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Psych Ward Male Night Nurses January 22, 2014

Posted by Crazy Mermaid in Mental Hospital, Mental Illness and Medication.
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The Psych Ward was in reality a maximum security prison. Nobody left of their own accord.  Every 20 minutes, the nursing staff made their rounds to track down every patient. Whether we were in the shower, asleep or whatever, they always knew where we were.  As we slept, the night nurse came into our dark bedroom with a flashlight and shined it on our face and chest to make sure we were still breathing. If we were in the bathroom, they stood outside the bathroom door calling our name.  If we didn’t open the door to tell them we were there, they assumed that we were either trying to hide,  trying to kill ourselves, or already dead.  So they opened the door and hunted us down. There was no such thing as patient privacy.

A 10 foot barbed wire fence (with razor wire at the very top) surrounded the entire building, including the tiny courtyard attached to the building.  We weren’t allowed outside except for supervised group smoke breaks inside that tiny little courtyard. There was no such thing as structured exercise- or even unstructured exercise. If it happened at all, it happened at 8 pm, provided we could talk a staff member into walking us down the hall and out the steel double doors to a gym. Most days, the nursing staff was too short-staffed for that, but occasionally we got the chance to actually stretch our limbs out and break a sweat.

The hospital was always short-staffed, and the hardest shifts to fill were the night shifts. Nobody wanted to be a nurse on a psych ward at night. Most nights the only people they could get to handle the night shift were male nurses.  So usually there were two male nurses on the night shift overseeing about 25 patients. Sometimes only one male nurse was on the night shift.  Night nurses had unlimited and unsupervised access to all of those drugged up people (everyone was given sleeping meds) lying in their dark bedrooms .  Were there cameras?  In a few rooms.  But not all.

Night nurses were  required to walk into those dark bedrooms and shine a flashlight on the patient’s  face and chest every 20 minutes to make sure we were still alive, so they had every right to be in a patient’s dark bedroom alone. Under those circumstances, it would be child’s play for an unscrupulous  person to take advantage of a patient lying alone in her dark bedroom- a patient who was so full of sedatives  that she  wouldn’t wake up under almost any circumstance.  Even a patient sharing the bedroom with another patient could be a target, since both were heavily medicated. Added to that was the fact that the general reputation of a psychotic patient was that they were unreliable and their memories untrustworthy, and the psych ward was a virtual hunting ground for an unethical night nurse.

The morning following a night with one male night nurse on staff, I  thought I might have been violated by a male nurse. But I couldn’t make my mind up.   Was it my imagination?   I just didn’t know. I admitted to myself that I had been heavily sedated. Even then, I was in a fog. Was it real? Or wasn’t it?

Realizing that I had to let the people in charge know about my suspicions, I complained to the head nurse on duty.   I explained to her what I thought happened and that I couldn’t be sure, since I was sedated during the night. But certain things pointed in that direction.

Although she brushed off my complaint,  I watched as she returned to the nursing station.  A look of shock flash across her face as she read my chart. She immediately sought out the male night nurse on duty, and I overheard her berating him. The head nurse was obviously shaken up by what happened, but nothing further was communicated with me.  I was, after all, just a psychotic mental patient, obviously delusional and unreliable.


Mental Health Court September 10, 2011

Posted by Crazy Mermaid in Healthcare, Mental Hospital, mental illness, Mental Illness and Medication, Uncategorized.

According to the news program Frontline, as of January 2010, one out of every 100 people in the United States is incarcerated . Of that population, nearly 25% of these 3 million people have a diagnosed mental illness, and 16% of the prison population has a severe mental illness. At a cost of 7% of the operating budget of the United States, the figure for incarceration of the mentally ill totals $910,000,000. It’s no wonder that prisons are the largest mental health institutions in the nation.

The latest weapons to help reduce the population of mentally ill in prisons are Mental Health Courts.  Designed as an alternative to incarceration of the mentally ill,  the cost of these courts is substantially less than the $62 per day that prisoners cost the taxpayer, saving taxpayers tens or hundreds of millions of dollars.

