ON MENTAL ILLNESS: Avoiding the Revolving Door

Jack Bragen
Thursday November 09, 2017 - 11:15:00 AM

Schizophrenia is a pernicious illness and should be treated aggressively. It is important to note that being "compliant" with treatment doesn't make a consumer immune to a relapse. I am currently dealing with a lot of depression, despite being completely medication compliant, and I am dealing with some psychosis. No one can be blamed for this. Depression, mania, hypomania, or a relapse of psychosis, can happen to any of us in spite of our best efforts.  

"The revolving door of the mental health system," is an expression for a commonly occurring scenario, of hospitalizations, releases, and relapses, only to be hospitalized again, and this happening on a repeated basis. Of course, it is to be avoided. And to successfully avoid this, a solid commitment to treatment is needed. My father once said that mental illness "does not go away by thinking it away." He also once said, "Judgment is the first thing to go."  

If we've gone a few years without a relapse, this success could be emboldening, sometimes leading to an attempt at stopping treatment. It might seem to us that we're fine, and that we are unnecessarily medicated.  

The memory could have faded of how awful, dangerous, and horrible it was to have a relapse. We may have forgotten how long it took to get back to a semblance of being able to function in society.  

The more repeat episodes we go through, the worse off we may end up in general. Repeated episodes of severe mental illness affect our life circumstances and liberty, they affect our brain condition, and they are a major setback.  

When a mental health consumer is doing better and has improved over time, that consumer, or even their treatment practitioner, might be tempted to put the consumer on less medication. This is sometimes a dire mistake. A psychiatrist once said, "Don't mess with success." If you are doing well, something was done right. 

Once the consumer is on less medication, symptoms could come back, and judgment could become impaired. As soon as judgment goes, the consumer is subject to losing the necessary insight that he or she has a mental illness and must remain in treatment. That is how it happens.  

How does a person avoid being bitten repeatedly by the same dog? In my case, I owe a lot of the credit to my wife, who said that if I stopped medication she would move out. 

However, when I had my most recent repeat episode of psychosis, which was in 1996, I realized that I had to stop this from happening again. I realized that my parents were getting too old to deal with me as a psychotic person. I realized I was getting old enough that the stresses of another episode might kill me. I realized that, up until that point, I had been very lucky to get through these relapses physically intact and uninjured, as well as not incarcerated. I realized that recovery was taking a longer amount of time with each successive episode, even though the episodes were about five or six years apart.  

Again, please note that a flare-up can occur despite our best efforts. It is important that we not get too self-critical--blaming ourselves if there is a relapse. Family, doctors, and ourselves, should not be judgmental if there is a relapse. 

Sometimes when things are beginning to worsen, we can halt the progression of a relapse before it gets to the point of requiring hospitalization.  

Yet, if we need hospitalization, we should go ahead and go in, since the alternative is that of being in society while psychotic, manic, or extremely depressed. If we need hospitalization and are not admitted, this could entail behavior that could cause injury or incarceration. And getting worse while delaying treatment could have bad long-term effects on the brain.