Is Forced Treatment for Mental Illness Okay?

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There is a word for not knowing when you are sick and it is called “anosognosia.” Like everything in the world of mental illness there is controversy about it. Some people don’t believe it exists at all, while others have developed extensive research projects defending it as a term.

But let’s cut to the chase. Is there ever a time when someone with a mental illness may not know he or she is sick? The answer to that question is “yes.” I don’t know if people can deny that is true, but many people who are experiencing psychotic episodes do not know they are sick. Some people who experience full-blown manic episodes have lost insight and don’t know they are sick. When this happens family members are left to try and find a way to get their loved one treatment in the hopes of bringing them back to reality.

Forty years ago the Supreme Court ruled that in order to be committed involuntarily one must be found “a danger to himself or others.” Some states have added language to include “an immediate danger.” Sometimes this is interpreted to mean even if a person may become a possible danger to himself or others, unless it is happening in the moment the person cannot be forced into treatment.

The problem with this law is that it really discounts situations when people are unable to competently judge for themselves when help might be necessary. Although many who have mental illness may never become a danger to themselves or others they may still benefit from treatment intervention. The bottom-line is you cannot legally make someone take medications.

I have been on both sides of this issue. I have filled out papers in the court house to have a family member committed during a manic episode, only to watch the system fail and for her not to get treatment. It took about three months before I was able to get her much needed help. In the meantime, I lost a number of sleepless nights and had to deal with the danger of someone not in her right frame of mind.  Just standing by waiting for the “shoe to drop.” Something bad would have happened if I had not have finally gotten her treatment because she had some major physical health issues and needed hospitalization. Without a mental state she may not have been able to communicate those life threatening physical symptoms.

In my own situation I have been involuntarily committed. Each time this happened I did not know I was ill. No matter how much anyone reasoned with me I felt like I was “fine.” I could not understand why people wanted me to get “locked up” for treatment.

Did the fact I was taken against my will into treatment cause me trauma? You bet it did. But if I were to sign a psychiatric Advanced Directive I would give family members who I trust the ability to make decisions for me, if I am unable to make them myself. And as a person who has benefited from treatment I want that intervention to take place.  All this can be spelled out in an Advanced Directive.

I understand the arguments on both sides of the fence. One where people have been fighting for mental disability rights for years to remove the archaic treatment and/or abuse that took place in mental institutions. They have brought freedom of choice for the mentally ill population. The freedom to accept or refuse treatment based on patients rights.

What if you want treatment when you are well, but refuse it when you don’t know you are sick? What should happen to you? What if the treatment team recommends more high-risk treatment like electro convulsive therapy (ECT)? Do you have a right to deny specific treatment options or are you at the mercy of the providers who evaluate you?

So many questions and not one clear cut example that makes this issue any less charged. I think the best solution is to write an Advanced Directive while you are well and put that in a place where everyone can find it. This way at least some of your wishes have a chance at being carried out.

For those who can’t get a loved one treatment, my heart goes out to you. It’s just a tough position to be in all the way around. This definitely makes the case for more education, information and awareness for mental illness, so people can be in a better position to make informed choices. It’s not perfect but who wants to go back in time to the 1960’s where anyone could have someone committed into an institution. That’s not a just solution either.

For a heart-wrenching story from the Washington Post about the inability of a family to help a man in need of treatment read Behind the yellow door, a man’s mental illness worsens. It will make you think about whether or not forced treatment is humane.

To read more about Advance Directives click here Advanced Directives Information.

 

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The Strengths Recovery Path – Part 2

“Sometimes psychiatric problems take over our life. Everything about our life can come to reflect our psychiatric history. We may feel like a psychiatric diagnosis spells the end of our chances for experiencing love, fun, or success. We can feel trapped in a life that is very limited and become bored, depressed and end up with negative feelings about ourselves1.”

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When I read this quote I said, “Yes, absolutely true for me.” It is very difficult to pick yourself back up after having your life completely interrupted by a mental illness. But once you have received treatment the next step is to work on putting your life back together again. I know this is what I had to do. And it is hard work, but so worth it when life starts to unfold its’ many surprises.

