Thursday, November 30, 2017

Diagnoses, Labels and Sensitivities

The list of labels available to those seeking a diagnosis can be long. Depression, anxiety and being stressed are common terms that many people feeling unwell use to describe their own state of mind. Generalized anxiety disorder, bipolar 1 and bipolar 2, manic depression, dysthymia, cyclothymia, major depressive disorders, obsessive compulsive disorder, or persistent depressive mood disorder are more complex diagnoses that might be provided by a psychiatrist. Schizophrenia, multiple or split personality disorder, dissociative identity disorder, and borderline personality disorder are diagnoses which many people confuse and think are related, although have very distinct symptoms. Fibromyalgia, post traumatic stress disorder, chronic or persistent pain, autism spectrum disorder, panic disorder, and misophonia are other labels which many people are aware of. Given all of these terms and specific disorders, how is one to proceed?

A diagnosis is helpful if there are clear and well known cures for an ailment, and this is the case with some physical diseases. The flue and a broken arm are easily differentiated by a layperson and knowing exactly what is wrong with you in cut-and-dry cases like these will facilitate a good recommendation from a doctor; a plaster cast for the broken bone, rest and fluids for the flue. Psychiatric illnesses are sometimes well defined, although even common varieties like depression may not be obvious to an individual when they first encounter the symptoms.

The psychiatrist I saw in the late 1990s agreed with my report that I was depressed, and at one point during the time that I saw him he suggested that a diagnosis of cyclothymia might be more accurate, but he didn't lean on this idea too much. At the time I was pleased to have this better and more precise diagnosis- to me it meant that I had something unusual wrong with me, not just garden variety depression! My psychiatrist didn't make much of this idea and as I recall he only commented on it once or twice which I think was ultimately helpful. The precise label that was applied to what was going on in my life wasn't nearly so much an issue as the symptoms that I had, and this is what we worked on.

There is an unusual 1995 film called "Safe" starring Julianne Moore. Julianne Moore plays Carol White an unremarkable suburban homemaker living in the San Fernando Valley. She lives in a lavish pastel home and spends her time decorating the house with the assistance of a Spanish speaking house keeper named Fulvia and the various hired workman who paint, deliver furniture and assist her. She goes to aerobics classes. She meets her friends for lunch and discusses bland topics with them like the new fruit diet that she tries briefly, and the fact that she seems to not sweat during exercise. In the first part of the film she feels "unwell", and after having several fainting spells, and vomiting in unusual scenarios, often after exposure to cosmetics or car fumes, she decides to seek treatment. She goes to see her doctor who can find nothing wrong with her, and after several visits he refers her to a psychiatrist.

Carol doesn't feel comfortable talking to the psychiatrist, and eventually sees an allergist who confirms that she does have reactions to certain substances that seem to be responsible for her attacks. Carol finds a flyer at her gym that asks the question "Do you smell FUMES?" and after attending a seminar she decides that the best explanation is that she is suffering from "environmental illness". At the mid point in this story it turns very dark. Carol stops wearing makeup, gives up her fashionable skirts for loose track pants and sweaters, and struggles with her relationships. As she begins to look more unhealthy and bedraggled she starts to carry a small green oxygen tank and mask with her so she can breath easily. She rejects her affluent chemical based lifestyle and sets up a toxin free room in her home completed by simple wood furniture upholstered with non-toxic white cotton materials. Eventually she decides that the chemical free room in her house in the valley is not pure enough and she leaves her husband and step son to go stay at a desert retreat for people with environmental illnesses called the Renwood center.

Every time I watch this film I have a number of strong reactions to it. What makes this film so difficult to watch isn't a the cool relationship between Carol and her distant generic businessman husband Greg, or the depiction of the peculiar illness that Carol has or the presentation of environmental issues. What is unpleasant about this film is Carol's conduct and values. She is dull, disengaged, mono-syllabic and stilted in the way she expresses herself. Initially she seems entitled, unaware of her privilege and easily upset- one of her major crises at the beginning of the film is an argument between herself and a furniture store clerk about the color of the couch that was delivered to her house. The clerk shows her the original order and points out that it specifies a black couch, she plaintively whines that this is "...impossible because black doesn't go with anything we have". This quick sketch of superficiality and poor interpersonal skills in many ways defines who Carol is.


