Inertia as harm reduction?
Discusses self harm and drug and alcohol abuse
The acute phase of my mental health crisis had a sort of sick glamour to it. I followed up my arrest with some non-criminal damage at home, as well as finding a dramatic but relatively safe way to self harm. People were shocked and concerned and nobody could have any doubt that I was going through a very bad time.
But I survived that phase, which meant I passed into the much less exciting chronic phase. I no longer did spectacularly unwise things, because I no longer did anything noticeable. I went through the motions of getting food, doing laundry, and going to places I'd already agreed to be, but I spent the vast majority of my time lying in bed and playing Farmville. Partly because the game is designed to be hard to put down, but mostly because imaginary cows were much easier to deal with than real grief.
My best friend tried to put a positive spin on this inertia, saying that Farmville was much safer - and thus better - than the many destructive things I'd done during the acute phase. But that felt like patronising false positivity. Finishing the day with nothing to show for it but a new imaginary cowshed didn't feel good. Nor did the tottering piles of clean laundry, the unfinished projects I had meant to work on, or the conversations that flagged because I had nothing to say. It might be safer than the acute phase, but it was just as painful in its own way.
I also instinctively recoiled from the idea that I should be happy just because something was better than my lowest moments. You could justify anything with that logic as long as you could think of a hypothetical worse thing. If I drank half a bottle of wine, that would be better than if I finished the bottle and did a line of cocaine. And that in turn would be better than if I got drunk and high and tried to drive a car. You could escalate forever, so it's meaningless as an attempt at comfort.
My friend tried to use the framework of harm reduction, but that doesn't really fit here. Harm reduction is about addressing a dangerous behaviour by mitigating the risks as far as possible rather than by trying to prohibit it outright. Most famously, it refers to offering drug users things like sterile needles and a safe place to use. You could say that I practised harm reduction when I cut myself with a clean blade and dressed the cuts immediately, but the only way my state of inertia is harm reduction is if you consider mental illness to be a behaviour.
To be fair to my friend, I don't think they intended that implication at all. They were using the term in a much looser sense to suggest that an absence of active harm can be progress worth celebrating even if it doesn't obviously look that way. But it still doesn't sit right with me.
Harm reduction approaches work well in public health because public health takes a long view. When you consider statistics, hypothetical deaths or infections that don't happen can show up as a positive trend. But I can't consider my life as a simple statistic: the fact that I have to live it day by day forces me to take a closer and narrower view.
I don't want to live with grief so intense that imaginary cows are my only solace. I don't want to look at the things I meant to do in happier times and feel a mixture of guilt and more grief. I want to do things I can boast about, so that I can feel good for a little while.
Perhaps these are unrealistic wishes, as my friend implied. Perhaps I need to learn to live with the grief and stop wanting anything more than what I currently have. But I can't help thinking that if I was able to do these things, I wouldn't have fallen into a mental health crisis in the first place, so it doesn't seem very useful as advice.