Columns

Many people who are involved in the mental health treatment system, or people who believe they know something about persons with mental illness, are under the impression that we would be just fine if only we would take our medication. In fact, mere compliance to the wishes of treatment professionals and sometimes families is not adequate to make our lives workable. The willingness to take medication entails a great deal of sacrifice. 

The attitude that says persons with mental illness are depraved or ignorant, or that we exhibit turpitude when we become "non-compliant" is not the whole picture. Taking medication to treat mental illness can be its own form of hell. People who take psychiatric medication ought to be given the Medal of Honor, and ought not be treated as less than a person—which is often how we are treated.  

Part of the picture is the numerous, distressing, and sometimes life-threatening side effects of psychiatric medication. 

Secondly, it requires a lot of courage and acceptance to face, and not be in denial of, being mentally ill and of having a "defect" in the brain. And that, by itself, could be a subject for one week's column.  

Listing the side effects of psychiatric medication would require more space than I have here. However, some of them include involuntary movements of the upper body—which constitute a disfigurement and which also are a handicap of their own. Other side effects include extreme weight gain, type II Diabetes, slow reflexes, and extreme sedation. Some of these medications produce breast enlargement in men, and body hair in women.  

Medications that have the side effects of psychiatric drugs, if intended to treat anything other than mental illness, would never have been approved for use by the FDA, because these side effects, some of which are extreme health risks, would ordinarily be considered unacceptable.  

I have seen people with involuntary contortions of the body caused by psychiatric medication, and each time I see this, I question the fact that in my column I advocate compliance with treatment. I, myself have had this involuntary muscle contortion and it entails a lot of suffering. Luckily in my case it wasn't permanent. For some people it is. These contortions, sometimes called "Tardive Dyskinesia," do not always go away once the medication is stopped. And if the medication is stopped, what is one supposed to do? Won't a person become psychotic?  

Thus, taking medication as we are told to do should be considered an honorable and self-sacrificial act. Instead of this type of regard, we are given the brunt of people's disrespect, are presumed as lesser people, and we are viewed with negative stereotypes.  

And yet, there are two sides to this. 

Unlike most other medical illnesses, psychiatric diseases affect behavior toward others. Someone with mental illness who is symptomatic can be disruptive to people's perceived orderliness. Many non-afflicted people perceive us as a nuisance in society or in their neighborhood. Furthermore, someone suffering from mental illness can be a threat to his or her own well being. The common belief that we are dangerous is usually not accurate, but is one reason mentally ill people are forced into treatment.  

If you have any other illness, it is almost assumed that you will get it treated. On the other hand, in some instances, people with a psychiatric problem are not always cooperative, and must be forced to undergo treatment. 

When someone has cancer and wants to pursue alternative medicine to treat it, generally speaking that is his or her choice. They may be pressured a lot by doctors and family to pursue conventional treatment, but generally force isn't involved. In that scenario, someone could be making a decision that leads to their demise. However, usually the individual is free to pursue alternative medicine, and there is not much people can do to stop them. This affects others, because that individual, when they pass away, won't be around to contribute to the lives of friends and family, and they will no longer be performing at their job.  

However, when someone is mentally ill, they are viewed with a perception of shame. This is where people are condemned on an interpersonal and social level for having behavior that doesn't comply to the social norms.  

The idea that we ought to just take our medication and comply with other people's expectations--that we not make any "trouble," is an oversimplification. When we are compliant and when we do behave as people would hope, basically there is little or nothing in life that brings meaning or gratification. Furthermore, taking medication brings real suffering due to the side effects and due to the amount of normal functioning that gets blocked.  

For many persons with mental illness, medication is a necessary evil. Medication isn't a great thing--and sometimes the "cure" is almost as bad as the ailment. This might be one reason why there are numerous mentally ill people who resist taking their medications.  

I see the stick but not the carrot. The mental health treatment system is set up to maintain some amount of control over the mentally ill "population." However, nothing is being offered as an incentive. Many persons with mental illness must look forward to a life of institutionalization, suppression of much of our mental functioning, and deprivation of most of the things in life that bring pleasure to affluent people.  

The above essay describes some of the reasons why I believe a lot is being asked of persons with mental illness, and why I believe we ought to be admired for our sacrifices. 

So the next time you are going to look derisively upon a non-compliant mentally ill person, or, on the other hand, upon one who is cooperating, you should realize you may be looking at a brave man or woman who faces an uncertain destiny.  

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