Saturday, September 21, 2013

How can we best respect the integrity and freedom of mentally ill people?

Just as the sun continually rises, our minds continually change.
I watched "Madness: A History" for the Abnormal Psychology course I am taking this semester.  This documentary gave an extraordinary overview of the history of mental illness throughout the centuries.  As explained in the film, the mentally ill were initially treated more like animals than human beings.  The most ancient way of curing the “polluted mind” was drilling a hole in the head, to give it some “fresh air”.  Other methods of [torture] purging insanity included leeching of blood, pouring hot fluids over the head, tranquilizing chairs, and whipping, stomping, or burning the mentally ill.  Asylums, and their unfortunate residents, were a popular form of amusement for 18th century Europeans.  There was a major turning point in the treatment of the mentally ill, when Pinel's philosophy of treating them with kindness, instead of cruelty, sparked a wave of psychiatric reform.  Across the Atlantic, Dorothea Dix was also sparking reform in the treatment of mentally ill people.  Science was underdeveloped, so people continued to turn to the supernatural as the causes of mental illness.  However, Sigmund Freud had a totally different vision of what caused mental illness.  He focused on psychoanalysis, the unconscious parts of the mind, and unlocking the influence of past experiences on current behavior/impulses.  The wealthy could afford his revolutionary therapy, but poor people received shock therapy and were institutionalized in asylums.  They also suffered disproportionally from syphilis.  The study of syphilis led to the development of neuroscience and a greater interest in cures for other mental illnesses.  Doctors began using insulin and Metrazol to generate convulsions, but the results were hard to guarantee and many patients died in the process.  Shock treatment continued to grow in popularity, and was the most widely used and the most successful method of curing mental illness. This treatment caused violent muscular reactions throughout the entire body and had to be supervised by a trained doctor.  Unfortunately, ECT's success also proved to be its downfall as it became overused and then inevitably abused.  Lobotomies were also introduced.  Initially only meant to be used selectively and as a last resort, they became a quick fix for many mentally ill patients.  Many people treated the lobotomy as a cure for almost any mental illness and a way of clearing out the country's asylums, packed with the psychological casualties of World War II.  It also appeared to be the most cost effective, a one time fee of about $250 vs $35,000 to maintain a patient in an asylum for one year.  By the early 1950s, psychiatric care had reached another dead end. Lobotomy was disgraced, shock therapy only helpful in some cases and the hospitals were once again crowded with patients with no hope of cure.  Thorazine was originally used to treat nausea after anesthesia, but also had amazing effects on acute psychotic illness.  Serotonin was studied further, and Prozac became the best selling drug of all time.   As per the film, “This is perhaps the greatest irony in medical history. We have traveled from the days when treatment was so horrific, the last thing you'd ever want to be is mentally ill, to a time when it is so effective, many of us confess to being ill in order to receive our happiness in an easy-to-swallow form”.  As technology continues to advance, treatment continues to improve.  Also, with increased public awareness, more people are changing their attitudes toward the mentally ill, understanding that they are in fact human beings and they need to be treated with respect and dignity.   

As stated in the video, “The human brain is the most complex object yet discovered in the universe. It contains billions of cells, or neurons, interlinked in impossibly complex ways.  Like any other organ of the body, the brain is affected by disease. It can malfunction. But a sick brain can change how we think and behave towards others, the very things that make us human”.  In the case of Geel, Belgium, the city has allowed mentally ill citizens a new chance at life. In their city of family care, people with mental illness are deinstitutionalized and given a safe place to recover in a dignified way.  They live independent lives, working in the city bicycle repair shop, interacting in “normal” society, under the supervision of foster parents and medical professionals.  

The amount of freedom the mentally ill enjoy in Geel is very surprising.  I did not know this city existed before watching this documentary. In learning of Geel, I am reminded of the struggles and historical growth of the Deaf community.  Geel is also the “utopian” type city that Martha’s Vineyard once was for Deaf people.  Deafness is not generally considered a condition that needs to be fixed.  Yet mental illness is treated in the exact opposite way.  Members of the Deaf community are proud to be deaf, defend their right to be deaf, and protect their culture as a different human experience, rather than identifying themselves as having a disability.  Contrary to Deaf people, mentally ill people tend to sacrifice their self-pride and respect (in many cases involuntarily). Many live their lives cloaked by their disability.  While Deaf people were tortured and victimized in their history, they have fought for their right to be recognized and supported.  It would be great if people with mental illness (or their families) could fight for their right to a dignified and respectful life/methods of treatment.  Why can’t the professionals in the mental illness world establish a Geel, USA, especially when the research, science and history show these methods are more effective?  Why can’t mental illness be treated as conditions that don’t need to be fixed, but perhaps expressed under medical supervision?  Should they be given the freedom via artistic avenues to express their minds, the voices or the spirits inside them?  (I’m presuming this would probably not apply to those with violent tendencies).  The fields of art, music, dance and animal therapy have continued to grow in popularity as alternatives to medicine, along with being alternatives that are sustainable, respectful and inclusive.  The way we treat adults with mental illness is also ironic, because as children with mental, social, emotional disabilities, they are protected under the IDEA act to receive their modified education in inclusive settings.  Then as adults, they are typically shut out of mainstream society or drugged up for many years, sometimes for life!  There’s got to be a better solution for the mentally ill. 

In the future, we might look back and ask, “What were we thinking, prescribing so many chemicals and pills to people without a proper system of checks and balances in place?”.  We might be shocked that so many people could consume so many pills without receiving cognitive behavioral therapy.   We might be shocked that our medicine was not socialized, so the people had to stop treatment abruptly when the money ran out.  We might be shocked that people did not get a “head check-up” when they went for their annual physical exam.  Lastly, we might be shocked that the mentally ill were still so misunderstood, and so many people (especially children) suffered in silence, from the fear of the social stigma of mental illness.  As we see in so many fields, technological advances will continue to change the human experience, and people will continue to receive treatment that may not yet be fully developed, but a big improvement from the last “great idea”.  

A memorable quote to remember and reflect on: “I think even today, there's a degree of fear in the general public of people who have been diagnosed with a psychiatric disorder, who have displayed usual behaviors, because we don't understand mental illness”. 

In closing, please don't fear or shut out people with mental illness!!  Dealing with people who suffer from mental illness is not easy.  I know from firsthand experience.  We must not be so quick to rely on medication to solve all of their problems, but instead seek alternative therapies, especially in the somatic practices.  Of course, the people providing such therapies should be certified/educated in the appropriate fields.  Psychiatric treatment is complicated in all senses of the terms--definitely not what I would call a D.I.Y. project!  However, we need to come from a place of love and patience--not fear, resentment or frustration when dealing with the mentally ill.  Above all, we need to respect their integrity and freedom.

Madness: A history. (DVD ISBN 978-0-7365-8443-2)

<3 paz. amor. felicidad siempre

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