Mental Health

Like a lot of people here in the U.S. and around the world, I have been reading about what happened in Newtown last week. I’ve read a few of the comments that accompany various articles, too, and it seems there’s a great deal of anger directed toward Adam Lanza’s mother. Like many, I wonder why she kept such deadly weapons in her house. But aside from the gun control issue, it seems some are under the impression that Nancy Lanza could have done more to help her son with whatever difficulties he was having. Since very little is known about what went on with the Lanza family in the last few weeks, it’s hard to say what more Mrs. Lanza could have done--aside from not keeping all those deadly weapons around.

I’ve had mental health issues most of my life, and my mother suffered from paranoid schizophrenia. So, for what it’s worth, I wanted to share a few thoughts about mental health and the mental health care system.

If you have a mildly autistic son who has serious trouble making friends and relating to others, it’s not like you can simply call up the Son Fixit Team on the phone, explain your problem and they’ll send a crew over to straighten things out.

You might hear a lot of propaganda about how mental illness is very treatable, and in many instances it is treatable. But most of the mental health care system is geared toward helping highly functional people deal with the vagaries of everyday life. Those people usually do get better. Many of them may even get better without treatment. But then there are others…

Back in my twenties, I was in the hospital for suicidal depression a few times, and I was in a number of group therapy sessions. I can remember one session in particular that will help illustrate my point. We were all gathered together in the ward’s day room. There was about twenty of us, aside from the therapist and a nurse. The therapist asked us all in turn to give a brief statement concerning who we were and why we were in the hospital. There were a few mothers there who were experiencing depression. A couple of them were survivors of childhood abuse. A middle aged man spoke of having anger issues. He recently divorced, and he revealed his father used to beat him. There was a teenage boy just out of high school who wasn’t sure what he wanted to do with his life. His parents were pressuring him because he seemed directionless. There was a young woman who was being abused by her boyfriend. And then there was a man of about sixty who turned in his chair, got up on his knees, rocked back and forth, and stared at the wall while the rest of us shared our stories. When the therapist asked him why he was in the hospital, he simply said, “I don’t know.” There is no magic pill for people like this, no magic treatment or process.

There was a time when acutely ill people were often institutionalized for years at a time, but most long-term treatment facilities are closed. They started shutting down places like that over fifty years ago. They were scary places where patients were often abused, and when antipsychotic medications were available, most of the patients were sent home. The plan was to built community daycare centers for the seriously ill. But those centers never materialized. It’s now primarily up to loved ones to look after people with serious mental health issues. And the pills…they’re not a cure, they don’t alleviate all symptoms, and the side effects can be extremely harsh.

It should also be noted that you can’t force treatment on an adult in this country unless they have been committed. Even if the person who needs treatment is your son living in your house. If he’s over the age of 18, then he has the legal right to refuse treatment. And it is very difficult to get someone committed. Even if a patient has a long history of mental health issues, even if they’ve been diagnosed with an incurable psychiatric disorder, it’s still difficult. A judge has to declare that a person is a danger to him/herself or others before the judge will commit. The judge sees the patient for no more than a few minutes, and most can hold it together for at least that long. When a patient can’t remain calm and coherent while speaking to a judge, the patient is pretty far gone. So families with a seriously ill loved one often have to deal with the situation on their own.

Another important thing to remember is that most mentally ill people are not violent. Some have a history of violence, and when the thought process is impaired, there is always the potential of violence, but most have never been violence and never will be violent. That man in the hospital with me, the one who preferred to stare at the wall than look at us during our group therapy session, he was a very lovable man. He was crazy as hell, but lovable. My mother was committed a number of times while she was alive, and when she was in the hospital, she was placed in the locked ward for acutely ill patients. I would visit her while she was in the hospital, of course, and I was never hugged and kissed more than when I was among all those seriously ill mental patients.

So what should we do? This is a very complicated issue, and I don’t have all the answers, but for one thing, I think it should be easier for family members to put a loved one in the hospital if they need to be in the hospital, even if the loved one doesn’t want to go. Of course we need to be aware that sometimes family members can try to commit a loved one for questionable reasons. In the past when it was easier to commit someone it happened all the time. Governments have been known to abuse the commitment process to get rid of dissidents. We need to protect civil liberties. But we also have to accept the fact that some of our citizens are not capable of deciding for themselves if they need treatment, and we shouldn’t make them wait until they’re running down the street naked throwing rocks through neighbors’ windows before we decide it’s time to overrule their objection to treatment. We need better treatments. We need more research. We need community support. Maybe assisted living facilities specifically for people with mental illness. And we need greater awareness of mental illness so that there’s less stigma.