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Trapped in Involuntary Commitment May 11, 2011

Posted by Crazy Mermaid in Involuntary Committment.
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Trapped!

As I stood outside, I glanced around the small courtyard, taking in my surroundings. A fifteen foot high chain link fence topped with two layers of razor barbed wire surrounded the south and east sides of the compound. The building itself served as a fence on the south side. A six foot high wrought iron fence with a small (locked) gate served as a sentry for the west side of the courtyard. The whole effect made an impermeable barrier from the outside world, discouraging anyone from trying to run away from the mental hospital.

Hours before, I had just learned that I had been involuntarily committed to a mental hospital.  As I came to realize the enormity of that fact, a sense of claustrophobia engulfed me.  I realized that I had been imprisoned, and there wasn’t a reason why.  I had been pulled out of society and stuck in a jail in some god-forsaken place, unable to even learn what city I was in.

They didn’t and wouldn’t call it jail, but that is in effect what involuntary commitment really is.  If you can’t leave when you want to, then you’re in jail.  If they won’t tell you when (or if) you’re ever going to be released, then you’re in jail.

Some people would argue that being locked up on a psych ward is no different than being on a job that you hate. I argue that in the case of the job, although you might feel trapped, you are in fact free to quit if you want to.  You can walk out of your “jail” any time you feel like it. The consequences might be such that you can’t afford to leave, but in fact you are free to walk away at any time and no one can or will stop you.

I, on the other hand, wasn’t being paid to be there.  In fact, unbeknownst to me at the time, I was being charged between $2,500 and $3,500 a day to be there.

I have never been one to stay in situations where I felt trapped for very long.  If someone tried to hold me down, I would kick and scream and bite until they finally decided that I wasn’t worth the effort.

In the case of hospitalization, no amount of trying would free me from my captors.

The daily grind of captivity lasted almost three weeks, and the worst part was that no one could tell me when (or if) I would be released.  It was up to my psychiatrist, and he wasn’t willing to let me out until I could comply with a set of criteria that I was not allowed to know about. For obvious reasons, they guarded that criteria from me because they knew that if I found out what that criteria was, I would do my best to trick them into thinking that I had complied in order to get out of “jail”. The object of their game was to get me to fulfill that criteria without a hint from them of what that criteria was.  I tried and tried to figure out what that criteria was, but in the end I wasn’t successful.  Eventually, as I would later learn, I was released ($60,000 later) when my insurance benefits came to an end.

There is no sweeter feeling than being released from a prison.   After 48 years of taking freedom for granted, that three weeks made me realize just how easy it is to get your freedom snatched from you, as you stand helplessly by. I never want to experience that jailed feeling again.

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Reluctant Gertie: Unwanted Medication February 3, 2011

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, mental illness.
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“NO!”

“You have to.”

“I won’t!” said Gertie, a 350 lb white woman dressed in a hospital gown, squeezed into a chair next to a blood pressure machine at the nurse’s station.

“Please, Gertie. We’ve been through this already.”

“You have no right…”

“We have every right, Gertie,” said Marjorie, the nurse handing out medication. “We’ve already been through this. Don’t you remember what happened before when you refused to take your medication?” She shook the cup of pills at Gertie. “Go ahead and take these.”

“But I don’t like the way they make me feel.”

“I’m sorry, but the doctor said you need to take these.” She rattled the cup again. “Please.”

Gertie shook her head.

“Then I have no choice.  We’ll have to give your medication to you intra-muscularly, Gertie. Just like we did before.”

Gertie continued to shake her head. “No.”

“Shall I get the other nurses?” asked a red-headed nurse in a pink tunic.

Nurse Marjorie nodded her head. “I really don’t want to do it this way, Gertie, but you’re giving me no choice.”

“Please don’t do this, Nurse,” begged Gertie.

“I’m sorry, Gertie, but I have no choice in the matter. You know that.”

“Our Father Who Art In Heaven. Please deliver me from having to take these pills,” Gertie prayed.“Please Nurse. Please. Don’t,” begged Gertie.

By this time, three other nurses had arrived

“Please God, save me from these evil nurses and their injection,” prayed Gertie as the nurses positioned themselves strategically around her.

As Nurse Marjorie prepared the syringe, I caught sight of a long needle.

“Please Gertie, don’t make me do this,” she begged.

