Blanket statements

So, my TV watching this evening provoked some thoughts; I know, I know, it’s just TV, but still.

1. Glee and the diabetes analogy — great episode overall. I loved the “Unpretty” song, and it’s not the only bit that made me a little teary. I think most of you would guess that I believe homosexual practice to be forbidden in the Bible, but I also firmly believe that gay people are people and should be treated with the same kindness and respect as any other people. I’m really glad this show is dealing with the issue.

However — and keep in mind this is just one thing out of a whole episode — I dislike the diabetes analogy for mental illness and treatment.

The diabetes analogy goes like this: If you had diabetes, you would take insulin. You wouldn’t expect to just snap out of diabetes, or just accept it. You should consider your mental illness the same way — take your medicine. It’s helpful in a limited way — helps with shame, with guilt, with the sense of “I should be able to beat this on my own.” But this analogy does not serve mental illness completely well, and I’m not sure it serves diabetes and other non-mental illnesses all that well, either.

It makes it seem black and white — clear, clean, and tidy; antiseptic, impersonal — thoroughly understood — without nuance, without a variety of diverse factors and contributors, or at least without them being considered significant.

It removes, or at least reduces, any possibility of being the victim (broadly speaking) of any people, and it removes or reduces any possibility of being personally responsible for the illness.

In reality, maybe your past experiences — what you received from others, what you chose for yourself, and the many experiences in which you were both receiver and agent — have a lot more to do both with your diabetes and with your depression.

In the episode, it’s clear that Emma has some past experiences that contribute to her OCD; perhaps in future episodes her therapist will deal with some of that, in addition to the SSRIs she prescribed immediately. Not that I am anti-psychiatry altogether; I take an SSRI myself and believe it helps. Someday I’d like to not need it anymore; and that is not a black and white question. What it is is a question of deciding what shade of gray I want to live with.

I remember attending a seminar about depression, at some Christian weekend conference thing, and being disappointed that it was all about clinical / medical depression, the kind you need medicine and a diagnosis for. I felt vaguely, at the time, that this approach dismissed, made invisible, my kind of depression, which until PPD hit was more about baggage than about neurochemistry. I feel more strongly about that now. I want people to talk more, and more acceptingly and helpfully, about this component of depression and other mental illnesses; perhaps there are some people for whom chemistry is really the only factor, but I suspect not. Even for those who do have chemical imbalances — myself perhaps included, since the SSRI helps me — I suspect baggage has a significant role to play.

I think we should look at medical illness the same way; to look not just at surface symptoms and treatment, but at all the many factors that could be in play, and all the many actions that could be taken. Robertson Davies’ The Cunning Man addresses this idea, among other things.

2. Raising Hope and sleep training

When we were brand-new parents, we, too, thought there were only two approaches to making babies sleep: Cry-it-out, or various attachment methods such as rocking to sleep and bed-sharing. And indeed, these were the only two options mentioned in the show. And, unfortunately (in my opinion), the family went with the cry-it-out option, claiming the attachment option had made their son a wuss. (As if infants are just like adults, and as if the way you deal with an infant will lock you into dealing with them that way forever.)

When I read — in Penelope Leach, I believe — about a middle way, I thought, this should have been obvious! But no one — just about NO ONE — ever talks about it!

The middle way is this: Your baby is somewhere around three months old. (If she is younger, go ahead and rock her to sleep and then put her down. She’s unlikely to wake again soon, and you’re not going to “spoil” her.) She is sleepy, but still a little awake. You’ve had your bedtime routine — story, diaper change, song, cuddle, feeding, whatever. Put her in her crib or moses basket, pat her for a minute, say good night, and leave. If she cries, return in a couple of minutes — do not pick her up, do not start a conversation — just pat her again, reassure her that you’re there, listening and responding, and that it’s bedtime, and leave again. Repeat until she no longer cries when you leave.

You’ll likely have a few really long repetitive nights. But just a few.

With the way my PPD went, and the kind of baggage I’ve got, and other factors, bed-sharing would not work for me. And rocking to sleep stopped working at about this age — she’d wake a half hour later and need to be rocked again. But with this middle way, I felt that I was still showing compassion and respect — indeed reassuring her that we were there and caring.

It reminds me of the concept of scaffolding — the idea that one role of a parent or teacher is to help a child do just a little more than they could do on their own. You’re not doing for or to — you’re doing with, providing just a little more help.

I wish people would talk about this more often. Cry-it-out is NOT the only other option if you can’t or don’t want to bed-share or rock to sleep forever.

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6 thoughts on “Blanket statements

  1. I didn’t see the show but I agree with you about the diabetes analogy and about root causes and such. I have at times thought I should just be able to snap out of being diabetic though and I don’t always take it seriously. I also believe there are many factors that come into play in both physical and mental illness, and that a many faceted approach is needed, including looking at our own role in how we got where we are. (That doesn’t mean carrying a burden or guilt or shame or beating ourselves up though.) There is no history of diabetes in my family that I know of, and none of my siblings have it, including my identical twin sister. I know there are aspects of it that are my fault: things that I did or didn’t do that made me more susceptible and brought things to the tipping point (stress and sleep deprivation being two biggies.) Also, research backs up the idea that changes occur in our brains based on life experiences and choices, so I sometimes wonder what came first, the chicken or the egg with some of these things. So, take your medicine, but don’t stop there.

    I really like what you said about the third option for helping a baby sleep. That is basically what I did. I did let them cry for a few minutes to see if they would settle back down on their own, but I never subscribed to the “cry it out” philosophy. Neither of our sons were challenging in this area though. They both started sleeping through the night at about 4 weeks. I hadn’t heard the term “scaffolding” used as you used it here. That is excellent.

    I am falling asleep and likely not making much sense, but great post.

    • And people using the diabetes analogy are talking about Type I, anyway, almost as if Type II doesn’t exist or isn’t important.

      You made just as much sense as I was making at that time last night! Perhaps even more.

  2. That particular episode of Glee hasn’t made it to New Zealand yet, but I agree with you: mental health issues are not the same as physical issues (although they can be interrelated, of course). I think we’re in the age where many people expect a magic-bullet to any issues they have.
    I’m pleased you found a way to settle your baby which you’re happy with. We did cry-it-out and controlled-crying with our first and it’s my biggest regret in parenting. We are now bed-sharers and wouldn’t have it any other way, and I understand not everyone can manage this approach. 🙂

  3. Is controlled-crying another name for the method I described? I am glad we never got into cry-it-out or rigid scheduling or the like.

    When Amy was newly born, our midwives told us about cultures where the new mama nests with the baby in bed for weeks, while everyone else cooks, cleans, and otherwise takes care of them. In some ways I would have liked to have done that, except a) I had PPD and could not be in the same room as the baby for very long and b) I didn’t have people around who would have taken up their caretaking roles cheerfully and helpfully without resenting and judging me.

    • No, I don’t think controlled crying is like what you did…it’s a different version of cry-it-out where the parents leave the baby for 1 minute, then 2 and so on.
      I love the sound of just being Mumma for those first three months or so – sadly modern western life just isn’t like that, is it?

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