if we didn’t, and then refused to write us an accommodations letter and we got fired from our job because we were unable to do said job without accommodations.
So it just got a bit worse, and a bit worse, and a bit worse, stacking up over and over, and it did get to a point that we HAD to stop working. We’d been overstraining ourselves for so damn long that honestly it has now permanently damaged our health, and if we were able to truly get actual support EARLIER then we would have been able to build that resilience and continue our life without it being completely derailed. We finally got a physical therapist who set us a lot more on the right track, and some doctors who have actually taken us seriously (although honestly, there's many other issues there too). Since that PT, we haven't had this kind of mobility in years, and while it still isn't enough to work - we did severely sprain our ankle just trying to walk at our job in August, after all, and we still can't stand for long - the PT exercises are actually stabilizing our joints in a way that none of the other 5+ PTs we've seen were able to do. What if we'd had this ages ago? What would have happened?
Grass is greener, etc. etc., I'm glad we're getting it now. Better late than never. But we're still lacking a lot of support and still struggling and even if we do "get better" on some things, we risk losing what little support we do have. Withholding support until a person is past a "crisis threshold" and then taking away that support if they improve not only contributes to making people worse but also keeps them there sometimes.
Final thoughts: This is a bit more loose rambling than a more organized essay like the bear in a forest one, but I think... I want this blog to be a little less pressured-to-polish, so to speak. I can always come back and edit this or write more or whatever. I don't want to end up not writing things because I feel pressured to always make it perfectly polished.
If you have any questions or comments, please feel free to comment below. I am always happy to clarify if something seems unclear!
Thank you for reading.