The following is a brief explanation of an overarching point of this newsletter: The Frontier Psychiatrists, for new and old readers alike.
It's mostly penned, in the Apple Pencil Pro sense of the word, by Owen Scott Muir, M.D., although I sometimes have guests. We already have a diffusion product: the series of RAMHT events! That's “rapid-acting mental health treatment,” co-created with Grady Hannah.
A crisis is not just a problem. It’s not just problems—plural. It’s the admixture of problems with hopelessness. This newsletter is written to go beyond providing “solutions to problems.” We have those already. If we knew we had problems with solutions at the ready? That does not meet “crisis criteria.” We need to address the crisis mentality surrounding the difficulties we face in our minds. Panic is sometimes understandable in that it can mobilize life-protecting responses in the context of imminent death by, for example, tiger maw. However, panic is axiomatically not rational. In a crisis that involves solutions that extend to payment models, policy, and complex systems? It becomes a truism that demonstrably neither panic nor crisis mentality will do anything useful.
We do not have a mental health crisis. We have a mental health crisis…crisis. We have become so panicked by the relentless onslaught of early, preventable death, loss, and sorrow that we cannot address it. The crisis frame creates panicked responses. Those responses have served up more death, suffering, and isolation.
No thanks, I say. This newsletter is written to address the “mental health crisis” as something other than a crisis. We face understandable problems with rational solutions—if we can think clearly. Some of what I have written is funny. It might be gallows humor. It might be absurdist. This serves two purposes—one, it is hard to laugh and panic at the same time. The message is the medicine. The second is more self-serving. I just can’t stand writing the number of words that will be necessary without having some fun, personally. I wish I could. I can’t. Other people write deeply serious tracts. Read those, if this is no laughing matter.
In my attempt to dismantle the crisis mentality, I am not stopping at one word. I’m going after the whole phrase. I’m a serial killer for “the mental health crisis.” Only the article—“The”—will be left standing by the end.
People use the term “mental health” more often than they mean it—by a factor of always. One of my favorite pandemic-era malapropisms-in-waiting is the saying: “Everyone has mental health.” What I imagine people mean to say, with the stigma baked right in, is that everyone has some degree of psychopathology. Everyone has problems. Does everyone have a risk for mental illness? Everyone has a mental state—it’s glib. It is maximally-pointless pablum.
Mental health is a nonsense phrase, and I will dispense with it as useful. Mental Health is a state of health as it applies to the mind. Perhaps there is an absence of problems with the brain, mind, and spirit? It’s as meaningful as saying, “Everyone has bones” at an orthopedic professional society meeting. The presence of bones are not at issue for orthopedics. It’s the fractures of said bones that matter. “Everyone is a little bit crazy” is the kind of thing generally well people can say. This is in the same way that other generally well people can claim there is no such thing as a psychiatric illness. Both statements are inaccurate and minimizing to individuals who are suffering deeply as a result of the very real truth that some people are very, very unwell.
There are two kinds of relevant “crazy.” One is psychiatric illness—which I believe exists because I have seen it up close and personal, and I don’t believe demonic possession is the only cause. The second is often also psychopathology, but more firmly rooted in problems of personality functioning—identity, self-direction, empathy, and intimacy. It is the kind of crazy people make true crime podcasts about. The kind of crazy people make comedy specials about. The kinds of crazy that lead anyone to run for political office. Personality plus more traditional illnesses of the mind—psychosis, obsession, despair—these together create very serious problems for all of us. We can look at crazy—in the “what do you mean 30 emails an hour” sense, from a stalker—and simply call it “crazy” without understanding why, what, and how to respond most adaptively.
We have problems that impact our wellness. We have unwell people who cause us all problems. Every once in a while it’s us—we have a psychiatric illness and find ourselves acting strangely, and worry—deeply—that we might be…you know, crazy.
This newsletter strives to address both of these issues—we define mental health problems, and we will examine how brains and minds can conspire with the outside world to drive behavior over the edge for vulnerable people.
It’s a newsletter about solutions to problems, second, and dismantling a crisis mentality first. Join us.