“PLEASE GOD!  DON’T LET THEM!” screamed Gertie.

All at once, the nurses grabbed Gertie, holding her down as Nurse Marjorie plunged the needle deep into Gertie’s thigh.

“NOOOOO!” screamed Gertie. “THEY’RE KILLING ME!”

The injection complete,  the nurses released their grip on Gertie.

“There. All done, Gertie,” said Nurse Marjorie, her voice shaking slightly as she fastened a band-aid on the injection site.

By this time, the entire ward was shaken up, having watched this gruesome display.

“I think it’s time for a special Smoke Break,” said Nurse Marjorie. “Everyone outside!”

(Excerpt from my book, I Thought I Was A Mermaid)

A Case for Involuntary Commitment January 1, 2011

Posted by Crazy Mermaid in Involuntary Committment, Medication, Mental Hospital, mental illness.
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As part of my psychotic experience, I believed that I had ESP (extra sensory perception). I thought I had famous people as part of my entourage, hanging on every brilliant “word” coming out of my “mouth”. At first, these conversations took place entirely inside my head, without me uttering a single word.  However, towards the end of my psychotic experience, my need to talk out loud to them became very strong. Too strong to ignore.

Thanking God for Bluetooth technology, I decided that talking out loud to my friends would be mistaken by everyone who witnessed it as simply conversing on the cell phone, as long as I had my “ear bud” in my ear. So I began wearing my “ear bud” everywhere except to bed.

In this section from my memoir (called I Thought I Was A Mermaid), I had just driven to Walmart (really) to go shopping with my (imaginary) friends.

(Note to blog readers: As far as the people with me go, they were a mixed bag. Although I had never met the real Claudia, she was in fact a real person whom I had heard about and wanted to meet.  Mike was actually based on my (real) boss at Mortenson, where I was a project manager on a $55 million ice hockey rink under construction.  Bill Gates needs no introduction, except to say that although I had never met him in real life, my circle of friends (really) included someone who had (really) worked with he and Melinda Gates, his wife, at Microsoft back in the day.

Rolling into the colossal Walmart parking lot, I turned off the key.

Me: Here we are, everyone!

Claudia: I can’t believe how nice the cars are. I thought they’d be all dumpy and old and stuff. But they’re not too bad. Even a Lexus or two.(Note to blog readers: the people I conversed with could see through my eyes, so they saw exactly what I saw).

Bill Gates: I’ve never been to a Walmart before. But I know someone who has. And she’s dying to meet you. Oprah Winfrey, meet Kathy. Kathy, meet Oprah. I was shocked, to put it mildly.

Me: I never expected to meet you in a million years, Ms. Winfrey.

Oprah: Call me Oprah, Kathy.  And it’s very nice to meet you.

Me: It’s nice to meet you also.

Oprah: I’ve been hearing a lot about you, Kathy.  Bill and Melinda Gates are friends of mine. When I heard they knew you, I begged them for an introduction. And it’s so funny that I’d meet you here in a Walmart parking lot. I grew up with Walmart.

***

During my three week involuntary hospitalization (at Fairfax Mental Hospital), I continued to believe that I had ESP. The day I was released from Fairfax, I met my new psychiatrist for the very first time. After my meeting with him, I believed that I talked with him via ESP during my car ride home.

My point is that it took over a month for the medication, initially forced on me during my hospitalization, to finally kick in enough that I no longer believed I had ESP. Without involuntary commitment and its accompanying medication, I would still believe I had ESP and I would still be talking out loud to my imaginary friends. At first I fought tooth and nail, but in the end, involuntary commitment saved my family and I from a terrible fate.

Anatomy of a Breakdown September 23, 2010

Posted by Crazy Mermaid in Delusions, Hallucinations, Involuntary Committment, mental illness.
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Looking back at my diaries of 2 years ago, I again became enmeshed in my identity crisis.  It reminded me of how difficult it was to lose who I was. And to find out that who I was wasn’t exactly pleasant.

Before I became psychotic, I was Kathy 1.  Then, when I became psychotic, so many things about me changed that I lost my identity as Kathy 1.  While I was psychotic, this change from Kathy  seemed a very natural turn of events, since my delusion had included my belief that I had always been someone else.  According to my delusion, I was, and always had been, a mermaid named Pangea. For 48 years I just never knew it.

