Question for those who have been hospitalized for mental illness

Miscellaneous and Personal Stuff I Must Share
1

I know there are a number of people here who have had to deal with mental illness, bipolar, schizophrenia, etc. I was hoping I could get some perspective from you, especially if you have been hospitalized involuntarily.

A couple months ago I served on a jury for the county’s mental health court. The defendant had been diagnosed with bipolar schizoaffective disorder, and was in a locked-down treatment facility. He was petitioning to get out from under the county’s conservatorship and get back out on his own. We had to decide if he was “gravely disabled” which means unable to provide for his own food, clothing and shelter. A key part of this was his plan for how he would provide for his needs and treatment outside of the facility.

The county’s only witness was a forensic psychologist who studied the case files, interviewed the defendant, talked to his treating doctors, family, law enforcement and previous hospitals. His opinion was that the defendant was gravely disabled because he had not yet achieved “insight”. Insight is the patient’s realization and acceptance that they are ill.

Schizoaffective disorder is a lifelong disease that needs constant daily treatment, much like diabetes. A patient who has not achieved insight will deny that they are ill and tend to blame others for their problems.

The defendant had been hospitalized 18 times in the last 2 years, usually for a couple weeks before returning to his parents’ home. He had lived in 2 boarding homes for only a couple months each before leaving due to conflict with the staff or dissatisfaction over the retrictions. The psychologist said he had trouble with anger and impulse control, and the last incident ended with his mother locked in her room fearing for her life. His parents refused to take him back anymore, and he was moved in to the locked facility 2 months before the hearing.

He said that many of the hospitalizations were due to a flaw in the system- once you have a reputation for being “crazy” they are much quicker to lock you up for getting a little bit angry.

His plan for freedom was to live on his own using $1000/mo in social security. He would get an apartment with a roommate somewhere, go to boarding care, or live with his aunt and uncle who said they would take him in. There was a clinic where he had done well before that he would attend and be covered by medicare. When it was mentioned that boarding hadn’t worked, he said he would try to find a place where the staff was more respectful and professional. He hadn’t researched any option for boarding, and didn’t give a definate idea of where he could find an apartment or roomate for $300/mo. His aunt and uncle live in Orange County which is far from the clinic in Pasadena, so he said he would search online for a different clinic closer to them.

We ended up voting to keep him where he was. His plan seemed more like vague intentions, and he didn’t seem motivated to come up with anything concrete since he knew he could just move in with his relatives. He hadn’t even considered the fact that he wouldn’t be able to get to his clinic of choice from there. Every time he had been hospitalized he had walked out as soon as he could and returned to his parents. Since he got locked up and couldn’t walk, he filed the petition as soon as he could with the plan to go to his relatives. It seemed like he was following the same pattern rather than staying and seeing the treatment through. He was doing well after two months of medication, routine and structure. The psychologist said most people need 12-18 months, but he was bright and motivated and would probably only need 9. We suspected he didn’t think he needed the treatment because he was fine, when in fact he was only doing fine because he was in the treatment.

I was wondering if someone here with mental illness has experienced something similar. All we had to go on was the testimony of the psychologist and the testimony of the defendant. We had to decide if he really believed what he was saying to us about understanding his illness, or if he was just telling us what he needed to, to get out. There was no way for us to get the whole story. Even if we couldn’t be sure we made the right decision in regard to the law, we were certain it was the one that was best for him.

2

As somebody on government disability for chronic depression, I’d say you did the right thing. If you can’t admit you’re sick, you generally end up not taking medication, skipping therapy, and crashing badly.

HOWEVER, I do agree with the guy on one point. He was extremely correct when he said that bearing a diagnosis makes it more likely that other people working in the mental health field will believe you are crazy. Some people are convinced that anybody with a PhD or MD can’t be wrong. They accept whatever your file says, regardless of how strongly you object.

When I was hospitalized in the sixth grade, one staffer wrote in my file that I wore two pairs of underwear at all times. Why they thought this, I don’t know. But that bit of data stayed in my file for years. More seriously, I was diagnosed early on as having a schizoid personality. Until, I was old enough to advocate for myself, that misdiagnosis stayed with me. That was at least a decade.

