I wasn’t able to arrange any interviews. The doctors in the Senegalese mental hospitals were defensive, fearful that I would paint a bad picture of conditions, or busy. The assurances of the State Department staff who were helping me didn’t sooth this naive patriotism or persuade them to give me half an hour, but I learned a little. There’s no social security in Senegal, so the mentally ill either rely on the care of their family or begging. I didn’t see many people who struck me as being afflicted on the streets (unlike London and Paris), so I assumed that they had been assimilated into the crowd and received care of sorts from other dwellers of Dakar’s streets.
The luckier among the mentally ill receive support from their families who send them to mental institutions where they receive treatment in the form of psychotropics. These help as long as the money holds out — a familiar story to those of us who remember the dark days before Obamacare. I can’t tell you about the conditions in the hospitals; so, I don’t know if they followed the best standards of care or if they were dank prisons where patients were chained or locked into padded cells.
Mental illness is recognized even in the more remote and traditional areas, which refutes the myth that people in Africa regard people living with schizophrenia and bipolar disorder as holy. Instead, they are ostracized and feared — as they have always been, even when they have found a niche as shamans.
Most of the mentally ill disappear into the mass of people walking the streets of this city. They are ignored and forgotten, their symptoms shrugged off which is not the reverence of the myth makers. There’s rumor of an American in one of the suburbs who is in episode; there is no retrieving him and taking him home, however, because he will not come into the embassy for evaluation.
If I stayed around, I might see more; time is running out, however.
When you are wandering around the city of Dakar, you are faced by people who make less in a month than you spend in a day. Street vendors assail you at the tourist places, handicapped beggars sit in the street. You tip the beggars and fend off the salesmen as best you can, but unless you are the Koch Brothers, you feel that overwhelmed by the poverty and impressed by the resolve of the people to make as good a living for themselves as possible. They probably never taste meat or enjoy soft drinks (that cost twice as much as they earn in a day). If anyone thinks they are lazy, they should follow one of these for a few hours. Begging is hard work and so is selling.
A woman in brightly colored native clothes started talking to us on the boat to Ile de Goree the other day. She was very friendly and, of course, she had an ulterior motive: to get Lynn and I to visit her shop and buy a few things. The boat was filled with Africans of all nations (including a few from the United States) and a few Europeans and white Americans. I do not know how she reached the conclusion that I was Muslim, but she wanted to know which of the women sitting next to me — Lynn and an Australian woman living in Geneva — was my first wife and which was my second wife.
I told her that I thought one wife was enough for me, that I didn’t want the trouble of arbitrating disputes between two or more women.
“I am the second wife,” she told us and smiled broadly.
I could not help but admire her spirit, so when we met her a few hours later, we bought a few things for our niece after fierce bargaining.
I’ve been in three time zones this trip, mere hours apart. Seven hours separate me now from my normal time zone; the heat and the humidity have been more of a problem that disruption of my circadian rhythms here in Senegal. When I feel a little drowsy in the morning, I have tea or Coca Cola. This augments my Vyvance without pushing me into mania.
A tomato on a sandwich proved to be more of a problem. This morning I had nausea so bad that it broke through my Zofran. The technicolor yawn spilled out of my mouth like the larva came out of John Hurt’s chest in Alien. I handed my shirt and pants for processing over by Mami the maid, took a nuclear grade antibiotic that the tropical medicine specialist gave me, and took a long nap.
The plot that my psychiatrist and I hatched is working. I take two Tegretol first thing in the morning and two more later in the day. There are no visits from Tigger or Eeyore, no wild scenes with strangers. i keep calm under pressure from street vendors; “de-de” is very much a part of my vocabulary. (I have yet to say “Jok fe” which is “Go away”.) They are only trying to make a living.
London is an hour ahead of Dakar and Paris is two hours. We’ve already been to the city on the Thames; we’ve been through Paris twice, but our real visit there begins Sunday morning. I am proud of the fact that I have not lost my temper and raged against the cities. Even when I was pickpocketed (I got the wallet back) I accepted what happened and went on with my life. The trip is a success.
I’ve gotten two jobs in London — or it is the same job? The first one seems to be in some kind of gym where speaking French is part of the job. The other is at a clinic or — is it the same place — where I lead a support group for people with bipolar disorder. About a quarter of the patients speak French. I acknowledge them in the few words of French that I know, hoping that no one will find out that I am faking and cause me to lose my job. Everyone lines up. They are all wearing white.
In a few days, we will leave our home and our pets in the hands of a housesitter; then, board a plane for Paris by way of Salt Lake City. The next day, we will take the Chunnel to London where we will spend a week before going to Africa. On our way back, we will stop again in Paris, then return via the same route to our home in Orange County.
