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A Mental Health Crisis

illness

Once again extensive and lengthy mental health issues are revealed after a heinous crime. Once again we are left wondering how can this happen? How can anyone living in today’s over-exposed world manage to evade authorities and/or medical attention? How can a person with repeated exhibitions of mental illness have access to weapons? These discoveries of warning signs and bells usually crop up during the first 24 hours of investigation. This speed suggests that the perpetrator’s mental health status was pretty well known. How does this happen?

How do police listen to a man talk about hearing voices and microwave vibrations and not have him hospitalized? How does someone retain his military security clearance after violent and erratic behavior? How does someone with a well-known history of mental imbalance own and keep a gun? It’s actually quite simple. We don’t want to get involved. We see examples of this aversion every single day. When you use a restroom and discover there is no toilet paper, it’s because at least one person before you did not tell management. We don’t want to get involved in even the most benign situations let alone one that might be complicated. And nothing is quite as complicated as mental illness. We are equally consumed with fears of offending someone behaving questionably as we are for our own safety.

We are woefully under equipped both personally and on a larger infrastructure level to deal with mental illness. If you work with someone who exhibits troubling behavior you might screw up your courage and go to personnel. Then what? A competent personnel officer may talk with the employee in question about services and counseling. Then what? Does the veil then lift from the employee’s eyes? Do they trot off to up until that moment an unknown resource known as counseling and become cured? Only in a Lifetime movie. What if it’s your next-door neighbor, the guy in the diner, or the woman on your bus? How do you alert anyone? Who do you tell?

When a person’s behavior becomes impossible to ignore, the police are often called. The police may or may not be well versed in the signs of mental illness. The police usually have some leeway as to whom they can have transported to an emergency room. Then what? If a person in distress makes it to the emergency room they are held for less than two days. If they are not a danger to themselves or others (which is determined by the patient saying the words; I am a danger to myself and others) they are released.

Over the years we’ve become more comfortable with the concept of mental illness. We bandy around terms like post-partum depression, P.T.S.D., eating disorders, O.C.D., etcetera. Many people are comfortable taking psychotropic medication and/or sedatives. But mental illness is far more vast and varied. There’s a whole lotta real estate in between social anxiety and paranoid schizophrenia and most of us are a bit vague about it all. Compounding the confusion is the fact that mental disease can be scary for spectators. Of course in our most rational moments we know that it is far scarier to ignore erratic behavior. But we can hardly be blamed for listening to our own little voice inside saying; “run the other way!”

In a world in which people often assume that someone else will take care of something, mental illness is mysterious and scary and our mental health infrastructure is flimsy at best it is no wonder that we have what we do on our hands. We’ve heard people (including politicians) say that guns don’t belong in the hands of the mentally ill. We’ve never heard what that means. Surely not all mental illnesses are considered in this classification. What has been spelled out is that “people with mental illnesses” will be identified as those who have sought help. This is a ludicrous and meaningless classification as it’s a deterrent to people to seek help, and we don’t really have many options for those seeking help. And that is the issue.

We’ve shrouded mental health issues for which there isn’t a kicky acronym or a medication to be peddled, in a thick cloud of secrecy and shame. We’ve manifested that sentiment in the abysmal mental health system with which we’ve settled. It’s great that you can get a flu shot and blood pressure check while picking up some cat litter. But what of prevention and detection of diseases that could affect public safety? How much devastation does it take before we face this issue? How many lives must be destroyed until we can say; we have a mental health crisis in this country?

 
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Posted by on September 18, 2013 in Cultural Critique, Well-Being

 

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Hoarders

firehouse

Reality television is at best a cracked lens on society. The percentage of toddlers wearing hairpieces, spray tans, dentures, and artificial nails is in actuality quite small. Most women don’t call themselves housewives, implant faces and bodies beyond recognition and parent so abysmally. Whether the people who participate in these shows are mentally healthy or not is an interesting question. Voguing for a camera (and hoping to land fame, fortune and book deals) is not currently classified as a mental illness. For the official-certified-it’s listed in the DSM-V, display of mental illness you need to turn to the addiction sub-genre of reality show.