Designed for violators who have committed a crime as a direct result of their mental illness, the program doesn’t allow anyone who has committed a felony to participate. The purpose of the program is to get those targeted mentally ill individuals help by giving them intense judicially supervised treatment including help with their mental illness that has up until that time eluded them in the judicial system.

In the Mental Health Court program, the prisoner, or client as he is known in the program, is given a choice of attending Mental Health Court or serving time in prison or jail. This program is entirely voluntary. If the client chooses Mental Health Court,he must participate in the entire program for the two year duration. A large part of this participation is receiving the needed mental health services as well as supervision by members of the mental health team, including the judge, prosecutor, public defender, and court mental health specialist. This team of people encourages the client to stay on track with the program.

As a result of attending Mental Health Court, the client, now medicated and a productive member of society, will graduate from the program in an official ceremony, receiving a certificate of graduation in front of friends and family. He then becomes a productive member of society rather than a burden on the already over-crowded prison population.

If the client drops out of the program or is terminated for any reason, he is sentenced for the crime. The penalty is no greater than if the client had not participated in the program, and the judge will normally take into consideration the fact that the client did make the effort to try Mental Health Court.

The goals of the Mental Health Court are to increase access to mental health resources, encourage a focus on recovery, prevent revolving door to the jail, give an opportunity to contribute to society, and spend less time in jail or prison.

As anyone with a mental illness can tell you, staying on the program and taking the needed medication goes a long way towards keeping the client out of the revolving door of jail. By the end of the two year period, the client is generally stabilized and capable of making the realization that he needs medication in order to function well in society. Hopefully, this realization will be enough to keep him medicated and out of the prison system, thus increasing his quality of life and decreasing the cost to American taxpayers.

The cost of housing mentally ill in jails is an expense we can all do without, as long as we are as a nation kept safe. We can use all the help we can get in these uncertain financial times.

Slowed Down Thinking and Mental Illness February 20, 2011

Posted by Crazy Mermaid in mental illness, Mental Illness and Medication.
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From the time each of us is born, we go about the world with the impression that the way we think, the speed that we think, and the number of things that we think about in a given space of time are all fixed and uniform from person to person. Although we never consciously identify ourselves based on the speed of our thinking, it turns out that it is in fact a core part of our very being.

All my life I always had the ability to hold several thoughts simultaneously. My job as Project Manager for construction companies forced me to comprehend vast sums of data quickly. I would routinely analyze a project schedule, a set of plans, and real-time job problems together and come up with solutions to problems quickly and efficiently. There was really no other way to do my difficult job, which is why I was highly paid for the work I did

At my first psychiatrist visit right after I left the mental hospital, my new psychiatrist told me that I would have some “cognitive discord” as a side effect of my new medication. I had no idea what he was talking about.

Sure enough, the speed of my thinking slowed down almost overnight. I am thankful that I am one of the rare people who had to go through this process. Processing information at about half as fast as I used to, I was left with a severe identity crisis.

We have no idea just how much of our identity is wrapped up in our speed of thinking until that speed changes. Everything about us is wrapped up in how fast we process information. When we can no longer process information at the speed we used to, it changes us in unfathomable ways.

What used to take me seconds to comprehend is now in some cases beyond my comprehension, no matter how long I am given to understand it. My former job is now off-limits to me due to this sea change. I can no longer read a set of plans like I used it. The ability to turn two dimensional information into a three dimensional model in my head is gone. I can’t comprehend the written word as completely and quickly. In the case of comprehending technical information, I sometimes can’t understand it at all.

Left with a shell of my former self and no points of reference, I am forced to rebuild my identity as someone else entirely. It goes beyond the concept of someone who loses a foot or is paralyzed. At least those people wake up with the same mind and the same identity as before their accident. I woke up in someone else’s body, with no frame of reference to go on. Where they have to rebuild their life with their new disability, I have to rebuild my very core being.