3

Person who has been committed chiming in. I was hospitalised when I experienced my first manic episode (which later was confirmed as being part of having bipolar disorder). I was in a secure hospital for six months, and whilst that sounds like a long time for a good portion of those months I really didn’t have a clue what was going on, and was even maintaining that I was fine. It took quite a while for me to come off the ceiling as the drugs took their effect, but even when I was grounded I was suffering from disordered thinking and not quite with it. Even with six months in hospital on a pretty severe drug regimen I was still not completely well again when I came out.

I’m not going to play amateur psychiatrist and advise on the guy in questions case, but I speak from experience when I say that it’s easy from the point of view of the ill person to think you’re fine when you’re actually extremely unwell, and that in the long run your interests are served better by getting the help than not.

4

Haven’t been in myself, but my then-wife checked herself in (as retaliation against me) while we were married.

If he’s had conflicts with relatives and his mother to the point where she feared for her safety, what chance does he have with maintaining any form of relationship with a roommate? What chance would he have with maintaining any long-term living arrangements, especially a contract based one like an apartment?

5

My uncle is paranoid schizoaffective, and it sounds like his case is similar to the one you reviewed.

My uncle lacks insight into his mental illness, he truly believes that he is being persecuted by the government and or/aliens. He is barely able to live on his own and has been involuntarily hospitalized repeatedly… probably on average at least one per month. He has been state-mandated to receive his injections via medication because he has refused to take his pills and is a danger to others without them. He has had violent outbursts against police officers and mental health workers. He views these acts as self-defense, because he is not mentally ill and is being unfairly persecuted.

That said, my uncle will lie like a dog if he thinks it will get him what he wants. He frequently tells his caseworkers and anyone who might feel sympathetic that he is mentally ill. He reported to his caseworker, in fact, that his family has nothing to do with him and he never sees us or receives financial support from us, when in fact my grandfather visits him at least weekly to take him grocery shopping and makes sure he has what he needs. He uses his mental illness all the time as an excuse why he can’t do things that he most certainly can do (like taking out the garbage, washing his clothes, etc.) In other words, he acknowledges his mental illness when it suits him.

As far as I know, my uncle has always tried to weasel out of work and manipulate people, long before he was diagnosed with this disorder, so I’m not going to comment on whether or not this is characteristic of most schizophrenics. What I will say is that lack of insight is certainly a common feature of the disorder, and generally a person who has been mentally ill for years is not going to suddenly gain this insight. In fact, recent research indicates that early insight (insight before the first psychotic break) is a key preventative factor for full-blown schizophrenia.

I think you made the right choice.

6

I was falsely accused of being suicidal and hospitalized when I refused to take the pill handed to me in the little paper cup after being bought to the institution. I was not told when the pill was, what it was supposed to do and what the side effects were. It took me fourteen hours to get some food and thirty-eight hours to get a toothbrush and toothpaste, but only two hours to get the pink pills, despite my history of addition.

They also questioned that I sleep on a floormat. I’ve yet to find the study that states that people who sleep on floormats are suicidal.

7

Can I just suggest a potential flaw in your survey here? You’re asking for thoughts and opinions from people who have been involuntarily hospitalized, knowing that such people are more likely than not to lack insight into their own mental illness. Your responses are probably going to be somewhat biased.

I know there are a broad range of experiences here, and I’ve known at least a couple of people who were involuntarily committed for very stupid reasons (one girl was hospitalized for commenting that she had gotten into an argument wanted to stab her roommate with a pencil, for example.)

But generally speaking, when you have someone who has been in and out of the hospital as many times as the man in your case, you are well and beyond the ‘‘innocent misunderstandings and assumptions’’ rationale. While the diagnosis might not be perfect, there is probably something pretty serious going on.

FWIW, I was committed myself for a brief hospitalization due to suicidal ideation about seven years ago, but my problem was depression, not psychosis, and I would have volunteered anyway because I feared for my own life. Insight is not something I ever lacked. What I lacked were the tools to recover.

8

Did you ever find out what the pill was?
Floormats are cool. Hell, I frequently sleep on the floor with no mat at all. Good for the back it is.

9

I think they should do it like “To Tell the Truth”. Pick two ringers who have never had a psychiatric diagnosis and aside from them pretending that they, too, have been held in a locked facility the last few weeks, have them answer truthfully about how they would plan for their food shelter and etc if that had been their situation.

