Assisted Outpatient Treatment

by Joseph Merlin Bowers

One of the more controversial parts of much legislation being considered in Congress currently is assisted outpatient treatment. It’s even been a source of a disagreement between one of my sons and I. Some of the trouble is that it doesn’t mean exactly and only what is says. It also means involuntary outpatient treatment and sometimes forced medication.

As anyone who knows me might expect, I have a lot to say about this issue as someone who has experienced psychosis, involuntary commitment and at least coerced medication.

In the West we greatly treasure civil liberties and freedom of choice as I think we should. So taking that away from an adult should never be done lightly or routinely. All of us in fact no matter our competency sometimes make bad choices and we should have the right and freedom to do so in a free society. Taking this freedom away should be very rare indeed. But civil liberties and freedom of choice are not just privileges. They are also a responsibility if sometimes only to ourselves.

Because of this responsibility, we don’t allow small children to make important life altering decisions or so burden them if that is how one looks at it. Nor should we allow or so burden someone who is mentally incompetent.

Who is and how do we decide who is mentally incompetent? Clearly this should be done on as limited a basis as is humane. I would say only those currently psychotic should be so deprived of freedom of choice. This should be determined, I think, by a licensed psychiatrist.

We are getting into gray areas here.

Should someone competent but extremely depressed be allowed to choose suicide? I think not. But I think most of the time involuntary commitment and forced medication shouldn’t be necessary to stop them.

I’ve been in a situation where the only way to gain my release from an institution was to convince a psychiatrist that I was fully competent. It is an extremely unpleasant feeling of complete helplessness that few need ever experience. However, having been psychotic and convinced at the same time that I was fine, I must say the following: If I ever get in that state again, please force me into treatment. It might save my life and I will thank you later.

The issue of forced medication and antipsychotics in general is nuanced and complicated. I may set forth my views on that in another blog one day. I’ll just say for now that I favor it when appropriate.

There is another legitimate question about forced commitment. When I am psychotic and someone else needs to be  given the power to make decisions for me how  do I know that when I become competent again he will give that power back to me? This to me is a real concern. Not a deal breaker but a real concern.

I am not a big believer in faith as the be all and end all of existence. I think blind faith is a very dangerous thing. But little can be done in life without exercising some faith in something or someone. Here I think we have to exercise some faith in competent professionals. It should not be without checks. There should be a reasonable time period for regular reevaluations by at least three psychiatrists, I think.

I don’t know exactly how the proposed legislation is written, but it’s entirely doable to address all legitimate concerns anyone may have. Even if the legislation is imperfect, I would strongly support it.

The alternative is the status quo which leaves incompetent people to their own devices. This has resulted in tens of thousands of needlessly wasted lives on the streets and in our jails and prisons.

No one competent chooses a life sleeping out of doors with cardboard blankets eating out of garbage cans. I’ve been arrested because of what I did while and because I was psychotic. I’ve been strip searched and body cavity searched in full view of a female guard. I’ve been put in jail house restraints lying on my belly on the floor with my wrists and ankles bound together behind my back. I’ve spent days in solitary confinement in a four by eight foot cell with only a peep hole to see out of while in a manic state and out of cigarettes. No one in his right mind would choose this over treatment. Take it from me.

 

 

The Pursuit of Happiness

by Joseph Merlin Bowers

I am currently trying to position myself in this community to where I can most effectively advocate for people with severe mental illnesses. On the surface this sounds all altruistic and noble, but it could legitimately be argued that I am doing this for selfish reasons. First of all is my bitterness for having been cursed with insanity. As it stands now if there is a God and I meet Him one day, He’s got a lot of splaining to do. If it turns out that I help people because of what I went through, that makes things better and easier to live with. I’d be OK with everything. Also I am pursuing happiness.

Many people think the successful pursuit of happiness means winning, proving personal superiority and/or amassing huge collections of things and of riches. When they do these things and discover that they are not happy, often they assume that they haven’t won enough, sufficiently proven superiority or amassed a large enough fortune. They double down and wonder how much is enough. How much does it take to win happiness?