I’m still coming to terms with this identity crisis, remaking my identity with the help of my counselor and psychiatrist.  While it’s been months since I was hospitalized, I keep waiting for my thinking to speed up.  I hoped that once my body adjusted to the medications, my thought process would speed up.  But this has not been the case.  I’m reconciling myself to living with the slower thinking, and as I get further away from the point of change, the memory of how much faster I used to think is slightly dimming.

And yet there is a silver lining.  Given a clean identity slate, I have been learning how to relate to people in ways that were impossible before my illness. Left with a vague sense of what I used to be like, I am in the process of rebuilding my personality framework in a more empathetic form.  I am much more humble, and much more tolerant of other people’s shortcomings. I now know there are different ways of thinking, and that speed of thinking isn’t the same for everyone.

And yet I yearn for my old mind back.

Although I am left in a body that I don’t recognize as my own, I’m learning to come to terms with my new identity. But it is a slow process.

LSD and Mental Illness October 8, 2010

Posted by Crazy Mermaid in mental illness, Mental Illness and Medication.
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Everyone knows that LSD is a dangerous drug, capable of driving us out of our minds.  We’ve heard this refrain all of our lives:  LSD is the most dangerous of the dangerous drugs. Stay away from this drug at all costs.

But new evidence suggests that we reconsider this idea. It’s quite possible that this drug is a solution rather than a problem. Instead of driving us out of our minds, new evidence suggests that LSD is capable of restoring a sense of sanity to the insane.

Even in the early 1960’s the drug began to change the face of psychology as we know it. Prior to this, it was common “knowledge” that mental illness was caused by environmental factors.  For example, bad parenting, the theory went, was responsible for schizophrenia.

But LSD’s ability to induce psychotic symptoms in otherwise perfectly normal people gave rise to the concept that chemical changes in the brain were causing the psychotic symptoms characteristic of certain mental illnesses such as schizophrenia.  A paradigm shift in thinking about mental illness resulted, and we began to seek solutions to the terrible symptoms of mental illness in pharmacology.

So how did a drug with so much possibility end up on the short list of the most dangerous drugs in the world?

First synthesized in 1938, the drug was made illegal in the United States in October 1968 after it became synonymous with out-of-control counterculteralism of the 1960’s.  The last FDA approved human study with LSD, for use in dying cancer patients, ended in 1980. Even Switzerland stopped its use in 1993.

But today, we are reconsidering the advisability of this action.  Banning a promising drug because of social unrest associated with it seems unwise at best and foolish at worst. As it turns out, current research points to successful use of LSD and other psychotropic drugs to reduce the clinical symptoms of mental illness such as bipolar disorder, schizoaffective disorder, and schizophrenia.

In the mid-1990’s Franz Vollenwider’s research showed that LSD, combined with behavioral therapy, could alleviate the symptoms of various psychiatric disorders such as schizophrenia and bipolar disorder. With the ability to study the effects of the drug using new tools such as functional magnetic resonance imaging, scientists are now able to use the new technology to see which areas of the brain are specifically affected by the psychotropic drugs. With this new knowledge, they will be able to make inroads into new treatment options for mental illness, including the administration of LSD.

It’s time to dust off the medicine cabinet and take another look at LSD and other psychotropic drugs. This is 2010, not 1960. We can’t afford to hold possible cures to mental illness hostage to long-ago prejudices.


Depression versus Bipolar Disorder August 24, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Depression, Medication, mental illness, Mental Illness and Medication.
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The stigma of having a mental illness has hit in yet another tangible way.

