following two stories involve families that are well-to-do. They have the means to go to the best clinics, hospitals and private practitioners available in the world. Most people do not have these privileges due to lack of financial means,; therefore, there is little is available to them for assistance except what is offered for free by governments’ welfare systems: psychiatric medication only.
1. Caught in the System: Low Functioning
(Names in this story are fictitious in order to protect the privacy of the people involved, but the story is an exact retelling of real circumstances.)
Sylvia is the youngest of 7 children, and although the family was not well to do in the early years of her life, Sylvia’s demands were always considered first. She generally got what she wanted as a child. When Sylvia was 18, she was diagnosed as schizophrenic and later as bipolar. She is now 56 years old. For thirty years, she has been taking a phenothiazine called fluphenazine”, or Prolixin. This is used to reduce psychotic symptoms in schizophrenia, as well as to reduce the acute manic phases of bipolar disorder.
Sylvia is under the care of her sister, Ann, a highly successful, wealthy businesswoman, aged 58, who worked closely with the mentally ill for two years before going into business. Ann chose to place Sylvia in a low-income apartment building close to Ann’s home, where Sylvia can walk to her psychiatrist and group therapy, as well as the bank and market. However, Sylvia is not able to follow the simple rules of the house, and her habits of being half-dressed in public places, and being abrasive and belligerent to others in the building may lead to her being evicted soon.
Sylvia says she stopped drinking alcohol 15 years ago, but Ann believes she continues to drink vodka regularly, and it’s her mixing alcohol with psychiatric medications that causes the hallucinations. “She knows how to take herself right to the edge, and she does it every day,” Anne told me, exasperated with how consistently Sylvia seems to take pleasure in disempowering herself, not taking any responsibility for herself, and manipulating others to care for her without regard to how that caring impacts their lives.
Thinking that it might be the drugs that kept Sylvia in this state, Anne asked the doctor, “What would happen if you weaned her off the drugs?” The doctor ushered her into a room to view a patient with severe tics and tremors to illustrate what Sylvia would be left with as the effects of taking the drug for 30 years and then stopping. Ann was horrified.
According to Ann, the conventional treatments of our mental health-care system only mask the symptoms of schizophrenia. Everyone with psychotic symptoms is given the same treatment, and the mental healthcare system seems incapable of treating each person as an individual, let alone addressing the spiritual nature of their situation.
In a way this supports patients not taking responsibility for themselves. They continue to be self-indulgent and self-absorbed, unable to relate to the needs of others or to the way their emotions or behaviors are impacting others.
My sister likes to be medicated. All she can do then is sit with an open mouth, drooling. She doesn’t have to face the world. She doesn’t have to function.
In group therapy Sylvia doesn’t tell the truth. She is constantly manipulating the system, manipulating others to get what she wants. It’s all about her and she’s very smart at using her intelligence to get what she wants.
The only way to get her to do something is when she understands the consequences that her actions or non-actions will have and understands that people will not always bail her out. But, our system continues to give her what she says she wants: medication to help her escape and remain self-indulgent.
Sylvia doesn’t appear to want to take care of herself, or help herself. She seems to want to ruin her own life. She also seems to have a crisis whenever I am about to celebrate something big: a wedding, a grandchild being born, etc. If she lived with me and my family, our life would be in chaos. But, it’s really hard for me to institutionalize her in a state hospital. Our family is used to taking care of each other…but, I wonder always how I may be enabling her illness by making things easy for her.
I know if Sylvia was alone, our system would institutionalize her in a locked ward, or leave her on the streets with minimal care. As it is, her life will likely be cut short by a drug overdose and/or her unhealthy habits, like smoking, eating poorly, and never exercising. It’s just a horrible situation.
Ideally, she would be treated as an individual and would be encouraged to be responsible for her actions and their consequences. Instead she is treated as a passive victim, and she continues to not take responsibility for herself or her actions, and to be insensitive to others and their needs.
I’ve come to believe that the common denominator in the seriously mentally ill is that there is nothing else in their worlds but themselves. They need to be put in a situation they can manage where they are sometimes attending to others: dogs, kids, someone else. They need to perceive that there is something greater than themselves, including what we call God or Spirit. Indulging them by helping them escape the world into themselves, into being passive, is not helping them to heal and it creates more dependency on the governmental welfare system, too.
I feel sure there is a better way than this. We have to get to the roots of what caused the self-destructive behavior in the first place. This means really treating each person as an individual. Next, we have to encourage self-responsibility and actions to assist others.”
2. Creating a Better System: High Functioning
Sascha Altman DuBrul (his real name) wrote his personal story of “The Bipolar World,” published in the San Francisco Bay Guardian in September 2002. It was published again in 2004 in Navigating the Space Between Brilliance and Madness: A Reader and Roadmap of Bipolar Worlds, edited by The Icarus Project. I met Sascha in 2008 and was impressed by how articulate he was, as well as his willingness to take a position of leadership in creating supportive community for those diagnosed with mental illness.
Sascha’s family considered him a highly sensitive youngster, maybe even too sensitive for his own good. Like Sylvia, he was first diagnosed with mental illness at age 18. He had not slept for months and had delusions and hallucinations. The symptoms of this manic state were first caused by an allergic reaction to penicillin that was supposed to be relieved by another prescription for prednisone, a steroid that he dutifully took on the advice of his physician.
Watching his struggle with the mania, his mother took Sascha to a hospital where, after observation, the attending psychiatrist diagnosed him with bipolar disorder. He was given another drug, Depakote, to stabilize his moods, and they were told Sascha would be managing this mental illness for the rest of his life.
Six years later, in 1999, he ended up returning to the same program, being diagnosed with schizoaffective disorder. This time he was given an antidepressant called Celexa (citalopram) and an antipsychotic called Zyprexa (olanzapine). Within a few weeks he began working at an organic farm, and eventually moved there—sowing seeds and taking care of plants. The drugs worked and afforded him some stability, but he didn’t like being dependent on them for his sense of wellbeing. He moved again after a few months.
In 2001, he was again put in a psychiatric unit as a result of destructive behavior in the streets of Los Angeles. He said, “I was convinced that the world had ended, and I was the center of the universe before they picked me up…[After I was apprehended] I spent the next month locked up in the LA County Jail.” This time he was again diagnosed with “bipolar disorder” and given medication. After being released, he spent