In my opinion these people are pursuing happiness from the wrong direction with faulty assumptions.

Some time ago one of my sons gave me his theory on happiness. He said that happiness comes from expressing one’s creativity and from service. I like this not just because it seems pure and nice, but because I think it’s true. It assumes that self respect is necessary for happiness.

Self expression can sometimes go awry and cause consternation, but there is joy and value in the creative process. When I wrote my book about my experiences with my serious mental illness, I wasn’t able to get many people to read it. This was massively disappointing, but through this act of creation I became a better, healthier more together (happier) person.

When I tie flies and get a couple good ones out of many attempts there is a feeling of accomplishment and happiness. This is augmented when I catch fish on flies I have tied myself.

It’s hard to argue with service as a source of self respect and happiness. Who doesn’t feel good when he thinks he has done something good and helped somebody.

So if you want to be happy for the rest of your life  don’t necessarily get an ugly woman to be your wife. Devote your life to creativity and service.

Doing the Right Thing for the Wrong Reasons

by Joseph Merlin Bowers

I was first hospitalized with a serious mental illness in 1964. Since then I have watched our mental health care system steadily decline. Because of this, I try to be a strong advocate for mental health reform. To this end, I frequent the web pages and Facebook pages of several advocacy organizations. They are making real progress of late, but some of their methods concern me.

They add to the sensationalism of tragedies involving mass shootings by someone with a mental illness. They tell us that we should improve our treatment of the severely mentally ill because that will make us and our society safer. They also promote reform because it would be cost effective.

Treating people sooner and better would make us and the people being treated safer. When one compares hospital and outpatient costs to costs the costs of imprisonment, emergency room visits and the potentially productive lives wasted on the streets it would be very cost effective. These facts are completely irrelevant. They are not why we should be supporting mental health reform.

We should be supporting mental health reform because it’s the right thing to do, because these people are terribly sick and desperately need our help, because if they had cancer, HIV, ALS or any other kind of disease than the one they have; we would be falling all over each other with compassion, sympathy and offers to help in any way possible.

When we push reform using fear, we add to public fear and stigma. Economic considerations should carry little weight next to humanitarian considerations.

Some say any publicity is good publicity, anything that produces good results is good. The ends justify the means.

Hogwash!

I say that we have no certain control over any desired ends. We only control our means. I worry that if we don’t act for the right reasons our ends will be tainted and distorted from what is desirable. I think our reasons matter. Maybe my worries are unjustified. I don’t think so.

Are Madness and Creative Genius Inseperable?

by Joseph Merlin Bowers

This morning I red a review in the Denver Post of a play entitled “Equus.” It is a famous fictional story of a young man with an insane obsession with a horse and a psychoanalyst conflicted about his profession. The doctor wonders if by easing the emotional pain of his suffering patient he is extinguishing the flame of creativity and genius. The thought that insanity and creativity somehow go hand in hand is one I keep encountering and that kind of pisses me off.

My perspective is from someone who has experienced, “madness,”  the emotional and fantasy journeys of severe psychosis. I will concede that many creative geniuses have also suffered from serious mental illnesses. I will also concede that insanity often demolishes any barriers to where one might go in his consciousness and what he might imagine and mentally experience (in that regard “madness” can be exciting, intoxicating and addictive), but I emphatically reject the premise of any correlation between madness and genius.

I believe that the appropriate metaphor is that of a highly complex machine that performs complex tasks having more things that could go wrong and requiring more maintenance than a simple machine that performs simple tasks. When the complex machine breaks down it is busted and cannot perform it’s functions. I am in complete agreement when a VanGogh  speculates on what wonders he might have created were it not for the madness.

When I was lost in the fantasy worlds of my insanity, I couldn’t focus on any task long enough to perform it-even something as simple as eating. After a psychotic episode, the cognitive impairment was noticeable even to me. After my first hospitalization returning to the “real world” to finish my junior year of high school, I was determined to graduate with my class. Because of this, my study habits and work ethic were much improved from before, but learning came much harder that it had previously. I had the same experience a couple of times in college.

