Jammin' It Down Your Throat

Now, you may find this very amusing. I know I do. Did you know that I was a psychiatric technician from 1973 to 1982? Yeah. I worked at a county institution, mostly because in 1973 I had a 4-year-old and a 1-year-old who needed their mommy during the day, so I worked the evening shift while my husband watched them.

No "it takes one to know one" jokes. Even though it's true. I began on the med/surg ward, worked there for about a year, learned to pour medication, give subcutaneous and intramuscular injections (nonprofessionals could do this in New Jersey at that time), and learned firsthand about death and insanity. The things I saw are forever a part of my consciousness and I hope I never forget them.

When I transferred to the short-term 30-day crisis intervention ward, it was there that I met people who were manic depressive. Amazing people, too. An opera singer, a sculptor, a writer, several seductive drug addicts who had immense charm and an unbelievable capacity for self-destruction. All of them brilliant and all of them in the desperate throes of the disorder. We'd all sit and talk for hours. I was their caretaker but they became my friends too. Little did I realize that we had an awful lot in common.

Their mania or depression very often triggered mine, although I was too lost in maintaining bare survival to recognize my own illness. And what was worse? A friend from high school, Becky, was brought into the ward screaming, out of control, trying to climb the barred windows. She was placed in seclusion immediately. And committed. Because I knew her, I was recused from caring for her. But I watched helplessly as she disintegrated mentally. It took five months of commitment before Becky was more or less stabilized. Mostly less but they let her out.

Back then, commitment was fairly simple. You went to your commitment hearing and two doctors had to pronounce you a danger to yourself or others in front of a judge. Then you got the old 60-day commitment order. You couldn't leave and you were forced to take the medication, even if it had to be administered via a shot in the butt.

Then came the public advocates and everything changed. Not for the better, either. Patients now had rights. They could refuse treatment, no matter what. So began the deinstitutionalization of our mental health hospitals. And out the patients went, all too often with no place to go, since their families were sick of dealing with them.

The question then and the question now is, when you are that mentally ill, do you have the right to refuse treatment?

This is a terribly hard moral dilemma. On the one hand, people with manic depression or schizophrenia can be helped with medication. On the other hand, forcing people to swallow pills and spend their days in straight jackets so they won't harm themselves seems to be enormously cruel.

It's not. As someone who has been off the wall crazy and shoved into a hospital against her will, I honestly thank God that I was forced to face my disorder and deal with it. Trust me, I was a hard sell. Maybe in my next post I'll tell you the story. It's in its way funny but also dead-on serious.

I was close to commitment but they didn't go through with it because in actuality, I was not suicidal but rather having suicidal ideations. Now, sometimes those can lead to the real thing but my history was ideations rather than actions, so they let me off the hook. To a point. I wanted to sign myself out but the doctor informed me that if I went out AMA (against medical advice), he'd get me commited. Yikes. I stayed.

When your sense of mental balance is so incredibly warped and out of control, you can't be capable of making sane decisions. Your brain is fucked up. You need someone to support you and maybe sit on you so that you take your meds and do what you need to do to get better.

This doesn't work in many cases. Trying to force someone who's off the wall to take meds is frequently a no-win deal for both sides. But I do believe that anyone that sick can't help themselves. I know I couldn't, when I was at that point. I will be forever grateful to that doctor at Fair Oaks who didn't give into me and made me take what I needed and face my demons.

Incidentally, I saw my high school friend Becky at my 40th reunion last weekend. I could have cried. She barely recognized me and I could see the madness in her eyes. Her hair was done in weird little braids, she wore a dress that was somewhat strange, and a mutual friend of ours, who is a nurse, was staying with her the whole evening. Lisa, the nurse, told me that Becky was very fragile and she was afraid that Becky might act out. She didn't but I could tell she was agitated.

It was then that I realized what I've probably known all along. There are striking degrees of manic depression. Even though I am diagnosed as bipolar I, I am what is known as a high-functioning manic depressive. I haven't been back to the hospital since that time, through the grace of God. I am blessed. I can function, even though it's a daily battle. Becky cannot. And clearly, all the commitments she went through, all the medication she's taken over the years, have brought her scant relief. I grieve for those for whom nothing works. But I don't know if commitment is the right answer or not.