Columns

This essay describes some of my love-hate relationship with the mental health treatment system and with the idea of medication compliance. Those who may have followed some of my writings might see a contrast in attitudes in which I often harshly criticize mental health caregivers and providers of psychiatric medication, and in which on the other hand I often argue in favor of medication compliance and cooperating with treatment professionals.  

Mental illness is a complex issue that requires complex thought. If one sees things in oversimplified thinking, it is easy to become polarized and, on the one hand, to be antipsychiatry, or, on the other hand, to believe that mental health caregivers can do no wrong. I believe mental illness exists and must be addressed with treatment. But that doesn’t change the fact of mistreatment in the mental health treatment systems and in society.  

The quality of care that is available depends distinctly on which mental health caregiver you are dealing with. Caregivers are in a position of authority. Some handle this power very well while others misuse it. Some of the maltreatment that people with mental illness receive in the system is subtle. Sometimes it seems to consist of badly executed good concepts.  

Getting "under the hood" of someone's psyche and not giving them exactly what they need can cause damage. For example, some therapeutic theory believes that a patient should open up all of those areas of suppressed emotion, experience the emotions at full power, and (hypothetically) release them. However, this theory doesn't work for a lot of people, and sometimes makes people's condition worse. When professionals believe they know a patient's needs better than does the patient, and then get forceful about it, it is often a form of therapeutic abuse.  

Persons with mental illness usually can not survive without treatment. However, some of this "treatment" consists of mind-numbing medication that resembles a chemical straitjacket. This medication is given or often forced on people without any alternatives offered.  

In a typical outpatient mental health treatment venue, the "clients" might be made to use a different restroom from the staff, they might have to use a different coffeepot, and a different water machine. There exists a line of separation.  

I believe there is some truth to the idea that mental illness is usually a medical type of problem with physical causes. Based on that, it makes a lot of sense to medicate people. Yet this doesn't make it any easier for us to tolerate psychiatric medications, many of which inherently create physical and mental suffering.  

I do not advocate noncompliance. I've lived among persons with mental illness for in excess of thirty years. Whenever I have seen someone become noncompliant, soon after, I have seen such a person relapse, behave psychotically, and get 5150'd. If you attribute this to the backlash of withdrawing from antipsychotic medication, it doesn't alter the fact that the individual has become acutely ill, has consequently sustained brain damage, and has lost his or her liberty.  

Prior to the invention of the first primitive psychiatric drugs, people with mental illness spent their lives locked away in "insane asylums." Or perhaps they became the "town drunk" or the "town idiot." Or perhaps the mentally ill person was unable to survive. The invention of psychiatric medication was largely a good thing for those who suffer from mental illness.  

In the past fifteen or more years, most of the treatment given to me has been caring and helpful. I currently go to a treatment venue where, for the most part, I have been respected and helped. In recent times, the worst I have been subject to is a little bit of condescension or maybe some incompetent counseling from trainees. When I requested to switch counselors, I was usually accommodated.  

It is also possible that I am getting the red carpet treatment because of being a mental health columnist.  

I admit that my paranoia is a factor in how I perceive mental health professionals. I know that back in the 1980's and even the 1990's, I experienced some real mistreatment. Part of what we are dealing with in present day is the economic, vocational and social discrimination of being a second-class citizen. This is a problem of society in general and is not limited to places where we go to get treatment.  

To summarize, I am not happy with how persons with mental illness are dealt with, but I still believe mental illnesses are usually biologically based, and this entails medical type treatment.