During my psychotic break, Kathy 1 was no more, wiped out of existence, replaced by an entirely new personality: Pangea the Mermaid.  Transfering my identity from Kathy 1 to Pangea was easy. It was an act initiated by me. It was an act controlled by me. I was drawn in gradually over a four month span of time into my new identity as Pangea. My final act of recognition of this sea change was that I planned to change my real legal name to Pangea.  But before I could carry out my plan, I was involuntarily committed to a mental hospital.

When I was hospitalized, the staff began the long process of stabilizing me.  Part of that process was administration of medication that pushed me out of my delusion that I was Pangea. Logically, removing Pangea from the equation should have left me back at identifying with Kathy 1.  Unfortunately (or not), this didn’t happen.”

It’s difficult to put into words, but the person who was Kathy 1 had certain thought patterns, certain ways of doing things, certain tastes in clothing, hair styles, and expressions of who she was, as well as a much faster speed of thinking, and other brain-related characteristics that made up her very soul. Her very existence.  Those characteristics are gone.

There’s a void where my identity is supposed to be. I try to feel a familiar pattern of thinking or feeling or being and there’s no familiarity at all. Zero. I have no idea who I am. It’s as if I woke up in someone else’s brain. I have no reference points.  I’m in a strange place and can’t find my way back to who I was before. But then do I really want to return to that person?

Through counseling, I learned to analyze  all of the little choices that Kathy 1 made in her life that brought her the total control that she was looking for, which ultimately led to her complete break with reality.  Little things and big things loomed in my head.  Overall, I realized that my efforts at control not only led to my complete break with reality, but in the process had turned me into what I would term a “flaming bitch”.  I had attempted to control virtually every facet of my life down to the last speck of dirt in the house to the greatest extent possible.  Everything was always about me.  It was embarrassing to come to this realization at the age of 48.  How horrible, how narcissistic. It was depressing to consider all of the wasted years, all of the misery, that I had inflicted on people, including those I loved, through the years.  Was there anything I could do to make up for my past bad behavior?

I need to find out how to get me back to who I was before- only nicer.  And if I can’t do that, then I need  to figure out who I am now. For lack of a better word, I’ll call myself Kathy 2.  I need help to discover who she is.

Eastern State Hospital (WA) and Photovoice August 18, 2010

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, mental illness.
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At a recent NAMI Conference I attended this past weekend, I had the privilege of listening to Dr. Jeff Ramirez and Ms. Elaine Alberti discuss the culture of Eastern State Hospital (http://www.dshs.wa.gov/mhsystems/esh.shtml).  Housing involuntarily committed civilly committed patients as well as patients who have been acquitted of committing crimes due to the fact that they were found Not Guilty By Reason of Insanity, the hospital is located in Medicine Lake, a rather isolated part of the State.

Dr. Ramirez and Ms. Alberti brought with them a wonderful Photovoice display, which showcased the work of some of the patients. Bringing the voice of hospitalized patients to the outside world, the powerpoint was a very powerful demonstration of the sometimes-forgotten humanity behind the various incarcerated individuals housed at that facility.

In an experiment designed and conducted by a clinical nurse specialist, a group of patients had the opportunity to participate in photo sessions in which they took pictures every other week. Photos were taken in and around the hospital grounds. Patients were not allowed to leave the grounds in order to take photos.

Taking four photos at each session, those photos were developed for the patients. Then, during group sessions, the photos were handed out to each patient. Patients put meaning and interpretations to their photos, sharing those meanings and interpretations with the group.

The clinical nurse specialist in charge of the program assisted the group in categorizing the narratives into four overarching themes: finding meaning, expressing anger, fighting stigma, and finding hope.  Each of the photos were identified as belonging to one of those four groups.  The resulting collage of photos were combined and set to music, and the end product was shown to the staff as well as others. Giving voice to the patients, it presented itself as a strategy to help reduce seclusion and restraints. Delivering a powerful message to all who saw the presentation, it resulted in a 96% reduction in restraint use.

Unfortunately, one of the unintended consequences of the escape of Philip Paul, the Eastern State mental patient, included the dissolution of this program. For about 4 months after Philip Paul’s escape, patients were in total and complete lock-down, unable to even get to their treatment mall to receive their medication much less take photographs even inside the hospital grounds.