While the film presents seriously the idea that living in a chemically laden environment is unhealthy, and seems to convince us that this is a large part of Carol's problem, environmental illness is not the core theme of this film, rather it just provides a backdrop and is what frightens and drives Carol. Carol's confusion, lack of depth and poor choices are at the heart of this story. While watching Carol deteriorate is difficult, its how this film makes me feel about Carol when I watch it that makes my skin crawl. I always find Carol's demise both terrifying and pathetic at the same time. Julianne Moore's outstanding portrayal of Carol leaves me feeling repulsed by her lack of sincere and meaningful values, judgmental about her inability to acknowledge those around her and feeling sympathy for the predicament and illness that her vacuous life has resulted in.

No one in this story seems to genuinely care about Carol. Her husband, doctors, psychiatrists, friends, and even the people at the retreat are dismissive with her and speak to her with either shallow reassurances, or condescending indifference. Ultimately what is frightening about Carol's illness is imagining ourselves in that position, a person suffering from a vague and undiagnosable disease, who generates little sympathy from her family and friends and is largely ignored by those around her.

She connects briefly with a group of patients at the retreat who make her a cake for her birthday and ask her for a speech, she says:

"I couldn't have done it without you... I don't know what I'm saying, its just that I really hated myself before I came here, and ... um, so I'm trying to see myself hopefully ... um, more as I am, more ... um, more positive, like seeing the pluses, like I think its slowly opening up now people's minds like ... um educating and ... and AIDS and other types of diseases ... 'cause ... 'cause, and it is a disease 'cause its out there and we just have to be more aware of it ... um make people aware of it, even ourselves like and going ... reading labels and going into buildings ..."

This film doesn't provide a standard narrative of illness, where we might expect the protagonist to die, leaving friends to mourn or revile their passing, or gets better and rediscovers life and possibly is forced to atone for past misdeeds. Instead this film simply doesn't give a lot of answers. One interpretation is that Carol is cursed with an undiagnosable illnesses that isn't resolved as the price for failing to find solid values in her life, but I think this may be highlighting the wrong message from the story. It may be simpler than this; that toxins and meaninglessness are part of American affluence and can happen together, that medicine doesn't have all the answers, that there are many individuals who are chronically unwell and don't have accepted explanations for what is wrong with them. While the Renwood retreat offers Carol some support the cure provided there doesn't seem effective as Carol's condition deteriorates up until the end of the last scene of the film. Ultimately Carol is isolated and unwell at the Renwood retreat living in a tiny igloo-shaped porcelain lined environmentally-pure safe-house. The thin meaning that Carol finds in learning about the toxins of modern living and how to minimize the impact of those poisons is not enough to cure her physically or spiritually.


I've watched this film many times over the years. The first time I saw it I hated it, but I remembered every detail. I've come back and watched it several times since then, I think partly because I struggle to understand it. "Safe" is an eloquently painted train wreck, a modern fairy tail of the most hideous kind. It isn't a psychological thriller or horror film in the standard sense, its a tragedy of a person consumed by a vague and undefined illness, for whom grasping at a diagnosis doesn't lead to a cure, and who doesn't get better. "Safe" is a compelling film because it plays on common, but often unacknowledged fears; a vague malaise, odd labels, whether others see us as inventing and diagnosing our own problems, the coldness of modern medicine, and whether unconventional group therapies can have any effect, or provide a refuge for an empty life.

While there are truths embedded in this film, Carol's story is not an average one. One of the key truths is that illnesses are often mysterious, and treating a diagnosis as a definition of who you are is not helpful. Carol's trajectory from meaningless affluence to commune therapy based isolation is something that we fear, but not something that frequently happens.

At Recovery meetings we follow a simple recipe for change through Cognitive Behavioral Therapy. The methods we employ are well documented, and there are numerous scientific studies that attest to their effectiveness. We don't try to diagnose what is wrong with those who attend, and we don't discuss psychiatric conditions in any depth. We accept that people struggle with fear, anger and other complex negative feelings and we provide simple recipes for dealing with these issues. We strongly recommend that attendees have a doctor evaluate any physical symptoms that they have to rule out physical conditions. We understand that many attendees have met with a psychiatrist or a therapist and may have been given a specific diagnosis, although we don't delve into these details. We acknowledge that nervous persons are afraid of being permanently handicapped, and afraid of set-backs. While these fears may be real and common, they are only based in partial truths. Depression is the common cold of mental illness, and while difficult, destructive and hard to understand, it is something that people recover from.


More Information

The Biology of Depression's Vicious Cycle

Mental Health Myths, Inkblot Tests and Electroshock Therapy

Fear is the Mind Killer