Captive Audience

I’ve been thinking a lot the last day or two about being kept locked up. Not in prison, because I’ve never been there, but in a place which some people I know thought of as much like prison – albeit a very well-appointed, well-staffed, expensive prison. the Menninger Clinic.

As I’ve mentioned many times before, I was a guest- voluntarily, as that’s the only kind they take – at Menninger from late February to mid-April of 2013. For 8 weeks, I was on their HOPE unit, which the Menninger Clinic describes, in part, as such: ‘Our program treats some of the most complicated adult patients at Menninger. They often have received multiple diagnoses in a variety of previous settings as well as multiple courses of treatment, both psychotherapeutic and pharmacological.’ (The rest can be found here.) At around (if my math is correct) $18,000 per two weeks, Menninger is not a cheap place to go for treatment – certainly several steps above the acute care facilities I’ve been to. But even a very comfy prison can still be a prison.

Let me be clear – I don’t think Menninger or HOPE was a prison. But I can certainly see why it would feel that way to patients. While we are there voluntarily, once we check in – during which our luggage is gone through for contraband items, such as razors, corded appliances, any kind of personal hygiene product that includes alcohol, and a list of other things – we are essentially a captive audience. There are no door knobs or handles; all the doors patients can access are push-to-open. The sinks in the room are motion-activated, so there are no knobs to remove. Patients are accounted for every half-hour, and so there is no way to lock doors to patient rooms. These are all precautions to keep a patient from hurting themselves or others. Oh, and patients are only allowed in their own rooms – nobody is ever allowed in another patient’s room. There are two locked doors between the patient area and the unit exit, which patients only go through on the way to meals, and if they go to various patient activities (gym, crafts) or AA/NA meetings – all of which are supervised by staff, of course.. Aside from that, the only taste of being outside patients get is the smoking terrace, a small (maybe 300 square feet) walled-in (with 10-foot walls) area outside, with grass, some lounge chairs, and partial shade if it rains where the smokers – and there are many – go between groups.

Patients don’t have their own phones; they are issued very simple cell phones, with no cameras, while they are at Menninger. And if you don’t write down a list of people you might want to contact, you’re out of luck – your phone is locked up until you leave, barring special circumstances. There is computer access, but only at certain hours, and there are up to 24 patients trying to use three PCs – which are restricted from accessing any kind of social networking or adult website. Patients work on Levels of Responsibility, or LOR – starting at 1 when they arrive, meaning they can’t go out on the few weekend excursions – up to three hours a day on Friday night and Saturday,and necessities shopping (at Wal-Mart or Target) Sunday mornings. If patients act up, break rules, refuse to attend groups, they lose privileges, and can even be restricted (especially in the staff thinks they are a danger to themselves or others) to One-to-One, meaning a staff member is with them at all times, they never leave the unit for any non-medical reason (so no activities or meals, so they have to hope the staff brings back something edible), and they get their presence registered every 15 minutes, instead of every 30.

Now, there are ways out – if you decide you want out early, you just have to tell the staff, fill out a form, and wait 3 hours – to let you calm down in case you try to do something dramatic while highly emotional – but there are no refunds; any money you pay stays. But otherwise, you are kept in a highly restricted area, with limited choices on what to wear, what to do, what to eat, who to talk to, and basically no options on where you can go. The staff at Menninger is top-notch, and I remember all the people I interacted with – from the resident MD, to my psychiatrist, therapist, and social worker, to the nurses and MHAs – fondly; I’m not saying any of this because I felt like I was there against my will. On the contrary, it changed my life for the better, and in a massive way. But for some people who were essentially told by family members that it was Menninger, or a long-term asylum, it was still very much like living in captivity. And I was also lucky in that I generally enjoyed the company of my fellow peers on the unit – I know others, who were in before and after me, who found themselves lost and often worried or scared by their fellow patients, which made it hard to open up to others and talk about their problems, something which impedes treatment significantly. 

