Archive for April, 2012

Last weekend, someone I loved decided to commit himself to a psychiatric ward in the Valley. It doesn’t matter who this person is, or even what brought him to make the decision he did. What matters is that he is improving and coming to an understanding of what led him to the hospital.

I was in a very strange position last week. I taught at an old mental institution, and then I headed over to visit my friend at a ‘new’ mental care facility. I was surrounded at all times with either the shadow of mental illness or the live version. There were many emotions coursing through me; my confusion and pain kicked off my own nemesis, anxiety and panic. This experience was part of a life lesson for me, a way to humanize and personalize mental illness so that I would no longer fear it, or find it morbidly fascinating.

It is extraordinarily difficult to define “illness”; if you try to kill yourself or you’re hearing voices, we can all ‘reasonably’ assume that you need to be hospitalized. That means that your freedom is abolished, since your freedom was too much to handle and allowed you to spiral into negative behaviors or facilitate a chemical glitch. There are no phones, no pens, no computers, no television, no contact with the outside world with the exception of visiting hours, and nothing is allowed that you could possibly injure yourself with, including—believe it or not—stuffed animals. No balloons, because you might strangle yourself with the strings; no notebooks, because you could turn the metal spiral into a weapon.

I watched everyone in there very carefully. I was allowed to participate in group therapy. I pushed aside my own pain, so that I could understand how we define mental illness and what it means to the person who is suffering. No matter what I thought I knew about the issue, it turns out I knew not nearly enough. First of all, people who hear voices, those diagnosed ‘bipolar,’ and those who experience paranoia or hallucinations are not all that different from the rest of us, no matter how much I always wanted to distance myself from the truly ‘crazy’. It was a shock to engage people in conversation that had a scary diagnosis (from my point of view) such as schizophrenia (and here I am only assuming that one would receive that diagnosis if one heard voices; I’m actually not sure how many other ‘mental disorders’ feature this as a symptom). They were, for the most part, entirely rational and able to discuss their disease. Suddenly, I got it: there is ‘you’, and there is this ‘disease’, and they are not the same. The illness afflicts you, but is NOT you. Once I understood that, mental illness became akin to any other chronic problem that you have to manage with medication and therapy. I wasn’t afraid of the people in that unit who had the ‘scariest’ diagnoses. They were, simply, people trying to recover.

Then there were people who received diagnoses that might or might not be clearly related to an illness requiring a variety of medications. In the case of my friend, I highly doubted the diagnosis he received. It seemed to misrepresent what was happening; it was a diagnosis of a psychiatrist who didn’t really know this person the way I did. I can only explain this by example: I have battled anxiety disorders my entire life. Sometimes I have to contend with debilitating panic attacks, but that’s only when I’m at my worst. If the anxiety goes on too long, I will become depressed. Do I consider myself ill? Do I need to be medicated? This is where the question becomes extraordinarily complex. I honestly don’t know the answer. At my worst, I tried medications that my therapists would push on me relentlessly, because it was always easier to push pills rather than disentangle a complicated and confusing pattern of thinking that led to painful physical and emotional symptoms.

Did the medication solve the problem? In my case, it never did. Although there was some relief from the worst of the physical symptoms, I never felt that the real issues that triggered my anxiety were ever sufficiently addressed. Disordered thinking creates illness, and until you learn how to guide your thoughts in a rational direction, you will not recover. Some people argue that you can’t guide your thoughts or control your moods until your brain chemistry is under control, and I have no argument there. The truth is, NO ONE KNOWS how much of mental illness is biological and how much is cognitive. I almost walked out in frustration from a group session where we could “ask a psychiatrist” any question we wanted. He couldn’t answer our most important questions. He simply didn’t know. Where does that leave concerned friends and family? If the ‘experts’ are at a loss, how are we supposed to keep our loved ones safe and healthy?

On this site, I have attempted to address questions that are very difficult to answer. In this case, I know that cutting-edge science is studying how changes in our thinking and perception actually alter brain chemistry and even structures. Good therapy can evince physical changes in the brain, as does exercise, certain supplements and maintaining healthy relationships. There is such an intimate relationship between our behavior and our brain chemistry that it might simply be impossible to decide what’s ‘chemical’ and what’s ‘cognitive’ when looking for causes of mental illness. There is a spectrum, though; schizophrenia is closer to a medical condition than a mood disorder, and requires the right drugs. Anxiety and panic do not always require medication.

Anxiety and panic disorder (and Generalized Anxiety Disorder, and phobias, etc.) are clinical diagnoses. Do I like the fact that I was diagnosed with a ‘disorder’? Absolutely not.  I understand my ‘disorder’ as being human, female and living in Los Angeles in 2012. My life, my circumstances and my history have all contributed to the fact that my friend’s hospitalization has kicked off panic attacks in restaurants and at 5:00 AM, when I so desperately need to sleep. Will I recover my equilibrium? I absolutely will, because I know what I need to do; I know what this “illness” requires of me, and I have a plan ready. That is exactly what they taught my friend to do during his stay in the hospital.

Those who were locked up for months and years at Camarillo State Hospital weren’t all that different from me. I am more saddened and distressed than I ever used to be at the thought that the patients were often treated with drugs only designed to keep them from expressing their pain or creating more work for the staff. In different circumstances, my friend would have found himself committed there and drugged into a stupor. My anxiety disorder might have landed me there, too, and I would have been treated in a similar fashion: knocked out and kept quiet. Thank God that modern psychiatry has evolved to the point that it has. A stay at the hospital for mental/emotional disorders now is nothing like it was then. The issue now is the exact opposite of what it was back in the Camarillo years: so that insurance companies can save money, you might find yourself back out in the world far more quickly than you should be. There is no time to completely recover.

One thing, however, is exactly the same. No one likes to discuss mental illness in the open. There is still a terrible stigma attached to it. We can talk endlessly about our diabetes, our high blood pressure, even our cancers. Why can’t we discuss what happens to our brains? Managing a mood disorder is no different from managing any other medical issue; we are afraid because it hits too close to home. We all have, to varying degrees, emotional and cognitive imbalances. Some of us get sick, others don’t; but we all have the potential to lose control of our fears or find ourselves unable to express our pain. To be human is to be, to some degree, mentally ill. It’s only the severity of the illness that determines how much intervention we require.

I will never view Camarillo in the same light. It used to be, “oh, those poor patients.” They were “other”, “not me”; now, after sharing my friend’s pain and holding him as he cried, after watching myself dissolve into fear, I realize that the patient in Camarillo was simply us, in more unfortunate circumstances.

Kirsten A. Thorne, Ph.D./PHW

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