This is why I am a huge advocate for recovery programs. Putting energy into healing and mapping out a future is so critically important in this process.

The first step in recovery is having are basic needs met.  Such as, housing, food, and clothing.  After those basic needs are met what we want to focus on is answering the questions, “How do I have a fulfilled life in spite of my psychiatric disability, a.k.a. mental illness?” We want answers to questions about “What’s next for me? What can I do for a career? How can I still be a good parent, wife, husband, partner, friend?”  What are some ways I can contribute to my community?

Often times I found myself searching for answers to those questions outside of me.  I seemed to have lost so much confidence and my self-esteem suffered enormously. I frequently doubted my ability to be anything more than a “mentally ill patient.” Getting sick knocked me so far down that I only saw myself as weak and damaged. This is why I sought validation of my self-worth outside of me.  But I quickly learned I was going to have to restore my inner confidence while I worked to create new dreams and goals for my life.

One of the things that helped me in the Recovery Program was developing a vision for my life. Stepping back and creating new dreams and outlining the long-term and short-term goals that were going to help me get there. Part of my vision was to become a Mental Health Advocate, specifically focusing on raising education and awareness. I have begun to live that dream and the more I walk down that path the better I feel.

But if I am honest I would tell you that I wrote that vision four years ago. It has taken longer than I expected to get to living my dream, but that’s because I had some setbacks along the way. The good news is I never forgot my vision. This is why it is so important to create a vision or have a dream. When you create it you can work within your limitations, not viewing them as obstacles, but viewing them as a hurdle.  Hurdles were meant to be jumped over!

The most important thing to realize if you or a loved one has a psychiatric disability is that there are many things that can still be accomplished. You just have to find the right path.

 

1”Pathways to Recovery: A Strengths Recovery Self-Help Workbook.” University of Kansas School of Social Welfare, 2002. Page 127.

The Strengths Recovery Path-Part 1

JTR-textYears ago I went through a 12 week course called the “Pathways to Recovery.”  The local chapter of the Depression Bipolar Support Alliance (DBSA) sponsored it.

At first I was very skeptical about the workshop. I thought, “What am I going to learn that’s going to help me?” After suffering from a very long major depressive episode, I knew I needed an extra boost to get me up and moving again.

So I enrolled in the program and received this fantastic workbook called “Pathways to Recovery: A Strengths Recovery Self-Help Workbook.” It is filled with a wealth of information. One of the things I like is one definition of recovery as listed below:

“Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It’s a way of living a satisfying, hopeful, and contributing life even within the limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.”

~William Anthony, Director, Center for Psychiatric Rehabilitation, Boston University

I liked this definition because it seemed to hit on all the areas that I know has been touched in my own journey of recovery. Many times I have struggled to pick myself back up after having setbacks and I have turned to this workbook for information. I have sat down and made new goals for myself, in light of the fact I could now face my limitations with a different attitude.

In my view I think that is one of the keys in recovery. The honest look into your current situation that says, “I am not the person I used to be, but I still have a great deal to offer. I can make new dreams and goals.”

In the course we spent a significant amount of time identifying our strengths. As a matter of fact, an entire chapter was devoted to help you point out and identify your strengths. The book suggests that we usually have a tendency to pay attention to our problems, personal deficits and weaknesses more than we actually pay attention to what we are good at.

If you want to take a stab at seeing how many strengths you can identify try taking a piece of paper and write down what you think are your strengths. It’s kind of fun. What I realized is that I had about three things I wrote down. They ask the question of whether you found it hard or not. “Yes,” was my answer.

I took a quote from the strengths chapter that highlights something I believe is true:

“If you constantly think of illness, you eventually become ill; if you believe yourself to be beautiful, you become so.” ~Shakti Gawain

The workbook encourages you to move from a problem orientation to a strengths orientation. Here are a couple of examples:

Problem Orientation: Instead of focusing on my problems, symptoms and deficits…Strengths Orientation: I am primarily concerned with what I want, desire, and dream of.

