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

Posted by Dindy in health, Memories, Mental illness, Personal.
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3 comments

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?

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The Fog Creeps in on Little Cat Feet (Part 1) November 2, 2009

Posted by Dindy in health, Memories, Mental illness, Personal.
Tags: , , , , , , , , , , , , , ,
2 comments

“The fog creeps in on little cat feet,” says the poem by Carl Sandburg. As I read that I think that Sandburg has to have had personal experience with chronic depression because that is what depression is like. It is insidious, creeping over you slowly, stealthily so you aren’t aware until you are deep within its grasp and unable to get out.

I have dealt with chronic depression for years, mostly very well with the help of medication until last December I did what is hard to understand- I went off my meds. The reasons are varied—we were going through a rough financial patch and trying to save money every way we could; I felt really good and didn’t think I needed them; I ran out and just didn’t have time to get the prescription renewed. And so on and so on. Yes, I went through withdrawal—mainly incredible nausea, but I weathered it, welcoming the loss of the few pounds that would surely accompany it.

There were advantages to not being on the meds—most notably I wasn’t sleepy all the time. See, the thing with drugs for mental illness is you seldom take just one, because they all have various side effects so you have to take several to balance out all the side effects and all the symptoms. The drug I took for depression also made me tense and gave me tremors and didn’t do anything to calm my panic attacks so I took another drug to balance that out. That drug works really well to handle the tension and panic but also makes me sleepy. One drug revs me up, the other calms me down, and I need both of them to function. Yes, it’s weird, but that’s mental illness for you.

At first there was this euphoria to being off meds that everyone told me I would be taking for the rest of my life. It’s the stigma of mental illness, the dislike I had for owing my daily ability to function on a couple of pills. Yes, I’ve taken thyroid medication for years but that has a real, quantifiable measurable effect. My doctor can tell that it’s working by looking at my lab results. The same with my cholesterol medication. The same with my blood sugar medication. But there’s nothing physical to look at with anti-depressants. The only way to tell they are working is by asking me how I feel. And for a brief period of time I think I feel really good. I relish those times. It’s almost a mania as I feel better than I have in years, creative, full of energy. My creative juices flow- I write, I work out, I start new activities, I reach out to talk to friends I haven’t heard from in years.

But then the ebb. The way too many times my husband asks me if I’m okay, if I need to talk to the doctor, if I need to start my meds back up. The times when I am unable to do more than lay on the sofa in a black haze and wish the world away. The times when I am at the bottom of a deep, dank, dark well, a pit of blackness. I cannot remember what it was like to feel good. I can’t remember anything but the darkness. I don’t want to climb out of the well; I just want to stay there, alone in the dark. I don’t care if I never see light again.

Before long the depression has taken over me and I spend more time at the bottom of the well until one day I finally admit to my husband that I need to go back on the meds. But this, like everything else in mental illness does not come easily either, for there is a price to pay for going off the meds. When I start taking the pills again, I go through reverse withdrawal. My body punishes me for taking away the medicine by ratcheting up the side effects. The nausea is unbearable and for days I am unable to eat. The pain is physical—the tension settles in my brow so I feel as though any minute I am going to burst into tears, but I hold the tears back until they press inward on the nerves of my face and skull, pounding and throbbing until they explode. My teeth clench and my jaw shudders and the back of my head aches from pulling against my teeth. My hands tremble so that I cannot type, cannot operate a computer mouse; at any given moment something I am holding might slip from my grasp. My feet and legs tremble so I stumble when I walk.

I curl into a ball on the sofa and clench a pillow to my stomach and think about retreating back into my well because at least there I couldn’t feel anything and that would be better than what I am going through now. I wonder if I really want to go back to the balance of the different medications required to keep me functioning, and I think about how much worse it must be for those with major mental illness as opposed to my relatively mild chronic depression.

I think about my daughter who deals with bipolarism and depression with incredible bravery. In the last two years she’s gone through the withdrawal and re-acclimation process twice. She went off her meds at first because she couldn’t afford them and with the bravura of youth she thought she’d be okay without them. Psychotropic drugs are expensive and many of them have no generic equivalents. Insurance companies don’t understand the delicate balance of neurological drugs, how one medication that works perfectly well for one person can do absolutely nothing for someone else, how the unique biochemistry of our brains determines which medication we will respond to and the insurance company’s definition of preferred drugs has absolutely nothing to do with it. My daughter’s insurance company prefers one psychotropic medication; her brain prefers another.

She didn’t tell us she went off her meds, knowing we would disapprove, wanting to handle things herself, until it got to be too much for her to handle. Unable to get to work, she quit her job, only telling us weeks later as though it were no big deal. Unable to pay her rent, she called us one night, frantic, sobbing, and we brought her home and moved her back in with us.

Back to the doctor she went and started the process of getting adjusted to her meds again, a long, painful year of sleeplessness, nausea, mania, brain zaps and mental exhaustion. Just when she thought she had achieved a balance and was starting to put her life back together again, she had a reaction to one of the medications, a reaction so severe that it shut down her liver. She had to stop the medication that maintained her emotional equilibrium and start the long slow process of stabilization again, only this time she had the additional burden of recovering from her physical illness at the same time.

(to be continued)