For the second time in a row, a friend who has suffered for years from depression went to a psychiatrist because her medication was no longer working for her  Or at least it was no longer working well enough for her.  She had been on an anti-depressant for about 15 years, but had wearied of the side effects. So she had gradually weaned herself off all but a tiny amount of the medication.  When she recently encountered a tremendous amount of stress, she got very depressed and a severe panic disorder reared its ugly head.  In desperation, she went to see her General Practitioner, who referred her to a psychiatrist.  She made an appointment with that psychiatrist but the earliest she could see her was 2 weeks out.  So she waited it out, trying her best to work though her bouts of panic disorder and depression.

Two weeks later, arriving at her new psychiatrist’s office, she was given a battery of questions and interviewed at length by the psychiatrist. Finally, after much interrogation, she was diagnosed with Bipolar Disorder Type 2.She wasn’t devastated at the news but she was definitely unpleasantly surprised as she relayed the turn of events to me. She had expected her new psychiatrist to simply regurgitate the previous diagnosis of depression, and it hadn’t occurred to her that her diagnosis might be something else.

In her mind, she had depression. End of subject.  She never considered the possibility that she might have anything else. In most people’s minds, depression doesn’t really qualify as a mental illness. It isn’t spoken of in the same breath as schizophrenia or Bipolar Disorder, which are both generally accepted by society as full-blown mental illnesses. With depression, it’s socially acceptable to admit you have it and that you’re taking medication for it because nobody considers you to have a mental illness. But with Bipolar Disorder you can’t hide from that label “mentally ill”.

With Bipolar Disorder, society in general puts that problem into the mental illness category.  There’s no getting around the fact that it’s a genuine mental illness.  And with having a mental illness comes all of the stigma associated with such a thing.

Furthermore, the use of an anti-depressant for treating depression is commonplace.  There’s even a book called “Prozac Nation” that intimates that many, many people are on Prozac. It isn’t viewed as a mental illness in part because too many people have it.  A mental illness is thought by the general public as being something that is uncommon.  Depression is not uncommon.

According to her new psychiatrist, the medication for Bipolar Disorder Type 2 is a mood stabilizer. The concept of being put on a mood stabilizer rather than an anti-depressant is bad, because of the stigma associated with a mood stabilizer.  By definition, it means that your mood needs to be stabilized.  That your mood is unstable. That your mind is unstable.  That you are unstable.  All of the negative ramifications of having an unstable mind come to the forefront.

It’s okay to suffer from depression, which doesn’t have the connotation of instability.  You might feel terrible- possibly like committing suicide- but at least you’re not considered to be unstable or out of your mind.  But Bipolar Disorder Type 2 is another story. With Bipolar Disorder, you’re unstable.  That’s why you need a mood stabilizer.  And, as the theory goes, people who are unstable have all kinds of problems. They’re not to be trusted.

No matter than with the mood stabilizers the thoughts of depression go away.  No matter that they feel better than they have for years.  The important thing, in their mind, is the stigma associated with having to take a medication that makes them stable. It means that they weren’t stable to begin with.

It will take my friend awhile to come to grips with this new reality.  In fact, she plans to visit another psychiatrist to get another opinion. In the meantime, although she can hope that her diagnosis is wrong, I hope that she will continue to take her mood stabilizer.

Suicide and Mental Illness August 19, 2010

Posted by Crazy Mermaid in Medication, mental illness, Mental Illness and Medication, Psychiatrists, Suicide.
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While at the NAMI Conference this past weekend, I was exposed to the concept of suicide in all its forms except for one.  With the exception of seeing someone actually commit the act in front of me, almost all other aspects were covered in some form by someone or something at the conference.

There was the mother/daughter team that dealt with attempted suicide many times as a symptom of the daughter’s bipolar disorder.  There was the wife who serenaded us about her survival from her husband’s unexpected suicide. There was the daughter whose father committed suicide during the filming of a documentary about him (“Unlisted”).  There was the woman whose son committed suicide (“When Medicine Got It Wrong”).  Suicide was everywhere. There was even a booth addressing the various aspects of suicide, all from the standpoint of the family.

Missing was in-depth coverage of suicide from the perspective of someone who considered it or tried it.  I know these people are around.  I qualify for the first part and know people who qualify for the second part.

