Harshly Mellow

I think it is highly frowned upon to refer to the seriously mentally ill as crazy, but a.) I'm referring to myself and b.) I'm still learning the language of madness so cut me some slack, 'eh?

I ran across a post on substack from Psychiatry at the Margins titled Hermeneutic Labor in Medicine and Psychiatry and it just resonated with me so hard. This is a really good way of looking at something that's plagued me pretty much forever.

It is straight up exhausting to have to carefully manage interactions with your providers. It's worse when you already aren't feeling well. A badly managed visit, though, can set your recovery back months if not years. This is something I've actually been exploring lately, whether the amount of medication I'm on is appropriate and if not (spoiler, it's not, I'm overmedicated and I'm not just saying that because I'm bipolar and we're famous for that shit) if it can be changed. The way I'll need to shape the narrative to fix that...hell, I'm not sure it can be fixed. This is what I'm talking about, from the article:

And when clinicians fail to perform this labor, or fail to perform it sufficiently well, this has detrimental effects where the hermeneutic burden is then shifted onto the patients. In fact, patients may not only be left with the hermeneutic burden of making sense of their own problems, but they may also be burdened with the task of figuring out how to tidily package and present their concerns to their clinicians in a manner that they are taken seriously. 

I had a PCP once upon a time--he was my doctor when I was diagnosed, actually--who did not believe that diagnosis even after I had a hospital stay. He was entirely focused on the fact that he had never seen me act bipolar (whatever that means!) and he told me this at every visit. Mostly I can pull my shit together for five or ten minutes, so yeah, he wouldn't have seen it. A day that bad and I wouldn't have been there. I've always been curious if he still would have doubted me if he'd seen me at my worst. 

But the larger point is that it's awful to have to plan carefully exactly how you want an encounter to go. Also all the ways it could go off the rails and have approaches planned for those contingencies as well. Also imagine your life hangs in the balance, from whether you can muster up the energy to take a shower to whether or not you can hold a job, with the things that give you joy hanging precariously in-between. The stakes are high, the communication compromised. Every choice in front of you is bad. Navigating the system is difficult or impossible. And somehow it lands on the person with the illness to try to fix it. 

It's not a good look.

This is a test post for formatting and all of that good stuff. I'll probably kill it in the morning.