Monday, February 3, 2014

Reflections on the culture around mental illness, including its treatment

Mental health stigma haunts the public discourse in all countries, it would seem. We would rather talk about almost anything else than what to do about mental illness. And we would certainly rather not accept the reality and its implications of the predictions that indicate most families will be affected by mental illness at some time in their history. Individuals do not want to acknowledge their own vulnerability to depression, to distressing thoughts that things will not get better, to their own failures and disappointments and their contribution to those dramas, the story of their family member who was addicted to alcohol, or who attempted or actually accomplished suicide, or who has a mid-life crisis (just another of the euphemisms that we have attached to something that can be life-changing in many ways, both positive and negative.)
It used to be that death was the silent and forbidden subject of polite conversation. And another silent and forbidden subject has been the unexpected pregnancy of a teen  co-ed, many of whom were shipped off to some home somewhat out of town to have the baby. If anyone in the family actually attempted suicide, the good name of the family was tarnished, if not trashed, for generations. Adults who knew the story repeat it whenever something happens that triggers their memory, and so generations of children grow up learning the local history of that family, that includes the man who took his own life, back in .......(fill in the blank with the year of his tragedy).
Rarely, if ever, does the story include how he suffered, how his business or his family life was falling apart, or how he may have sought help from the medical profession, without much more than a prescription for his depression, and another appointment some six months in the future  to ascertain how he is doing. Rarely, too, does the street version of events include his intellectual ability, his creative accomplishments, his un-trumped assistance to many members of that same community.
And rarely, if ever, is there any mention of how the family of the current story-teller attempted to support, guide, walk beside or even comfort the man prior to his eventual death.
It is none of our business, how another person or another family lives, runs the conventional wisdom.
We would only be interfering in something that they have to deal with. If one member of our family were in danger of committing suicide, we would be so ashamed that we certainly would not want someone from across the street or down the street to tell anyone that we were about to suffer a serious tragedy in our family.
What is more, most families are and choose to remain, unaware of any of the signs portending to suicide. We did not see it coming is a phrase that is heard too often following too many incidents in which individuals take their own life. That is because we choose not to anticipate the event. And yet....the signs are growing increasingly large and persistent. Soldiers with post-traumatic stress disorder are returning from combat, and taking their lives, according to published reports, mainly because they are not receiving medical, social and spiritual support following their deployments. And when the issue is raised in the parliament, of course, the government shouts about how much money they have thrown at the issue of mental health for veterans, without acknowledging the more significant fact that that money has not found the professionally accredited hires to fill the spots that the money was supposed to fill.  In Canada, for example, the smoke-screen of closing Veterans Affairs offices across the country, and installing veterans affairs officers in Service Canada offices only serves to mask the reality that psychological and psychiatric, as well as spiritual counsellors simply have not been hired to the level that the current population of veterans requires. So all the public noise, is so much sound and fury signifying nothing, again.
We learned today from reports of a study commissioned by the Heart and Stroke Foundation of Ontario, done by a cardiologist for the foundation, that over half of Ontario residents who have suffered either a heart attack or a stroke fail to adjust their lifestyle to accommodate the changes that would attempt to prevent a second attack. And those who do seem to have significant support from their families to make the needed changes.
If we are failing to adjust to those medical emergencies, image how immune we choose to be and to remain in the face of something that is much less easily documented, and much less easily treated. We all know that a healthy diet and exercise will go a long way to preventing both stroke and heart attacks. We are not educated about the preventive measures that would help ward off mental illness. And what is more, we have a mental health regime that continues to warehouse the most seriously mentally ill among us in places that are governed by rules and regulations that are too often, if not universally, focused on security of staff and not on effective patient treatment and care.
For example, there is a Form 14 in the province of Ontario, used by the psychiatrists who are in charge of admissions to psychiatric wards, that provides the documentation under which the patient will be treated. As a Voluntary Admission, a patient has the right to refuse medications or treatments recommended by the presiding psychiatrist. However, under Form 14, if anyone suspects that a patient is either a danger to others or to him/herself, the psychiatrist can, using the Form 14, a document designed and created by the legal profession, for the protection of the institutions and their staff in which these patients are being treated, can change the designation from Voluntary to Involuntary, and then force the patient to accept whatever treatment is prescribed.
And the trigger incidents under which this Form 14 is applied could be as little as a patient waking to a bad dream and wishing to call his or her spouse, for comfort in the middle of the night and complaining to the night staff when denied. Such complaints whether boisterous or less so, can and do trigger Form 14, for those who have entered under the Voluntary Admission criteria.
Two categories, Voluntary and Involuntary, do not fit the many shades of grey that accompany the various degrees of mental illness, but management, security and the prevention of law suits seem to trump patient care, comfort and family support.
Of course, under particular kinds of distress, different patients will respond to Form 14 changes in their status very differently. As a basic minimum, the public needs to be better educated in the implications of their role, should a member of their family need to be hospitalized in a psychiatric ward, at least in Ontario, and we suspect in many other jurisdictions.
Legal beagles, and their forms, should not be permitted to be the prime source for the drafting of Forms; that process would be much better left to the medical fraternity, whose understanding of their needs, balanced with those of the patient, could easily be transmitted to the legal professionals for their "wording"....
Also, however, if this is the kind of attitude, linked to a highly significant and operative FORM, that prevails among mental health care professionals, then how can we expect the general public to grow a healthy appreciation for the causes, and the preventions of mental illness, as a integral component in our families.
Let's not let this opportunity pass, either, to point a spotlight onto the Canadian culture's addiction to the FORM, as the paper trail for everything we do, in our anal attempt to cover our ass. Whether that FORM, originally based on trees from our forests aplenty morphs into a digital universe, the anal addiction nevertheless remains. And of course, our mere fixation on our need for everyone in every transaction, especially in our public institutions, to commit that transaction to a document (either digital or hard copy) is part of our lack of trust of each other, and our anal anticipation of a law suit. The trail, then, has become, (even if it was not originally intended as such) our defence in the event that our person or our institution is sued.
And we all remember the Hospital for Sick Children case against Susan Nelles, in the death of several babies, decades ago. Restoring trust in our institutions, including our public hospitals, will require much more than our released from our fixation on the FORM, and our obsequious fawning to the legal profession, whose talents are many and varied. The lawyers  must be and remain our agents, not our masters.
It says here that our servitude to such inappropriate masters:
  • the legal profession for the mental health profession,
  • the economist for the political class and the plutocracy,
  • the single parent for the child (she needs the whole village),
  • the newspaper for our intelligent comprehension of the meaning behind our news stories,
  • the internet for our social connections....
  • the "expert" over the generalist, thereby depriving too many situations of the common sense they require
  • the academic over the community-based perceptions, and conclusions
  • the political class for the governance of the city, province or country

these are all signs of our refusal to accept our individual and our collective responsibility for our lives, and for the culture required to generate and sustain healthy lifestyles. While we must wisely continue not seek the guidance and the knowledge of the specialists, we nevertheless have a huge responsibility to sift and filter that "input" with our own "earned" common sense, based on the deep and profound reflections on our unique experiences. And those reflections require a constantly monitored and sustained pipeline both into and out of our public discourse.
And it is not only our health care budgets that will continue to be strained, to the breaking point if we continue our "pedestalling" of the expert, but also our acceptance and understanding of ourselves and our neighbours, especially when tragedy of whatever kind strikes, as we all know it will.
(The trophy wife will know all to well just how insidious is the process of which I write!)

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