That there is an audience at all to watch people struggle with a mental illness is itself disturbing. But evidently there is, and the proof is the shows focusing on obesity, drug and alcohol addiction and hoarding. You’ll note that there are no shows about mental illness that have a less quantifiable or compelling visual behavior. There’s yet to be a “Watch The Narcissist” show, and to be fair it’s probably due to the redundancy factor. There’ll never be a “Depressed Divas” show as depressed people are never entertaining. A “BiPolar Bonanza” would demand a far too attentive director and shooting schedule (dammit his mood just shifted, where is the camera!) We, the audience, are not very interested in mental illness per se, what we like is wacky behavior. And if that behavior stems from a syndrome all the better. We love nothing more than hearing from a person with questionable credentials (‘therapist’ needs a modifier to mean anything) spout psychobabble about the behavior. The hoarding shows center around this very phenomenon. We see a ‘therapist’ gently talking the hoarder into parting with the petrified pet. In the next scene she actively listens to distraught and frustrated family members and explains ‘the process’ to them. We sit in our over-accessorized homes, eating chips and dip out of a chip and dip bowl, as we wear our ‘tv watching’ outfit and snort over the wasteful accumulation. “That’s f*&^ed up” we say as we accidentally tip over the tower of DVDs.

This interest in wacky behavior doesn’t just guide free cable programming decisions. It also seems to guide political policy and expenditure. There are currently 85 communities across this country that consider hoarding to be a serious public health hazard. Hoarding, of course is not necessarily a health hazard. No one has been physically harmed by a Madame Alexander doll or Thomas Kinkade collection. Possibly a more apt description for the kind of behavior with which the authorities are concerned is ‘filth’. There’s a method that’s been used since the dawn of filth for such scenarios; it’s called condemning. There are no soft-spoken ‘therapists’ or understanding fire chiefs necessary. If a home poses a genuine risk to the public, shut it down. Anything else is utterly disingenuous. Hoarding and living in filthy squalor is only the presenting behavior. There’s a reason people engage in barricade building. Convincing someone to part with a few carcasses and some urine soaked newspaper may make the helpers feel better, but dollars to dozens and dozens of donuts, that home is going to fill the hell up again. And why shouldn’t it?! What business is it of anyone’s how someone else chooses to live? This is when someone pipes up and says “It’s a public heath issue”. Is it? Not always. If the person lives rurally it’s not. If it really and truly is then shut it down. But wait, what’s to become of the hoarder? Well, if we really believe that the person is a danger to themselves and others (and if they’re not we have no business bothering them) than they need to live in a protected environment.

That homes are being cleaned out, very slowly and often at taxpayer expense, by community officials is troubling. On its surface it appears that we care about our most fragile neighbors. If that is even remotely true why aren’t the same resources being used to remodel shantytowns? Surely people living in doorways, under bridges and in tunnels are also worthy of a clean dwelling. It stands to reason that people living on the street, presumably without access to health care also pose a public health hazard. It is always better to err on the side of helping, but it is the responsibility of the strong to be clear about who exactly they are helping and why. Wrapping ourselves in rhetoric to impinge on someone’s autonomy is not helping anyone but ourselves.

 

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A Chance For Happy Days

arnolds

Adolescence is not fun or pretty. There is nothing “How lovely to be a woman” or “I am 17 going on 18″ about it. It’s a wretched maelstrom of physical and emotional change. Everything feels chaotic and unending and there’s not enough life experience to offer a glimmer of hope. This is why teen suicide is so very tragic. No one would deny a teen’s real and crushing psychic pain. But we would probably challenge them in their sense of permanency. ‘Wait’ we collectively say; ‘it gets better.’ And we mean it, and it’s likely to be true. For some time the news of teen suicides has be packaged with pleas for adolescent mental health care. Articles and news desk pundits tell us how to identify a child in crisis and where to get help. But today’s news that 55% of suicidal teenagers had received mental health care is jarring. Yes, there are still 45% of suicidal teenagers not receiving care. But the majority of teens in crisis are getting help. Therapy is tricky business of course. Finding the right therapist for a patient can be challenging. Finding gifted and accessible adolescent specialists can be tough. Prescribing just the right medication to someone who isn’t growing and changing daily is difficult. Monitoring the taking of medication is…well if you’ve ever met (or been) a teen, you know how crafty they can be.

Whether we think that ending one’s life is a personal choice is irrelevant when it comes to adolescents. We may believe that grown people who have exhausted themselves and every option to alleviate their physical and/or psychic pain are entitled to just stop, but that’s not applicable to discussions of children. Teenagers are by definition closer to children on the maturity spectrum. They simply don’t have the life experience or fully developed brain to make such a decision. There are teens who have serious physical and/or mental health issues. There are teens who’ve witnessed or been victims of horrific acts. If they were middle-aged people still suffering intensely this would be a different conversation. But they are teenagers. They are not allowed to drink, vote, live alone or rent a car. They are simply incapable of making a rational terminal decision.

