And when you can’t crawl…

the message Something I struggle with a lot as a person with several years of recovery from depression and anxiety disorders is how to talk about it with people who are in the middle of it, because it feels anything I say tends to be seen as bootstrapping.  In weight loss, if someone else loses weight, that’s encouraging, right?  I guess it depends on whether you are working on losing weight or still in that part of life when you can’t yet contemplate it.

We talk about process, but what does that mean?  What is this process we are supposed to trust?  I got a glimpse of it this week talking to a podiatrist, that brought me back to lifespan development levels of safety and a blog by this guy I saw on a Ted Talk, who put it like this:

  1. Unconsciously incorrect
  2. Consciously incorrect
  3. Consciously correct
  4. Unconsciously correct

He was talking about what he had to learn about things he was doing that injured his back when he was in medical school.  In orthopedics you can talk about it this way because there’s very clear lines around what is normal and what is not.  It’s a bit trickier in mental health and weight management behavior, or so we think, because people don’t agree on a definition of correct.  What if we allow that in orthopedics, you don’t have a uniformity of shoe size, leg proportion, body mass and so forth.  Even in obesity, there is some diversity to what seems a straightforward issue: excess body fat.  The real issue is hypertension and inflammatory response, which some minority of obese people don’t suffer, and some people who are not obese do.

The extension to lifespan safety goes in the opposite direction, the Primary level is prevention, or what you do to help everyone avoid problems.  Secondary could be viewed as accommodation, reaching out to people with known risk factors.  Tertiary is intervention, helping people who are in the middle of a problem.  Some models even have a Quaternary level.

I used to be very opposed to the treatment of mental health disorders by Primary care providers, and this is something we talk about quite a bit in Abnormal Psychology.  But after going through some of this with my kids, I have seen that the mental health specialist system is overtaxed with Tertiary cases.  It may be tragic, but it’s the reality, that the Secondary level needs to be concerned with people in the 2.5 area, not the 1.5.  And there’s the “health home” model, which is a relabelling of PCP, or one doctor who knows about all your problems.  (It was relabelled because some people called them gatekeepers, which I understand the frustration behind, but lack of med coordination kills people).

There is this unfortunate tendency to think that accommodations weaken us, that we will slide down the slope from Primary to Tertiary or worse.  When I worked in the glasses business, people often didn’t want glasses if they could see well enough to drive without them.  I used to think this way, and my eyes got worse and worse from age 20 to 35, but when I started wearing my glasses all the time they levelled off.  If we avoid intervention and accommodation, our capacities can get fatigued and eventually break down.

I guess I’m hopeful we can stop thinking in terms of the dichotomy of whether or not we’re under treatment vs. self help, and understand something more like the process I described at the top.  Treatment can cover different levels, and self care is part of every stage.

P.S.  My title is from that Firefly episode with the charming undead guy.  “When you can’t run, you walk, and when you can’t walk, you crawl, and when you can’t crawl, you find someone to carry you.”

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