I am the Number 60

Sera Davidow
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I am the number 60.   That is, I have scored a 60 on the M3 Screen, a tool now widely promoted by Mental Health America (MHA).  More importantly (according to an alarming box that popped onto the center of my screen before I could even read the rest of my post-test assessment), some of my answers “raised a red flag” that prompted the recommendation that I either call the National Suicide Prevention Lifeline or proceed directly to an Emergency Room for “immediate treatment.”  And in case I had not already rushed off to the ER, the results further recommended that I “contact [my] physician or a mental health care provider as soon as possible to begin a discussion of [my] M3 results.”  All this was surmised from a three-minute(!) test for “Depression, Anxiety, Bipolar and PTSD.”  Three minutes.  Wow.

This self-screening tool is being promoted along with a pledge that reads:

“I am pledging to help end the stigma and ignorance that exists with mental health disorders today. I promise to take care of my mental health. I just took Mental Health America’s M3 screener to evaluate myself, and I promise to continue to monitor myself and learn ways I can live a mentally healthier life. Please join me by taking this pledge, the M3 screener, and sharing this post with your friends.”

It was posted to MHA’s Facebook page on Tuesday, December 18th, only a few short days following the Sandy Hook Tragedy.  Opportunistic self-promotion?  Perhaps.  Well intended?  Maybe.  But what on earth does it all mean?  And what would happen to me if I followed those insistent instructions to seek immediate help?  For better or worse, I can answer that last question with a fair amount of certainty.  Because I’ve been there.

On more than one occasion I have reached out to mental health providers, convinced there was something wrong with me and that only they would know how to ‘fix it.’  Each time, they have responded with authority.  They, too, believed they knew what to do (or at least what they were supposed to do) and that generally included therapy, medication and – at times – hospitalization.  I can actually remember the excitement and satisfaction of receiving my first diagnosis.  I wore it home gleefully (clutching my first ever prescription for psychiatric drugs), and introduced it proudly to my roommates.  In the long run, though, the labels and services were not helpful.  In fact, some of them were quite damaging, and I now typically credit my stubborn-born ‘non-compliance’ with saving my life.

However, many people are still caught up in desperation, hoping someone else does have the answer and praying for that answer to be easy and direct.  Abstractions and complexities are not favored.  Most people are more than ready and willing to grab ahold of any basic framework that at least seems like it might make some sense.  Unfortunately, that leaves them particularly vulnerable to any brand of salesman, be his intentions honestly driven or not.

When I took my son in for his 9-year physical, the receptionist at the doctor’s office nonchalantly handed me a form to complete.  After a few moments, I realized that the form was asking me to answer questions that were quite similar to what can be found on the M3.  She had handed me a mental health screener for my 9-year-old son!  When I refused to fill it out, my son’s doctor acknowledged that they actually get paid(!) for each completed mental health screener.  I was stunned into silence and didn’t act fast enough to find out by whom they were paid, but after just a little bit of research I can say it at least seems clear who is paying Mental Health America.  According to several documents (including their own website and annual reports), MHA has received literally millions in funds from pharmaceutical companies including Eli Lilly, Bristol-Myers Squibb, and Pfizer.

So, who does the M3 recommend seek treatment?  Not surprisingly, just about everyone.  According to the M3, scores over a 33 mean that one’s life may be impacted by a mood disorder and professional consultation should be sought.  Alas, do not fear should you happen to land with a score of under 33!  There’s a caveat that I uncovered when I backtracked and answered every question with a ‘rarely’ experienced, and managed a lowly 28.   It read, “Your LOW overall M3 Score means that your condition is perhaps somewhat milder than average. However, mild symptoms still may have a negative effect on your well being and, when left untreated, can grow worse with time.  You should find the time to contact your physician or a mental health care provider to begin a discussion of your M3 results.”

Looking deeper, there’s another frightening (but all-too-true) message to be found in the fine print.  For individuals who report suicidal thinking, the M3 states that a mood or anxiety disorder can usually be ‘found.’  It goes on to say, “This is true even for those who feel that due to life circumstances they have legitimate reasons for having such thoughts.”  Go figure.  A person in distress goes to a provider who has been rigorously trained to diagnose people for both treatment and billing purposes.  That person’s life circumstances are ignored – or at the very least, seen as somehow secondary – and the person comes out with a psychiatric label.  Shocking.  Given that those labels are applied strictly through a process of subjective opinion (there is, after all, no blood or any other sort of objective test for psychiatric labels) and cultural and financial pressure to come up with the ‘answer’ abounds, it should be no surprise that people end up diagnosed.  And yet, what on earth does it prove?

