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The Fog Creeps in on Little Cat Feet (Part 2) November 9, 2009

Posted by Bill in health, Memories, Mental illness, Personal.
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Perception is everything, and perception is one of the things that makes it so hard to deal with being mentally ill because people think it’s all in your head. Echoing Professor Harold Hill, they espouse the “think method.” Just think happy thoughts and you can fly. Whistle while you work and let a smile be your umbrella. The power of positive thinking. People don’t understand why our twenty-five-year-old daughter still lives at home, why she doesn’t work, why she only recently started back to school. “You need to be firm with her, make her take responsibility, quit mollycoddling her, use Tough Love” as though putting her in time out would make the fireworks stop going off inside her head. They don’t see what we see, how she doesn’t watch movies because she can’t concentrate on them for long enough to follow the plot, how she forgets simple things because of the lightning careening in her head, how her brain is exhausted from the lack of sleep.

How do you explain this to people who equate mental illness with thoughts of Sybil, split personality, homeless people hearing voices on the street? They don’t understand, can’t understand because there’s nothing to relate it to, how someone can look and seem perfectly healthy and yet be unable to do the things we take for granted- watch a movie, go to work, go out with friends.

She’s fortunate to have a family who understands her illness, just as I am fortunate to have a husband to understand mine, because mental illness is so poorly understood. As I look back through my own family I can see the trail of mental illness through the family tree, misunderstood, misdiagnosed, and left untreated. I look at a friend of my older daughter, a lovely, intelligent girl who first started showing the signs of mental illness in her late teens until one night she showed up at our house in the grips of a full blown delusional episode telling us a bizarre story of her mother holding her down while her father raped her, pointing to non-existent bruises on her arm, laughing, hopping and reaching her hand out to wave away the demons that only she could see. At one point, she told us her parents had taken her to a witch doctor to dispel the spirit that had taken hold of her, and I can understand the parents’  frustration, the desire to do something, anything that would remove the illness from their daughter’s mind and make her whole again. Since she was over eighteen years of age, the mental ward could not keep her without her consent so although she was clearly not capable of taking care of herself, they had to let her go.

Part of me feels that the mental wards should have been able to keep her against her will, to force the medications into her. I rationalize this by saying that if she were in her right mind, she surely would want herself to be treated, would want someone to make her take the medicines that allow the cylinders in her brain to fire properly, but my daughter reminds me that the same rationale could have been used to hospitalize her, and I remember back to the days when she was first diagnosed, when I received the phone call at work that would rock my universe.

She was happy, healthy, working at a job she loved, with a good group of friends, going to college, had the world by the tail. Our golden child, the girl for whom everything came easily. Smart enough to graduate from high school and start college at age fifteen, to maintain a 4.0 average in a science major, to impress her college professors with the depth of her thought. Life was good until the day my cell phone rang, and a strange woman’s voice said, “You don’t know me but I am a counselor at the psychiatric hospital. We have your daughter here, and she’s in a bad state. We think she needs to stay here but she doesn’t want to.”

I tried to take it in. “Which daughter?” I asked dumbly. “Are you sure you have the right number?”

“She’s got some cuts on her arm. They are pretty bad. Are you aware she’s been cutting herself? Did you know she’s tried to kill herself?”

Suddenly nothing was important but getting to the hospital. I got up and walked away from my job, calling my husband from the car, driving with tears running down my face, knowing I had to get to the hospital and not sure of what I would find. I envisioned my daughter curled up in a fetal position in the corner. I thought of long cuts raking down her arm, of stitches, of arms so swathed with bandages I would be unable to see her beneath.

When I got there, I was sent to a room where my daughter was sitting in a chair at a table by herself. I walked in and she grinned sheepishly at me. “I don’t want to stay here,” she said flatly, defiantly.

I looked at her cautiously. She looked normal. No bandages, no blood, no fetal contortions. “Let me see your arms,” I said mildly.

She held them out and I saw two thin red lines, scratches. Not even bandage worthy. “I don’t want to stay here,” she repeated.

“Let’s talk about it,” I said.

She and I talked, and then the counselor came in and we talked, and as we talked, the more convinced I became that my daughter did not need to be in this place, did not need to be shut away from a job she loved, from all contact with friends she valued, away from the family who loved her, to be put in isolation among strangers, treated alongside patients who heard voices and built castles in the sky. The counselor didn’t want to let her go and threatened to call the police to swear that she was a danger to herself so they could commit her, but I counter offered that I would keep her under supervision. The counselor and I bargained and finally we were allowed to leave on the condition that I would watch my daughter 24 hours a day, would lock away all sharp implements, and hide all the pills.

When I got her home I started a volley of phone calls till I got her into see a psychiatrist on an emergency consultation. My husband and I started our new regime of keeping her under close supervision—making her leave the door of her bedroom open, taking away her car keys, taking away her freedoms, transforming ourselves from parents into jailers.

With the passage of time and experience gained, we can see now that, while her condition was serious, our gut instincts were right, and she did not need to be locked away. Our family doctor had been treating her for depression, had given her samples left by a pharmaceutical salesman. One day while under the effect of this drug she picked up a pair of scissors lying on her desk and gave her wrist two quick scratches. When she showed them to the doctor at her next visit, he quite rightly grew concerned and sent her to the hospital. It wasn’t till the psychiatrist entered the picture and told us about the importance of matching the anti-depressant to the patient that she was able to achieve some relief from her mental illness.

So where does that leave me on the issue of forcibly hospitalizing the mentally ill? Nowhere but with the realization that like most issues, it is not clear cut. A thin regime of pills separates my daughter from the people on the street. The difference is that she has a family who is supportive, who will make sure she maintains her medications, who will make sure she cooperates with her treatment. The people on the street, for whatever reason, do not. Nevertheless, I cannot just say with surety that they should be scooped up and hospitalized, medicated and tranquilized. When I am in the depths of my bottomless pit should I be forcibly medicated? Or should I be allowed to wait it out while it sits on its silent haunches until it moves on?



1. Freya - November 9, 2009

This is why I think that general practitioners should not be able to prescribe psych drugs, leave it to the psychiatrists. Unfortunately, there’s a shortage, which is why I think psychologists should be able to prescribe meds as well, and may be LPCs, LMFTs, and licensed social workers if they take continuing educations courses on meds and spend time in a psychiatric hospital.

I also think that with the exception of extreme cases that outpatient should be tried first (match the client with a psychiatrist AND a counselor who are in contact with each other and have the client see them and monitor his/her progress) before inpatient. Of course, then you get into the world of grey with what counts as an extreme case and reality that most people don’t realize that they need help or seek it.

2. Dindy - November 9, 2009

Good points all. Although I did not want to say it in my blog, it did not escape my notice that the hospital she was sent to was a private hospital and they had a great deal of financial incentive to try to get her admitted.

Thank you for reading and commenting on my blog.

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