Knowing is Half the Battle: Mental health in Before Pittsburgh

Before Pittsburgh explores the mental health care Brian seeks through two therapists. The unnamed Barcelona Shrink (another blog post on why she’s never named) and Dr. Moses in San Francisco.

Brian says Moses told him in the Spring of 1999, right after Tony’s death, that his best friend’s suicide was Brian’s fault, and he should get his shit together.

It’s unlikely the therapist said either of those things but that’s an unreliable narrator for you.

When Brian returns from Barcelona, he also returns to the care of Dr. Moses. But he’s changed by his time abroad:

I’d met Dr. Moses when I was downward spiraling and he had been like a match to dried tinder. I hated him. I fled San Francisco partly to get the fuck away from this guy. 

Then my Barcelona shrink had helped me understand that weekly, habitual, focused contemplation was a path to healing. She was less bossy, less judgey, less Moses. And she had zero contact with my father. Moses had been recruited by him, and though my relationship with Dad was better, I didn’t think that fixed my relationship with Moses. Both therapists knew I had a lot of work to do, and me and Barcelona shrink had done it. A good bit of it. But there was more to be done. I still felt broken. 

In one month, I would be through the first year without Tony since we were eight and neighbors and best friends. Barcelona shrink had encouraged my writing to Tony. Moses would hate that. She had suggested I unpack the addictions I had to smoking, sex, and drinking. Recognize them as failed coping strategies. Moses would hate that, too. 

He was less empathetic to what he called self-destructive behavior. More business-like. In the few appointments we’d had last spring, he’d kept an air of man-to-man objectivity. Like a job interview. 

Before Pittsburgh, Chrysalis Press, 2021

Mental health is a more common topic now. We expect people who are struggling to seek help. We show empathy toward things like triggers and addictions and PTSD. 

Historically, people suffering from PTSD were often misunderstood (Mrs. Dalloway), those with addictions were ridiculed (Hoosiers), and bipolar disorder was so misunderstood as to be treated with shock therapy (The Bell Jar).

In the 90s, there was a fringe awareness of mental health; drugs were coming on the market and diagnoses were becoming more common. But it would be thirty years before we had mainstreamed words like panic attack, social anxiety, and cognitive dissonance.

Even now, there’s a stigma around clinical depression that suggests it’s something individuals can choose to treat and recover from.

Part of what Brian has to work through is recognizing his grief and sadness as expected, human responses to Tony’s death. In juxtaposition to Tony’s clinical, biological challenges with undiagnosed bipolar disorder and heroin addiction.

Brian’s work with the therapists was not a usual experience in the 90s. I didn’t know anyone in therapy. But man, we all needed it. I’ve taken liberties with the Barcelona Shrink and Dr. Moses because as a storyteller, I needed a device to have Brian unpack what had happened to him and describe how he would process it and move forward.

When did you become aware of mental health as a practice? 

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