This morning’s email brings a notice from Medicare.gov: “John, it’s just as important to take care of your mental health as your physical health.” I am informed that depression screening, individual and group psychotherapy, and family counseling are available to me if I need them. Also tips on caring for my mental health.
I do care about my mental health. I try to remember there’s a world outside of my skull that I need to engage with. I’ll live longer if I do, as reality is unforgiving and murderous when you ignore it.
I try to see the truth no matter the cost. But mental health can be unpleasant even when it’s saving your life. To paraphrase Student Barbie, “Reality is hard.”
Reality is hard. It doesn’t respond to magical thinking. It can be depressing. It can make you crazy with rage and disappointment. It will kill you eventually, even if you don’t ignore it. The narcissistic defenses against it—denial and projection—tend to turn into depression over time, and depression is a particularly grim form of madness. It turns your own brain against you. In horror-movie terms, the maniac’s call is coming from one of the downstairs extensions.
The Medicare folks mean well, I am sure, but their personalized message is counterproductive. Why are they advising me about this right now? Have they discovered I’ve been telling people my age that our generation will be dealing with murderously pissed-off grandchildren? That exponential feedback loops have turned a stable climate and benign world economy into false memories? That by 2030, we will be living in interesting times—interesting, as in the Chinese curse?
How did they get my email address, anyway?
Worrying that a governmental agency is taking exclusive note of you is paranoia, especially when they profess to care about your mental health. Paranoia can be a self-fulfilling prophecy, and I’ve seen too many people go down the conspiracy-theory rabbit hole once they start thinking that librarians, religious authorities, or the CIA are paying deep attention to them.
Paranoia is a kind of flawed fortress, a defense of the self that depends on rigid walls of delusion. It damages your ability to survive in this world. By seeing enemies behind every bush, paranoids lose sight of surprises, and reality is full of surprises.
That’s why people who appear to be suspicious of everything still get blindsided. They invest in Ponzi schemes. They vote for anyone who will identify scapegoats for them. Seeking security, they adopt a human relations first-strike policy and end up alone and lonely.
They’ll reject the simplest explanation for everything—i.e., the IRS is after you because you didn’t pay your taxes—in favor of the complex and improbable. The IRS has zeroed in on you because they know that you know that the moon landing was shot in a Hollywood studio or that John Kennedy was killed on Lyndon Johnson’s orders or that the people who erected the Georgia Guidestones are using MRNA vaccines to reduce the population to 500 million by 2030.
Paranoia is a malfunction of the ego, an impossibly vain belief that you are exactly the person you think you are, and that you’re important enough to become the focus of someone’s malignant attention. You become convinced that reality is all about the violation of boundaries. All it takes is a vaccination syringe, or a non-gendered restroom, or someone threatening to take your guns away, and you find yourself on your internal ramparts, pouring boiling oil on imaginary enemies.
Paranoia eventually miniaturizes the person it defends. When the walls of the fortress are finally breached by death, you’ll need a microscope to see what’s left inside.
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Our medical-industrial complex is a mess, and we’re getting shoddier medical care for a higher price than poorer and less advanced countries. Medicare is one of the few bright spots in the picture, as it does exert some downward pressure on prices and frees older Americans from the lethal stress of choosing between insurance bills or medical bills as the route to bankruptcy.
So I take Medicare seriously. I also take depression seriously, because I once went through a clinical depression and it came close to killing me. I take reality seriously, because the self I had constructed prior to my depression rested on a foundation of lies, which was the reason I got depressed. If I was to be happy ever again, my old self had to be torn down and reconstructed on a foundation of truth. It was not a painless project, and it’s not finished yet, but the new structure seems to be sturdier than the old one.
Still, when the nice folks at Medicare address me by name and say I need to worry about depression, I believe them. So far—it’s been thirty years since I made a conscious choice to do whatever was necessary to live rather than to die—if I have bad days, there’s an external reason for them. For the moment, I can tell Medicare that my mental health is okay, thank you very much. I’m merely a bit disappointed in the world. Quite a bit, actually.
