Friday, January 21, 2011

On Mental Health Issues

I haven't really gotten into this topic much, preferring to rant rather than delve into it to the extent I could, but I've left hints here and there that there have been many -- severe -- mental health issues among members of my family. I've lived with the consequences all my life. It's not an easy topic to broach or to discuss.

But the recent upsurge in interest in mental health issues following the dreadful shooting in Tucson has opened the door a crack. I realize that most people have no idea what mental illness is -- let alone does -- and they see it as a relatively trivial matter that doesn't concern them. In fact, mental illness, and the price all of us pay for the lack of mental health care services in this country is an ongoing catastrophe.

The shootings are only part of the picture, a relatively small part -- though they are the ones that get the most attention. My impression is that far more mentally ill individuals wind up getting shot, either by Authority or by others, than they shoot, and most people are just as happy it is so.

Punishing and killing the mentally ill -- or simply "allowing" them to die -- is the way things have been in this country for many a long year.

To review: My brother was autistic; my sister suffered from a serious bi-polar condition. My mother became more and more demented as she got older -- but there were signs of serious trouble from early on. My father was an alcoholic who suffered from severe -- untreated -- depression most of his life. And I myself have struggled with alcoholism and depression and various forms of PTSD most of my life.

Oh yes, I had a very traumatic childhood, one that I can recall with both joy and horror -- depending on circumstances recollected -- in almost too great of detail.

That said, when I was young, mental health care was available through public health agencies as well as private providers, and while there could be stigmas to utilizing mental health care services, it wasn't that big an issue for most people. If you needed to get your head shrunk -- or thought you did -- you did it. If you were acting out, the 'van men' came (the term is from an Edward Albee play, "The American Dream") and took you away for a while, sometimes a long time, in a public facility, and you would be provided with at least minimal care and treatment, not necessarily based on "The Snake Pit," either. Millions of Americans were housed or treated in the mental health care system -- when there was one -- in this country.

Involuntary commitment was relatively rare, though it did happen with somewhat more frequency than I believe was necessary. Voluntary commitment was far more common.

Treatment, unfortunately, was primitive when it wasn't downright barbaric. Professionals in the field did not know what caused mental illness and so they often did not know how to treat it effectively. Often it seemed that the basic premise of mental health care and treatment was "This too shall pass." In truth, that's how it sometimes works out. Provide the mentally ill with a safe and positive environment, listen to them, provide therapeutic activities and wah-lah!, something approaching a cure. Well. For a while anyway.

That was the easiest, and in my experience, the most common approach, but if a patient did not improve through utilization of simple methods, there were others. Electroshock. Cold and hot baths. Insulin shock. Other means of "forcing" the patient to get better. If nothing else worked, there was always the lobotomy. That worked real good. Oh yeah.

As I say, primitive if not barbaric. But most patients did not go through those treatments. Too many -- far too many -- did, but most were treated as simply as possible, and many who could not recover for whatever reason (ie: brain damage, dementia, Downs and other syndromes, autism, etc.) would be housed, as safely and comfortably as possible either in a public facility or with local providers for the rest of their lives.

Yes, there were abuses, terrible abuses, and in too many cases, those abuses were not addressed adequately -- or at all -- until very late in the game, indeed, not until the policy decisions were made to shut down the entire public mental health care system as it once was. Abusing the mentally ill was sport for the sadists who all too frequently had free rein in public and private facilities. Sadists on the street could be just as cruel if not more so. Too often, they got away with it.

But the effort to dismantle the entire system of mental health care was based on truly horrific concepts that should not have ever been allowed to prevail.

The basic premise: "Let them fend for themselves; let their families take care of them. If they make any trouble, punish them or kill them."

And this was marketed far and wide as "liberation!" "freedom!"

It was and is a grotesque perversion of the terms.

But you see, I'm getting into rant-mode again. And I don't want to stay in that place, so I'll have to stop for a little while.


Rant mode off for a bit.

