RSN Fundraising Banner
FB Share
Email This Page
add comment

writing for godot

Critical Mental Illness

Print
Written by margiealtman   
Tuesday, 03 May 2016 10:47




Article 3
Pandora’s Black Box of Critical Mental Illnesses Beyond Serious
Schizophrenia, has been considered to be The Black Box within the domain of acute Psychotic Illnesses and this cautionary designation applies to Major Depression and Bipolar disorder. These are the “Serious” Mental Illnesses; so disabling and difficult to treat that individuals who have these disorders live with extremely painful emotional and cognitive symptoms and they are marginalized, criminalized and constantly re-traumatized. Their families are entrapped in cycles of suffering; watching the deterioration, trying to care for and protect their loved ones in an environment that offers little, if any support and often blames them for the illness. Our existing Mental Health System has failed in its societal and moral task of making a range of treatments available. Somewhere, inside of Pandora’s Black Box we will find the causes, and the treatments that are effective but we may also find the persistent barriers of stigma, diversion of funding to more “attractive” causes and misinformation. We will also, find that we need time, targeted research, education, patience and a dedicated focus upon this major issue in our society. These are resources that are scarce in our driven and profit hungry society.
The Key Word is Critical
The urgent message in this article is that the Black Box of Mental Illnesses is not a neatly arranged homogeneous set of illnesses that can be surgically separated into 3 major categories (primarily Schizophrenia, Major Depression, Bipolar Disorder) with specific, distinct symptoms. This, the prevailing view, makes diagnosis via formulaic algorithms fast and easy but ignores an essential issue. For although the illnesses of Schizophrenia, Major Depression and Bipolar Disorder as they are described by the DSM have overlapping characteristics; psychosis, hallucinations, sensory dysfunction, emotional dysregulation, memory and attention dysfunction etc they also and most significantly have different levels of intensity ranging from critical to mild in terms of the degree of impairment for the individual.
For those who are in critical states of Schizophrenia, for example, the individual is vastly impaired, unable to engage in our society, barricaded in back rooms of family homes, avoiding blows by hiding under bunks in jail, sleeping under bridges on our freeways and freezing to death in alleyways. Occasionally, they come to our attention when their paranoia explodes into aggressive behavior or they end their pain in suicide. The symptoms of critical mental illness surpass the serious marker.
Most significantly and relevant at this time when reforms and policies are part of the political and economic conversation is that professionals and other invested individuals is that the most critical levels of mental illness are not being viewed as requiring different kinds of approaches in engagement, treatment and in recovery programs. As we will see in brief descriptions of programs below, the critically mentally ill are consistently left out of the circle of care as are their families.
Families of the Acute/Critically mentally ill have been keen observers of their uniquely intense symptoms and needs for decades and have attempted to bring attention to the reality that these mentally ill loved ones cannot walk into a clinic, cannot ask for help, cannot understand the black box that imprisons them. In their own words we can hear them cry and plead for understanding;

“No one understands like other parents. No one. There is a sense of helplessness, alarm and fear when the person does not respond to your outreach and your efforts are responded to with anger and suspicion. You know something is terribly wrong and at this stage, without information, all you can do is try to make contact and watch the frightening process unfold. He was no longer the boy he knew – the happy-go-lucky child with the black mop of hair who preferred to play with the family's pots and pans than his own toys. He was someone else.”
A Grandmother speaks “As I lay, M hit me again and again in the head, continuing to speak in his strange language. I remember that I raised my hands to shield myself but M continued undeterred: he beat me until my fingers broke and the white bed, the white walls, the white vaulted ceiling were splattered with blood. “
If family reports are insufficient to describe the kind of behavior, thought and emotional expressions that characterize the acute levels of mental illness research is now providing a biological foundation that may explain the different levels of intensity. The Biomarker studies that are emerging from MRI imaging, genetic exploration and other sources reveal that at least 3 levels of intensity that are correlated with functional impairment are identifiable.
People with different biotypes differed in their mix of psychosis-related impairments. For example, cases classified as Biotype 1 showed the most severe impairment in a set of brain functions that the researchers distilled into a construct they call “cognitive control” – the ability to flexibly exert control over attention and information processing to meet one's goals. Biotype 1 cases were also the most socially impaired. Biotype 2 cases showed intermediate levels of impaired cognitive control, but had normal to accentuated brain responses to sensory inputs and fast visual orienting, a set of brain functions called “sensorimotor reactivity” – the ability to detect and process sensory stimuli. Those classified as Biotype 3 showed normal cognitive control, modestly impaired sensorimotor reactivity, were the least socially impaired and had the lowest positive (e.g., hallucinations and delusions) and negative (e.g., blunted emotion) symptoms.
Of the observed biotypes:
• Biotype 1 was the most impaired, according to researchers. Patients demonstrated poor cognition and eye tracking and the most brain tissue damage. All of the usual psychosis diagnoses appeared in Biotype 1, but schizophrenia cases were slightly predominant.
• Biotype 2 demonstrated cognitive impairment, poor eye tracking, and high brain wave response, with patients often rated as overstimulated, hyperactive, or hypersensitive. Biotype 2 had worse scores on mood scales, such as depression and mania.
• Biotype 3 was the least impaired. Subjects had near-normal evaluations of cognition, EEG function, and brain structure and were slightly more likely to be diagnosed with bipolar disorder.
All three biologically driven disease constructs, or biotypes, might be clinically diagnosed as having schizophrenia, schizoaffective, or bipolar disorder.
Current programs and policies are targeting the middle or lower level of “Serious Mental Illnesses” and, while they are much needed, they ignore the critically ill section of population that remains invisible, locked in back rooms of family homes, terrified and terrorizing their loved ones, not taking care of themselves, disorganized and disoriented in time and space….ultimately lost in a corner of the Black Box.
A critically ill person will not voluntarily walk into a community mental health program as described below from SAMSHA
•Recovery is person-driven: Self-determination and self-direction are the
foundations for recovery as individuals define their own life goals and design
their unique path(s) toward those goals. Individuals optimize their autonomy
and independence to the greatest extent possible by leading, controlling, and
exercising choice over the services and supports that assist their recovery
and resilience. In so doing, they are empowered and provided the resources
to make informed decisions, initiate recovery, build on their strengths, and
gain or regain control over their lives.
Peer recovery support services are delivered by people who use lived experience of recovery from mental health and/or substance use, plus skills learned in formal training. These skills may include, but are not limited to, peer mentoring or coaching, recovery resource connecting, support counseling, facilitating and leading recovery groups, and building community to promote mind-body recovery and resiliency. Recovery support is provided through community-based programs by behavioral health care providers, peer providers, family members, friends and social networks, the faith community, and people with experience in recovery. Recovery support services help people enter into and navigate systems of care, remove barriers to recovery, stay engaged in the recovery process, and live full lives in communities of their choice.