Not once does the M3 ask, “Do you have the support you need,” or “What does this mean to you?”  It fails entirely to raise issues about trauma, relationships and environment.  (This is in spite of the fact that there are several articles about the Adverse Childhood Experiences [ACE] Study – one of the most influential studies available linking trauma histories to mental and physical health issues – on other parts of the MHA website.)  Nowhere does it refer to the potential for support found with people other than medical professionals.  (Pass the Zyprexa, please!)  It does, however, come with a disclaimer:  “The maker and provider of this form disclaims any liability, loss, or risk incurred as a consequence, directly or indirectly, from the use and application of any of this material.”  The warning seems apt, given this mental health screener (like all others I’ve ever seen) appears to be specifically designed to feed anyone who takes it seriously into the same formulaic ‘treatment’ mill that has already harmed so many.

I am the number 60.  In the past, I’ve been reduced to a label – Major Depression, Generalized Anxiety, Borderline Personality Disorder and more.  Now I’m a number on a one-hundred point scale, but that number only seems to lead back to more of the same.  Funny how, in actuality, I have managed to live without any of that for most of my 30’s.  Yes, I still think about suicide.  (I have since I was a teen.)  Yes, I still experience a number of ups and downs.  Yes, at times I still struggle more than some others might.  And yet, I’ve learned that those same self-reflective, intensely analytical qualities that lead me to feel so deeply are also a large part of what make me good at the work that I do.

And that anger and hurt about what has happened to me in the past that sometimes still makes my mind race and floods me with images I can’t always control, it also energizes me to want to fight for social justice and change.  The stark awareness of all that is painful around me makes some days hard to move through and leaves me feeling socially awkward in many situations, but also motivates me to want to keep going and be the best mother I can be to my two children.  These are not symptoms waiting to be diagnosed.  These are me as I have come to be with all I have learned and loved and lived through.  This is life.  Instead of disrupting my family, my work and all to which I am currently connected by following the M3’s recommendations, I think I’ll just keep living it.

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Sera Davidow
Tangible Intangibilities: Sera writes here to share her thoughts on how the language we choose and our apparent need to concretize the inherently complex is leading to violations of rights and humanity on a daily basis.

23 COMMENTS

  1. Hi Sera,
    This is a very important story that you have shared! Thank you for telling it so clearly. I hope this goes viral so many others will read this and have the awareness of just how dangerous this self screening tool is! I had no idea it existed! so thank you for posting this important blog.

    ps…I just read your comments to my blog in November and replied…
    🙂

  2. I’m always amused by those internet “tests” that, regardless of your score, indicate physician follow-up. The only difference is how fast you’re told to run to their office! You’ve rightly discovered the money behind the exercise which explains things. That physicians offices get paid by how many of these “assessments” they can get patients to complete was a new, and disturbing, wrinkle to me.

    Nice piece. Pithy.

  3. This is such fantastic writing and perspective, Sera! You’ve pinpointed the damned-if-you-do-damned-if-you-don’t tendencies of mental health screenings to inevitably result in evidence of a “mental disorder”.

    No matter what you say or how you answer, you simply are not okay or are at imminent risk for being not okay. As people who have been lucky enough to have gained awareness of the mechanisms of marketing and manipulation around mental health topics, this is so obviously social and economic engineering.

    I appreciate your recollection of walking away with your new diagnosis and your first prescription. There have been times that I have also found something strangely appealing about the thought that there may be an organic cause for struggle, with a nice little label to set me apart as a person who “couldn’t help it.” The subtext of that ironic comfort was actually deeply damaging. As you indicated, there is a propensity for every aspect of one’s human experience to be defined from the axis of diagnosis and that is ultmate insult to self-determination, validation, and actualization.

    Thank you for exposing this marketing tool of the mental illness industry and for shedding some light on the ways it distorts and yet defines our humanity.

    Doctors really get paid for screening children?

    Does MHA get the results of the screenings?

    Thanks again…

  4. I survived 16 years of imprisonment and torture at the hands of my sex criminal father. When I complained about the residual effects of this, the docs said the real problem was the non-testable brain chemical imbalance. I almost didn’t survive their treatments. I went from one kind of rape straight into rape by Corporate Med. It was as if they said, “Oh yeah? Well, now we’ll REALLY give you something to cry about.

    This is great writing. It gives me heart to read articulate personal stories from chemical rape survivors.

  5. Psychiatry isn’t interested in our “mental-health”, it is only concerned with dealing with society’s emotional, psychological and moral lepers. To them we are little more than contaminants that society must vaccinate itself against, so that we don’t get in the way of dominant society’s single-minded quest for happiness. To them we are little more than receptacles of undesirable emotions, thoughts and beliefs that must be denied, trivialized and medicalized, and the individual who carries them must be ostracized, just in case his/her misery and fear begins to spread and diffuses throughout the collective consciousness of those who have supressed and live in denial of the fear, lunacy and misery that all human flesh is heir to.

    “On more than one occasion I have reached out to mental health providers, convinced something was wrong with me and only they had the power to ‘fix’ it.”

    Inevitable, because of the inculcation from infancy of ideas that lead to false-consciousness. People wonder why the medical-model exerts such authority over the popular imagination, unaware of the role power plays in the construction and dissemination of knowledge. The belief that we have these “mental illnesses” requiring treatment by psychiatrists is the end product of years of intellectual and perceptual programming in a direction favourable to the interests of the most powerful social groups.

