I’ve been thinking a lot about the middle man lately, us “moderates”.
In the current system of mental health, there are three labels which determine the level of “care” you receive: “Mild”, “Moderate”, and “Severe”.
There’s no doubt that some people face deeper challenges than some of us, someone always will. But have these organizational categories really organized the system into something that’s useful?
Alright, the milds. I was in this category for a brief period when the only diagnosis I held was Social Anxiety. First I was told I’d grow out of it. Secondly, I was told I’d grow out of it. Thirdly, again, GROW OUT OF IT.
I was called shy, told to “speak up” so frequently the phrase has become something I despise. The worst thing I think, though, was when people walked up to me and said “you’re so quiet”. I–I’m aware I am, I’m glad you’ve realized it as well. That too, I began regarding as an insult. I’m still highly sensitive to these words.
Because no one really saw the level of distress I held on my shoulders, and because I couldn’t properly express that distress because I didn’t understand it, I was told by therapists that I just needed to get out there and expose myself to social crowds. I did. It didn’t help much. And when I said that, well, it’s because things take time and I wasn’t trying hard enough.
The mild category is where those of us with anxieties, sometimes depression, and other experiences like phobias are tossed away. We’re taken serious, but often not serious enough.
This is where you want to land in the world of mental health IF you want serious care. This isn’t where you want to land in the world of mental health if you want to maintain dignity and independence, because sometimes the “Care” that’s provided steals those right from under your feet. You won’t even see it coming. Like a snake in the grass. Wear high, rubber boots if you’re wading in this swamp.
Damn, my jokes are lame.
This is often where you’re placed briefly if you’re being hospitalized. It’s also where you hear of the “severe mental illnesses”, people labeled with schizophrenia or bipolar 1, schizoaffective, DID, sometimes OCD, and so on.
Of course there are different layers to this thing we call diagnosis because it’s SO scientific, and someone labeled severe can eventually jump down to Moderate and even mild depending on what kind of treatment they receive, what they are told about themselves, and what they choose to believe about themselves and their life.
With my most recent hospitalization, all previous diagnoses were thrown out the window. Four options were put under a microscope: Bipolar 1, Depression with Psychotic Features, Psychosis NOS, and Schizoaffective, and there’s still no consensus as different opinions yield different results. Psychiatry is very scientific, I’m telling you.
I’m not one to chase a diganosis, but what they put on that little piece of paper will determine, in combination with my experiences, the level of “care” I’m given (with insurance limitations), regardless of what I feel I really need. Complicated.
Those with the “severe” label often are those who are homeless, who can’t have a “coherent” conversation (to the outside observer), who can’t take care of personal hygiene, and who can’t work. Disability benefits is often one of their life lines.
I think this category wasn’t created intentionally, but as a result of people who were a combination of both of the above. For myself, there are times when I am what they call functional, and times where I am what they call not functional. Where do I go? In the moderate pile. What do I get in the moderate pile? Well . . . not much.
Therapy every couple of weeks is nice I guess.
Often, those of us who have been neglected and/or abused in some way in the past, whether that abuse was intentional or not, have trouble speaking up for ourselves. We’re trapped in that victim mentality, and that can render therapy useless at times. It also means we need a little more guidance and help understanding what is healthy and what isn’t–because we never learned. This means: what is a healthy way to treat ourselves? What is a healthy way to treat others? When do we know our relationships and friendships aren’t healthy?
Therapy can help with that. Support from multiple outlets can help with that. Moderates don’t always have the option of intensive support because we’re decently functional: we shower most of the time, we have a place to live even if that place isn’t healthy, and most of the time we have some source of income, whether it’s part time work, freelance work, or full time work.
The problem with this category is often it can lead to “severe states”. And you have to wait until that point before you’re really serviced.
What Can We Do?
It’s time this “moderate” category get taken serious as a category. Attenuated Psychosis Syndrome, the DSM board’s attempt at bridging the gap between “moderate” care and “severe” care, their attempt at launching a preemptive strike on psychosis, failed majorly.
We don’t need more diagnosis to bridge that gap. In fact, that’s the last thing we need. We just need more of a focus on the moderates. We need programs dedicated towards us. We need care specialized towards us. It’s not that difficult: if we can do it for the “severe”, we can do it for the “moderates”.
This also requires us moderates to really vouch for ourselves. It requires us to step outside of what we’ve been taught and really express the struggle we face. Because what we stuff down has to come out eventually, and that’s what launches those of us in the moderate category into the severe.
“A closed mouth don’t get fed”. Yet another saying jammed down my throat I’ve learned to hate, regardless of how truthful it is.
If you’re a moderate, get involved in something. If therapy is the only thing you receive, and you feel it isn’t helping, reach out your fingers into other options, I know I’ve been trying to. Support groups, peer mentors, community groups, retreats (if you’ve got that kind of money), anything that will support you.
You are your biggest support, until the system catches up.