Problem Orientation: Rather than see myself as my diagnostic label…Strengths Orientation: I see myself as a unique human being, with a strong mind, body and spirit.

The whole idea of changing our attitude and focusing on the solution instead of on the problem begins to shift our minds. It is a great way to move from getting down to looking for the “good” things about us. Because everyone on this journey of recovery knows you have to learn how to be kind to yourself and focus on the positive aspects so you can overcome the challenges.

 

 

 

 

 

 

 

Mental Illness and Surviving the Memory Tides

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I think it’s fair to say those of us with mental illness “suffer.” We often experience pain and loss that is incredibly intense and cannot be put into enough words to describe how it actually feels. The cruel thing is we not only suffer with an illness we also suffer when we move along the process in recovery. Additionally, we are usually expected to suffer in silence because no one else can see our illness in x-rays or test results. They just don’t understand what they cannot see.

It has taken me a long time to understand the trials and tribulations of my own struggles with bipolar disorder. Sometimes I feel like I have been sitting in the middle of the ocean and for some reason I survived the “memory tides.” The memory tides hit you with high tides and you nearly drown in snapshots of your mental health journey. Then, for some unknown reason low tide hits and you get bits and pieces of the past without getting knocked over.

There have been times in my own healing process where I have literally gone back to bed because I have been knocked over by such intense memories it wore me out. I would just lie there in bed and let my mind take me wherever it needed to go. In the moment, I recognized I was processing the past and for some reason it was a necessary evil that I had to experience.

I have read that hospitalizations can be traumatizing. Depending on what happened in my hospital stay I would have to agree with that, even though I believe if you need hospitalization it is a safe place to go. But I can say that in my memory tides I have viewed my hospital stays in photographic frames. Play by play I see the faces of the doctors and nurses who cared for me.

Sometimes the memories are so intense I can recall the not so nice things and good things a healthcare provider may have said to me.   But worse than what people said is what they did when I was experiencing a psychotic episode. I have seen the paint peeled walls of seclusion rooms and felt the tight leather restraints around my wrist and ankles. I have had to learn how to cope with the pain of those memories as well.

More than 15 years ago, I was in a small community hospital and  was left in restraints for 16 hours. I was asleep almost the entire time, only waking up to realize I was tied to a bed. They finally let me up when I needed to use the restroom. I felt mistreated in that situation and it took me a long time to heal from it.

So when people say the word “suffer” to me I really get what that means. These experiences drive me to advocate for mental illness, because I don’t want other people to suffer as much or more than I did. In the meantime when the memory tides come I just sit back and brace myself for what I am about to see. Everyday gets better and one day I hope to replace those pictures with something much more pleasant.
 

 

Eliminating Self-Stigma is a must!

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There is so much to comprehend when you receive a mental illness diagnosis. Not only do you have to learn about the illness and subsequent treatment options, you may also get exposed to stigma. Sometimes stigma is from other people and sometimes it is from yourself.

When I first learned about mental illness stigma I was about twenty years old. My mother had struggled with bipolar disorder and ended up having a psychotic episode. It didn’t take long for some family members to treat her as if she was an outcast. The invitations to gatherings ceased, as did their phone calls.

I immediately understood I wasn’t allowed to talk about her episode because I feared what people would think and say about her. It was all supposed to be a secret undermining everything that was natural about wanting to have compassion and support through a difficult time.

By the time I was diagnosed with bipolar disorder I had experience with external stigma, but I was introduced to self-stigma. I have had to fight through many aspects of self-stigma. Sometimes I have tortured myself with tremendous shame, blame and guilt all because I now carried a “label” of bipolar disorder.

For many years I did not have a name for self-stigma. It wasn’t until I started researching mental illness that I realized I had fallen victim to the stigma cloud. All of the sudden I had an answer to why it was so difficult to accept a diagnosis, much less treatment.