(How would YOU do it if YOU were currently unemployed and YOUR current place of residence was YourCounty Mental Hygiene Facility and you had no big savings accounts, no relatives or buddies who’d let you live with them or hire you as a favor? What’s YOUR plan?)

If the jury can’t tell which one is the psychotic from behavior displayed and answers given, psychotic guy gets to walk.
AND… how would a non-delusional person who does have insight who happens to disagree with their diagnosing physician answer questions about their “illness” ? It’s a bit of a Catch-22, isn’t it?

“You must be crazy. You are in HERE, after all”

“Doctors do make mistakes. I think the contents of my head and the patterns of my own behavior are healthy and I do not wish to take psychiatric medications or continue seeing psychiatric professionals.”

“TOLD you you were crazy! See, you lack INSIGHT!”

Any part of that truly sound irrational or delusional to you? If he’d said he was gonna stand in the sunshine and photosynthesize and didn’t need a roof over his head, that would be a different story, but you should not have to sound any MORE sane or MORE rational than the average person in order to not be locked up in a cage as too crazy to be free, don’t you think?

Also, it should not be so damn binary. Outpatient services that include advice and social work assistance in locating domicile and employment should be made available to folks at discharge without them being required to make use of it.

10

Celuxa, an psychotopic drug, or as I now call it “mind-altering.” NOBODY should expect a person to take an unknown drug. 28 years of being drug-free shot to hell.

I refer to this as the Taliban treatment–being locked up, tortured and stoned. And we wonder why we have such a drugged up society.

11

I agree. Asking those that were involuntarily hospitalised compared to those who were voluntarily hospitalised is going to give you a vast difference in responses, IMHO. You would probably get a “closer to reality” version of things from someone who has been in hospital voluntarily or from a carer.

FWIW, I was hospitalised, voluntarily, for 3 months last year for major depression and anxiety - I wan’t psychotic but I was suicidal. I understood my situation and illness completely and knew I needed help and asked for it. There were quite a number of patients that refused to admit they had a problem, let alone acknowledge it as an illness.

12

Actually all the responses I’ve seen thus far seem very well thought out, rational, and come from the heart. Just because someone was hospitalized at one time does not mean they are currently irrational. In fact, going through years of therapy may give someone a lot MORE insight into things than a person who’s “normal” but never thought too much or been in therapy.

13

If it’s not a problem FOR ME, and I’m not violating any laws, YOU don’t get to define MY difference as “an illness” or “a problem”. I’m allowed to like how I am and celebrate it (or ignore it as neither celebration-worthy nor an illness, for that matter).

Incarcerating people involuntarily when they haven’t done anything wrong, on the other hand, IS a problem. A social problem, not one that resides in our neurons.

14

It’s a tough question. Based on this story it sounds like the decision that was made will help this guy make a more stable life for himself in the future. Although I don’t really agree, in principle, with imprisoning even the most mentally ill people against their will, unless they are violent/dangerous or suicidal.

I don’t have bipolar, personality, or schitzoid disorders but I’ve spent forced time in a treatment center for problems I did not and have never had. I did sign myself in, but only because my mother coerced and threatened me into doing so. I was assumed to be delusional/lying by the staff at the facility for the entire time, which was a mindfuck. Also I was exposed to depths of disturbed behavior in the other patients that I had never in my life imagined, much less experienced, which was even more of a mindfuck. Despite never getting a diagnosis that would warrent use of such medications, I was heavily medicated on my arrival with both a strong anti-psychotic (Risperdal) that gave me serious side-effects, and an anti-depressant (Effexor) commonly used to treat bipolar disorder. It took me a year or two after the experience to wean myself off these medications and I felt much better (both physically and mentally) once I was done with them (which took a long time and was unpleasant - Effexor withdrawal is often compared to opiate withdrawal, for some people at least).

At the time my mom decided to put me in the place, I was very depressed and anxious, and wasn’t eating very much due to both. However I was perfectly sane, utterly rational, and wasn’t suicidal, self-destructive, pyschotic, or clinically eating disordered. I was just stuck with a bad family life and was utterly miserable about it, and when I am miserable I can’t eat much. I have always been stick-thin, which is what made everyone assume I was sick in the first place I suppose, although I didn’t and have never had any health problems or issues that would indicate I was malnourished or eating disorderd. At the time my sisters were kids, they would later grow up to be stick-thin as well, we must have got it from my dad’s side of the family (he is adopted).

