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Lessons in Truisms

Writer's picture: Nathan ColeyNathan Coley

I generally dislike truisms. It’s not because they aren’t true (many of them have more than a kernel of truth), but because their continued usage speaks to a serious lack of creativity. Use these phrases enough, and the redundancy eventually strips them of their meaning. Truisms can take fantastic points and dull them. A true subset of the dreaded cliche, the truism saps an idea of its vibrance and, for a moment, makes you doubt that the saying ought to be taken seriously.


For example: It is what it is tops my list of disliked truisms. That being said, it’s not exactly wrong. It’s basically a semi-statement of the Aristotelian law of non-contradiction: A is A. A can be A, and it cannot be B, as B is B. It is, as they say, what it is. I dislike the expression, but to doubt it is to doubt the most unassailable pillar of Aristotelian thought.


So with all this being said, please allow me to center this post around a truism, and particularly, a mental health truism.


Advocate for yourself.


I’m ashamed to say that in years past I treated this phrase with a kind of cynicism. To me, the phrase “advocate for yourself” was often code for, “Ah, I see. You’re not listening to an expert that probably knows more than you.” In my warped view of this notion, this phrase took away the agency of providers and put it all in the hands of the patients, many of whom were not qualified to care for Cabbage Patch dolls, let alone their own healthcare.


Forgive me for this notion, as there’s plenty of evidence that I have not been thinking clearly for a painfully long time. Mental illness can harden a person, and as the saying goes, hurt people hurt people.


There go them darned sayings again.


My journey to advocating for myself, fully and confidently, without a hint of cynicism to the idea, started with a lot of phone calls, a lot of wait times, a lot of voicemails, and a lot of phone numbers for individual therapists, many of whom had to operate as their own administrative staff. The hospital system and insurance that I use, University of Pittsburgh Medical Center, becomes decidedly inelegant if you decide you need a psychiatrist instead of a family provider. If you’re trying to fix the headspace, simple and easy online scheduling systems suddenly become unavailable.


For the first round of calls I made, which was around a dozen, one therapist finally got back to me with a response, but was not keen on the Telehealth that I needed at the time.


I kept at it. I found more phone numbers, left more voicemails, and found more discouragement. Some relief came through a program provided by my employer; this led me to 10 sessions with a therapist, or 8 with a psychiatrist. As I needed both, and as I didn’t gel with the first therapist right away, those sessions stretched as far as 5 dollars in a modern day Subway—presently, this is no longer a sufficient sum of money for a footlong.


I eventually found a therapist, and then got fired by said therapist (to be fair, I am fairly certain that I scared this poor person, who was not on the receiving end of my kindness), and then found another therapist, and then had a couple of sessions.


And then I found myself as an official inpatient at Western Psych, a hospital that seemed more like a fiction than a reality to me; Before I entered the hospital in my own timeline, the last memory I had of it was from the movie adaption of The Perks of Being a Wallflower, also of the same name. The magic of cinema made this place, couched in a deeply touching and well-crafted drama, even more surreal for me.


But it was very real to me in the summer of 2023, and I very much needed an inpatient stay, and as things were looking in the intake room, past the metal detectors and counter where they take stuff that you could use to hurt yourself or plan a daring escape, it wasn’t looking like I was going to get 201’d into a bed.  In the state of Pennsylvania, this is code for, “I am admitting myself to the hospital because I may be a danger to myself, or to others.” At the time of the 201, I very much believed the former of these propositions to be a possibility.


I sat on a chair that was clearly too big to be turned into a weapon and looked at the intake psychiatrist. She looked back at me as if I were a dented can of sauce and couldn’t decide whether she wanted to toss it or preserve her .99 cent investment. Then she said:


“Borderline personalty isn’t really something that inpatient helps.”


Here my memory fails me a little, but I know this: my father, who had accompanied me, felt as I felt. We wouldn’t take no for an answer. It was not long before I was waiting for a bed.


As a guest at the Unit 11 Hotel, or what the staff always called the “chill floor” (I assumed this meant that there would be less use of fast acting tranquilizers near me), I found myself in a period of peak distress, and to the point where the nurse did not hesitate to see if I had Zyprexa, a mood stabilizer, on my chart of OK things to try. The medication dissolved under my tongue—20 minutes later, the awareness to my problems was present, but the distress was appreciably muted and much more manageable. I was stunned, and made a mental note to tell this to future doctors.


This is exactly what I did to two other doctors who had the ability to prescribe such medication. I sang the glowing praises of the mood stabilizer, always emphasizing my constant and violently shifting mood swings. The first doctor who learned this information, my outpatient psych, took excellent care of me on a plan of two other drugs. The Zyprexa was never mentioned again, and I was too timid to ask. Outpatient came to its scheduled end, which meant it was time for a new doctor. The next doctor learned the same information, noted it, and said nothing about it. Over the course of two visits, I was too timid to ask for what I thought I deeply needed.


When I arrived at my current doctor, whom I have only seen for a handful of visits, he naturally asked what I had taken in recent memory and how that had worked out for me. When I told him that I was very much enthused by the calming but hardly disorienting effects of mood stabilizers, he asked, “And nobody else tried one with you?”


Nope, and though I didn’t ask and probably won’t, I do wonder what would have happened if I hadn’t noted, once again, in glowing enthusiasm, that I thought I should try a particular class of drug.


I trust medical professionals. They go through lots of training and work in stressful, volatile situations. Nevertheless, there are cracks in the system, and in the foundation, things both anomalous and systemic, and those things translate to this truism:


Advocate for yourself.


If I had not done so, I would not have been admitted to the hospital. Had I not been admitted, I would not have been exposed to a cocktail of medicines that would turn out to work for me, truly enabling me to sense some serenity in the midst of apparent chaos (and remember, apparent chaos is all a borderline needs to melt down into a spiral). I also wouldn’t have made it into a much needed intensive outpatient program, which would help me get back to earth and help me set my meds right. If none of this had happened, I could very well be throwing back a Lexapro, knowing full well that it would launch me into a panic attack an hour later (a med adjustment side effect I never got over while taking it).


And that’s just the medicinal side of things. My heart is tired of speculating on much else at the moment, but use your imagination and envision me without my pills. If you know me closely, you don’t want to do this exercise while driving.


Cliches are clunky, and truisms are annoying, but these expressions are not in the wrong.


Sometimes it’s the squeaky wheel that gets the Prozac.




Yours Mentally,



Nathan


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