So what can be done? We know that boys are more ‘successful’ at attempts than girls. We also know they tend to be more violent overall. Unfortunately it does not go without saying that there should never be weapons in a home that includes children. There also should be no access (no guns or other weapons in cars, workplace, sheds, trailers, etc.) No weapons ever. There needs to be talking lots of talking. Most teens are sullen and uncommunicative at times, but adults should not be. Your teen may be bigger and stronger than you, but you are still the adult. If your child is more sullen than not, and/or has lost interest in activities (did he/she quit a team or a friend?) tell the school’s administration and teachers. The more people watching out the better. If the child is utterly noncompliant (won’t come out of room, won’t go to school, etc.) it’s time to involve more people and perhaps inpatient care.

It’s hard to think of an adult-ish appearing person with a full vocabulary as a child. But they are. For some purposes a teenager is more akin to a newborn than an adult. They are on the brink of learning an entirely new way of engaging with the world. They are often frightened of leaving the security of the home and entering the world on their own. We, (i.e., all adults in a teens life) must think back to how we scrutinized every movement and development in their newborn lives. We must revert back to the parenting that intervenes when something seems off. It’s frightening to challenge anyone let alone your child who makes your heart ache. It’s scary to exert authority over someone who might be larger then yourself. It’s terrifying to think that you might say the wrong thing; the thing that will actually drive him/her over the edge or out of your reach. Silence never saved anyone.

 
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Posted by on January 9, 2013 in Childhood, Well-Being

 

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An Illness In The Family

 

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Periodically, most often prompted by crisis, mental health pops up in our cultural conversation. Pundits point out the obvious flaws in our care system, medical professionals speak of conflicting and vague diagnostics, and some families share heart wrenching personal tales. This flurry of post-crisis activity is actually a microcosm of the complex issues of mental health care: People state the obvious, others admit to the complexity and the people in need are suffering.

Family members (and by ‘family’ we mean everyone who shares love) are often in the direct line of fire of mental illness. Their lives can be upended by the illness of a loved one and their every moment consumed with pursuing effective care. It is those closest to someone ill who will witness and be subjected to troubling behaviors. And unless the ill person is a minor or the behaviors so blatantly outrageous, it is difficult to judge when it’s appropriate to intervene and to what extent. We are a culture that holds personal freedom and autonomy in the highest regard. And while we like to tell people what to do with their lives in the abstract, we shrink from doing so in reality. We don’t want to unnecessarily offend and even if we did, it’s difficult to know what to say or do. It might be helpful to think of behaviors and approaches categorically.

Danger to self or others - There’s no wiggle room here. Our society has agreed that impending physical harm trumps personal freedom. While the “danger to self or others” definition is meant to be applied in crisis, the philosophy applies more universally. When asking ourselves; “Is it time to seriously intervene?” we can use this statement as a guide. It is time to move on from nagging and/or cajoling a family member to eat when you see/feel that their weight loss is dangerous. If someone is driving when drinking, passing out and/or injuring themselves when drinking, they are a danger. If someone cannot get out of bed and has vulnerable people in his/her care he/she is a danger. The question to ask when making this judgment is; “Is someone going to get hurt?”

In crisis is probably the most common presenting challenge. There is no immediate danger but instead a person who is simply not well. For the most challenging mental illnesses (i.e., schizophrenia, bi-polar, personality disorders) a state of crisis is a common occurrence. For people faced with depression or anxiety, crises can be one-offs or few and far between. Depression is a real and debilitating illness, it should not be confused with sadness. Being sad is prompted by incident: a death, a world event, a hormonal event all can trigger sadness. Of course these events can also trigger depression. The key is how long is the darkness lasting and has it changed the very nature of the individual? The same is true for anxiety. When a response to real and present danger morphs into sustained hyper-vigilance it is not serving the individual well.

Intervention – Erase any image you might have of corralled family members confronting someone while shakily holding index cards. It’s a powerful scene for television and movies but is flat out surreal in real life. If there are other caring people who can assist in getting the person in need appropriate care, so be it. But folding chairs and prepared statements are not necessary. If the person is in crisis (danger to self or others) they need immediate professional assistance. If someone has demonstrated a desire to hurt themselves or others they can and should be hospitalized and treated until they are stable. If the person in crisis is compliant you can take them to an emergency room yourself. If they are violent the police will help them to the hospital. *Note: It is best to assume that each and every threat of harm is valid. There is nothing to gain from assuming someone is crying wolf. If nothing else the emergency room staff will become more familiar with the person in crisis and be able to provide more specific care with each return trip.

