"What are we celebrating?" "My daughter found out she has a debilitating disease."

When I was in my early teens a child psychologist diagnosed me with Non-Verbal Learning Disability. This isn't something I used to think about a whole lot. I didn't like the psychologist very much, so I was predisposed to dismiss him and everything he had to say. He gave me the Rorschach test, which I had very little patience for then and still refuse to take seriously. (He also really liked Marvin the Martian, an obviously tedious cartoon character.) Also I'm pretty sure I didn't love being told that I had a learning disability. It felt like being called stupid. Which is not what any learning disability means, and no one told me that it did, but you may have gathered that I'm very good at finding criticism where none exists.

So what is NVLD, or NLD, as it's also abbreviated? Well. What I remember of what I was told at the time is that it involved issues with spatial reasoning and certain kinds of math, like fractions. I've never had trouble with math, but my spatial reasoning can be wonky, as anyone who has seen me attempt to stack a cart or a pallet will tell you. And there's a lot more to it than that, as I found out when I started reading about it recently. Here is as good a description as any I've found, from this website:

Although it is not yet recognized as a formal diagnosis with agreed-upon diagnostic criteria and it appears that it will not be included in the DSM-5, Nonverbal Learning Disability (NLD) is usually described as a syndrome characterized by a pattern of unusual strengths and deficits thought to be due to dysfunction in the right hemisphere of the brain.

In terms of unusual strengths, children and teenagers with NLD often have a history of early speech and vocabulary development. They may have outstanding rote memory skills and attention to auditory detail. They also often have a history of early reading development and advanced or precocious spelling skills.

As gifted as they appear in these aspects of their skills development, however, they tend to have major deficits in other skills and aspects of functioning. For example, while children with NLD can decode text with relative fluency, they may struggle to comprehend what they are reading due to difficulty in organization and higher level reasoning. Do not let their strong rote memory or attention to detail mislead you: these children “see every tree but can’t understand a forest.” Although they may have an excellent retention of material presented orally, they don’t always comprehend or “get” the subtleties and nuances of language. Impaired in problem-solving skills, they may fail to apply or generalize previously learned skills to new situations or materials. Impairments in problem-solving skills also impair the child or teen socially as they are unable to figure out what to do in social situations or how to respond to the unexpected.

The discrepant skills development may also be manifest in mathematics. Because of their advanced rote memorization skills, they may find it easy to memorize their math facts or equations, but when it comes to applying the information, they may struggle, often displaying poor visual attention to the various algebraic signs. Visual-spatial deficits are also reflected in poor visual recall, faulty space perceptions, and poor sense of directionality. Indeed, poor comprehension of visually presented material is one of the hallmark characteristics of NLD, and there is often (but not always) a significant Verbal IQ – Performance IQ discrepancy on intelligence tests (with VIQ significantly higher than PIQ which is impacted by severe visual-spatial deficits).

In general, children and teens with NLD may function relatively normally when presented with verbally mediated information, but they do poorly in coping with nonverbal information. This impairment not only affects their academic functioning, but also impairs them socially. Social anxiety, avoidance behavior, and depression often emerge, particularly in adolescence, where the inability to develop and maintain normal social relationships becomes more obvious to others.
 
On a motoric level, students with NLD also appear to be clumsy, and many will have balance problems as well as graphomotor or handwriting impairment. Handwriting issues are more pronounced in younger children and tends to improve with age.

 If that's a little too technical, try this:

Children with NVLD struggle with life skills that require an understanding of spatial relationships (such as recognizing how parts fit together into a whole, completing jigsaw puzzles or building with Legos, learning routes for travel, and manipulating objects in space, such as learning to tie shoelaces), but they have strong language abilities (such as a well-developed vocabulary, the ability to learn facts from a list, and the ability to easily recall details of a narrative story). These problems in understanding part-whole relationships may create difficulties with understanding the “big picture” and with identifying the main idea in a narrative story, even though the child understands the individual words of the story or recalls its concrete details. These characteristics may make a child seem “spacey.”

Children with NVLD may have trouble with fine-motor skills and learning to use tools and utensils and they may have poor handwriting. They may also have a hard time learning math in school. They are interested in social relationships and have the capacity for empathy, but some children with NVLD complain that they do not have satisfying friendships. They may feel isolated from others socially, even though they want friendships. Children with NVLD can have trouble understanding humor or sarcasm, which may contribute to their social problems. Children with NVLD also may have difficulty dealing with new situations that they haven’t seen or encountered before.

There are bits and pieces of both descriptions that don't apply to me, of course. No two people manifest a condition like this in exactly the same way. Some of the deficits affect me only mildly. But mostly it's so accurate that I just about want to cry.

