Gargoyles Over the Abyss

Posted on October 21, 2007 in Psych Wards Stigma

Gareth and I both suffer from bipolar disorder. And the two of us are concerned about the present state of the mental health system from the point of view of people who do not like coercion other than the natural coercion of suffering. Gareth feels that “unwanted, involuntary psychiatric hospitalization really is experienced as being just the same as jail.” I’m a little more open to its use, but in cases when the safety of the person is threatened or the safety of those around them is threatened.

But I think you have to make a pretty good case for it, namely that there is a knife or a gun in the person’s hands or that the person has physically attacked other people. In other words, the person has to be doing more than waving her or his hands wildly or expressing profanity.

I think there is something to this:

I’m talking to people who choose or have chosen to be homeless or psychotic or both, who say they know exactly what they are choosing and it is the situation they prefer (less stressful, familiar, feels better than other ways they have tried).

We should all be able to relate to knowingly taking risks in life. The more freedom, the more risk you can take on. We drive on the freeway. Some people choose to be fire fighters or fighter pilots or sports players or police officers. Some people do really choose to be homeless knowing they could be raped or murdered. Some people also choose to move to neighborhoods full of homeless people and be “urban pioneers.”

Frankly, I think an Atlanta police officer is one of the very last people who should be telling me I should not be free to do things that could get me killed!

It’s no accident that our Vietnam veterans are often among those most comfortable on the streets or at the margins.

Of course the question Gareth needs to answer is “if these people are mentally ill, how can we trust their choices?”

Setting this as a standard, we can’t. But neither can we trust the choice of any of these to seek therapy on their own or to begin taking medication. The country of trust becomes very small when we follow these definitions and the country of distrust a continent. You hear it from both sides. There are those who want to lock every single mentally ill person up and those who want to keep their loved ones out of the hospital lest they become dependent on the State or a bad reflection on their families. The tyrannies facing us come from all quarters and, sometimes, from people who have attached themselves to the patients’ rights movement for reasons that confound recovery.

There’s another point on view, the “non-medical model” that insists that “nearly” all mental illness* is the product of past trauma. Some patient-rights advocates, drunk on the juice of [[Thomas Szasz]], feel that the State should abandon the successful chemical imbalance model altogether. (I think there is evidence to suggest that they’ve never seriously implemented it.) These feel that the issue is trauma. Much of their zealotry is based, probably, on bad experiences with hospitals that take away all your rights the moment they confiscate your shoelaces, that shoot you up with [[Thorazine]], and warehouse you.

You see, many state hospitals have not caught up with the early Twenty-First century, seeing their job as merely keeping patients off the streets.

I’ve been fortunate in that my hospital experience was not like that, but then I went to the best “behavioral health unit” my insurance would pay for, where they combined reasonable doses of medication with talk-therapy. The psychiatrist I visit appreciates that I need both medical and psychological support for my recovery. I’m told that this is rare, but from the experience that I glean from others the problem seems to be the patient choosing one over the other or just not listening to what the psychiatrist or counselor is telling them.

It sucks to suffer. And I relate to those who flail about distrusting the establishment because the world already feels like a cage. Who wants to become a tame animal, collar around his neck after all? I’ve lived on the edge of the abyss, peering down like a gargoyle afraid of his shadow and of the shadow of the planet. More than once I have traced shallow cuts across my skin in suicidal play and once I came close to doing the real thing. I have been haunted by hallucinations of knives that I could not talk into leaving. Years of talk therapy alone and years of medication alone never gave me the stability I needed to live like a man. It’s been the combination that has helped me through the times and raised me to a place of self-satisfaction and reliance.

I have not been shoved into an institution (I chose it myself) but others have, often by panicky families and public officials, people who operated on the basis of the stigma. Bipolar disorder exists, but it is not an excuse for denying any person her or his civil rights. As for the sane, there must be crimes committed before a person can involuntarily lose freedom. Sometimes, I dare say, this must be done. And when it must be done, it should but with choice preserved even in jails. As it is elsewhere in our democratic society, it is through choice that we shed our stone wings and fly steadily.

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*A contemporary two-step used by stealth Szaszians. The implication here is that the meds are always for some person other than the person who doesn’t want to be on meds.