    Most humans are little more than ventriloquist dummies operated by the ascendent ideological forces of their society, the conditioning process subtly facilitated by the fact that the medical-model and its implicit prescriptions allows us to delegate responsibility for dealing with our problems to doctors, whilst also offering us hope that despair, misery, tragedy and lunacy are merely the paroxysms of an illness, and not ineluctably a part of living in a world mercilessly, pitilessly indifferent to our wails of despair, our self-flagellations and supplications for mercy. Instead we place all our hope in psychiatrists as if they were like existential alchemysts, who as it turns out, are only in it for what they can get out of it.

    Of course, as you imply, this leaves the mentally-distressed a prey to the many different species of anthropomorphic vultures circling over and crapping on our heads, such as the rogue medical professional aka psychiatrist, aided and abetted as they are by their happy slaves, the collaborationists, the obedient mental patients, who shirk their moral duties in propitiation of their psychiatric masters, such as your Kay Jamison Redfields and your Elyn Saks’s.

  6. “However, many people are still caught up in desperation, hoping someone else does have the answer and praying for that answer to be easy and direct. Abstractions and complexities are not favored. Most people are more than ready and willing to grab ahold of any basic framework that at least seems like it might make some sense.”

    Wonderful writing and naming of the dependency (attachment) issue in all our human, physiological & psychological problems. Perhaps we “project” a parental need (the good enough parent) onto authority figures, particularily the “good” Doctor, who bares the burden of such projections?

    Beneath all the rationalizations about society and way it works, do we turn a blind eye to our own emotional dependence projections? Consider Bowen’s notion of a family projection process in wider society;

    “The societal projection process: The family projection process is as vigorous in society as it is in the family. The essential ingredients are anxiety and three people. Two people get together and enhance their functioning at the expense of a third, the “scapegoated” one. Social scientists use the word scapegoat , I prefer the term “projection process,” to indicate a reciprocal process in which the twosome can force the third into submission, or the process is more mutual, or the third can force the other two to treat him as inferior.

    The biggest group of societal scapegoats are the hundreds of thousands of mental patients in institutions. People can be held there against their wishes, or stay voluntarily, or they can force society to keep them there as objects of pity. All society gains something from the benevolent posture to this segment of people. A fair percentage of people are too impaired to ever exist outside the institution where they will remain for life as permanently impaired objects of the projection process.

    The conventional steps in the examination, diagnosis, hospitalization, and treatment of “mental patients” are so fixed as a part of medicine, psychiatry, and all interlocking medical, legal, and social systems that change is difficult. There are other projection processes. Society is creating more ‘patients” of people with dysfunctions whose dysfunctions are a product of the projection process. Alcoholism is a good example. At the very time alcoholism was being understood as the product of family relationships, the concept of ‘alcoholism as a disease” finally came into general acceptance.

    There might be some advantage to treating it as a disease rather than a social offense, but labeling with a diagnosis invokes the ills of the societal projection process, it helps fix the problem in the patient, and it absolves the family and society of their contribution. Other categories of functional dysfunctions are in the process of being called sickness. The total trend is seen as the product of a lower level of self in society. If, and when, society pulls up to a higher level of functioning such issues will be automatically modified to fit the new level of differentation. To debate such a specific issue in society, with the amount of intense emotion in the issue, would result in non-productive polarization and further fixation of current policy and procedures.

    The most vulnerable new groups for objects of the projection process are probably welfare recipients and the poor. These groups fit the best criteria for long term, anxiety relieving projection. They are vulnerable to become the pitiful objects of the benevolent, over sympathetic segment of society that improves its functioning at the expense of the pitiful. Just as the least adequate child in a family can become more impaired when he becomes an object of pity and over sympathetic help from the family, so can the lowest segment of society be chronically impaired by the very attention designed to help. No matter how good the principle behind such programs, it is essentially impossible to implement them without the built-in complications of the projection process.” _Murray Bowen.

    Denial of our dependency projections is well out-stripped by our greatest denial though, in our denial of the “meaning” in that ungodly word “evolution,” and the instinctual underpinning of our complex emotions. Yet the first law of survival for all animals, is life eats life? Do follow this law “emotionally” like all predator – prey animals?

    “Of course, as you imply, this leaves the mentally-distressed a prey to the many different species of anthropomorphic vultures circling over and crapping on our heads, such as the rogue medical professional aka psychiatrist, aided and abetted as they are by their happy slaves, the collaborationists, the obedient mental patients, who shirk their moral duties in propitiation of their psychiatric masters, such as your Kay Jamison Redfields and your Elyn Saks’s.”

    Does the ego feed on others, in its defining of a sense-of-self, by judgments of “I’m not like them?”

    We used to have “rights of passage” to teach the young how to recognize the imaginative fantazies of childhood and the adult needs of reality testing, do we now prefer to keep people emotionaly dependant, in “intellectual-fantazy” assumptions about so-called responsible behavior?

    Best wishes,

    David Bates.