In a way this supports patients not taking responsibility for themselves. They continue to be self-indulgent and self-absorbed, unable to relate to the needs of others or to the way their emotions or behaviors are impacting others.
My sister likes to be medicated. All she can do then is sit with an open mouth, drooling. She doesn’t have to face the world. She doesn’t have to function.
In group therapy Sylvia doesn’t tell the truth. She is constantly manipulating the system, manipulating others to get what she wants. It’s all about her and she’s very smart at using her intelligence to get what she wants.
The only way to get her to do something is when she understands the consequences that her actions or non-actions will have and understands that people will not always bail her out. But, our system continues to give her what she says she wants: medication to help her escape and remain self-indulgent.
Sylvia doesn’t appear to want to take care of herself, or help herself. She seems to want to ruin her own life. She also seems to have a crisis whenever I am about to celebrate something big: a wedding, a grandchild being born, etc. If she lived with me and my family, our life would be in chaos. But, it’s really hard for me to institutionalize her in a state hospital. Our family is used to taking care of each other…but, I wonder always how I may be enabling her illness by making things easy for her.
I know if Sylvia was alone, our system would institutionalize her in a locked ward, or leave her on the streets with minimal care. As it is, her life will likely be cut short by a drug overdose and/or her unhealthy habits, like smoking, eating poorly, and never exercising. It’s just a horrible situation.
Ideally, she would be treated as an individual and would be encouraged to be responsible for her actions and their consequences. Instead she is treated as a passive victim, and she continues to not take responsibility for herself or her actions, and to be insensitive to others and their needs.
I’ve come to believe that the common denominator in the seriously mentally ill is that there is nothing else in their worlds but themselves. They need to be put in a situation they can manage where they are sometimes attending to others: dogs, kids, someone else. They need to perceive that there is something greater than themselves, including what we call God or Spirit. Indulging them by helping them escape the world into themselves, into being passive, is not helping them to heal and it creates more dependency on the governmental welfare system, too.
I feel sure there is a better way than this. We have to get to the roots of what caused the self-destructive behavior in the first place. This means really treating each person as an individual. Next, we have to encourage self-responsibility and actions to assist others.”
2. Creating a Better System: High Functioning
Sascha Altman DuBrul (his real name) wrote his personal story of “The Bipolar World,” published in the San Francisco Bay Guardian in September 2002. It was published again in 2004 in Navigating the Space Between Brilliance and Madness: A Reader and Roadmap of Bipolar Worlds, edited by The Icarus Project. I met Sascha in 2008 and was impressed by how articulate he was, as well as his willingness to take a position of leadership in creating supportive community for those diagnosed with mental illness.
Sascha’s family considered him a highly sensitive youngster, maybe even too sensitive for his own good. Like Sylvia, he was first diagnosed with mental illness at age 18. He had not slept for months and had delusions and hallucinations. The symptoms of this manic state were first caused by an allergic reaction to penicillin that was supposed to be relieved by another prescription for prednisone, a steroid that he dutifully took on the advice of his physician.
Watching his struggle with the mania, his mother took Sascha to a hospital where, after observation, the attending psychiatrist diagnosed him with bipolar disorder. He was given another drug, Depakote, to stabilize his moods, and they were told Sascha would be managing this mental illness for the rest of his life.
Six years later, in 1999, he ended up returning to the same program, being diagnosed with schizoaffective disorder. This time he was given an antidepressant called Celexa (citalopram) and an antipsychotic called Zyprexa (olanzapine). Within a few weeks he began working at an organic farm, and eventually moved there—sowing seeds and taking care of plants. The drugs worked and afforded him some stability, but he didn’t like being dependent on them for his sense of wellbeing. He moved again after a few months.
In 2001, he was again put in a psychiatric unit as a result of destructive behavior in the streets of Los Angeles. He said, “I was convinced that the world had ended, and I was the center of the universe before they picked me up…[After I was apprehended] I spent the next month locked up in the LA County Jail.” This time he was again diagnosed with “bipolar disorder” and given medication. After being released, he spent a couple of weeks in a Kaiser psychiatric ward, followed by four months in a halfway house. Eventually he returned to live with friends in a collective house in North Oakland, California. By that time he was on lithium for mood-stabilization and the antidepressant Wellbutrin (bupropion).
Stabilized with the help of medications, at age 27 he began to study books about his condition. He studied psychopharmacology to understand the chemistry of the illness. He wrote, “I started coming to terms with the paradox that, however much contempt I feel toward the pharmaceutical industry for making a profit from manic-depressive people’s misery and however much I aspire to be living outside the system, the drugs help keep me alive, and in the end I’m so thankful for them.”
Sascha also studied books that helped patients and their families with creating lives that work. He was especially inspired to read about the connection between creative genius and bipolar disorder. Authors such as Virginia Woolf, T.S. Eliot, Hermann Hesse, and painters like Vincent van Gogh and Jackson Pollock all experienced serious mental imbalances and channeled their eccentricities into creative expressions that have offered profound sources of inspiration to many exposed to them.
Sascha wondered how to help teenagers find inspiration and support—especially those not exposed to the study and perspectives he had gained. He then went on to co-coordinate “The Icarus Project (www.TheIcarusProject.com),” a place for people like himself to connect, tell stories, and create a shared language that reflects both “the complexity and the brilliance that we hold inside.”
Although Sascha has found a way to positively contribute to society, he has to monitor himself and make sure he lives a life with a balanced diet and enough sleep, exercise, and time in nature, as well as the right balance of psychiatric medications. He has developed the self-discipline to monitor his lifestyle choices and make himself do what he needs to do for himself. He lives knowing that if he fails to provide for himself in these ways, he might again slip into an episode that is destructive to him and others.
How Much Mental Illness Do We Have and What are We Doing About It?
According to the National Institute of Mental Health’s “National Survey on Drug Use and Health” of 2008, serious mental illness (SMI) cripples almost 5% of the population. They defined SMI as “a mental, behavioral or emotional disorder resulting in serious functional impairment that substantially interferes with or limits one or more major life activities and was diagnosable within the last year.” Five percent of the population of 311,500,000 today (mid-2011), is more than 15.5 million people in the USA now experiencing serious mental health issues.
A 2004 study revealed the outcome of first-episode psychosis in USA, treated in the usual way primarily with drugs: Only 13.7% of subjects met full recovery criteria for two years or longer (Robinson et al., 2004).
Robert Whitaker, author of Anatomy of an Epidemic (2010), which made him the winner of a 2011 national award for investigative journalism, reported it this way: In 1955, when psychiatric medications were not yet used, there were 355,000 people [in the USA] with a psychiatric diagnosis