Dec 20, 2012
The Kind of Help they Need
Parents can no longer leave their mentally-ill children to fend for themselves while they devote all their time pursuing a job or a career. They need better guidance on how to help their child find something positive to get engaged in. And they need a support system that helps the parents to cope better with this overwhelming situation.
A distinction should be made between the temporary, but still real, emotional difficulties that we all find ourselves in, which can be cured by someone like Dr. Albert Ellis with his Rational Emotive Therapy, and the more permanent illnesses of the brain: schizophrenia, manic-depression, and clinical depression. Many people who are not aware of this distinction think the latter illnesses are not real; they lump them in with the emotional disturbances that can be helped with talk therapy. In reality the brain, as an organ of the body, is subject to illness just as much as a heart or a lung. Anyone who doubts this should go to Amazon.com and look for books under "neuroscience schizophrenia". There is 50 years of hard evidence appearing in peer-reviewed journals, and that has been confirmed and cumulatively built upon using the scientific method, finding the physical basis of these illnesses in the brain.
Sometimes the hardest thing to do when dealing with the sufferers of these illnesses is to treat them nicely even when they are lashing out—knowing that their acting out is caused by the mental illness. Often if you assure them that you are there for them, their episode won't last long. You have to keep reminding yourself not to blame the victim of the disease. It's harder to remember in the heat of the moment, especially since the illness causing the behavior is invisible from the outside, and our instinct is to react as if a healthy person was acting out.
Added upon the death of Robin Williams, August 2014
In a person with mental illness, depression is not always triggered by external (environmental) factors. Depression comes from internal chemical fluctuations which often occur independently of what the person is experiencing externally. The best we spouses and friends can do to be truly supportive is to tell the ill person we are there for them. And then be there for them. Spend time, share their ups and downs, reassure and love them.
I have no idea whether Robin Williams got this from his wife. I have a strong feeling Kurt Cobain did not get this from Courtney Love. But it's not easy for the spouse to have the wisdom and maturity required in these cases.
Outpatient programs for the mentally-ill
Abraham Maslow spoke of a hierarchy of needs. First we have to meet our basic needs of food, clothing shelter, and safety. Then we can address our social needs, our needs for love. And finally at the top of the ladder stands the need for self-actualization: doing something challenging, something that engages and expands the greatest part of our abilities. Self-actualization can bring us satisfaction. A program for the mentally ill should try to help them get to that end of the ladder. Many sufferers from manic-depressive illness have a creative bent—Hemingway, Van Gogh, Vivien Leigh, and Jimi Hendrix all had the illness. We should help participants in a program choose and follow a creative pursuit: writing, playing an instrument, art, interior design, etc. Give them training, followed by a means to pursue these crafts. Some of the less artistic people can learn cooking, making furniture, designing and making clothes—something to give them a long-term occupation.
The majority, once trained, should be provided work environments and managers that understand their needs and allow them leeway to take a day off when their illness is giving them an especially bad day. The employers would have to be compensated by the program. Otherwise, most employers would not agree to this arrangement.
I have known two psychiatric nurses, and they are fine decent people. But I am afraid the field as a whole has gone astray.
We can no longer accept a mental health profession saying "Alright, we've established control over this individual. Now our job is done." We are human beings—and so is the person suffering from the illness. Feeling content to see them watch TV all their lives, and feeding them the occasional buzz bar (Haldol) if they act up and annoy the nurses, does not measure up.
We should be giving the patients a chance to get involved in challenging work and activities according to their abilities. Let them do some or most of the cooking. Cleaning and steaming vegetables takes time. The patients have lots of time, more than the staff. And how often are they given a chance to exercise, and what quality of exercise?
Interview with Louise Fletcher on Studio 360. The evil of Nurse Ratched, the villainy of that character, is that she is sure that she knows what's best for the patients, and is convinced that she is doing good.
My added take-away from this movie is this — part of Nurse Ratched's villainy, along with the authoritarian aspect, is the refusal to provide enriching elements to the patients' lives. To afford them opportunities to engage in activities. Activities like building ships, writing, making music, or making crafts like pottery or any kind of art. And of course, activities like that boat excursion in the harbor which made a bright scene in the movie One Flew over the Cuckoo's Nest.
The severity of these illnesses varies from acute to mild. Some people suffer from a combination of two of them. The psychiatrist must find the drug and the dose for each patient that maximizes the patient's ability to function. Too high a dose and the patient will end up 'comfortably numb', with little opportunity to do anything rewarding. Here the interests of big pharma conflict with those of the general public. Big pharma will encourage the doctor to prescribe more and more.
I invite you to make comments and suggestions in this area. I can say that the present system of shelters and group home facilities leads many to prefer homelessness.
“Probably one of those places with a high wire fence and yowling inmates”
Afford the patient dignity, and combat the stigma that persists even to this day surrounding mental illness—a stigma that does not attach to, say, cancer. The typical attitude, and a great answer to it, are laid out in the opening scene of Now, Voyager:
Mrs. Vale to Charlotte, who has just entered the room: Dr. Jaquith has a sanitarium—in Vermont, I believe. Probably one of those places with a high wire fence and yowling inmates.
Dr. Jaquith: Well now, I wouldn't want anyone to have that mistaken notion. Cascade is just a place in the country. People come to it when they're tired. You go to the seashore. They come there.
Mrs. Vale: The very word psychiatry, Dr. Jaquith (she looks away from him, toward Charlotte). Doesn't it fill you with shame? My daughter. A member of our family!
Dr. Jaquith, allowing a little pique to show in his voice: There's nothing shameful about my work, or frightening, or anything else. It's very simple, really, what I try to do. People walk along the road. They come to a fork in the road. They're confused. They don't know which way to turn. I just put up a sign-post. Not that way. This way.
This article grew out of a recent addition to one of the ValeTales articles.