For people not in crisis, intervention can be a hairy and anxiety provoking business. Every situation, relationship and individual is different. There are no universal guidelines on what to do, but there are some pretty clear guidelines on what not to do. Do not make it easy for someone to not get help. Do not take on the role of amateur therapist. Do some research and find a therapist in the right price-range (any doctor’s office, school, women’s health clinic, or divorce attorney will have referrals.) When the individual seeks to emote or purge have a contact number on hand and take full responsibility; “I want to help in a meaningful way, I’m your friend/family but not a therapist.” If an individual refuses professional help do not abandon them but do not engage in the fiction (i.e., “it’s just a phase, the season, pesticides, politics, etc.) Keep in mind that they are not entirely themselves and may not be the most reliable narrator. Bring them into the world (perhaps kicking and screaming.) Do not sit by their side and watch television. Go for a walk; remind them of the world they’re missing out on. Do not lose sight of the goal of professional help. Do not give up until you’ve exhausted every argument and yourself.

Someday we will treat mental health as we do dental or physical health. Blame and shame will dissipate and systemic effective care will be available to all. Family (in all its definitions) will always be at the front, but in time they will have proper support. There simply is no sane alternative.

 
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Posted by on January 7, 2013 in Cultural Critique, Well-Being

 

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The Stigma of Psychopathy

balcony

It’s fascinating to consider how our attitudes change over time. It is almost amusing to flip through a magazine from more than 40 years ago. Advertisements, editorial content and choices speak volumes about our priorities and concerns at the time of publication. Old movies also tell us much (often in the guise of propaganda or by virtue of what’s left out of a story.) While it’s doubtful that any newlywed couple ever slept in separate twin beds it is for certain that Hollywood wanted us thinking so. A study of older cinema is illuminating in what it tells us about what people held dear and what they scorned. Some of these values are practically foreign to many of us. You might need a crib sheet to understand the subtlety of a woman scorned for working outside the home, or the degenerating effects of a broken home. You may very well need to hit the pause button to consider what exactly ‘ruined’ a woman or what a ‘deserter’ was and what it supposedly said about a person.

How intriguing that we once felt so strongly about issues that have lost their power to shock or hurt. It must be a sign of some sort of progress? Our attitudes about marriage, relationships, parenthood, working, religion, and the public versus the private world have changed drastically since married people were shown sleeping in twin beds. If they choose to be relevant, media (in all forms) must somewhat reflect the realities of the time. Slowly but surely families are depicted as the freeform drawing they often are, rather than the coloring within the lines they might have once been. The melding of the public and private means most of us now know far more than we care to about strangers. Diseases and ‘conditions’ that were once private, feared, or barely noted, are discussed in loud outdoor advertising voices. There really are no private parts anymore. Except one: the mind.

Mental illness, despite all of our progress is still quite demonized and stigmatized in our media. Certainly we can all comfortably bandy about pop-psycholoigy terms. We could probably rattle off the names of a handful of medications for depression or anxiety. Thanks to reality television we think we know what obsessive compulsive disorder is. What we know and what we’re comfortable discussing is cocktail party chatter. Any mental illness serious or complex enough to not warrant a television commercial, magazine advert, awareness campaign or walkathon is a no-go zone. Shrouding mental illness in shame in secrecy only fuels our misunderstanding yet we hold onto this attitude.

When the newsreader intones (in sotto voce) “The suspect sought counseling” we get the message: ‘Oh, he/she is crazy.’ (For the record you know what’s actually crazy? Thinking you’re not crazy.) The toxicity of this message; 1) seeking help for mental health is suspect 2) mental illness is synonymous with criminality is the very definition of stigmatization. The only thing all criminals have in common is that they committed a crime. Mental illness takes many forms and very few of them involve any violent behaviors. People with illnesses are much more likely to hurt themselves (passively or actively.)

It’s the ambiguity of mental illness that is at the core of these attitudes. The mind is confusing. It is difficult to talk about personality disorders in 60 seconds. Many mental illness can be quite complicated and often incurable. A true understanding of the subtleties and complexities is probably best left to the professionals. But we don’t need to understand something to accept it. What we need to do is rebrand mental illness. Newsreaders think nothing of loudly broadcasting starlet rehabilitation for drug addiction or eating disorders (psst: nice lady reading the teleprompter – addiction and eating disorders are mental illnesses.) We speak publicly and loudly about post-traumatic stress disorder and post-partum depression (mental illness, mental illness.) If all mental illnesses were called by their proper name(s) perhaps we could shed the shame. Words are powerful (just think of all the ones you no longer feel comfortable using.) Once mental illness is seen as diverse expansive and existing any and everywhere, we can celebrate and support treatment in a meaningful way.

 
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Posted by on December 10, 2012 in Media/Marketing, Well-Being

 

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