Over and Over

The sad truth is that mental illness is the bastard stepchild of medical policy as seen by federal, state and even local governments. They seem to treat all mental illness as either laziness, addiction or a weakness of character while not realizing that many people who are lazy, addicted or weak of character are not mentally ill. They are simply lazy, addicted or weak.

Some are mentally ill, though. Their behavior is a symptom of the greater illness they suffer from. It’s not the cause. And for those people, getting treatment is almost impossible. Even if they want it.

Not long after I met Shannon, I found out about his history of mental illness, something that a psychiatrist who had known him since childhood and has become a dear friend to me told me about very bluntly. Shannon was in never-never land, ranting and raving and yelling and screaming, but he wasn’t a danger to himself or anyone else, so our friend told me, “Let’s go run an errand. You have an errand, don’t you?”

Before we got to the end of the block he told me the brutal, honest truth: Shannon was bipolar and had been all his life, but wouldn’t accept the diagnosis. I let out a sigh of relief, as I remember, because I finally had a name for what was going on. I knew there had to be a reason, but giving it a name made it much easier to deal with.

We got back from my “errand”, and I managed to get Shannon calm enough to sleep, and when he woke up a few hours later, he didn’t really remember much of what had happened. Our friend had already gone, and Shannon only vaguely remembered that he’d been there.

That’s when I told him that he was mentally ill and needed help of some sort. He resisted at first. He said people had been saying that for years, but he didn’t believe them. When I started pointing out the psycho things he’d done since I had known him, he started to come round.

I told him it wasn’t weakness, laziness or anything other than a health issue. One that he needed treatment for. That I’d had my own bouts with it, and that it’s real. I knew it was real. I told him about the time I found myself curled up in almost a fetal position at the end of a hall in college crying for no reason I could name. About planning my suicide.

I have an aversion to guns in general, and knives hurt, so I had chosen pills as my preferred method of self-euthanasia. And I certainly wasn’t going to set myself on fire. I was going to take an overdose of something and go to sleep.

For whatever reason, he listened to me after ignoring so many other people. He admitted that he might have an illness. Maybe it was the way I framed the discussion as purely health-related. Or that I told him my own history.

I don’t know. But he agreed to try to find help.

That’s when the fun began.

We quickly found out that there are few to none inexpensive options for treating mentally ill adults in our area. Even though we lived in a very liberal, open city, there are almost no mental health services available for less than $100/hr. Even when he got SSI, there were still almost none.

Then he applied for and got Veterans’ coverage based on his short stint in the Navy decades ago. It turns out that the VA has the biggest mental health business in town. It’s about the only place to find help if $100/hr. is too rich for your blood. They have an income-based fee schedule, and the expensive medication he needed suddenly became affordable. Shannon paid very little at first, and then nothing later on.

But he got the counseling and medication he needed to keep him sane. Finally. After years of denial, then acceptance and then being hit with roadblock after roadblock, he could be happy.

People wonder why the Tucson shooter didn’t get help or why someone didn’t intervene. It probably wouldn’t have mattered unless Tucson is very different than Austin. I’m in a larger metropolitan area, but at any given time, there are precious few beds available for mentally ill patients.

When Shannon had a couple of breakdowns, they put him in the CCU of a local hospital that had 1 mental health professional (a psychologist) on hand. There weren’t any beds at the psychiatric hospital, and it was not equipped to deal with his other health problems, anyway. He wasn’t healthy enough to go to the psychiatric facility, and the CCU had no real resources to deal with a mentally ill patient.

The one time he got into the psychiatric hospital, he ended up back at the other hospital because the psych folks neglected to get him his meds. I told him that I’d take care of him from there on out. And I did.

It meant wrestling him down and getting him to take a blood pressure pill and a sleeping pill, literally forcing them down his throat and holding his mouth closed so he wouldn’t spit them out because he was hallucinating. He always came back to the scenario where someone was trying to poison him. Once I got the pills down him, he was okay.

That’s the state of mental health care in the most open and liberal city in Texas. It’s okay to be gay and it’s okay to have any handicap other than mental illness. There are no readily available resources for people that don’t either know or want to admit that they’re mentally ill, much less the ones who realize it and want help. As if they would even be able to function on a high enough level to know how to find where to go for what little help there is or navigate the system once they found it.

Most mentally ill people lose the capacity to make the rational judgments that would lead them to seek care. And even in progressive communities, mental illness is still stigmatized, so there is an over-riding social pressure to pretend it’s not there. To pretend it’s not real.

I got up one morning and realized that Shannon hadn’t moved from the spot on the couch where he’d been when I went to bed the night before. He was staring blankly into space. I asked him if he knew where he was. He shook his head “no”. I asked if he knew who I was, and he shook his head “no” again. Then I asked him if he knew who he was. When he shook his “no” again, I knew we were in for a long day.

I assumed custodianship of his illness early on in our relationship and did my best to see that he had appropriate care and was treated with respect, even when he didn’t know who he was. Most mentally ill people don’t have that kind of an advocate. They simply wander through life alone.

And people don’t like to talk about it. It’s too dark and too scary a topic for most. They’d rather talk about cancer or drug addiction, two conditions that have lost the stigma that mental illness still carries. No one makes a conscious choice to get a tumor or become an addict, but neither does one make a choice to be mentally ill. They all suck, and no one would take any of them on voluntarily.

Until the stigma goes away and people talk about mental illness the same way they talk about lymphoma or rehab, Tucson will happen again, over and over. Until people realize that they have to intervene and take care of those they love, even when the one they love protests, it will happen again. Until there is widely available and adequate treatment, it will happen again.

Over and over.