But you can witness the wars in Ukraine and Sudan, see the crawling evil that is Vladimir Putin, acknowledge that we have a corrupt Supreme Court, and admit that you wouldn’t want to leave Donald Trump unsupervised with your country or your daughter or your power tools, and still find life worth living.
Really. And if you close your eyes to the evil in this world, you also close your eyes to the good. You not only damage your self, you damage the world. You turn it into a boring place, where the colors are all pastels when they’re not shades of beige, and then you have to live there.
Innocuous becomes your watchword, and gradually you start discounting the things that disturb your blind inner placidity. The bright terrifying beauty of the world is one of them.
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Long-time readers know that I’m a fan of the late British psychiatrist R.D. Laing. He early on developed the idea that for those of us raised in western civilization, sanity is hard to come by. Judging by its tendency to destroy its physical and emotional habitat, Laing notes that our culture has a deathwish.
Such a culture defines sanity itself as insane. Those of us who manage to function in it develop a false—and crazy—self to face getting up and going to work every morning. That false self looks like a responsible citizen if a crazy one, and we confuse it with our real self.
The worst thing about mistaking your crazy self for your real self is that your real self is robbed of its experience. Our cultural condition is to be starved of real experience. Everything becomes unreal.
In my dotage, I’ve decided that no matter how attractive these ideas are, R.D. Laing shouldn’t have introduced them to people who hear voices that tell them to hurt other people or themselves. In our current political situation, it’s not just paranoid schizophrenics who are hearing those voices. And while it’s reasonably clear that the culture is criminally insane, you don’t want to bet that you’re sane just because you’re an alienated, angry person who can’t hold a job and who understands that the Deep State is keeping you from your destiny.
Also, even if you’re living among the shards of one or more false selves that didn’t survive contact with reality, don’t assume that what you have left is your real self. Some folks just end up with shards.
Constructing an authentic self takes time, effort, creativity, discipline, close attention to the difference between experience and expectation, and a great deal of patience. If you’re lucky and work hard, you’ll have a real, honest-to-God self by the time you die.
R.D. Laing has created as much pain as he’s relieved with these ideas. They tend to encourage people who think they alone have agency and consciousness in a world where other people are asleep sheep. They privilege the paranoid experience. If I ever believed that was a good idea, I don’t anymore.
But if you’re still working on being conscious and aware and can believe in an indifferent world rather than a hostile one, hang on to Laing’s idea that you need to pay respect to and protect your experience. It’s your doorway to an existence where you can get in touch with reality.
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My mother died of Alzheimer’s, and if there’s one thing that will make you doubt your own sanity, it’s maintaining a relationship with a person with dementia, especially a person whom you’ve known well. Time disappears, and you don’t know which part of your life you’ll relive when you enter that room in the nursing home. Dead family members come to raging life and live ones—even yourself, sitting there—are gone, maybe dead. You learn things you’d rather not know. You can’t ask about things you would like to know. Your passionate commitment to reality disappears as it becomes more and more arbitrary. The horror of mindlessness hits you full on, unsoftened by the real and true, and you start thinking about what you would do if your heredity dooms you to Alzheimer’s.
I’m hoping to avoid it, myself, but at this stage of life, I find myself grieving for lost family members, lost friends, and the lost worlds they inhabited. I’m tempted into the vast territory of a poorly remembered past. I realize I’m at risk of getting stuck there, even though most of my thoughts—no matter what you read in this journal—are sane and reasonably happy ones.
It's not a hypothesis you can test experimentally, but I’ve come to think that the cause of dementia is grief. The brain, due to disease or old age, starts losing executive function. But it hangs in there, sorting out truth from lies, reality from illusion, dead people from live ones, until the accumulated grief of a lifetime hits critical mass. Then reality becomes too painful to grasp. A choice is made to lose one’s mind.
King Lear made that choice. Nietzsche made it. We can, too.
Scientific? Probably not. Intuitive? Certainly. Correct? Who knows?
The Medicare folks, bless their hearts, don’t know that I have these thoughts. I doubt they would consider them mentally healthy. But if I sought help, it’s likely they would say that whatever my condition is, Medicare doesn’t cover it, and maybe I should just forget that they ever brought it up.