For those unfamiliar with his story, Philip Paul was incarcerated at Eastern State Hospital in eastern Washington for the death of Ruth Motteley, a woman whom Paul thought was a witch.  He said that voices in his head told him to kill her, and he obeyed them.  Diagnosed as a paranoid schizophrenic, he was found not guilty by reason of insanity and taken to Eastern State Hospital, where he has been held on and off since April 1987, escaping from a field trip to a fair on September 17, 2009.  The history of his incarceration can be found in a September 21, 2009 article in the Spokane Review (http://www.spokesman.com/stories/2009/sep/21/key-developments-pauls-legal-history/).

It’s unfortunate that a program with the success rate of this one has been cast aside because of the behavior of a few.

$58,752 for 18 Days of Involuntary Committment to Mental Hospital August 14, 2010

Posted by Crazy Mermaid in Escalating Healthcare Costs, Health Insurance and Mental Illness, Involuntary Committment, Mental Hospital, mental illness.
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$58,752. Take a good look at this number.  It’s the cost for 18 days of room and board (no additional services like medication and Dr. visits are included) at Fairfax, a private mental hospital in Kirkland, Washington.*, where I was involuntarily committed back in May 2008 to mid June 2008.  That breaks down to $3,900.20 per day for the first 10 days and $2,468.75 for the final 8 days.

At Eastern State Hospital  (WA), a comparative public facility, the average cost per day for a stay there is $524 per day.  My stay there (room and board ONLY) would have cost $9,432. At Western State Hospital  in Lakewood, Washington, also a public facility, the average cost per day is $438.  My cost for 18 days of room and board there would have been $7,884.   Fairfax, a private hospital, charged over six times as much for the identical service.  What’s wrong with this picture?

It gets even better. At these rates, if 25 patients pay $3,900 a day, Fairfax grosses $97,000 a day.  If the beds stay full for a year, Fairfax grosses $35 MILLION dollars.

My family and, by extension, I, had no say in whether I would be involuntarily committed, much less the location or cost of my commitment. The State of Washington made the determination that I would be involuntarily committed.  Because it was an emergency situation, forced on me, my family had no opportunity to explore the various facilities and then do a cost comparison.  Even if we had known the cost, we had no choice. Fairfax was the only mental health hospital in the State with a bed. The State of Washington was forcing me to be involuntarily committed (against my will).  I had to go somewhere, and Fairfax was the only place with a bed. That’s why I went there.  Fairfax had me over a barrel, with no other options.  They took advantage of the situation to make their stockholders a little richer.

Lest you think I was at Club Med, let me rid you of that misconception. The food was cafeteria-style, brought to us on trays stacked in a three foot high mobile metal tray rack.  Built in the 1960’s, the building has not undergone any visible major or minor remodeling since its inception.  As it is a private hospital, the public information disclosure required by the State hospitals is not required of it. My stay there was not in some kind of padded room.  It was in a plain old regular dorm room, similar to one you’d find at an old college.  Granted, the doors to the outside were locked 24/7, but the facility itself was run-down. Unlike Western and Eastern State Hospitals, there is no website data from Fairfax citing its daily cost.  It’s a private facility.

Oh yeah: one more thing.  Fairfax is owned by Psychiatric Solutions Inc. (PSI). Please join me in congratulating PSI for making Fortune Magazine’s list of Top 100 Fastest-Growing Companies:

FRANKLIN, Tenn., Aug 18, 2009 (BUSINESS WIRE) — For the fourth consecutive year, Psychiatric Solutions, Inc. (”PSI”) (NASDAQ: PSYS) has made Fortune magazine’s list of the Top 100 Fastest-Growing Companies. It is the only Tennessee company to make this year’s list, as it was in 2008 and 2006. https://www.psysolutions.com/facilities/news/fortune-magazine.html

PSI, which is the largest operator of psychiatric inpatient facilities in the country, ranked No. 98 on the list released by the magazine in August 2009, which considers factors such as revenue and earnings per share (EPS) growth rates. Last year, PSI ranked No. 64. In 2007 and 2006, it ranked No. 49 and No. 34, respectively.

How can they get away with this? Simple: There is more demand than supply for short-term mental health care facilities. Solution: build more short-term care facilities.  I think that everyone would agree that $35 Million builds quite a few new facilities.

