I'm continuing on yesterday's theme... bringing my experience with the psychiatric system into focus, as I reflect on the anniversary of my first hospitalizations, 20 years ago. I was so unhappy with the treatment and prognosis, and so motivated to recover, that I sought help in our twelve step rooms.
Today, I think parts of both "models" of psychiatry are still relevant: I believe unresolved issues in our history can set us up for "mental illness." Once we look more deeply and do the inventory around our childhoods, many of us notice that there are triggers that contribute to our emotional vulnerability. When those vulnerabilities are not addressed in a healthy way, that may be when we experience symptoms that are indeed, "biochemistry gone amok."
Yet, my experience in augmenting my recovery with therapy and nurturing 12-step groups has not convinced that the medications alone actually "correct" my biochemistry. In my case, it corrects itself pretty quickly. For prevention of relapse, I need to get to the root of the dis-ease, and I find that in my narrative and in my thinking. To me, whatever form it takes, psychotherapy is still an important tool that cannot be replaced strictly by medications.
I believe for those of us that are vulnerable, our way of interpreting our history creates "bumps" where we can stumble and find ourselves in an emotional (even "biochemical") crisis. If we don't use therapy, our unique narrative is important for us to look at closely. Program is superb at encouraging us to do just that.
Here is the pattern I see from my hospital experiences. I see how patients and doctors each struggle... to make honest sense of their experiences with one another. Most hospital doctors don't have the time or talent to gain the confidence of a patient like me, so I remain a huge mystery to them. Faulty biochemistry is a grossly oversimplified story, but it is the only one the hospitals can tell these days.
I can tell you why, based on my personal experience. Since the other story that was "made up" about me twenty years ago (in that rural hospital in which I failed therapy) I have had only one experience where someone got a narrative from me. I was reached by one compassionate and caring person who wanted to hear my story. That admissions nurse was patient and took all the time we needed. She even helped me to avoid rooming with a person who I could tell was going to trigger me and keep me from being able to sleep (which always worsens my symptoms.) This hospital stay was "voluntary," and I expect that is why I was able to keep some control over the amount of medication I was administered.
On my release from involuntary stays, I am given a script that consists of huge horse tabs EVERY time. I know that they believe those horse tabs are correcting faulty biochemistry, and they think that faulty biochemistry is permanent. Only they never measure any biochemical problem. I have learned my crisis is not a permanent state for me, but is rather ephemeral.
Word is that things are changing, and hospitals are starting to tell patients that medication alone won't work, for those suffering from depression. Patients are told that exercise, good nutrition and meditation are important tools.
But education for those who've had psychosis has not advanced beyond strict reliance on medications.
As I see it, the profession of psychiatry still lacks conclusive tools for those of us who experience psychosis. And they tell themselves the same mistruths until they finally come to believe themselves. They really need to listen to us to get the whole truth. Instead, all they have is observations of our behavior. No back story at all, from those of us that lack the wherewithal to be admitted voluntarily.
To add insult to injury, they rarely ask any questions. Everyone thinks if you are psychotic you must be hearing voices. As I struggled to stay awake on the unit, this last time, I was even told, "You are hearing voices," when the only voices I heard were the voices of the staff, saying the usual clinical and distancing things they are trained to say. They did not ask, "Ma'am are you hearing voices?" Many times I am simply going in and out of a dream state, fighting medications to stay awake. But the staff have the power-- they observe, talk about patients in the third person, and draw their own conclusions. From assumptions alone, they decide whether to raise the medications.
My experience is that pharmaceuticals just silence symptoms, when what I really need is to sleep. This last time I had a relapse, the hospital did not give me medication to sleep, believing I needed treatment for psychotic symptoms alone. Fortunately the medications helped me stay asleep (once their sedating power knocked me out). But all the other side effects that went along are almost unbearable. I left the hospital after four days, never having a bowel movement. Can you spell "constipation verging on impaction?" And what about sleep that pins you to the mattress for ten hours at a time?
Our days on the unit are spent being shepherded from group to group and lined up for medications that we cannot refuse. Many hospitals I've been in only allowed in-mates to go outside to smoke. So.... being a person who needs the perspective of nature, I went outside with the smokers, even though I don't smoke.
Sometimes "involuntaries" are not allowed to eat in the hospital cafeteria. When we are most voiceless, we get a delivery instead-- of the MOST constipating foods possible. Even in the good hospitals in my state, patients don't get real exercise either, except for "game time" or pacing the halls.
Today I know that, if I get restorative sleep and my anxiety is quelled (by clear thinking and/or use of short-term anti-anxiety medications), I am sane many days before I leave the hospital. It is OK to credit the medications with that! Other than that, I am not happy with the system's treatment, but I would be happy to give my narrative and make their records accurate and complete. My story could be used to help another patient, of that I am sure. Only they never ask.