This is still kind of tough for me to think of and talk about because my doctors, my therapists, my mom and my entire extended family still believe I had and have clinical anorexia (which I never did get a diagnosis for!) and am deluded, and there was a lot of what I can only describe as brainwashing in a few years time to make me think I was ‘sick’ when I am NOT (although I definitely needed some sort of help for the crippling depression/anxiety I was experiencing). Ugh.

The day I got on the road to good mental health was the day I moved away from my abusive mom.

15

The defendant in this case had believed at times that the biblical Jesus was fake because HE was the real Jesus, and had the power to bring God’s wrath upon those who pissed him off. His delusions were such that one could objectively say he was sick. Some of the hospitalizations may have been overreactions as he claimed, but the fact that his parents finally cut him off after 5 years points to there being a real problem.

The challenge was that in the hearing he was quite rational, eloquent, non-psychotic. He had the benefit of several weeks of medication, routine, and counseling. Should someone who has been having delusions be released as soon as the medication has kicked in because at that moment they are “sane”? How do you determine that they have reached the point where they can manage their illness on their own well enough to provide for themselves?

His ability to provide shelter depended on his ability to get along with others. He had difficulty doing that in boarding care, and if he couldn’t live with his own parents then finding roomates through Craigslist or something didn’t promise to be much better. The only difference between his plan and what he had been doing for the last two years was that he intended to live with his aunt and uncle rather than his parents. He had been in the hospital long enough to get points for good behavior, and say and do all of the right things to get out. However he would have filed for the petition very soon after arriving, and that combined with the vagueness of his plan didn’t show much commitment to changing his life.

We felt that if he really wanted to overcome his illness and live his own independent life again, he would do what it takes and see his treatment through. He thought he could handle it on his own, but since that involved mostly doing what he had already been doing, we didn’t see much chance in that working out.

I guess what I am looking for from this thread is, what made the difference for you (or someone you know)? Were you in and out of hospitals, and getting committed against your will? Did you go from that to making a stable life for yourself, holding down a job, maintaining relationships? Insight isn’t just knowing you have a mental illness. The defendant knew what his diagnosis was and understood it. What he seemed to lack was the desire to overcome it, or the understanding of what it was going to take to do it.

16

You might not see your “difference” as an illness or a problem, but it becomes your problem when it isolates you from everyone else. You may be fine thinking you are Jesus and all the customers at your job really do have it in for you, but eventually you will be out of work, and no one will be willing to live with you. Then you will become homeless or supported by the government, which is the social problem that this kind of incarceration is seeking to avoid.

The hope is that the cost of forcing you to get treatment until you are no longer Gravely Disabled (able to maintain your own food, clothing, shelter) will be less than the burden you will place on society as an unstable mentally ill person. If you can be homeless and mentally ill and totally without need of medical care or any other benefit of society, then I guess that’s fine.

17

If you’re going to continue to treat someone as non compos mentis as far as their right to make (the rest of) their own decisions even after the drugs have had their effect, why drug them up to begin with?

“OK we have good news and bad news. The good news is that in our opinion the drugs we shot you up with have made you sane. Maybe you would not have taken them voluntarily but we definitely like the results. The bad news is that your sanity doesn’t count, because it’s just the drugs speaking, so we’re going to keep you locked up as a nutcase.”

18

Wouldn’t lining me and others like me in front of a wall and shooting us be cheaper yet?
Actually, as long as I stay away from psychiatrists and psychiatric drugs, I seem to be self-sustaining. Current status as an unemployed person beside the point. Hmm that IS another point. As an unemployed schizzy I don’t think I’m costing the system any more than the average unemployed NONschizzy.

If you can demonstrate that someone is actually incapable of arranging their own feeding, etc, that they are thorougly incompetent, that’s one thing, but the benefit of the doubt should be in favor of freedom, not in favor of forced treatment or forced anything else.

19

AHunter3, the guy’s mother was in fear for her life.

20

I was in therapy for ten years and was hospitalized once, so yeah, I know. But we’re talking about psychosis here, particularly schizophrenia. It’s a highly biological illness, and can be very difficult to treat, particularly in the United States. And, as mentioned above, lack of ‘‘insight’’ is a very common feature of this particular disorder. One of the reasons it’s so damn hard to treat is because most people who have it don’t believe they have it, or in the very least don’t believe they need medication to treat it.