I wandered into an interesting thought this morning while casually simulating aspects of a major collapse of human civilization in my head (as one does):
Normally, these days, when we get to talking about alternatives to available psychopharmaceutical tools for treating mental illnesses and related issues, it can very quickly slide into ableist suggestions that the alternatives are of course superior and should be used instead or at least the consideration of those tools should be considered unnatural and therefore abandoned and/or swearing profusely about the kind of abuse said suggestions actually constitutes.
I want a reboot of the conversation under a different framework. Entirely.
So, let me try to start.
Currently, the undisputed best class of tools in many cases (but not all) and many places (but not all) for treating mental illnesses are, yes, drugs! No, we’re not going to argue that, and forget insisting on “natural only” if you have a chronic illness causing significant suffering in your ”natural” body. Most of what we call “natural” is a poorly drawn boundary between “new” and “old” technology, tools, and artifacts. The best definition of technology I ever heard was the a broad anthropological version: a technology is a way of doing things. Arguing for “natural methods only” is just asking us to use a kind of vague bias towards older technologies that may or may not have been through any rigorous clinical testing in order to validate efficacy because, for some people, pills and shots are scary and/or disgusting.
I just started wondering how someone like myself would cope if we didn’t have access to our meds if our pharmaceutical infrastructure started failing significantly for any reason. Then the fact that access to these tools isn’t universal came back to mind, and made this future-hypothetical many peoples’ current-day-to-day.
So, I really do wish, in my capacity as imaginary temporary world governor for the minute, to suggest the following processes and lines of inquiry happen:
Inventory and ideate what other kinds of treatment might be possible. Think broadly. Educated, aware, and genuine community support could be considered a portion of a treatment plan, so it doesn’t have to be just something the individual does for and by themselves. Exercise could, or even possibly very specific exercises could. Certain foods or diets could. Everything currently regarded as having ever been attempted, so long as humans can do it with only minimally sophisticated tools (electronic gizmos that talk to smartphones are probably right out … very simple electronics that can be field-supported and supplied with very common items might be alright, though) or tools that might be very sophisticated in nature but made portable, durable, and maintainable using only minimally sophisticated means (books and other instructional materials, as well as many clinical testing devices that don’t rely on electronics are, in their own way, incredibly sophisticated things … but they’re just paper, plastic, wood, and/or metal and if treated gently don’t require anything other than being intelligible and understandable in how to use them by the right people at the right time).
Inventory it. All of it. But… here’s the catch:
We need to vet it using the same standards we do now for our existing best tools. We need to experiment with different combinations of tools, too, to see if some in conjunction with one another work better than in isolation. We need to develop sophisticated, concrete, and testable theories as to why these things work when they do, why they don’t when they don’t, understand their limits. We need to accept the fact that significant portions of that inventory WILL be complete junk. That’s a certainty given the inventory’s provenance. We need to also, though, accept the fact that we might well need to understand the significance and mechanisms of things we find in there that have far less efficacy and reliability than we’re accustomed to compared to psychopharmaceuticals, and we need to be able to treat them as significant and document that.
If we can get to a place where we at least understand some of the when and the why the few that have any real benefit do work, that’s the start of treatment algorithms.
SOME of this work has already been done. It’s not like scientists haven’t been curious about some of it. It’s just hard to turn a profit off of that research, so it isn’t likely to attract funding and won’t attract many researchers beyond it being someone’s personal curiosity they insist on pursuing or there’s at least SOMEONE who thinks there’s an angle they can.
But that’s what needs to change, somehow, to make better use of that junk pile of “proposed treatments” and treat it more like a scrap yard. Which is probably the best use of it, rather than leaving it to rot or leaving it to some few to venerate and wave at those of us who take our meds like we’re crazy for taking our meds. (No! That’s how we retain what sanity we have! It’s when we DON’T take them that you should worry more.)
The same process can be used, although to a much more limited extent, with other chronic illnesses. The same logic applies. The same bleak sorting through the scrapyard also applies, with just as much or more to discard.
This is not just for its own sake or the pursuit of pure knowledge, though. Newp. Because what little comes out of that pipeline and out of the scrapyard?
That’s the kind of stuff that should be made common lay knowledge:
How helpful is it really: what can it do, what can’t it do, and a basic understanding of why.
When is it helpful.
And for who.
It needs to become lay knowledge. Like first aid. That means not many people know the full extent, but everyone knows some basics, and most people at least know enough to know what they don’t know and how to locate someone who does.
Because not everyone has access to the better tools now. But we can almost certainly restart this conversation and align it to make some carefully vetted lesser tools known. Some of them almost certainly make good adjuncts.
Because the process of making this lay knowledge will go thousands of miles to help disabuse people of the prejudices and bigotry out there against mental illness. People used to flee from any visible illness they saw, mental or not. It’s time mental illnesses was fully first class — meaning at the very least people are no more likely to ostracize mental illness than they are someone with a broken bone, and see it not as a weakness but just something that needs dealing with, sometimes urgently sometimes not, depending on the presentation.
Because sometimes circumstances change, and sometimes people really DO find themselves unable to access medications they’d been taking. Loss of employment. House burns down. Hurricane comes in and renders the city unnavigable for weeks and you’re actually one of the genuinely lucky ones IN a shelter, as opposed to slowly starving and dehydrating on a roof somewhere. I don’t know, maybe godsdamned Mothra versus Godzilla in Chicago for real. The circumstances should matter only in as much as they do or don’t limit access to resources and people with the right knowledge in these cases. If there’s much more literate lay-knowledge in general on how to mitigate and give bare-basic treatment for mental illness, it’s better than nothing.
It’s also probably a good way we can sloooowly start to shut down those conversations about how some of us should really try kombucha instead of our antidepressants beforrrre they start. I can’t STAND kombucha… feels like I swallowed the world’s largest booger. (Something I have to DISCOURAGE one of my cats from doing on a weekly basis.) You all who like the stuff can have my share, you enjoy it just enjoy it in peace, it sounds like they’re inventing the BEST flavors for it these days and… Um… Can I get a glass of water, though? coughs