Wednesday, December 19, 2012

Treatment Isn't Easy

Treatment for mental illness has been in the news quite a bit lately due to the Newtown, CT shooting and then a blog post that came out from a mother with a child with mental illness. There have been many responses from people with other children who have similar issues and the difficulties in getting treatment. Some say they can not get enough help, and then there is an issue brought up by one mother that we need to accept that medicaiton is a good option for kids.

I am glad we are having this conversation and I cannot say what treatments I think are the "right" ones. In reality, I think that treatment is different based on every person. And that is why I think it is important to speak to the fact that for most of us there is no easy solution to treatment.

I have had different mental health problems since I was 6 years old but did not start to receive treatment until I was 19. That means I have been at this treatment thing with psychyatrists and psychologists for 15 years. And clearly we know from my blog posts that I am not free from my illness. For many of us, treatment is just not that easy.

Photo by Jeff Norris
First there is the issue of medication. Many people think if all mentally ill people just received medication and kept up with taking it that we would all be free from our illness. You can see through many of my previous posts that medication has not worked for me and actually caused severe side effects. It is promoted by many doctors and the media that most side effects include things like weight gain, nausea, lack of libido, sleep disturbance, dry mouth, and other things that people say we can put up with in order to be free of our illness. First, unless you have experienced those side effects, you don't know that for many people they are pretty debilitating and life altering. Furthermore, most people don't tell you about those of us who have severe side effects like decreased cognitive functioning, organ failure, heart disease, and more. We can not present medicine in simplistic terms and assume it is safe and/or effective for everyone. There is always the argument from people who see better behavior in an individual on medicine and then get angry when the person goes off the medication. However, if the medicine were really working, we would keep taking it. Clearly it is not working well enough if we stop taking it. Either it is not controlling the irrational thinking enough so we think we don't need it, or the side effects are so bad that we stop taking it. Medication works for many people but we should not judge those for whom it does not work. And finding the right medication is hard. It may take 8-10 years at the minimum to find the right medications. We need to be understanding when the illness is not treated quickly and easily.

Second there is the issue of all the other lifestyle changes doctors suggest for treatment such as exercise, diet, sleep schedule, and meditation. Everyone I know, regardless of mental state, has a hard time keeping a balanced life at all times. For people with mental illness, it is especially hard to do so and we have less wiggle room for how much can get out of balance. In college, other people could barely sleep for a week and be just fine functioning. They would need a few days of extra sleep and could get right on back on track with life. For me, one night of bad sleep meant possibly weeks of worsening symptoms and I needed a lot of help to get back on track. Here again we need to be compassionate about treatment. If someone can not keep the perfect diet, keeps forgetting to take medication, has issues sleeping, etc... that does not mean they are not trying. The worst thing you can do for someone trying to make positive lifestyle choices is to argue that because they don't stick with it that they are failing and need to learn to make better choices, or that they just should not do it anymore because it is clearly not working. Our lives are worth fighting for.
Photo by Jeff Norris

Third, people also have co-occuring disorders so they may have many road blocks in their treatment plan. Such as for me diet is a huge help in my treatment but I also have a binge eating disorder which makes it very hard to stick with the right diet. If you have PTSD it can sneak up on you in times that you would not think have anything to do with a past traumatic event so watch out for that getting in the way. If you can find the link it is often something you can work through. What I really like about my therapist is that he looks at every "setback" as an opportunity to learn more about me and what we might need to work on in order to help me be healthy. That is different than the usual mentality that if you do not get better instantly you are not trying hard enough, make bad choices, and you won't ever get better.

Last, there is the inevitable "if this is an emergency dial 911" message on your doctors phone. Many doctors and other people think if you go to the psychiatric unit you will be cured, but that typically is just between a few days and a few weeks of treatment. It takes at least six weeks just to see if a medication has a chance of working for you. And there is little support for how to live life out of a treatment center. Honestly, most of us can't keep going back into the hospital and we need much more support in our every day life than most of our communities and insurance companies (if you are even lucky enough to have insurance) are willing to give us. You see a therapist and/or psychiatrist every day in a facility and then in regular life you might go to therapy once a week and see your psychiatrist once every six weeks. You have none of the outside stimulus, none of the people and situations that might contribute to your illness, and far less that can trigger you in a facility. Then you go back into the same life you had before and don't know how to manage. Going into treatment is beneficial to many people but the success rate could be even higher if we didn't just assume a few weeks in a hospital cured everyone and if we had better programming out of the hospital. Good care for a psych patient includes a plan after the hospital. A great start is if you have a loved one who is in a facility, to think about what changes you might need to make at home to help them keep up with treatment or how much assistance they might need with taking meds, eating, sleep, and exercising.

All this is to say, treatment is not simple and I don't know that we always have an understanding of how complicated it is. Some people ask me why I would write my blog if I am not "cured" or my illness is not under control. I write because my situation is much more common than we think it is. It can feel very lonely to look for resources on mental illness and often have it portrayed that there is a simple fix- if we would just take our meds and do what our doctors tell us. I wish it was not that hard. I wish there was a simple solution for everyone. Sometimes we have to just keep trying even if it does not work over, and over, and over again.


Rev. Katie

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