* Taken from Fairfax’s invoices to my insurance company.

Psychotic Wife Tests Marriage August 5, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Delusions, Hallucinations, Involuntary Committment, Mental Hospital, mental illness.
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My nervous breakdown tested my marriage in a major way.  I’m very lucky that my marriage has survived that horrible ordeal- at least for the present.

From the time the voices started in February to the time I was hospitalized in late May, the voices tried to convince me to divorce my husband of 25 years.

The first reason that the voices told me to divorce him was to protect my newly acquired $1.5 million jewelry collection. This collection included a supposedly “yellow diamond” ring acquired at Target for $20, which the voices assured me was actually a real yellow diamond ring worth a million dollars (not true) and an abalone bracelet that I bought from Goodwill that the voices said was an antique bracelet once owned by my Great-grandmother Mermaid and now worth $500,000 (also not true).

The second reason they said I should divorce him was that he was the real behind-the-scenes person responsible for locking me up in a mental hospital, and he was going to keep me there as long as he legally could (not true) and that my only chance of escape from my “prison” was to divorce him as soon as possible. So the first chance I got at the mental hospital I called my attorney to get the divorce proceedings started.  But as the medication began to take effect, I lost the ability to follow through with my actions because I became lethargic and confused. Finally, as the medication began to cause the delusions and hallucinations to go away, I came to realize that my husband wasn’t really trying to keep me locked up, and that I really didn’t have a $1.5 million jewelry collection for him to go after.

After I returned home and began to realize the magnitude of the damage I inflicted both personally and financially, I became convinced that he was going to divorce me, and that he was just waiting for me to get well enough to divorce him. After all, why would he stay?

Besides the paranoia about what I perceived as my impending divorce, I was undergoing a major medication-induced identity crisis.

The reality was that Bob was free to divorce me at any time, and many less patient men would have simply walked away from me at numerous points. Some husbands would have left back in February or May, when I started talking about wanting a divorce, or in late May when I was spending tens of thousands of dollars. Others would have served me divorce papers in the hospital, as happened to some of my fellow patients.  Still other spouses would have waited until I was on my feet again, able to take care of myself, before cutting the cord.

He put up with the trials of living with a woman going through a severe break with reality, including the delusions and paranoia that accompanied the break. He watched helplessly as an out-of-control woman who was legally still his wife but whom he didn’t recognize begin to dismantle his financial future by spending thousands of dollars on clothes and plants and even a $50,000 Lexus convertible.

Then, he suffered through the three weeks I spent at a mental hospital, unable to share that fact with anyone due to the tremendous stigma attached to that fact. As if the fact that I was at a mental hospital wasn’t shocking enough, he found the courage to visit me on a daily basis, despite my less-than-pleasant reception ( I thought he was holding me there on purpose against my will). He didn’t understand what kind of world I inhabited, but realized that I wasn’t really “there” when he visited me, but nevertheless suffered through his daily visits with me anyway. He watched as I tried to take up smoking. He listened when I continued to ask him for a divorce, even listening patienly as I gave him a piece of paper that represented a preliminary breakdown of the assets I planned to receive in our upcoming divorce settlement.

Even when he saw that I was not getting better, and when I ignored him when he visited, he still hung in there. He understood the very real possibility that my mind might be forever locked up in my fantasy world, unable to return to the real world. He realized that he might have to take care of me – what was left of me- alone, might have to raise our kids- alone.

My real road to recovery didn’t begin to materialize until several weeks after I was released.  But as the medication that would bring me back to the real world began to take effect, the side effects from the medication were another nightmare. Depression, suicide thoughts, Parkinson’s disease symptoms, grogginess, fainting, constant crying, weight gain, and a myriad of other medication-induced symptoms became the norm. I couldn’t read, couldn’t drive, could barely walk, had balance problems, couldn’t comb my hair or peel a banana or make my bed. I was anxiety-riddled, having to have my days planned out to the last minute or I’d become miserable. I was almost totally helpless, and there was no guarantee that my physical health would ever return. He supported me through that horrible period without complaint. He was always there for me.

As my side effects slowly began to diminish over time, and as I again returned to the land of the living, some of the pressure is off.  But without the love and support of him and my family, I would still be in the psychotic world, disconnected from reality, for the rest of my life. I’m one of the few lucky ones who has managed to find their way back.

