AMBER LOVE 01-MAR-2014 A hot button mental health debate: I’m far from being the first person to talk about this one element to the many mental health controversies — Treatment. I was reading a post by Rep. Ron Barber (D, Arizona) on The Hill which is specifically about $15 million in the US budget allotted for first aid training in cases of mental illness. I’m not here to weigh in on whether that will prevent panicked law enforcement officers from shooting people when they don’t know the person’s diagnosis. However, the article did bring back a grain of a memory that was stored in my mind and get the hamster in my head spinning her wheel.
Preface: This stance is based on a key assumption that someone would have the mental capacity to make their own decisions.
I remember a bit of a conversation. I have no idea if it was a real conversation between people or if it was something I read of if it was on an episode of HOUSE. Somewhere someone compared mental illness to other diseases like diabetes or cancer. I heard that same comparison again when I went to visit a friend in a hospital after he overdosed on his antidepressants, you know those marvels of modern science that are supposed to “cure” you from wanting to kill yourself. People are blamed for their cancer if they’re smokers; people are blamed for their diabetes if they’re fat. Surprisingly, there is an awful lot of blame surrounding how someone chooses to face their battle with mental illness. I wrote this a week before I found myself having repetitive thoughts of how I really cannot bear one more day. Now before you get nervous and think this is “THAT letter,” it’s not. I unloaded 99% of what’s bothering me to my mother, found a couple things that made me laugh, left my comfort zone for an hour to have a drink with people I really didn’t want to see socially, and giggled with a girlfriend on Skype. But two days ago, I didn’t care if those moments were coming. That’s quite different than not believing moments of laughter would never come; I knew they would but I did not care.
Something that you as the observer should work hard to remember is that you don’t know what that person is going through nor what they have gone through in the past. When I post about my state of being, I am inevitably asked the same exact questions:
“Are you in therapy?”
“Are you medicated?”
“How’s your diet?”
“Do you workout?”
“Have you called the suicide hotline or your employer’s EAP?”
Besides the fact that someone journaling, blogging, or podcasting about their illness is a sign of how far they want to open up, those are extremely personal questions. Unless you are a mental health professional, you have no business asking someone those questions; yet questions are part of any conversation. When it comes to medical information there is a dubious line which one should not cross. If you are rationally and genuinely concerned for a person and not simply unaware that what you are is morbidly curious about someone’s disease, then take those questions out of public view. Let the person be the one to decide whether any of those topics are okay to discuss publicly. When a friend emails me privately, I appreciate that opportunity to make that decision. I can then go back to the comments thread and add more. For example, I could write something like, “A friend just asked if I’ve called the suicide hotline. I never have but I know some people feel it’s helpful. Believe me or not but the number is programmed into my phone and at my worst moments I still cannot press to dial it.” That’s giving me, the person suffering and the original person who created the status update/blog/video/etc. the opportunity to elaborate or not.
A better question to ask, if you are sincere, is, “How can I help?” or “Is there anything I can do for you right now?”
Treatment for mental illness – as with cancer – is unlikely to be a one pill or one step solution. All of those people might have valid reasons for wondering whether a person has tried the latest and greatest kale and lemon juice shake that will definitely cure their condition because they heard it worked for someone else.
I reiterate the distinction: Are you concerned or are you curious?
One of my friends brought up another point about treatment. It was after one of our many US mass shootings. I was publicly philosophizing that police have no idea if someone is mentally ill; they are responding in crisis mode and their directive is to protect other people and then consider protecting the villain with the gun. This discussion lead to talking about treatment. Tweets abound and morning show television hosts ask, “Why didn’t that person have treatment?” All that does is take people down the rabbit hole of our medical and political industries which is not the same as talking about a person’s treatment. My friend reminded me that the reason a diagnosis matters is to determine if a person is a danger to themselves or to others. That is the key thing that has gnawed at me for a year and didn’t reveal itself. I had this nagging annoyance and couldn’t identify it. Other people believe a person that is a danger to themselves or to others requires treatment.
Here’s where the debate gets stuck in my craw. I can easily see that you’d want to prevent someone from harming others – evil people like molesters, gunmen, bombers, or random act of putting razors in butter. Why does anyone else get to decide if someone can or cannot harm themselves? First of all, you have no idea if “treatment” will help the situation. Second of all, it’s presumptuous that anyone would think a person with mental illness who rejects one protocol would reject all treatment. Third, perhaps pharmaceutical therapies are not worth the impact on the person’s life in other regards. Finally, how do you define treatment?
It’s possible the available “treatments” on the market are being rejected such as pharmaceuticals or exercise. When you can sit back and look at that big picture you’ll see it’s not the same thing as someone ignoring their disease because you believe they have a desire to hoist their non-conforming behaviors onto you; it is not about you or your idea of what’s best. Medications do not produce the same results predictably on everyone; neither does exercise (sorry to burst your bubble but doing what some celeb does won’t turn your into them). At some point, a patient could be fatigued by the years of being a lab rab going from prescription to prescription, dose to dose and never knowing what version of themselves they’ll wake up to seeing in the mirror. Expecting their house filled with loved ones to tolerate is also, in my opinion, cruel. For me, that very situation made me feel worse than no medications at all; your mileage may vary. Yet, during the years when I could say I was being “treated” there was far more compassion than after I decided I’d have my body adjust and live the best way it can without intervention.
A perfect example of someone not being treated the way mainstream America would like them to be is in the case of Borderline Personality Disorder. According the NIMH website (12-Feb-2014):
“No medications have been approved by the U.S. Food and Drug Administration to treat BPD. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with BPD are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.”
If someone chooses to not treat their cancer or their diabetes or their cholesterol (and they are not a danger to others), their course of treatment even no treatment at all, is their call.
LINKS of interest:
NAMI – National Alliance on Mental Illness http://nami.org
NIMH – National Institue of Mental Health http://www.nimh.nih.gov
Mental Illness Happy Hour Podcast – http://mentalpod.com
TED Talk by Andrew Solomon – http://new.ted.com/talks/andrew_solomon_depression_the_secret_we_share
“The opposite of depression is not happiness; it’s vitality.” ~Andrew Solomon