Mental Illness - Up Close and Personal

Mental Illness – Up Close and Personal

One of the blogs I follow faithfully is I'm So Vintage. On reading Laura’s post-Sandy Hook blog post entitled Breaking Free of Fear, these words spoke directly to me and touched a wounded place in my heart:

We can decide to pull away from the fear and anger and not become part of it. We can walk away from it.

No, that does not mean we are being disrespectful of the events that happened [at Sandy Hook]. It means that we choose to rejoice in our lives and work to change things so that events like the one at Sandy Hook last week don't happen again.

The things we do can be big or small. They can be as simple as sharing a smile with a stranger or kissing a loved one. Or they can be larger like writing about gun control and mental health access on your blog or contacting your representatives in Washington.

So, inspired by Laura’s words, I feel called to write about mental health access – a topic that strikes painfully close to home.  You see, my mother was schizophrenic.  Yes, certifiably mentally ill.  Crazy.

My pretty mom with wavy brown hair and red lipstick, who wore pedal pushers and blue jeans when most farm wives  in the 50s and 60s were wearing frumpy housedresses and full aprons, who danced and smooched with my dad in the kitchen when “their song” played on the radio, began to change. It was sad to watch.   My mom, the high school valedictorian, who could type 110 words per minute on a manual typewriter, who had been a second grade teacher until she married my dad, who home-schooled my brother and me through kindergarten because country schools did not have kindergarten classes, started hearing voices when I was 8 or 9 years old.

If you’ve seen the movie, A Beautiful Mind (2001), you have seen a realistic portrayal of schizophrenia.  If you have not seen it, I’d highly recommend it.  The film is a biographical drama based on the life of John Nash, a Nobel Laureate in Economics.  It was inspired by a book written by Sylvia Nasar. The film won an Oscar for Best Picture, and Ron Howard, who directed the film, also won an Oscar for Best Director.  Russell Crowe played John Nash.

Thankfully, my mother was hospitalized at a time when the law was evolving to recognize a "constitutional right to receive such individual treatment as will give each [mentally ill person] a realistic opportunity to be cured or to improve his or her mental condition." [i]  When she was on her medication, my mother was more like Mom – the person I knew and loved as a young child.  When she was off her medication, the voices tormented her, or she would stare into space (catatonic).  At one point, she burned her pillow because she thought there was a device inside that was recording her thoughts.  When she couldn’t silence the voices, she attempted suicide one Halloween.  I was in 8^th grade.  She was hospitalized from October 31 through May.  Nearly every weekend we drove 97 miles to visit her. 

Ten months after she returned home, my dad dropped dead of a heart attack.  I thought his heart was so broken, it burst.  But as an adult, I now realize the stress--- my mother’s illness, massive hospital bills, failed crops, single parenting, managing a farm, and dealing with a demanding widowed mother –undoubtedly aggravated a pre-existing heart defect.

 

After my dad’s death, we were essentially evicted from the farm which belonged to my grandmother, so we moved to a tiny apartment in town.  I assumed much of the responsibility for parenting my mom and my younger brother.  My mom was unable to hold a steady job, so we lived on Social Security Survivor Benefits.  One of the most beautifully-written accounts of what it is like to be a teenager caring for a mentally ill parent is in Gloria Steinem’s book, Outrageous Acts and Everyday Rebellions, originally published in 1983[ii].  The chapter entitled Ruth’s Song –Because She Couldn’t Sing it for Herself is a tribute to Steinem’s mother, who also suffered from mental illness.

Over the past 30 or 40 years, the formerly recognized “right to treatment” was replaced by a policy of “deinstitutionalization” of the mentally ill.[iii]   In theory, people like my mom would no longer be hospitalized in psychiatric wards of hospitals, or state mental hospitals.  Instead, they would be treated on an out-patient basis through community-based treatment programs. 

Sounds great in theory, right?  No more extended hospital stays.  The mentally ill would have the support of family while receiving treatment.  The problem was, those community-based treatment programs were never adequately staffed or funded.   Many, many mentally ill persons “fell through the cracks.”  And not all mentally ill persons have the support of friends or family members. 

According to the Mental Illness Policy Organization,” people with untreated psychiatric illnesses comprise one-third, or 250,000, of the estimated 744,000 homeless population in the United States.[iv]   And a very substantial number of mentally ill adults, an estimated 1.25 million, have been re-institutionalized in jails and prisons – which are funded, but often ill-equipped to deal with the mentally ill.[v]   The rate of mental illness in the prison population is five times greater than the rate of mental illness in the general population – and in women’s correctional facilities, the percentage of mentally ill inmates is even higher.  So much for offering treatment in the “least restrictive environment” as required under the Americans with Disabilities Act! 

My mother was spared these indignities, in part because she remained in the small town where she grew up after my brother and I grew up and moved away.  Most people in our little home town knew Mom was a little crazy, but loved her anyway.  So periodically, we’d get a call from her pastor, or her landlord, or her neighbor lady, letting us know that Mom appeared to be off her medication again.  Another godsend was that her doctor (a high school classmate of mine) also had a close family member who suffered from mental illness, so he was careful not to overmedicate, and he kept up with the medical literature, trying new medications with less devastating side effects.    The last 15 years of her life, my mom had monthly injections and led a fairly normal life until her death in 2005 at the age of 75.

So why have I written about my crazy mother?  Not as a personal catharsis.  It’s not something I talk about often.  But with all the focus on guns in the aftermath of Sandy Hook, I think it is important not to lose sight of the other major contributing factor in this tragedy – untreated or inadequately managed mental illness. 

The pendulum has swung so far away from the “right to treatment” that we now have a “right to refuse treatment.”[vi]  As if the lack of adequate community based resources weren’t enough of a barrier to access to treatment, now a delusional person can refuse treatment.   The right to refuse treatment, in my humble opinion, is based on a fallacy.  It presumes (falsely) that a delusional person is capable of making a rational choice regarding treatment.  In truth, the reason treatment is an issue is because the person is irrational! The end result:  It is extremely difficult for many mentally ill persons and their families to obtain access to treatment, and many judges are afraid to commit seriously mentally ill persons to in-patient treatment facilities, even for as long as 72 hours.  

We need a saner approach to mental illness.  Deinstitutionalization has failed miserably.  So has the “right to refuse treatment.”  Now, while the memory of Sandy Hook is still with us, let us begin to break the silence and begin to talk about these difficult issues.

And for God’s sake, and the sake of innocent victims, please do not let chronically mentally ill persons have access to assault weapons.

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[i] Wyatt v. Stickney, 325 F. Supp. 781(M.D. Ala.1971), 334 F. Supp. 1341 (M.D..Ala. 1971), 344 F. Supp. 373(M.D. Ala. 1972), sub nom Wyatt v. Aderholt, 503 F.2d 1305 (5th Cir. 1974).

[ii] Steinem, G., Outrageous Acts and Everyday Rebellions (2^nd ed.), Holt Paperbacks (1995). ISBN-10: 0805042024.

[iii] http://www.rooseveltcampusnetwork.org/blog/how-we-got-here-history-deinstitutionalization

[iv] http://mentalillnesspolicy.org/consequences/homeless-mentally-ill.html

[v] http://www.hrw.org/news/2006/09/05/us-number-mentally-ill-prisons-quadrupled

[vi] O'Connor v. Donaldson, 422 U.S. 563 (1975).