Mental Illness and The Law: How We Got Where We Are June 29, 2010

Posted by Crazy Mermaid in History, Insanity, Involuntary Committment, Mental Hospital, mental illness, Mental Illness and Medication, Psychotic.
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If you want to change things, first you need to understand how they got the way they are.  In the case of mental illness law, politicians and lawyers had the best of intentions, but as with other ventures, the devil was in the details.  The unintended consequences of their actions continue to remain the source of frustration and even danger.

In his 1946 article “Bedlam 1946: Most Mental Hospitals Are A Shame and A Disgrace” http://www.mnddc.org/parallels2/prologue/6a-bedlam/bedlam-life1946.pdf in Life Magazine, Albert Maisel made the case that mental hospitals were terrible institutions.  The final paragraph of his article summarized his point succinctly: “Given the facts…the people of any state will rally… to put an end to concentration camps that masquerade as ( mental) hospitals and to make cure rather than incarceration the goal of their mental institutions.”

While the sentiment is perfectly understandable given the horrific conditions he found when he investigated the state of mental hospitals throughout the United States shortly after the close of World War Two, he threw out the baby with the bath water when he declared, in effect, that nobody should have to be institutionalized.  The wildly popular Life Magazine gave Maisel a platform from which to launch his idea of closing all mental hospitals, also called deinstitutionalizing the mentally ill.

Helping this idea along was the development of the first generation of antipsychotic drugs in the 1950’s. Used to treat schizophrenia and other psychoses as well as acute mania, agitation and other conditions, their discovery allowed many mentally ill people once hospitalized to return to their families, hopefully with their illness under control and able to function as productive members of society in many cases.  In many cases this was true, but not in all.

The advent of these new antipsychotics lent fuel to the fire of the deinstitutionalization movement, and, combined with the publicity of the atrocities perpetuated in the mental hospitals, served to throw the doors to the mental institutions wide open in the mid-1950’s.

From the mid-1950’s to the mid-1960’s, a small percentage of the eventually deinstitutionalized were released. But from that point forward, the trickle became a flood, culminating in the release of the majority of the mentally ill by the mid-1980’s. And as the mentally ill were released from the hospitals, rather than wait to see whether whether the experiment was going to work, those hospitals were closed down forever, shrinking from a high of around 550,000 beds in the mid-1950’s to around 40,000 today. As this experiment failed,the homeless and prison populations of every major city and State ballooned.

In the meantime, California was the first state to pass the Lanterman-Petris-Short Act in 1967, giving the mentally ill the legal right to avoid treatment for their mental illness, regardless of how damaging that mental illness became. Unless the person was in imminent (immediate) danger of severely harming or killing themselves or someone else, they had the right to be left alone, free to wander the streets, homeless and victimized, eating out of dumpsters, lost in their own world. Other States followed their example, with the former Governor of California, Ronald Reagan, leading the charge on a national level as he ascended the highest office in the land, the Presidency.

The mistakes the do-gooders made in this two-pronged approach of first deinstitutionalizing and then arming the mentally ill with the right to refuse treatment were twofold.  Their first mistake was  in perceiving all hospitalization to be bad hospitalization. Secondly they assumed that anyone who has a mental illness has the presence of mind to know when to seek treatment for that illness.

Treating mental illness like any other illness, disregarding the fact that one of the symptoms of the illness can be a failure to realize they are ill, and denigrating all mental hospitals as evil are poor choices for which we have all paid dearly, in the form of the fallout from our endless supply of suicides, the incarcerated mentally ill population, the homeless population, and mentally ill people who attack and assault others.

Until we realize that mental hospitals can also be used for good, and that mentally ill people can’t always help themselves, nothing will change.

(Note:  Part of my research for this article was done with the help of Dr. E. Fuller Torrey’s book The Insanity Offense. (2008).

Anosognosia Symptom: Lack of Insight into Mental Illness June 22, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Involuntary Committment, mental illness, Schizophrenia.
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It’s a crying shame that I had never even heard of the term ansognosia until I read Dr. E. Fuller Torrey’s latest book, The Insanity Offense (2008), since it’s such an integral part of understanding how the symptoms of mental illness interfere with a person’s ability to get help.