Back in July 2008, after I was released from the mental hospital, I had a major relapse of symptoms.  The choice I was given by my psychiatrist was to either return to the mental hospital or go on a drug called Haldol.

Wishing to stay out of the hospital at any cost, I chose the Haldol. I should have had a clue about the task I was to undertake (stopping the psychotic symptoms dead in their tracks) when I had trouble filling the prescription.  The usual dose carried by pharmacies is .5 mg.  My prescription was for 5 mg.  Calling around to various pharmacies, we finally found a Fred Meyer pharmacy that carried the dose I needed.

Taking the pills the second I got in the car, I felt the symptoms subside within hours.  But the prescription said to continue the Haldol beyond the point that the symptoms disappeared.  As I continued the Haldol, I became more emotional, crying at nothing at all.  My husband took me to a very nice restaurant for our 25th wedding anniversary, and I could do nothing but sit across from him and cry. Fortunately it was summertime, so I had an excuse for wearing dark sunglasses. It was a miserable time for both of us.

At around the second week of taking the drug, I got the twinge of a desire to commit suicide. As the days progressed, my desire got stronger. I cried and cried, wanting desperately to end my life.  I spent hours thinking about the method I would use to do it.  That was my sole focus. My guns were gone, confiscated by my dad as a condition of my release from the mental hospital.  I didn’t think I could get away with a knife because someone would stop me.  The same went for pills. I was stymied. I didn’t care one ounce about the people around me, who it would hurt, what kind of a terrible wake it would leave behind me.  None of that mattered.  All that I could focus on was how good it would feel to be dead.

In the meantime, my psychiatrist had given me his emergency telephone number during my first visit with him a month before, with strict instructions to use it to contact him during a crisis. Interestingly enough, I didn’t want to bother him with my crisis. Despite my family begging me to call him, I repeatedly refused to call him to tell him about what was going on.  As I lay there suffering, my family swarmed around me, not knowing what to do.  They were helpless.  They were scared. They wanted to make the emotional pain go away, but they didn’t know how.

Finally, I was persuaded by my husband and sister that this was precisely the condition my doctor meant when he gave me his emergency number. So, after much cajoling, I made that call to my doctor. But he didn’t answer the phone immediately.  So I left him a message, and then I got up from the couch that I had been sitting on and walked around the room.  I felt a little better after having made the call, but I still felt like committing suicide.

Besides imparting the urge to commit suicide, one of the other side effects of Haldol was that it increased my anxiety level. Not able to just sit around and wait for his call, I decided to take a walk.  I thought the activity would be good for me.  My family didn’t know whether to leave me alone while I went on the walk, fearful that I might find a way to commit suicide while I was out.  In the end, they decided to let me go for the walk unaccompanied.  In hindsight, I realize that their decision could have been a huge mistake had I realized that all I had to do to die was to step in front of a moving car.

In the meantime, while I was on my walk, my doctor called. As I wasn’t there to take the call, he talked with my husband instead. He probably did a better job of explaining what was going on, being more objective that I could have been. When I returned from my walk, my husband told me the doctor said to stop the Haldol immediately.  As I discontinued the Haldol, it left my system over a period of days.  As it left my system, my suicide desire gradually left.  But my family couldn’t be sure exactly when I was out of danger, so they continued to swarm around me, trying to assess when the danger was gone.  Finally they satisfied themselves that I was out of danger and life returned to normal.

Having lived through this episode of wanting desperately to commit suicide due to a reaction to a medication, I am convinced that most, if not all, suicides are caused by brain function impairment of some sort.  The brain chemistry of the suicide victim gets messed up, just like mine did.  But the difference is that they aren’t put on “suicide watch” and aren’t under the care of an experienced psychiatrist. Those two things are what saved my life.