The strange thing I found was it was much easier for me to support family members who had bipolar disorder than it was for me to accept it myself. It seemed as if I didn’t want to be included with a group of people who suffered with not only a mental illness, but also the prejudice and discrimination that often comes with it.

Little did I know that the number one person who was discriminating against me was looking back at me in the mirror. I had to learn and re-learn how to be kind to myself while I was learning how to manage the many symptoms of my illness.

It has taken me many years to accept my illness as something that was outside of my control. Even now there are days when I catch myself going down the, “I’m lazy path” when I experience depression symptoms. I know better now. I accept the fact that I am living with a severe illness. But even so I continue to fight the hangover effect of self-stigma.

I am almost embarrassed by how much pain and suffering I have caused myself with such negative thinking. I have beaten myself up with ruminating self-blame so much so that I probably made my depression worse at times. I know better—when you know better you do better! But it remains a fight to overcome the automatic internal control switch that tells me, “I need to get a handle on these depression symptoms. It’s my own fault I’m depressed anyhow.”

This is where the fine line between self-stigma blame and self-care begin to collide. I don’t want to blame myself, however, I do need to recognize what I can control and what I cannot. For example, “I can control being adherent with my medications. I cannot control how the medications work in my body.” “I can control what time I go to bed at night. I cannot control unwanted depressive symptoms that cause me to sleep for 16 hours.” You get the idea.

Self-stigma is sneaky. It creeps right into your mind when you least expect it. Be on the look out for unwanted thoughts that do nothing but claw away at your self-esteem and confidence. There is no reason to shame yourself for having a mental illness anymore than you would shame yourself for having cancer. Hopefully the more you are aware of self-stigma, the easier it will be to recognize. There are plenty of obstacles in the way of recovery, why not remove one you can control?

Should mental health disorders be treated with medications?

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I did not realize it but there is a population of people out there who do not believe mental disorders are illnesses. They don’t believe in the “disease model” for mental health issues and believe people should not be treated with medications. When I heard this I wondered what makes a disorder worthy of an illness label? And why wouldn’t there be something wrong with the brain if you had a psychotic episode?

Some people actually believe a psychotic episode is a “normal” response to certain life events. They also believe most people would do better without anti-psychotics than with them on board.

And then there is the evil empire pharmaceutical industry theory, which says pharma pays big bucks for drugs to be developed and approved so they can make profits, as if the sole purpose for all the scientific work is some preconceived conspiracy. Pharmaceutical companies did not create schizophrenia or bipolar disorder. Sorry but I’m not buying this theory. They research compounds that make a difference and when they are successful they make lots of money. This is the American way. Without the profits there would probably be few life saving medications.

When I heard this view point I was a little shocked. It seems we have come so far with people understanding mental illness as an actual “illness” instead of just a state of mind and something you can control without any intervention. I suppose it really makes a difference as to what mental disorder you are talking about—but who gets to decide what is a serious mental illness that needs medication and what is a disorder that can be controlled with a behavioral modification program. Explain this to a person having a full-blown psychotic episode.

I am all for differing opinions and debates. It’s healthy discourse and keeps everyone in a position to back up what they say. But I’m really confused about why psychiatry continues to have so much controversy in utilizing treatments. I agree that not everyone who is prescribed an anti-depressant or anti-psychotic needs one, but that’s just how it is with every therapeutic class of drugs. There is always over-utilization and under-utilization of different medications.

I have suffered with bipolar disorder most of my adult life and have finally gotten to a point where the medication regimen seems to have stabilized me. I’d hate to go back off all my medication only to find myself very sick again. It’s hard enough to fight depression while trying different medications let alone stopping all medication all together. And I can’t afford to leave mania untreated because it almost always results in a psychotic episode. As far as I’m concerned psychosis is a dangerous state of mind and I don’t want to experience that again.

Just because we can’t see the broken “brain” on x-ray doesn’t mean it’s not broken. There are many diseases that we do not understand the cause. We can’t always know conclusively how a medication really works. Sometimes you have to use common sense and be okay with the unknown. Sometimes you just have to take a leap of faith and trust that people studying mental illness treatments are doing so with ethics and integrity.