Accurate how? Like this: I don't tie my shoelaces the way most people do. When I was five I simply could not process the knot I was being shown. So I was taught something simpler that I still use. I was thinking about this in the last year or so, and I watched a couple YouTube videos meant to teach people the usual knot. I still can't follow it. I'm 30 years old, and whatever you people are doing is like fucking witchcraft to me. I could probably pick it up if somebody put a shoe in front of me and showed me often enough. (I don't need anyone to offer, though. What I do works fine.) I can learn involved spatial maneuvers, if you show me several more times than you would have to show the average person.

I work in the deli section of a large retailer. We put sauce on some of our hot foods by emptying the baskets from the fryer into shaker buckets. There are handle-like protuberances at the top edges of the baskets that you can use to empty them into the buckets quickly without spilling anything. It took me forever to figure out exactly how that worked, even after being shown repeatedly, to a point where I'm sure that some of my co-workers were wondering what was wrong with me. I still can't picture the process in the abstract; I just know it by rote now. What I don't know is how to work the blade sharpener for our meat and cheese slicers. I've been shown at least twice, and I'm sure that most people could figure out what goes where just by looking at the shape of the sharpener and the shape of the blade. Not me, though.

For the rest of it: my fine motor skills are not great. My handwriting's bad and used to be much worse, the only reason I don't drop things all the time is that I've learned to grip tightly and move slowly to compensate, and me putting a pair of single-use gloves on looks like a comedy routine. Then there are the behavioral aspects. Anxiety, social avoidance, depression? If you're reading this blog you know the answers there are yes, yes, and yes. I don't have much trouble reading facial expressions and social cues anymore, but I used to, and the paranoia and self-loathing that came of being aware that I was freaking people out never really went away. As for "They may feel isolated from others socially, even though they want friendships," which, well, it really is a miracle that I'm not crying right now.

What might seem weird is that I'm not on the verge of tears only because I'm sad. In a way I find (re)discovering these aspects of NVLD comforting. The realization that some of my emotional problems follow naturally from deficits that are obviously neurological makes it easier to believe what I'm always saying: that I'm sick rather than weak. The very fact that it's called a learning disability is part of that, I think. We take for granted now (though it wasn't always this way) that learning disabilities are objectively real, the result of the workings of the brain rather than laziness or low intelligence or a failure of will. And just as we understand (or should understand) that learning disabilities are localized problems and reveal nothing about the overall intelligence of those who suffer from them, so we should recognize that mental illnesses don't define or limit our emotional and intellectual capacities.

The title of this post is a quote from "Sick and Tired," a painfully unfunny Very Special Episode of The Golden Girls in which Dorothy is diagnosed with Chronic Fatigue Syndrome. And she is celebrating, because she's pleased to be able to put a name to it. There's something validating in a technical-sounding label. There shouldn't be, but there is.

Make Mine Marvel

I've been reading a lot of comic books lately. Probably too many. Solitary bingeing on any form of entertainment can be a depressive behavior, especially if it's something mentally disposable like superhero comics. But that's a topic for another time. Last October I subscribed to Marvel Unlimited, a subscription service where you can read everything Marvel publishes for a flat monthly or annual fee. New issues of current titles are added six months after publication, and there's a back catalog of thousands of issues, including pretty much everything from the last twelve or fifteen years. You can see how I could get lost in it.

A couple years ago Marvel did one of those big crossover events where the whole history of the fictional universe gets tweaked to create a new jumping-on point. I figured that was a good enough place to start, so I spent a couple very busy weeks catching up, and since then I've been reading everything in the main continuity as it comes out. One big feature of this reboot is an effort to make the diversity of the hero lineup match the diversity of the country. Thor and Wolverine are female, there's a black Captain America and a Hispanic Spider-Man, Ms. Marvel is a Muslim teenager, the Hulk is Asian. And there are quite a few gay characters.

I've always told myself that I don't need validation from portrayals of gay people in popular culture. I'm too tough for that, too much of a loner. I don't need a sense of community, and I don't see any value in applauding straight people for deeming me worthy of inclusion in their narratives. I wanted to punch Ranul Keru in the face. I don't find Cecil and Carlos even remotely charming.

But there's something about the gay characters in the Marvel Universe that's cutting through that tough loner bullshit. (Where did I get that from, anyway? It may be one of the vestigial ways in which the idea of masculinity still has a hold on me.) Hulkling and Wiccan give me what I'm going to be honest and call the warm fuzzies, and Iceman... A couple weeks ago when I started drafting this post I went back to reread the issues where Iceman comes out, and they made me cry. Granted, around the same time the sight of an elderly dog made me cry, so that's not saying a whole lot. But still, I'm not sure why these gay characters in particular are affecting me so much.

