More Redemption in the Mines of Madness

[usuakari]

Dear LJ, for my birthday I actually to got to break free from the psychiatric ward I've been spending time in for the past month. Freedom included discussing more mentally ill people living in the community in the morning, and then hooning around parts of the Derwent Valley in the afternoon pumping people full of antipsychotics. Sounds like fun,

Comments

[alecto23]

I've always thought the border between "sane, but with some problems" and "mentally ill" is far too grey and woolly for comfort. Even if you try to put other layers on it, such as "Is the person able to function in their day to day life or are their mental problems massively disrupting it?", it's still far from clear-cut. I think the things that bother me most are the impermeability of the border - as you say, once classified as schizophrenic (and presumably other things as well), it's hard to get rid of that - and also the stigma associated with mental illness. For all that some high profile people have come out of the depression closet, it's still not something I feel comfortable admitting to. And it has repercussions on my recovery as well - because I think I shouldn't be so depressed I'm trying really hard to deny/overcome it. Sometimes this is counter-productive - you can't bypass it, you have to just go through. Anyway, if we thought of mental illness really as an illness, something that needs treatment and care and you can get better, and sometimes a hospital may be the best place to provide that treatment and care whereas in other cases, outpatient treatment is fine, maybe it would be easier for people to get the help they need and not to get stuck in places where they might not need to be.

But community nursing sounds cool. I get that you can't necessarily spend heaps of time with people in emerg situations, but that more nuanced health care is something I wish was more prevalent.

And I'll be interested to hear your stories from the intensive care ward!

[usuakari]

I've always thought the border between "sane, but with some problems" and "mentally ill" is far too grey and woolly for comfort. Even if you try to put other layers on it, such as "Is the person able to function in their day to day life or are their mental problems massively disrupting it?", it's still far from clear-cut

IMHO, it's very, very thin. It's actually quite easy to see the porous border between what we'd classically regard as 'normal', 'neurotic', and 'psychotic' issues and how one can become the other, and vice versa. Especially if you look at the same thing on a different day, or use different tools to assess a given issue.

As a partial aside, the Global Assessment of Functioning (Axis 5 on the current DSM IV TR) is an interesting attempt to quantify the ability of someone to function in the real world. It can be mildly hilarious to see in use - almost as much fun as doing a Mini-Mental State Examination on someone with dementia, which often produces weird results. My favourite on the MMSE is the surprisingly large array of people who cram the numbers 1-12 in the upper right quadrant of a blank circle when asked to write them in as if they were writing the hours on a clock face.

However, while the border may seem pretty visible and (sometimes) open to traffic in both directions in a clinical setting, getting rid of or changing a diagnosis definitely seesm to be a challenge in the outside world. I was pleasantly surprised to see a consultant psychiatrist reining in his registrar this morning. The patient we were talking to was describing some really excellent conspiracy theories (with very little in the way of coroborating evidence able to be uncovered), driving rapidly in the direction of delusions of reference and was generally pretty weird. However the consultant suggested that the patient was only a smidge over 18, and had admitted to using rather a lot of marijuana recently. Their mind and diagnosis were still in doubt as a result of both, and he wasn't in any great rush to saddle them with a specific diagnosis because of this. One expert who's well aware of the issues surrounding attaching a particular word and possible trajectory to a person.

[usuakari]

For all that some high profile people have come out of the depression closet, it's still not something I feel comfortable admitting to.

Anyway, if we thought of mental illness really as an illness, something that needs treatment and care and you can get better, and sometimes a hospital may be the best place to provide that treatment and care whereas in other cases, outpatient treatment is fine, maybe it would be easier for people to get the help they need and not to get stuck in places where they might not need to be.

Ah, such an interesting conundrum. If we make it an illness and medicalise it, do we restrict some avenues of dealing with it? Are spiritual practices a help, or a hinderance, in dealing with psychosis, for example? Do we also keep slicing and dicing with terms and definitions, deciding that X is pathological and requiring treatment (even if we don't fully understand the cause or the proposed treatment) and Y is just an ordinary experience or feeling? What about next year when we discover a positive correlation between seretonin or GABA and Y? And what does that do to peoples' senses of control of their own lives? Are they a 'better' or 'safer' type of person now?

OTOH, if the idea that bright yellow elephants are hiding in the ceiling and whispering to you through the chip in your teeth that the moon landings were faked by a combination of the Saucer People and the Coca-Cola Corporation is simply that some people are just fucking weird or possibly even bad, what does that mean? Should we tolerate that departure from consensus reality as an individual right or abberation? What level of control or responsibility should people have or bear in such a case?

It's about as much philosophical fun as the 'I choose to be queer' / 'I was born queer and can't help it' debate. There's significant pros and cons to each path.

What I would like to see is less fear surrounding the idea of mental illness, and more general knowledge about the idea that it can often be managed successfully, sometimes just endured or got through, and sometimes even resolves completely. Making a mental illness analogous with another, better understood, chronic condition like asthma or diabetes has some real use there. The hitch is that many sufferers and wider society then tend to automatically head down the medicalisation path in terms of understanding and best (or only) management.