On the Bus

All of us either have some form of mental illness, or know someone else who does. Are we crazy? Are we different from normal people?

Almost everybody knows someone with a mental illness. It is unfortunately all too common. Crazy and normal are really a poor choices of words. Healthy and ill are better choices. But even then they are variable terms. A person can have a broken leg and still be healthy. Likewise, a person can have diabetes or even cancer and still be considered healthy. Conversely, a person can have the common cold and be terribly ill!

The question that all of us have asked ourselves is, “Why me?” Why are we ill and others are healthy? Why do we have these thoughts that make us say and do the things we do?

Something happened to each of us, something not very good. Yet these same things happen to other people, and they do not become mentally ill. Or at least they do not let it affect their lives.

There is a body of evidence that abusive and dysfunctional homes are not the cause of mental illness. I have no idea how they came to that conclusion, but try explaining that to someone who has lived that experience! Yet some people do survive this kind of experience and go on the lead happy, healthy, and successful lives. They must represent a statistical majority, although I have met very few people that can say they are one of them!

There is obviously a biochemical component to mental illness. Adding certain chemicals and using other chemicals to impede or enhance our body’s own chemicals do make a difference in how we think, act, and feel. For some people, some of these chemicals work very well, for some, with varying degrees, and others, not at all!

There is considerable research into the genetic component of mental illness. In wild animals, where most of their behaviors are instinctive, almost all of these behaviors are genetically encoded. Many of these encoded behaviors lie dormant until environmental conditions predicate that they engage. We do not like to think of ourselves on the same level as the animal world, but we most certainly are. We also must certainly have genetically encoded instincts and behaviors that become triggered by environmental conditions. Many of the selective pressures under which our ancestors have evolved have diminished in importance to our survival. From a purely parochial scientific viewpoint, many people who would not have survived under the old pressures have survived to produce offspring. Much of this encoded information may have been intensified, altered, diminished, or out bred altogether!

All of us, as children, imprint upon our parents. We speak the same language and use the same inflections. We learn to act like them in many ways. Maybe for a child growing up with a mentally ill parent, mental illness may be a learned behavior!

But! But! But! Normal people have all these same things, what makes them different and why cant I be like them? Normal is a setting on the dryer or air conditioner. Considering that there is an estimated 40 million undiagnosed and untreated mentally ill in this country, and the World Health Organization believes that mental illness is the worlds number one public health problem, there may not be anything such as normal! Much like flu or the common cold, even the healthiest person can have a “touch” of mental illness, and then it goes away. It doesn’t have to be forever

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For those of you who have not heard my mantra before, here it is again; “mental illness can be treated, managed, and controlled. Mentally ill people can lead happy and successful lives.” Essentially, they can become normal. Maybe the “normies”, unlike us, do not have to go to a doctor or therapist to learn to do these things. They devise their own strategies for dealing with their symptoms. When something doesn’t work, they try something else. They never give up!

Maybe we aren’t so different after all!

See you on the bus!

Most of us who have suffered from, and have been treated for mental illness will empathize for the stories main character, Virginia Stewart Cunningham. Hopefully, the author, Mary Jane Ward, did some actual research on mental illness and it’s treatment before writing the book (1946), that was then made into a movie in 1948. We all can hope that things certainly were not actually that bad in mental hospitals of the time. But the film was so emotionally powerful that it change peoples attitude about the treatment of the mentally ill.

The Wards are numbered by the severity of the illness, lower numbers being the better patients, higher numbers being the more severe. At the time, she is housed in ward three. All of the patients are pretty disassociative, and even in ward one, are still fairly delusional. Patients within a ward are all together, even at night, and are not separated from one another. The facility itself is dark and dank. It has bare brick walls and is very prison like. The film is in black and white and this adds to the effect.

The first scene in the movie, Virginia is sitting on a park bench and hearing voices. She has actually been in the institution for five months and has no recollection of that time or the events that brought her there. Virginia is unsure of who and where she is, and is unable to have a coherent conversation with her doctor. He decides on electroshock therapy, of which Virginia gets several treatments. The break through comes when she realizes that she is ill and in an institution. She does however, slip back and forth between reality and delusion, and displays extreme anxiety over minor issues.

The doctor then tries a drug induced hypnotic regression. Oddly, this was the only time during the film that any medications were administered. (I can only assume, that in 1948, drug therapy for mental illness consisted of a sub-lethal dose of barbiturates!) During this regression, the doctor finds some Freudian issues dealing with her ability to have a relationship with her husband, treats her based on that premise.

Another issue dealt with in the film is the nursing staff. The nurses complain that they have too many patients to deal with. They have an “I am doing my job“ attitude, “behave and follow the rules!” they are generally uncompassionate toward the plight of the patients. In one case, the charge nurse schedule Virginia for another shock treatment even though the doctor has has not ordered it, having failed to even look at the patients chart! In another case, this attitude causes Virginia to have an extreme anxiety attack which the nurses responded to by putting her in a straight jacket and shipping her off to ward 33! The role models for Nurse Cratchet in “Cukoo’s Nest.”