I could offer up some theories. It may just be that I'm reading these comics right now, when I'm trying to be more open to my sense of vulnerability and my discomfort with my sexuality. Or maybe I subconsciously see comic books as more mass-market, all-ages than other media, a more definitive test of social inclusion. That would be a false belief, both because comics aren't actually mass-market any more and because media portrayals are a poor metric of social inclusion, but you can't argue with the subconscious. I could mention Iceman being iconic not only in comics generally but also in my imagination. One of the first comic books I can remember seeing was a reprint copy of The X-Men #1 that my father bought, or showed me in a store, or something. I was young enough that I really don't remember the circumstances, but you could gin up some Freudian thing or other around it.

But I don't know that I believe any of those theories. I'm not sure we can ever fully explain powerful emotional responses. The layers of our histories are too complicated, the large and small experiences that shape us too numerous to be remembered and classified. All we can do is admit what we're feeling. And I am really very desperate for more gay characters in comic books. Once I get through this week's new titles (only ten issues to go) I'm going to be hunting through the back catalog for more Hulkling and Wiccan. And that's OK. I am allowed to be moved by whatever moves me, even if it's gay superheroes.

On Being Too Smart for Your Own Good (II)

I was in therapy for a few months several years ago. It didn't go especially well. The therapist I saw was very nice, but her style wasn't compatible with my needs. Mixed into a collection of printouts she gave me to read over were some quotes from Deepak Chopra. And she kept pressuring me to listen to these self-hypnosis tapes, one of which encouraged me to picture myself floating away from my cares in a big blue balloon. The metaphor was a little threadbare, which prevented me from approaching the thing in the correct spirit. In this specific case you might not blame me, but I think it points to a larger problem: self-help materials aren't typically aimed at an audience that regards itself as intellectually sophisticated, and therefore people who regard themselves as intellectually sophisticated have little patience for self-help.

There's something in me that brims over with contempt at the very word: "self-help." That part of me isn't big on "self-esteem" either. Which is why it took me a damn long time to admit that I have self-esteem problems. (You'd think I might have guessed when, asked by the intake person at the clinic where I saw that therapist, what my good qualities were, it took about a minute of stumbling and stuttering to admit that I was probably smart. That is pathology, not modesty.) There are good reasons to be wary of mass market self-help. It can promote bright simplifications and easy fixes, some of its practitioners are out for a buck, and some of its adherents are looking for excuses rather than solutions. But bad doctors and bad patients aren't proof illness doesn't exist.

That pamphlet my therapist gave me was a mishmash of pop neuroscience, New Age stuff, mindfulness, and conventional therapeutic material. Because things like these do exist along a continuum, it's easy to dismiss all of it as fringe nonsense, quackery, unworthy of consideration by serious people. It's easy to say, "I have a vigorous mind, I have a lot of responsibilities, of course I've going to feel stressed, anxious, depressed, etc. That's just a part of life." But it's not. Or it doesn't have to be.

I'm not suggesting that everyone with a post-graduate degree ought to rush out and buy a copy of I'm OK, You're OK. It just helps to be open to things. Mental health is about more than medication. It takes practical work. The best comparison, I think, is to physical therapy. The mind is like the body: it needs exercise to get back to working the way it's supposed to work. Making that effort is usually the last thing in the world you want to do: the illness by its very nature encourages you not to test and strengthen the part of the body that it has weakened. And let's face it: you probably feel pretty silly flailing around like that. But if you don't do the exercises, you're not going to get better.

Bad

I'm having a bad week.

It doesn't matter why. If someone with a mental illness ever tells you he's anxious or depressed, don't ask, "Why?" There may or may not be a reason, and if there is one it might sound petty. That's the mark of anxiety and depression as mental illnesses: the response is disproportionate to the stimulus. It's reasonable for me to be upset about what's been happening-- it's an ugly situation. But should I be having trouble sleeping, eating, working? Should my stomach be twisting into a knot every time I remember it after managing to forget about it for a few minutes? Should it be this hard to enjoy anything?

No. And there's a feedback loop problem here: the belief that I should be able to handle this better is just another thing for the depression to feed on. This situation is much worse for other people, and feeling shitty for not focusing on them is yet another thing for it to feed on. There are psychological as well as psychiatric reasons I'm having the kind of trouble I am, and guilt over those is one more thing for it to feed on. I'm intellectually aware of steps I could take to address those psychological problems, and shame at being too scared to take them is... you get the idea.

I said in the other post that I didn't think I needed more medication. That may have been over-optimistic. When I first went on meds a couple years ago I thought the boost they gave would be enough. I was able to transfer into a position that would have been unthinkable with my earlier level of social anxiety. But since then I've plateaued. So many basic things- filling out an online job application, putting together a resume, picking up a pizza, calling a doctor's office-- seem impossible, for the direct social interaction they involve or for maybe possibly leading to one. I can still do my job because the social skills involved have become rote, but otherwise I might as well be back where I was two years ago.

