The Personal is Financial (Or, An Accounting of Mental Illness)
Let’s do a rough tally of my mental health expenses for the past two and a half years. $175 a therapy session, once a week, for 120 weeks. $180 dollars for a 20 minute psychiatrist visit, every six weeks. $175 for medication, once a month, for 120 weeks. $85 for group therapy, once a week, for 15 weeks. Add in the tangential costs of being mentally ill — intakes, consultations, medical treatment for the accompanying chronic back pain, time off work, mileage — and we’re looking at, all in all, upwards of $45,000. Did I mention I make $55,000 a year and live in California?
I was diagnosed with Obsessive Compulsive Disorder when I was 14 years old. Even that’s a tale of money: I had been attending an outpatient drug treatment program at Kaiser for almost a year, courtesy of my parents’ health insurance. My therapist, who had gotten to know me well, made a miraculously fast diagnosis when I came in one day, terrified because I couldn’t stop thinking about the possibility that I might be gay, that I couldn’t go to school without having panic attacks, that I couldn’t even look at other women anymore without wanting to die. She said, “You mentioned a few months back that you like to squeeze your fists, one at a time, until you feel ‘evened out.’ Let’s get you assessed for OCD.” And, within a month, I had my diagnosis and my meds and my normal, healthy teenage angst back. I’m an extreme anomaly: most OCD sufferers go decades without being properly diagnosed, if ever. And there’s a lot of us: 1 in 40 adults has OCD. My type of OCD is even trickier to catch (previously called Pure OCD), because I don’t suffer from the Detective Monk, washing-my-hands-and-counting-things variety. It’s all in my noggin.
Twelve years after this initial diagnosis, I’m living in Tokyo with an amazing man, an amazing job. I’m writing a book and eating sushi for lunch every day and spending my nights smoking cigarettes in jazz bars. I stop taking my medication. I was, after all, diagnosed over a decade ago. I’m tired of feeling dull, a little numb, frustrated with my libido. And I’m on a baby dose of Prozac. If my OCD is so severe, why is such a piddly medication able to stem the tide? I conclude I’ve outgrown my mental illness and toss the meds in the bin.
I think we began to realize something was wrong when I began spontaneously sobbing in a coffee shop in Jinbōchō. The Syrian refugee crisis was hitting the news nonstop, and I could think of nothing else. I spent hours online, reading about it and planning trips to Lesbos to work in the refugee camps and figuring out which charities were the most reputable and researching and researching and researching and researching… But isn’t that how I should be reacting to such a humanitarian crisis? I’m Middle Eastern, a political woman, a bleeding heart. If anything, everyone around me lacked empathy. I was, to my mind, the only sane person I knew.
We moved back to California two months later, and I spent the next two years a crushed shell of a human being. I developed, along with other more minor obsessions, a profound form of Relationship OCD, which is characterized by an onslaught of intrusive thoughts about your partner. It certainly sounds more benign than other forms of OCD: there’s Sexual OCD (fearing one is a pedophile; fearing one is attracted to a parent or sibling; doubting one’s generally long-chosen sexuality), there’s Contamination OCD, Hoarding, Harm OCD (fear of wanting to kill loved ones; fear of inadvertently endangering others), Bodily OCD (fear that one’s normal bodily functions will fail; fear of having a fatal illness; intense preoccupation with processes like blinking or breathing), Symmetry and Orderliness, and the list goes on.
An old-timer in Alcoholics Anonymous once said to me, “It doesn’t matter how much you drank, or what you drank, or why you drank. It matters how it made you feel. That’s what makes someone an alcoholic.” My OCD was like that. The category I was dealing with sounds relatively painless, but my symptoms were ineffable, relentless, excruciating. I thought about ruining my then-eight year sobriety daily, just to get a little relief. I obsessed and compulsed in my sleep. For a full year, I had at least two, but typically four, full-blown panic attacks a day. It wasn’t unusual for my boyfriend to come into the bathroom and find me on the floor, sobbing and rocking back and forth. Crying hysterically in his arms for thirty minutes a night became a bedtime ritual. The best way I’ve found to articulate the experience of OCD is comparing it to schizophrenia: there’s a voice, constantly bullying you, screaming your worst fears at you, but it’s inside your head, and it’s in your own voice. Maybe your dad, your hero, molested you. Maybe you don’t remember because you don’t want to. Maybe that’s why you don’t call him enough. Maybe that’s why you became promiscuous at a young age. Maybe you don’t remember because you’re weak. Maybe that’s why… ad infinitum.
I began to seek treatment relatively quickly. After all, I’m a good millenial, all about self-care, no shame about therapy and all that. My calculations regarding health insurance were such: I could pay $240 a month for a catastrophic Kaiser policy (the cheapest option available to me). That would cover most of my medication, but I would have copays to see the psychiatrist. Seeing a weekly therapist isn’t truly an option under this HMO; you get an appointment every two weeks at best (my personal experience has been more like every three weeks to once a month). And I’ve never found an OCD specialist in the Kaiser system. Thus, I’d still have to pay out-of-pocket for the true meat and potatoes of my recovery. Or I could pay the Obamacare penalty, cross my fingers that I wouldn’t get sick, and pay for treatment in cash and on credit cards. I chose the latter. I’ve done the math, and I made the right financial decision.