Mental Illness and Smoking July 29, 2010

Posted by Crazy Mermaid in Mental Hospital, mental illness, Mental Illness and Medication, Smoking and Mental Illness, Stress.
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Not a smoker myself, I had the luxury of watching the etiquette of cigarette smoking unveiled right before my very eyes as I roamed the small courtyard at our 15 minute cigarette breaks during my three week stay at “Hotel Fairfax”, the mental hospital.

Without the luxury of time afforded their rich brethren with their ready-made cigarettes like Camel and Virginia Slims, the homeless patients- who comprised more than half the mental hospital population- managed to use their ingenuity and creativity to make cigarette rolling into an art form, combining speed and efficiency.  It was fascinating to watch a patient impress his rolling technique with his own personality. Some rollers – mostly men- fancied thick, squatty joint-looking rolls. Others- mostly women- preferred thinner, more ladylike looking cigarettes. Each cigarette had its own distinct look. It was amazing how much variety could be squeezed out of the same ingredients. Who knew that tobacco and rolling paper could be formed into so many individual shapes while still retaining their purpose?

As a nonsmoker, I was initially offended by this dichotomy: serving cancer sticks to the ill seemed morally bankrupt. Later on, I came to understand the stabilizing influence of tobacco. Its anti-anxiety effects became crystal clear to me as I watched the nicotine-deprived mentally ill patients visibly calm down after the administration of a cigarette or two.  Forcing a psychotic patient to suddenly stop smoking was not good medicine, I came to realize. Besides, if the nicotine was looked upon as an anti-anxiety drug, then its administration to a suicidal patient became an action similar to administration of morphine to a cancer patient. Side effects, in other words, are relative.

Watching the daily calming influence of nicotine became a siren call for me to take up smoking, much to my husband’s chagrin.  His daily visits, usually during smoke breaks, were spent watching me learn to roll cigarettes, and then having to listen to my explanation of why I was going to start smoking. To his credit, he neither discouraged nor encouraged me, sensing that any direction whatsoever to a psychotic mentally ill person- especially his wife- would be useless and even counter-productive.

My announcement to the nursing staff of my intention to start smoking was met with less than enthusiasm. The nursing staff, viewing my intentions as simply another manifestation of my mental illness, did everything they could think of to discourage me from lighting up. But the reality was that the same tobacco and rolling paper the homeless used was also available to anyone who wanted to start smoking. Even me.

My anxiety, from the medications as well as the illness, was enormous. Unbearable, even. It was so awful that I would do anything, try anything, to alleviate as much anxiety as I could.  The prospect of dying of lung cancer paled compared to the anxiety of desperately wanting to crawl out of my skin. If smoking would relieve even a small portion of that horrible anxiety, I reasoned, then the price was more than worth it.

While not outrightly engaging in any sort of discriminatory behavior, the nursing staff nevertheless managed to communicate their dislike of smoking, stopping short of suggesting to the smokers that it might be a good time to quit. They realized the very strong stabilizing effect of tobacco on their charges’ psyche. But while they didn’t actively engage in trying to get people to stop smoking, Hell was going to freeze over before they were going to allow a non-smoking patient to take up smoking.

Their first line of defense was to try to reason with me.  Didn’t I realize that the reason the drug (tobacco) calmed people down was because it was a “fix” from the habit of smoking? That it really didn’t alleviate anxiety like the anti-anxiety pills did?

But I wasn’t buying any of their bullshit. They were lying to me.  I was convinced the drug really was like an extra dose of the anti-anxiety pills. Besides, the doctors limited the number of pills we could take, but not the number of cigarettes we could smoke. It was, I believed, like getting an extra dose of Klonopin.  Besides, all my new friends smoked.

In the end, I couldn’t make my mind up whether to start before I was discharged from the hospital. Once out of the smoking environment, I totally forgot about my desire to take up smoking. Besides, the tools- the tobacco, paper, and rolling machine- were no longer at my fingertips.

M medication is stabilized and I no longer have that incredible surge of anxiety through my system…most of the time.  Although I am glad that I never took the habit up, I no longer pass judgment on the smokers of the world.