The term anosognosia is derived from the Greek words “nosos” which means disease and the word “gnosis” which means knowledge. The “an” prefix notates the negative.  A person who suffers from anosognosia is unaware of the existence of their mental illness.

This lack of insight into their illness, associated with damage to the right hemisphere of the cerebral cortex or the frontal lobe,  is a problem of major proportions because it’s the main reason why people with certain mental illnesses such as schizophrenia and bipolar disorder refuse to take their medications.   They aren’t trying to be a pain in the ass: they truly believe that they’re not ill.  And if they’re not ill, there’s no reason to take medication. Period. End of Story.

If a patient can be made to take their medication, a large percentage of them will improve their awareness of their mental illness and thus continue taking their medication on their own.  But under the current laws, forcing a patient to take necessary medication is illegal, in a large part because the law refuses to take into account anosognosia in making decisions regarding who should be forced to take medication and who should not.

It’s not easy to convey to the average person what it means to be unaware that you have an illness. How can someone who is sick not know it, especially when their symptoms are so obvious to others? Because it’s not like any other illness. It’s the brain, rather than other parts of the body, that is the problem.

In the case of the paranoid schizophrenic, there is another layer of difficulty to add to the equation. The paranoid schizophrenic lives in a world where the universe is out to get him.  So he views any attempt to get him help as simply another attempt at persecution.  He distrusts anyone who tries to get him help. It’s a magnification of anosognosia.

Unfortunately, treatment of a patient whose symptoms include anosognosia is impossible, since treatment for an illness requires admission that there is in fact an illness and cooperation by the patient in treatment of that illness. The law of the land is written around the concept that a person is capable of deciding whether or not he is ill, and therefore whether or not treatment for that illness is appropriate. The law, in other words, has never heard of the symptom called anosognosia, which makes it impossible for the patient to believe that he is mentally ill, and therefore makes it impossible for him to believe that he needs treatment. The result of this failure of the law to consider this singular symptom is that the patient goes about his business believing that he is not ill, living in his own world. How is this a problem?

Instead of being able to treat those people whose symptoms include anosognosia, families of people with mental illness live in fear of their  loved ones, aware they’re living with a ticking time bomb. They know it’s only a matter of time before their loved one hurts or kills someone, but they’re unable to prevent the atrocity from happening because the law ties their hands.

Prisons are full of people with anosognosia who commit crimes- sometimes horrendous crimes. Had they been forced to seek treatment for their mental illness, they might have lived full and productive lives. Instead, they fill our prisons, unmedicated, costing taxpayers tens of thousands of dollars a year. Or they murder police officers or random people before being apprehended and found to be not guilty by reason of insanity, then locked up in mental hospitals.

The streets of every major city in the United States are full of people with anosognosia who refuse to believe they have a mental illness. Instead of being forced to get treatment, they wander the streets, victims of crime, living off the streets, eating out of dumpsters, and living a horrible life simply because they cannot believe they are in need of medical help.

We have to change our laws, taking into consideration this terrible symptom.  We have to make it easier to involuntarily commit those with this symptom, thus improving the quality of life of those with anosognosia and making the world a much safer place for all of us.

(Note: Research for this article was done with the help of articles by the following: Dr. Kevin Thompson, PhD http://www.mentalmeds.org/articles/anosognosia.html ; Treatment Advocacy Center http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=27&Itemid=56; Pages 112 and 113 of Dr. E. Fuller Torrey’s new book, The Insanity Offense (2008) among other sources)

Least Restrictive Treatment March 28, 2010

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, mental illness.
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On a beautiful summer day in 2008, the evening before what turned out to be the discharge date from my involuntary commitment to a mental hospital, my court-appointed attorney, Devin, came to the hospital to see me. 

At that point, I had been at the hospital for 3 weeks, with no idea of how long I would be staying.  During my entire stay, my psychiatrist, Dr. S, continually refused my request to be released. In fact only hours before, he made it clear that I wasn’t yet ready to be released and continued his refusal to give me a date or even a time frame on when I could expect to be released. So when my attorney arrived to “spring” me the following day (on June 18), I didn’t know who to believe. Pragmatically, I chose to believe him over her, but gladly cooperated with her in case she was right.

Opening her briefcase, Devin took out a stack of paperwork and laid it on the table in front of me.  The second she told me that the paperwork was going to get me discharged from the hospital, she had my undivided attention.