I have been feeling the strain of this trip for several weeks. I’ve trained the house sitter in the management of our pets, introduced her to the housekeeper, made sure she was authorized to call for repairmen and get the animals treated if they get sick. We’ve gotten the proper shots and picked up prescriptions for antimalarials and antibiotics. I felt slight fevers after the vaccinations. This means I am done with typhoid, influenza, and yellow fever. We have mosquito repellent and netting to cover our faces. Loc at my pharmacy negotiated with the insurance companies so that I would not run out of medication. My psychiatrist wrote a prescription with an extra dose of mood stabilizers to get me through the disruption of my inner clock. I am bringing Benadryl to help knock me out. Now I am shifting my sleeping and waking times by a few hours each day until I arrive in the same time zone as Paris.
I have developed this perspective over the course of many years. Denial was part of my life for many years. I made my wife’s life hell and I was a thrall to those who knew how to trigger me. It has not been easy. Now that I am on medication, I feel much better and in control of my emotions. Nevertheless, I respect the decision not to take medication by some, but often find that they do not respect mine. This article stakes out my position and makes a stand for what I believe.
I wrote this in June and set it aside to season.
Lynn grows a third eye, not on the forehead where they emerge by tradition, but to the left of her other eyes. It is smaller than the other two. She makes arrangements to have it removed, but something goes wrong with her right eye and she has to have it excised. I suggest that they replace the right eye with the third eye but she tells me that this is impossible. They are going to cut the extra eye in four pieces before they remove it a week later.
The opposition to Murphy’s Law has made some strange bedfellows, but I am not willing to get into bed with just any of them. An old logical fallacy is in operation — “the enemy of my enemy is my enemy” and its application here is just wrong.
I cannot break bread with anti-psychiatrists, as much for for the fact that they are often wrong as for their abuse of people like me.
There are many varieties of anti-psychiatrists. Prominent among them is, of course, the Church of Scientology whose fallacies I will leave to you to explore on your own. New Agers and vitamin addicts also raise their voices — I have had my arguments with types who rail on about Big Pharm but are ignorant about the $4 billion a year alternative medicine and supplements industry; who claim that vitamins and herbal medications have no side effects and do no harm; who insist that their nostrums are more effective than psychotropics and that clinical trials to the contrary are rigged by Big Pharm. But the god of all of these is Thomas Szasz.
Blaming the victim is an aspect of stigma that should hardly be new to those who experience stigma. “If the mentally ill did not act so odd, they wouldn’t be harassed.” “If they took their meds, nobody would pick on them.” (I have heard it said of people who do take their meds!) You can sum this up as “it is all their fault, not those who harass them or bully them.” You can class this as nothing more than an attempt to evade responsibility. You hear it in rape trials a lot. You hear it when people beat up gays and lesbians. You hear it when they talk about people like us.
I’ve often heard that the homeless are homeless because they won’t get a job or take their meds. This dismisses realities such as the lack of community mental health clinics, the fact that you need a stable address before you can get many jobs, and medications are just too damned expensive for many people. What happens when someone doesn’t respond well to lithium but needs a more expensive medication such as Abilify? There are all kinds of excuses for not feeling compassion for this person, but that is all they are — excuses.
Stigma is often masked as reasonable, but a closer examination shows that the arguments supporting it are flawed. We who live with mental illness have good reason to object to it: Prejudice costs us jobs, friendships, and self-dignity. The isolation which we live in worsens our state of mind. Stigma is not only evoked by people who do not suffer as we do, but also by anti-psychiatrists who oppose treatment and who deny mental illness. Both are often clever in hiding tactics, but I have written this article so that you might recognize and confront them successfully.
Herein I shall describe many logical fallacies that are used by people who invest in stigma either to promote an agenda or directly attack those of us with mental illness, giving examples for each. Remember these the next time someone uses them, identify them for what they are and let them know that they are standing on shaky ground.
Dear Mr. President:
I live with bipolar disorder.
Recently, you called the Republicans in the Senate “crazies”. While I will admit that they are out of control, you put me — a Democrat — in an awkward position.
Every day of my life I live with an illness that affects my mind and draws prejudice to me. I hear that I am violent even though statistics show otherwise; I hear that I am unable to think and reason; I am left out of society by unemployment and ostracization. People fear me because I am mentally ill.
You have been a great supporter of people like me. Your health care plan made it possible for the dysfunctions of our brain to receive the same right of treatment as the dysfunctions of our liver, our colons, our pancreas, our kidneys, our thyroid — to name a few. Our privacy is protected under HIPAA. These are all great things.
But when you call your political opponents “crazy”, you use my diagnosis as an insult. You add to the stigma that I must deal with from many quarters. And you put me in the same pen as the most destructive political movement since the decade before the Civil War.
I am crazy. The Republican Congress is willful, destructive, and evil. Please make the separation. Do not paint them with the brush that I already must wear.