My Own Voices Return (Again) July 7, 2010

Posted by Crazy Mermaid in Hallucinations, Hearing Voices, mental illness, Mental Illness and Medication.
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My sleep cycle got off a few days ago when we were camping.  I was sleep-deprived more or less when a 1 ½ year old boy belonging to one of the families we were with kept waking up about every 2 hours during the night. Combined with the inconvenience of sleeping in a tent in a strange place, my sleep and my schedule took a severe beating which meant that my stress level increased proportionally.  Not surprisingly, I began hearing voices again.

Although hearing voices would be scary to the average individual, someone like me, who has a history of hearing voices, isn’t frightened by them for several reasons. The first reason is that they’re relatively comfortable- like an old shoe. I’ve had them before, and I will probably have them again.  Secondly, thanks to my wonderful psychiatrist and counselor, I know that with proper treatment they will go away. Just how severe that treatment has to be to get them to leave is the real question.  Can I just reduce the stress and make them go away by myself, or do we need to escalate treatment up to the Haldol level or commitment to the mental hospital level?

Whenever I hear voices, I have an agreement with my family and physician. I must always tell my husband and sister, whether I want to or not. I realize that not telling them is a slippery slope, leading me back to the point where I once again get comfortable with them.  I want to discourage that mindset as soon as it starts to rear its ugly head.

Regardless of my own relative lack of concern, learning that I’m hearing voices again is always scary from my family’s perspective. Besides my family’s fear factor, one of the more unfortunate and upsetting points about hearing voices (for me) is that once again I have to come face to face with the fact that I have a mental illness.

Before the camping trip, I was feeling so good that it was easy to convince myself that I was no longer mentally ill.  Maybe, in fact, I had never really been mentally ill. Maybe it was all a mistake. Based on the relative stability of a couple of weeks or months,  I had convinced myself that I no longer needed any counseling and that soon I would be going off my meds entirely.

But now with this latest episode bringing back the voices, I must once again confront the fact that obviously am not “cured” like I thought I was, and that’s a major disappointment for me.   I really had myself convinced that I wasn’t sick any more.  I believed that I had grown out of my illness (or was misdiagnosed), and that very shortly I would be going back to my old way of living and working.   I thought I didn’t need my medications anymore because I was no longer mentally ill.  Things were going so well before the camping trip vacation that I really thought I had the illness under control and maybe whipped for good.  It was so nice to feel that good, looking forward to an illness-free future.

My latest episode of hearing voices returns me back to the point where once again I have to acknowledge that I have a mental illness and that I have certain limitations in my daily living.  I have to adhere to those restrictions or else I will find myself going back into my old psychotic ways.  Because I took action right away, although the voices came back, they weren’t nearly as loud and dominating as they used to be.  But when they returned, I realized that if I didn’t do something about them (get more sleep and reduce my stress levels as much as possible) the voices would increase in loudness and frequency, and it’s possible that I would find myself hospitalized once again.

And so yesterday afternoon I began my program of doing nothing, and today I continued that program.  The only thing I accomplished today was doing a blog on anosognosia, which is the inability of a person with a mental illness to realize they are ill.  It’s ironic that I did that blog, since I believed based on my own personal lack of symptoms for several weeks that I no longer had a mental illness. Because I had been symptom-free for so long,  I was so sure that I was no longer mentally ill that I was prepared to stop my medication because I believed that I was close to being “cured”.

It’s easy for me to understand how someone with a mental illness can be in denial.  It’s  a lack of symptoms kind of thing.  I think that’s what a lot of people on medication get caught up in.  It’s a logical point: If I take medication and I get better, then I actually get well entirely and no longer need that medication. Therefore, I can discontinue its use and return to my old way of life. It’s a cause and effect thing. No symptoms for a certain amount of time means that I am no longer ill.  It’s such a symptom-driven illness that the absence of the symptoms indicates an absence of the illness itself.