And having a specialist to treat OCD is, for most of us, a necessary expense for getting better. A friend from one of my recovery groups who has harm OCD (the intense fear, in his case, that he’s a secret serial killer) initially sought help from a non-specialist; she called the police on him during his first consultation. He didn’t seek help again for another year. A woman in my group, also with harm OCD, almost had her child taken away from her when she expressed fears of hurting her newborn. In my case, an intake psychologist at a nearby clinic suggested that I was using my earlier diagnosis as a crutch; maybe I just wasn’t into my partner anymore. This offhand suggestion, somewhat understandable from a professional without OCD training, caused an emotional backslide that resulted in my not being able to leave bed for two weeks.
Before this latest OCD relapse, I had $15,000 saved in my bank account. I was hoping that, in the coming years, my partner and I could buy a little home, or have a child, or just get myself that early 2000s Toyota Celica I had dreamed of since I was a teenager. Maybe I could pay off my student loans early. I now live paycheck to paycheck, still incredibly comfortable in comparison to most Americans, but with no real savings to speak of. My three credit cards, which before were used only for emergencies or big purchases, are usually always maxed out. Has it all been worth it? Of course. I’m recovering, slowly but surely. I’m still with my partner, and our relationship is even stronger than it was before. I’m still sober. I’m still alive. All of these were dicey, at best, a year ago.
And my work, my expenses, continues. The acute trauma of these past two years, of having absolutely no control over my mind, of feeling intense, life-threatening terror even in my sleep, has left its mark. My teeth are damaged from grinding them in my sleep. I have to watch what I eat, because my anxiety caused recurrent acid reflux. I have to make sure to weight train three times a week because, when my mind couldn’t take it anymore during those two years, all that pain went straight to my back. I suspect that I’ve developed some degree of PTSD, because my skin still crawls and my chest still collapses and I have to take a Klonopin and resist scratching the insides of my wrists when faced with certain triggers. The $175 a therapy session still continues, as do the meds.
You don’t have to tell me that I’m one of the lucky ones. I have two degrees from UC Berkeley. I work from home, for myself, and completely make my own schedule. My partner makes a decent salary. Both my parents and partners’ are unrelentingly supportive, and our families have, could, and absolutely would continue to help us if need be. No, I’m not lucky — I’m an absolute aberration, a marked deviation from the norm, in a country where suicide rates are up nearly 30% since 1999, overdoses are the leading cause of death among Americans under 50, millions remained uninsured (and these numbers are projected to increase by roughly 20 million people when Trump repeals Obamacare), and the median household income in California is $63,783.
The late intellectual Mark Fisher, who we lost to suicide in 2017, wrote,
“Capitalist realism insists on treating mental health as if it were a natural fact, like weather (but, then again, weather is no longer a natural fact so much as a political-economic effect). In the 1960s and 1970s, radical theory and politics (Laing, Foucault, Deleuze and Guattari, etc.) coalesced around extreme mental conditions such as schizophrenia, arguing, for instance, that madness was not a natural, but a political, category. But what is needed now is a politicization of much more common disorders. Indeed, it is their very commonness which is the issue: in Britain, depression is now the condition that is most treated by the NHS. In his book The Selfish Capitalist, Oliver James has convincingly posited a correlation between rising rates of mental distress and the neoliberal mode of capitalism practiced in countries like Britain, the USA and Australia. In line with James’s claims, I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of stress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill?”
Let me finish with a tale of two women, friends of mine. Both suffer from lifelong, chronic depression. Both, in 2017, confessed to feeling suicidal and expressed the need to be institutionalized. One, an upper middle class woman, sought 45-day treatment at an inpatient facility. There, she received individual and group therapy, a nutritionist and specially-plated meals to deal with her eating disorder, a trainer, and genetic testing to determine which medications would interact best with her anatomy. The bill was above $50,000. Afterward, she transferred to a three-month residential aftercare program, where she enjoyed around-the-clock care and support and community with other women in treatment. This cost another $50,000.
My other friend, a previously-undocumented woman from Mexico, has no health insurance. Her family cannot afford to provide her with any financial support. She recently checked herself in to a state-funded hospital for a 72-hour hold. When I spoke with her during her stay, she was hysterical: her bed and pillow smelled like urine, she was getting no one-on-one treatment, and she had never wanted to die more in her life.
The key to getting better is money, baby, and God help you if you don’t have it.
If you or someone you know needs help in the United States, call the National Suicide Prevention Lifeline at 1–800–273–8255. For outside of the US, you can find contact information for crisis centers around the world from the International Association for Suicide Prevention and Befrienders Worldwide.
For information on OCD and recovery resources, click here.
To read about the Democratic Socialists of America platform on Medicare for all, click here.
To read about the case for universal healthcare in the United States, click here.