 

 

Struggling with Depression

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I am slowly waking up from a bipolar depressive episode. I raise my head up, look at the calendar and ask, “Where has all the time gone?” I may have seemed like I was present the past few months, but I’ve really just been hanging in there fighting the depression symptoms.

When I start to feel better I often find myself tempted to ruminate about the past. Oh the days when life was so much better—the times when I had friends over for dinner—oh heck just the times when I had some friends to call. How lonely life can become when you struggle with a mental illness. Especially when you struggle with depression, an illness that causes you to isolate yourself from others.

I contemplated taking a walk today, but I haven’t gotten there yet. I don’t know what I’m waiting for other than the symptoms from my latest medication to “wear off.” I think the doctor got carried away with pushing the dose of the new medication and the side effects are starting to cause me to sleep longer. I am so frustrated, it’s as if I’m constantly beating my head against the wall wondering when the wall is gonna break yet knowing that is not possible.

I want relief. Relief from the loneliness. I want involvement and yet I don’t know if I can keep my commitments. I want friends. Yet I don’t know if I have anything to talk about except my illness struggles and my past successes. Who wants to sit around hearing old tales about the past? People live in the present. They have lives. I feel like I have an existence. I try hard to stay positive and look for opportunities to “live.” But in all actuality I am struggling day by day with lingering depressive symptoms.

Depression keeps me from living to my potential. Sometimes the best I can do is get out of bed in the morning and that’s a huge accomplishment. The fact that I am trying to write is success. What I write is not inspiring or hopeful like I want it to be. I write about the struggle and the pain. I wish it could be different. All I can do is keep trying, that’s what I would tell a friend with the same challenge.

On a positive note, I do work part-time. It makes me put on my make-up and get out of the house. It’s not my ideal job, but it serves a lot of purposes. I work a few hours every week. Nothing I can’t handle even in the midst of fighting depression. I think about working more, but I don’t think I can handle it. I question my ability to handle stressful situations without triggering my illness.

So, I read and I write. Hoping that somehow I’ll get a pearl of wisdom to jump off the page into my heart. I might feel something click and maybe I’ll smile. Maybe I can relate to someone just like me and in that moment I won’t feel as bad.

 

 

When Will Mental Illness Be Treated Like Cancer?

“My goal is to see that mental illness is treated like cancer.”

~Jane Pauley

One day the general public is going to wake up and say, “Wow, mental illness is really rampant in our society. What happened to all those research dollars they should have been spending on these life threatening and disabling illnesses?”

Right now it seems that people just want to continue keeping their heads buried in the sand and push the entire mental illness conversation under the carpet. It’s the case of, “if we don’t acknowledge it, maybe it will go away.”

Sorry. I don’t think mental illness is going anywhere. As a matter of fact it seems more prevalent today than ever before. Maybe this is because we actually collect statistics about it now. I’m not sure. But I do know some of the statistics and as far as public health goes we have a near crises on our hands.

Consider this…

  • The Center for Disease Control reports that suicide is the 10th leading cause of death in the United States
  • According to the Global Burden of Disease Study Mental Illness and Low Back Pain are the number one causes of disability worldwide

One of the authors of The Global Burden of Disease Study, Dr. Ali Mokdad professor of Global Health from the University of Washington suggests the following:

“It’s about time for us to combine physical and mental health as one issue that we need to deal with,” Mokdad said. “Unfortunately, in the United States, mental health or mental conditions become an issue when there is an unfortunate event, a shooting somewhere, and then we talk about it. That is what reminds us that we have a problem. In reality, the data tells us that we have a major problem with mental health and we should give it the attention we give other risk factors, such as smoking.”

Those of us who live with mental health conditions have a great deal of insights into what it is like to live with these diseases. We need better access to care and better treatment.

What kind of statistics is it going to take to treat mental illness like any other serious physical illness?  What’s it going to take for the public to realize how prevalent mental illness is?  Share your opinion in the comments section.  I’m curious to know what you think.