And so, it’s not particularly surprising to learn that roughly 70 percent of people with mental illness stop taking their medication at some point in their life.  We so badly want to be cured that we wish ourselves into being cured.  In my own case, I was really, truly symptom-free for weeks  (which is forever in the mental illness realm).  No voices, not even a hint.  And with a little lack of sleep and stress, a cocktail of mental illness symptoms raised its ugly head.  That fast.

Of course, going off my medication, had I decided to go that route, would have doubtlessly put me back into a severe case of psychosis, bringing me to the point (possibly) of hospitalization.  At the end of the day, I would have returned to a much stronger cocktail of medication designed to make the psychosis, whatever its form, go away, along with the voices that would surely accompany it.  It likely wouldn’t have taken me long to fall back into that abyss of voices and psychosis. And what a horrible thing that would have been to do to my family.  So I’m glad that I had that little episode while camping. It kept me from having bigger problems than just a few voices.

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).

The Cost of Generic Drugs VS Name Brands: Lamictal June 9, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Health Insurance and Mental Illness, Healthcare, Medication, mental illness, Mental Illness and Medication.
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The Cost of Generic Drugs versus Name Brands:  Lamictal

Although first approved by the FDA for treatment of  epileptic seizures in December 1994, Lamictal wasn’t approved for maintenance treatment of Bipolar 1 Disorder until June 2003. The first drug since lithium that was approved for this use, it is also used “off-label” for treatment of schizoaffective disorder, Bipolar II Disorder, borderline personality disorder, and Post-Traumatic Stress Disorder.

I was started on Lamictal in the mental hospital to treat the symptoms of Bipolar I, but my supply of medication ran out about 1 week after I was discharged.  When I got my prescription filled for a 30 day supply of Lamictal, I was shocked beyond belief to learn that the cost for that one month supply of 300 mg  was in the neighborhood of $450, or $5,400  a year.

In July 2008, Teva Manufacturing began offering a generic form of Lamictal in the 150 mg doses that I require.  Previously, it only made 25 mg and 50 mg doses, so it wasn’t practical for me to take 12 pills at a time in order to get the required 300 mg dose. When Teva began making the 150 mg pills in July 2008, it became practical to take two of them to equal my 300 mg dose.  At that point, my insurance company insisted that I change from the name brand Lamictal to the generic lamotrigine.  The cost of my medication was reduced from $450 per month to about $150 per month for 300 mg, or about $1,800 per year- a substantial savings of $3,600 a year,  but still out of the realm of most people’s idea of a bargain.

Now, almost 2 years later, I’m paying $14 for a one month supply, or $168 for a year’s supply of yet another generic form of  lamotrigine, this one manufactured by Cadila (Zydus). This drug is available to me through a mail-order prescription drug company, Medco, which is part of our insurance package. So what happened?  How can a drug cost go from $5,400 per year to $168 per year within a two year period of time?

In one word: generics.

But are they safe?  Are the generic formulas the same as the name-brand formulas?

To answer that question, I went onto the Federal Drug Administration’s website http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079068.htm#Reference%20Listed%20Drug to learn how the generic assessment is done. In a nutshell, the generics are tested on people just like the original brand-name drugs were tested, though the number of people they were tested on isn’t as large.  In the end, the FDA decides whether the test results are good enough to grant the manufacturer of the generic form of the drug approval to sell his drug, and makes that determination available online to the general public. In the case of lamotrigine, each dose, by manufacturer, has been tested and approved by the FDA (see http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm?Appl_No=077633&TABLE1=OB_Rx).

In the final analysis, it’s up to the patient to decide whether the generic brand works as well as the name brand, but according to the FDA, the active ingredients are the same.

Is $450 a month an appropriate amount of money to pay for a medication?  Is it appropriate that the cost of the same medication varied from $5,400 a year to $168 a year within a two year period of time?  Is it any wonder that our health care costs are out of control?