Whether the meds have slowly reduced in effectiveness (it happens) or whether I've always been at this level and am just now noticing, I think I need to try something else. I'm not actually on anything for depression, because the anxiety meds seemed to cover it. (Anxiety and depression are often linked, but they're not quite the same thing. Before this week, I was mostly dealing with spells of depression. Now they're working in concert.) It's a mistake to think medications can solve all your problems, but it's also a mistake to artificially cut off the possibility that they might.


I write these things in the hope of helping other people, but I also do it because it's therapeutic for me. I feel better having purged some of this. But I don't think that's going to help for long. Chronic illness of any kind defies narrative progression and catharsis. There's no permanent solution delivered just in time for a final laugh line before the credits roll. I've been this low before, I'll probably be this low again. Anything that might hold it back for a while is worth trying.

On Being Too Smart for Your Own Good (I)

I'm pretty smart.

(Well, a certain kind of smart. The way we talk about intelligence is horribly limiting. We've taken a concept that ought to cover every aspect of how people deploy their skills to navigate the challenges of daily life, and we've reduced it to test scores and socio-economic markers. IQ scores correlate to academic and professional success, we're told, so they must be measuring something real, as if success itself is an unquestionable and objective metric. The circularity of psychometrics, like that of any theological system, has a certain beauty. But that's a topic for another time. For now, just know that I mean what we usually call "book smart.")

I don't say that to brag, because I don't see that there's anything to brag about. It's not something I achieved through hard work; it's something I was born with. I might as well brag about having green eyes or being 5'8''. My brain works in a certain way that's useful for taking in, retaining, and synthesizing information. Whatever. The idea that intelligence in the abstract is a sign of personal worth is a reflection of the idea that our minds are entirely under our control, and that in turn contributes to the stigmatization of mental illness. And mental illness is what we're really talking about here.

I got good grades in high school, so from time to time I heard what a lot of high-achieving kids hear from their classmates: "I wish I was as smart as Brendan." I've never known what to say to that. It's an implicit compliment, and even though I'm desperate for the approval of others I have no idea how to handle direct expressions of it. But if someone said it in my Latin teacher's classroom, she had an answer: "No, you don't really want that."

She was a character. Very smart, eccentric, opinionated, an intellectual snob. The kind of teacher that gets in trouble, sometimes deservedly so, for being too familiar with students, treating them more like contemporaries than charges. Which is why I know that she tried to kill herself shortly before the start of my senior year. A few years later, still in her mid-50s, she died. According to her obituary it was "unexpectedly" and "at home." I don't know, and I suppose that's just as well.

Let's be clear: there are plenty of people who are very smart and very happy. I'm not saying, "Woe is me, I have a 138 IQ." That's about as convincing as "Don't hate me because I'm beautiful" or "Money doesn't buy happiness." What I'm getting at-- what I think my Latin teacher meant-- is that a quick mind is not always a wonderful thing to have. The brain that lets me multiply two-digit numbers in my head and read 50 or 60 pages in an hour is also the brain that kept me awake until midnight last night, endlessly circling around a very mild social conflict even though I'd been up since 4:00 AM and just wanted to get some fucking sleep.

It's not that uncontrollable brain functions are the entire problem. My brain would have nothing to tear into if I'd developed normal social skills and useful emotional responses to particular impulses, so that the slightest tremor in my relationship with literally anybody wouldn't be devastating. But then, developing those things would have been easier if my brain hadn't spent years producing a panic state at the mere thought of an unstructured interaction with another person or group of people. That is, the illness was reinforcing itself, and my world was getting smaller and smaller, until I was desperate enough to seek medical help.

Right now I'm on some mild anti-anxiety meds, without which I wouldn't be able to function in my current, customer-service heavy job. I need to move into a different line of work soon, but the thought of the mundane steps involved is so terrifying. More medication isn't the answer, I don't think. There's a risk of slowing my brain down too much, and taking away my best asset. I just have to be brave and learn things other people learned in their late teens.

It's important to understand mental illness as a subset of physical illness rather than a separate domain. But it's also important to acknowledge that management of any chronic illness, of the leg or the stomach or the brain, requires conscious effort. And with the brain, the most complex organ in the human body, the challenge can be staggering. Your mind runs in the grooves it developed to compensate for the illness, trapping you in a defensive posture that's now a hindrance instead of a help. It's so hard to change the way you think. Thoughts feel so instinctive that controlling them feels unimaginable. Every failure is an excuse to say, "It's impossible," and give up. But it's not impossible. It's not.

Next: another angle on intelligence vs. mental illness