She noted that although I was being released under a 90 day “Less Restrictive Treatment” plan (LRT), I was in fact still a mental patient.The only difference was that I could be treated at home instead of at the mental hospital.  In order to remain out of the hospital, I had to meet certain conditions.  Should I fail to meet those conditions, she made it very clear that I would return to the mental hospital (involuntarily, of course).

The first conditiotn of the LRT was that I had to have my first visit with a psychiatrist and therapist set up and arranged before I could leave.  Obviously, hat meant that I had to have a psychiatrist.  My hope of the discharge momentarily left me, since I had neither the way nor means to locate a psychiatrist and set up an appointment. Thankfully, Michelle, my caseworker at the hospital, had located one and set up that first appointment for me.  On the LRT form, my new psychiatrist’s name and the date of my first appointment had been neatly printed on the form, arranged for me without my involvement in the decision-making process.

According to the paperwork, my first appointment with my therapist was for 1 pm the following day (June 18) and my first appointment with my new psychiatrist, Dr. K.,  was for 1 pm June 19.

The second condition was that I must take all of my medications as prescribed, including the medications prescribed by my attending psychiatrist at the mental hospital, and to comply with any lab tests for medication monitoring if required.  This meant that they had the right to draw blood from me whenever they deemed fit, which was particularly useful in the case of lithium, since checking my lithium levels would also be checking to verify that I was indeed taking my lithium.

The third condition under the LRT was that I had to refrain from the use of alcohol and unprescribed drugs and comply with random urinalysis if requested.  In other words, no drinking.

Although I am not what you would call a big drinker, I am (or was) a social drinker.  It’s not the “full glass” situation that I miss. There is always the option of having that glass of sparkling cider or diet coke or water. I miss not being able to participate in those occasions by having that glass of wine or beer with everyone else. I also miss the taste of beer and wine.

I know many people who choose not to drink.  Some don’t like the taste of alcohol or choose not to drink because they don’t like the effect of alcohol on their bodies. Others had problems with alcohol and so choose to give it up. But I don’t fit into any of those categories. I didn’t choose not to drink.  It’s a choice that was made for me. And no matter what anyone says, it’s different when you didn’t choose not to drink.

The fourth condition of the LRT was that I couldn’t harm myself, others, or the property of others.  No repeat acts of the Evergreen Hospital scenario, in other words, where I threw a stool against the wall repeatedly trying to break a small window in a door.

Other than to remind the patient how he/she got involuntarily committed in the first place,this condition seems pointless, since the law already allows the State to commit anyone who presents a danger to himself or others or who damages the property of others.  It seems redundant to state following the letter of the law already on the books as a condition of the LRT.  Unlike the other conditions, which are new and specific, this condition is nebulous and general and to me seems unnecessary.  Nevertheless, it was a condition of the LRT.

The final condition of the LRT was that I couldn’t possess any firearms.

Explaining to I Devin that I was a hunter, I protested that I had some guns. She told me that I would have to make arrangements to get rid of those guns or risk not being allowed to leave. Furthermore, she said that people who have been mental patients are legally barred from possessing firearms. This was a permanent thing rather than a 90 day thing, on other words.  As I continued to grouse about the unfairness of it all,  she said that eventually, say a few years from then, I could petition the courts to allow me to get my guns back and return to hunting, but for now I had to give that up. Although I didn’t know it at the time, my dad had already removed my guns from my house before I signed the LRT form.

The purpose of this condition was to prevent my death by suicide.  With bipolar disorder, especially when the patient is in the depressed stage, large numbers of us attempt suicide.  And one of the more popular ways to commit suicide is to shoot ourselves with guns.  Therefore, the purpose of removing guns from the grasp of a mentally ill patient is to prevent that patient from committing suicide.

But that didn’t make giving up my guns and hunting any easier.  Although I hadn’t been hunting for several years, I wanted the ability to decide for myself whether or not to hunt or shoot clay pigeons or target practice with my 30-06 rifle.  That had been taken away from me as a condition of my release from the mental hospital.

Although I wasn’t exactly thrilled with any of the conditions of my Least Restrictive Treatment, I have continued to abide by those conditions even beyond that 90 day period of time.  While life is significantly more boring in my new world, at least I don’t risk a return to the mental hospital.