These things may not sound like much hardship to others – after all, there was good food, nice beds, generally friendly people. It’s a lot better than prison, and many steps above the average acute care facility. But because of suffering from mental illness, we have to be essentially confined for long periods of our treatment – how many other people with non-infectious medical problems can say that? And that doesn’t even consider the treatment at less-well-appointed treatment centers; the VA hospital that Eric Arauz describes in his book, An American’s Resurrection, sounds not too far removed from something out of One Flew Over The Cuckoo’s Nest – and Arauz’s story is real. And even that is nothing compared to the terrifying experience it must be to be both homeless and mentally ill, which MentalIllnessPolicy.org estimated included some 250,000 people back in 2007. 

We’re already often captives inside our own minds; it’s sad that to get treatment we have to be held physically, as well.

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Acceptance

My therapist recently recommended that I check out a book by a speaker he had recently heard, a man named Eric Arauz. His book is called An American’s Resurrection: My Pilgrimage from Child Abuse and Mental Illness to Salvation. I couldn’t find it in physical form, but luckily, it was available as an e-book. It’s one of the few books on mental illness that I’ve read, or started to read, that is from the perspective of someone who has mental illness; most are just books on research, what is known thus far about various mental illnesses, and generally somewhat academic topics like that. I’ve really only just started the book, but I’ve already gotten to a point where I feel he’s got some important things to say; they are things that I have mentioned before, but they can always use more air-time.

I think the most important thing he has mentioned so far is the idea of acceptance. Once you are diagnosed with a mental illness, accepting this as the truth can take a while. But acceptance is one of the things that has to happen. There’s really no way around it. If you don’t accept that you have an illness, then getting the right treatment is going to be impossible. I’ve seen people who didn’t want to accept that they had an illness, or who felt that they were able to handle their illness on their own, without outside help. But dealing with mental illness is different than relying on your immune system to power through an illness. For one, mental illnesses don’t go away; they can’t be cured, just managed. And for another, when you decide that you can handle your illness on your own, you are essentially using a compromised mind to fix itself.

Accepting that treatment is necessary is one of the most important parts of treatment, because without it, you aren’t going to get anywhere.It took me years to figure that out, because while I knew I had clinical depression, I never accepted it. I thought that if somehow, I could ignore it, it might go away. It’s a foolish thought, but then those are what you get when one part of your mind is working against the rest. But Acceptance is the key; without it, you are stuck fighting a battle that you can’t win.

It isn’t just acceptance of one’s illness that is important, though. That’s the first step, but it is also important to accept help. If your mind is compromised, then you have to rely, to some extent, on the minds and aid of others. The others don’t even have to be mentally uncompromised themselves; I have found that some of the best aid and advice I have received has come from friends who have their own mental issues to deal with. But help is necessary, whether it comes in the form of medication, therapy, other treatments (like TMS or ECT), or even just being able to tell other people about what is going on I’ve seen books at the bookstore I work at with titles like The Depression Cure, or other things that imply that a person can cure themselves of a mental illness with no outside help besides the techniques learned in a book. That is dangerous, and untrue – there is no cure for depression, like there is no cure for any mental illness; believing in a miracle cure is more likely to kill you than do anything to help.

Acceptance can help you get to a point where you can manage your illness. I know that my symptoms abate when I take my medication, and that I often feel a significant lessening of emotional stress, and when these things are managed, I find that my decision-making ability – something that is significantly compromised when my symptoms are untreated, leading to things like my suicide attempts – is clear, and I feel more like the person I was before I was diagnosed. It is this managing of my illness that will hopefully help me to dodge an unfortunate reality of mental illness, something noted by Mr. Arauz: “The population of people with serious mental illness die fifteen to twenty-five years earlier than the average American according to the National Association of State Mental Health Program Directors (NASMHPD).”

Like I said, I’m just getting into this book – that quote is from the end of Chapter 2, for instance – but I expect that as I progress through the book, I’ll find a lot more of interest. I can already see why my therapist would recommend this book. I just thought this was important to get out there.