Mental Health, Stigmas, and Forced Care

I had every intention of working on a different blog post today (Ron, I’ve not forgotten the one I talked with you about at GRL in… god I think it was Denver… so overdue)

But then, driving home from dropping off the offspring at work, I heard an NPR spot.  (Which I’m not presently able to find to link you all to… which is frustrating me. Tags for myself and for you if you want to look for it:  WSKG, PA, Bipolar, Kim, Involuntary)

“Praying for Involuntary Commitment”

https://wskg.org/news/praying-for-involuntary-commitment-family-struggles-to-help-bipolar-relative/

 

Precis of the story:

Kim is 27, lives in PA and has bipolar. She took herself off her meds when she turned 18 and lives in a shed behind the apartment her parents bought her so she wouldn’t be homeless, scavenges from dumpsters and feels that she is discriminated against because people tell her that her brain and thoughts are bad. Her parents want her involuntarily committed but the PA laws are very strict on what allows that. (post-script to story is that Kim showed up at her parents’ place after the story was recorded and was violent, and is on a 72hour hold, her parents hope she’s committed after that to ‘get the help she needs’)

 

This story hit me hard on a number of levels, because hey… guess who has a child with bipolar who takes meds? Guess who could, possibly, be facing a similar situation in the future?

But, here’s some things I took away from the story.

  1. Kim is a victim of the stigma we have put on mental illness.
    She has been infected with the idea that she is ‘bad’ or less than, or something by (probably) her parents and community as a young adult. I’m betting there were some comparisons with her siblings and “don’t you want to be like Timmy?” going on. WITH THE BEST INTENT, but still… it’s left Kim feeling like who she IS lacks value, and is ‘wrong’ … instead of just her experiencing symptoms of a disease.If we don’t teach people with mental health issues that they STILL HAVE VALUE, by treating them like… oh… like they still have value? They will be unable to distinguish symptom from situation. The treatment of symptoms becomes a dismissal of their entire state of being.Kim is struggling to find a sense of agency, of value, of having control over who she is. She is hampered in this by a mental illness that robs her of a constant SENSE of who she is, so she’s constantly re-meeting herself and trying to build a sense of self from the ground up. NOBODY seems to have stood next to her and said “OK dude, who do you want to be?” and helped hold the bricks while she built a foundation of her sense of self.
  2. Kim’s family needs to suffer with the reality of letting go.
    This is fucking hard and I’m not about to pretend that I’m all sorted with that. When my kid turns 18, in UNDER THREE YEARS ….Uhhh … pardon me, I need to go find a paper bag to breathe in…… OK, better…

    ANYWAY. When they turn 18, they can make all the incredibly brilliant, bad, creative, fucked-up, rash, passionate, impulsive, willy-nilly decisions that we all make, and have to live with the consequences and rewards of those. They may be great! (I met the partner with whom I sired said child at 19… and we’re still together) Theyyy may be bad.

    But Kim’s family is a classic example of trying to control other people. They bought her an apartment. Great, so she lives in the shed. Why? Because she wants AGENCY. OK, yes, she is also clearly at the mercy of some really serious symptoms right now, but I came away with the clear sense that Kim has never felt like she had control over her own care. She’s been “treated” not given tools and a partnership.

    … and I really hope I don’t eat these words as a terrible humble pie in 10 years, but seriously. Lemme tell you, the last couple of years has been my crash course in powerlessness.  It’s been good for me.

    It SUCKS, but it’s been good for me.

  3. We, as society, live a hard balance of giving people autonomy, and keeping them safe.
    When do we step in?
    Seriously, when do we step in and ‘save people from themselves?’I’m gonna go back to my bipolar/diabetes analogy here: Do we say that it’s right to forcibly hospitalize people with diabetes who are living/eating/etc in a manner that is not medically optimal? Because it’s for their own good?Do we immediately hospitalize anyone who is not showing what we think of as ‘neurotypical’ processing behavior?

    I’m not gonna pretend I have the perfect answers here, I’m not going to say that I’ve got the flowchart of decisions for “yes, you’re going to the medical lockup” versus “nope, you’re cool.”

    First thing we have to do, I think, is get a lot more real about the fact that we all die. ALL of us. You, me, the dog, the sun (given a long enough timescale) … we all die. We are still HELLA stuck on {quantity > quality} … and that’s kinda fucked up, you know? Maybe if we’re not so much focused on “we don’t want you to die” and get on “we want you to LIVE” … we’ll have better results? By ‘live’ there, I mean “have agency, have experiences, make choices, explore and experience” not “continue to be biologically present in the ecosystem as a consumer.”

    I have this suspicion that if we actually treat death as an option, a lot of people might feel less like it’s their only option. One door of many looks a lot different than the end of an alley. Creating choices for people ALWAYS gives them more agency and a better chance of choosing an optimal outcome.

    Yes, I’ve avoided answering my own question here… because – I DON’T HAVE ONE.  But I think we need to ponder it.

  4. Don’t pretend that there’s no such thing as mental illness.
    Ok, I get that we want to be accepting of a wide range of thought process, just like we want to accept that there is a wide range of physical reality. We are getting a LOT better at (for example) accepting that simply because someone isn’t skinny, they’re not necessarily ill. That numbers on a scale aren’t the be-all of life.But there is still an objective level of (for example) weight that isn’t healthy, that’s interfering with your health. NO, it’s not defined by freaking BMI (honestly, do you know that was created for insurance companies to rank people for premiums and coverage?) HOWEVER, there is a point where your ability to live and function IS impaired. Spectrum still have extremes.The same holds true for mental function. OK? It just does. Yes, everyone’s brain works differently, and that’s fine. And there is ZERO reason for everyone to be forced into the same mold. There is no reason your brain, and my brain and Sally’s brain should all work the same way.

    HOWEVER… there is a point where the brain function that someone experiences as a daily thing IMPEDES THEIR ABILITY TO LIVE AND FUNCTION. If you are constantly fighting voices you can hear that come from nowhere, cycles of emotion so extreme that you can’t function within the daily requirements, or an inability to distinguish reality from a fantasy that you have created and which nobody else agrees with… you are reduced to occupying the very definition of the demimonde, or the US Presidency.

    Frankly, I wouldn’t wish either of those on any of you.

    We do nobody any favors by telling them that it’s ‘just the way their brain works, and to embrace it’ any more than we do by saying that ‘measles just wants to live with you, embrace it.’  … what we DO is say “it sounds like your body isn’t regulating all of it’s brain chemicals super well, we have some medication that may help that. Would you like to give them a try?”

    GIVE. PEOPLE. OPTIONS. 
    EMPOWER THEM.

 

In summary: This story hit me hard. It scared me, because yeah… I could end up where Kim’s family is. That would break my heart, but for the fuckin love… THE ONLY solution I see is giving my child the maximum tools and information and sense of agency NOW, when they are FIFTEEN to empower them to go “man I hate when my chemicals are all out of whack, I should find a doctor I trust to work with for the rest of my life so that I don’t live at the mercy of those.”

I want them to always, ALWAYS feel that they? Have choices.

 

OK, that’s it. Love and health to you all. Keep reading, keep writing, keep listening.

Keep sharing your stories.

 

Cheers.

-G

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