In the Los Angeles Jail Systems, the locked psychiatric units and emergency rooms this author has worked with many John and Jane Does who are part of the critically ill segment of the mentally ill population. Their situations and conditions are dire on every level and the things that they lack in their bare existences make a list that is deplorable and inexcusable for our society; John and Jane Doe have no family, no money, no safe place to call home, no understanding about their illness, no identification paperwork, no clean clothes, no food on any regular basis, no medical attention no transportation…..
The things that John and Jane Doe do have are; serious medical problems and infections, terror of being harmed, a history of trauma, a history of incarcerations and hospitalizations, emotional emptiness when they are not terrified, confusion, memory and attention dysfunction, sensory dysfunction, extreme difficulty organizing and communicating thoughts and feelings, command hallucinations, delusions, sometimes a history of self-medication, experiences with being taunted teased and marginalized.
In rather stark contrast U.S News printed “stories” of seriously mentally ill individuals and their “progress” in accessing the Community Mental Health systems in their areas. One such story stands out.
Joe lives with schizophrenia and has been able to access treatment through the Community Mental Health system following a hospitalization. He has been guided and supported by counselors and other resourceful staff members. He is thankful that it has been 15 years since he was homeless. Joe does very well living independently in the community. He is a friendly and quiet neighbor. He sees his doctor and therapist, follows their advice, and takes care of himself. However, despite Joe’s best efforts, he came close to losing his home. Joe’s landlord informed him that his lease would not be renewed.
Minor problems had escalated. A patio door did not shut properly, and in a state of anxiety, Joe irritated his landlord by calling hourly to report it. Joe’s neighbor threw loud parties late at night, and the noise aggravated Joe’s symptoms of schizophrenia and anxiety. Joe called the police several times, which caused tension with the neighbor. A good landlord/tenant relationship deteriorated quickly.
Joe called his Mental Health Center. His advocate listened to his concerns. Joe wanted to stay in his apartment, so the advocate referred him to a housing attorney. The advocate then helped Joe communicate with the landlord. The advocate explained to the landlord that Joe didn’t mean to be a nuisance, but he was responding to symptoms of an illness. The advocate helped Joe understand that he needed to call the landlord less, and they made a list of other ways for Joe to deal with his anxiety. Today Joe has a good relationship with his landlord, and he again enjoys the security of not facing a harsh Minnesota winter without a home.
Hopefully, this work has communicated a plea for consideration of the terribly urgent needs of our critically ill family members and loved ones. There are, in several locations, programs that go out into the community and establish a rapport with the John and Jane Does but these are very limited, “pilot” programs. It takes a great deal of time and patience to establish a trusting relationship with John and Jane Doe but, from this author’s experience, it is very worthwhile. Often they do not ask for or expect extraordinary benefits. Often the touch of a hand and a kind word with a blanket and sandwich makes them unbelievably grateful. Sometimes they will accept bus tokens and come to a clinic just for medical problems at first. Rarely will they bite the hand that feeds and reaches out to them. This, along with drop in centers that offer a cot, a meal and a kind word is another way to bridge the gap and begin a process of humanizing a person who has lost everything and who will respond when given that chance to regain some dignity, identity and hope.
e-max.it: your social media marketing partner
Email This Page

 

THE NEW STREAMLINED RSN LOGIN PROCESS: Register once, then login and you are ready to comment. All you need is a Username and a Password of your choosing and you are free to comment whenever you like! Welcome to the Reader Supported News community.

RSNRSN