My brother had the most severe long term mental illness in the family, and he was cared for at first by family members; when that became impossible, he was cared for by friends of the family; when they could no longer care for him, he was transferred to a state facility where he did not live much longer, not because of any neglect or abuse that I'm aware of but principally because he couldn't handle the change and lost his will to live.

My sister became a mental health care professional and worked in the field for forty years. She died as a consequence of being caught in the middle of a take down of an obstreperous inmate at Atascadero State Hospital -- really a prison for the criminally insane. Her injuries required surgery. She got a blood clot. She died the day after surgery.

She suffered from what was eventually diagnosed as "Manic-Depression", now known as "bi-polar disorder." She voluntarily committed herself to a private, locked facility several times, and she received repeated courses of electroshock therapy. I wouldn't say it helped. It just gave her another set of challenges and problems to deal with. She was put on lithium several years before she died, and it really did seem to help. She was somewhat distant due I think to the shock therapy, but she was highly functional to the end.

My mother went untreated for many years, though she knew there was something wrong in her head. She saw a series of therapists when it became harder and harder for her to get along in the world, and she was put on high doses of psychotropic drugs. They helped in a sense. She was much calmer and able to function, which she and everyone else appreciated, but she became more and more unfocused and to my eye at any rate she became more and more unhappy, until finally she decided to stop taking the medications. Mistake. It took several months to clear the medications from her system, and the person who emerged was all but unrecognizable. That's why I posted the "Nan" videos. My mother had become someone very much like "Nan." One can cope with people in that condition, but it isn't easy. She deteriorated, moved north, could not take care of herself, was looked after by one of her granddaughters and finally died of lung disease -- for she never stopped smoking right up to the end.

My father's depression started soon after his first wife's death. It wasn't really recognized. It was never treated. He tried to self-medicate with alcohol -- which had the effect of making him a drunk. As he got older, he completely withdrew from the outside world. The only people who even saw him toward the end were some religious nuts who had moved into his house. They... didn't help, and by the time he was taken to the hospital suffering from cancer, it was really too late to do anything to save him. He died within a week.

I've seen counselors and psychiatrists for some of my own issues, but strangely, they've tended to say I'm "fine" -- or at least doing as well as can be expected under the circumstances. I've never taken drugs, but for a time, I was drinking very heavily and came to understand, when I hit bottom as they say, that drinking was my attempt at self-medication. Getting better took a long time, but I haven't had a drink in almost 20 years, I keep working on recovery, and I certainly don't miss the sauce ;-). I have developed a lot of coping strategies when depression comes over me, most of them suggested by one or another counselor, and for what it's worth, in a halting way, my ad hoc efforts work. I still get occasional panic attacks, but far fewer than before I retired.

That's the nutshell version of my own private nuthouse.

While I recognize that my family's situation is unusual, it's not that unusual. At one time, help was available -- even if it wasn't the best -- and it was utilized by most of us at one time or another.

It is not the case that "help is available" any more. I read over and over that people who are trained in dealing with mentally ill people are trained to call the police if there is any suspicion that the individual might be a threat to the safety of himself or anyone else. Time after time, when the police respond, they kill the suspect. It is always justified homicide. Always.

Why do people call the police? They think they are supposed to on the one hand, and they literally have no other choice on the other. Mentally ill people acting out -- or even threatening to -- are "always" a matter for Authority and too often summary execution. There is no other option.

If they are not killed on the spot, they are taken away either for a 3 day observation, or if a law can be found that they have broken, they are taken to jail, where they are likely to be beaten and abused by the guards for sport. I could go on and on and on detailing what happens to the mentally ill caught up in the grip of our punishment obsession and the absence of appropriate mental health care services.

I can't help but think what would have happened to members of my own family if this regime of mal or non-treatment of the mentally ill had been in place when they were diagnosed and suffering.

It's appalling.

Which is why I tend to rant about it rather than calmly consider.

It all goes back to Reagan, his wife Nancy, and her (step) father. Well, that and the series of lawsuits filed by the ACLU to "liberate" mental patients.

I'm getting back into rant mode, so I'm going to stop for the time being, maybe look up some links to include here later, and consider more deeply what it is we really need in this country to provide for mentally ill people.

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