In ward 33, Virginia has an epiphany. Surround by the extremely ill, she realizes that she is one of them, though not quite as delusional. She becomes the friend of one of these women, Hester, and tries to help her. Over time, the Freudian based therapy appears to work and her family would like to take her home. She goes to “Staff”, where the doctors examine her prior to release. She is not ready. During the course of the exam, one doctor badgers her about remembering facts about her life in an unsympathetic manner. He shakes his cigar holding finger in her face. This causes another very severe attack, and its back to the wards.

The therapy continues and Virginia begins to realize that the causes of her illness are things that she cannot control and that she does not have to let them ruin her life. She passes through “Staff”, and makes a breakthrough with her friend Hester.

It’s a powerful movie. It won an academy award and was nominated for eight others. I’m sure in 1948 it was shocking and thought provoking. After the movie’s release, 26 states changed their laws on how the mentally ill should be treated. In great Britain, the censors required and introduction that pronounced that mental Hospitals in Great Britain bear no resemblance to the institution portrayed in the film.

The film does accurately portray Virginia’s progression through her illness toward wellness; grief and denial, acceptance and coping, to management and even advocacy. What is portrayed inaccurately , are the patients. While I am sure there are people like that, I do not believe that they make up the majority of the mentally ill. I also fear that the portrayal of the mentally ill and their treatment may have contributed to the stigma associated with the mentally ill, and the fear of seeking treatment. I can only hope that administrators, doctors and nurses in institutions are more compassionate and knowledgeable about the suffering of their patients, than those in the movie.

While in this case, the Freudian based therapy was successful, my sources tell that it is now considered to be overly simplistic. It does raise the question; why do these traumas send some people over the edge, and others are able to go on living normal lives? See the movie and think about it.

Welcome bus riders!

People who suffer from mental illness’s and people with other handicaps are often the victims of stigmas. Personally, I did not know how bad it was to have mental illness, until I had it. The people who practice stigmatization probably aren’t bad, they just don’t know any better. It is up to us to educate them.

The very first thing you can and must do is be an advocate for yourself. Sometimes this may require “Coming Out“, and being open, honest, and public about your illness. But it can be as simple as doing those same things within the framework of your treatment professionals, and/or support groups. Say what you want! By that I don’t mean say anything, but stand up for yourself, and try to do it in a rational manner. If you are going to be critical, try to be specific and constructive. If your treatment isn’t working for you, ask what kind of changes can be made. Your doctor and support group may respond by asking you what changes you think you should make. You must also be prepared to take criticism.

OK! You’ve become a successful advocate for yourself. Congratulations! You have put yourself on the road to wellness and recovery. You may have noticed how other people have the same problems that you have dealt with, but are not doing so well at it. It’s time to be an advocate for others, and there are numerous ways of doing this.

Some people are very good at “Working the System”. They know what programs are available, where to go, and who to talk to. There is a large assortment of benefits available; low priced and free medication, low priced and free psychiatric care, housing, transportation, food, employment, general medical care, and even cash! Obviously, it can be very difficult to get well and manage your illness without some of these things.

Being supportive is both a talent and a skill. It comes naturally to some, but there are courses you can take that are very helpful. Saying the right thing at the right time to keep someone out of crisis, or pulling out someone who is in crisis, is invaluable to our community.

Knowing about medication can be a tricky subject. Everybody’s illness is different. Everybody’s brain chemistry is different. There may be co-occurring medical condition. What works for one person, may not work well for others. Be Careful! I know within the NAMI model, we are prohibited from suggesting medication. Too much like practicing medicine.

Take charge! “If you want something done right, do it yourself!” “If nobody else is going to do something, I will!” Assume a leadership role in your support group and community. Be politically active. Speak publicly. The general public needs to realize that the mentally ill need not be incompetent. Many of us are highly educated!

Being an advocate is good for you. I try to get people involved in our DBSA board. It’s not high stress, and it gives them a feeling of accomplishment. I took a peer facilitator course from NAMI. I’ve facilitated meetings for DBSA many times and it was easy for me. It was not so easy for others. I would tell them, “ The first time you realize that you have helped someone, you’ll think to yourself,’ I can do this!’”

I cannot let this subject go without a big thank you to Edwina and Kelly, who started and run this chat room. They have continued to expand and improve it. It has turned into a valuable, international resource for the mentally ill. What an accomplishment! All of us know them both, some better than others. Like the rest of us, they have their own problems. But they both serve as a shinning example of how you do not have to feel good all the time to be an advocate and help others. Hey, You can do it too!