The cognitive decline did seem to wear off. Over time, I think, my cognitive abilities returned to normal. A psychiatrist once, I think aptly, likened a psychotic episode to me to a bad concussion in the effect it has on one’s brain.

I’ve been told that I have accomplished a lot and had a good life “all things considered.” I will never be able to stop wondering what I might have accomplished were it not for the madness.

Is God Bipolar?

by Joseph Merlin Bowers

This morning while attempting to meditate, I had a very strange thought-God might be bipolar. I want to say that I prefer the term manic-depressive as a more accurate and meaningful term for the illness but will use bipolar here as it is in much more common usage today. I was remembering a recent fishing trip through the country along I-70 West of Denver.

I’ve seen most of the United States at one time or another in my travels and I’ve been in the Rockies much of my life, but I’ve never seen anything as spectacular as that country. My thought was that it was almost too much-overdone. One can visualize God being in creative ecstasy while making such places-creative ecstasy being characteristic of mania.

If one takes many of the Old Testament stories literally, some are indicative of unreasonable, unreasoned fury which often accompanies severe bipolar depression. My theory would certainly explain a lot of things that have bothered me since my earliest exposure to scripture as I try to believe in a powerful, compassionate God. .

If one attributes much of what goes on today as the will of God, as a friend, I would tell Him that He has a problem that needs to be addressed.  I would be so brave as to advise God to find a good med and to talk to someone wise and understanding.

Having a Serious Mental Illness in the Sixties Versus Now

by Joseph Merlin Bowers

The prognosis for me with my serious mental illness in 1964 was better than it would be for me today.

 

I was diagnosed as paranoid schizophrenic in 1964 in a state mental hospital. My diagnosis was recently changed to bipolar 1 with psychotic features. I had two bad psychotic episodes in the sixties. I was a minor the first time and admitted to a state mental hospital. The second time as an adult I was initially arrested and held overnight. In the morning I saw a judge who ruled that I should go to the psychiatric hospital. Due to the nature of my delusions, I agreed to sign myself in. In both cases I was kept for several months during which time I was effectively treated.

 

Through most of the seventies, I had only minor episodes that didn’t get me in serious trouble.

 

In 1979 I had a really bad episode that resulted in my again being arrested. By this time, the system had already deteriorated significantly. Initially I went to jail because there were no beds available in the hospital that had a psych ward. When eventually I got to the psych ward they couldn’t keep me because I did not present a danger to myself or others so it was back to jail. At my insistence, my court appointed lawyer found grounds for me to return to the hospital a couple of times. Overall I spent more than three times as many days in the jail as in the hospital.

 

In the jail I experienced psychical restraints and solitary confinement. However, in that jail at that time a guard came by each evening carrying a tray full of medications. I was given a cup of liquid Thorazine which the guard stood and watched until I drank it. If I had wanted to fake it, it would have been much harder than Jack Nicholson faking taking a pill. Eventually, I stabilized and returned to life outside.

 

Over the intervening years, I have had one more extensive stay in a psych ward, but have found a more effective medication and have learned to control my disease very well. I have not had a serious psychotic episode in a very long time.

 

These days I try to advocate any way I can for the four percent with serious mental illnesses. To that end, I volunteer at a local drop in center for the mentally ill. There I get to talk with people recently released from the nearby state mental hospital and people working toward release who are doing well enough to get day passes.

 

Invariably, these people have been kept not a matter of months like I was but a matter of years-most often sex to eight years. I ask myself why that is.

 

Everyone I have talked to got to the hospital through the legal system. To be released they can’t simply recover to where a psychiatrist will declare them well. They get periodic court appearances where a judge decides if justice has been done and if they would be safe out on the street.

Why did they all get there through the legal system? If an adult is seriously mentally ill and doesn’t know it, he can’t be forced into treatment. Eventually he will run afoul of the law for something minor or major. If someone has enough awareness to seek treatment, he probably can’t find it. If he does, few of us can afford it. Eventually he will further deteriorate and usually get arrested for some crime he has committed-if he is lucky.

 

 

 

 

 

People Feel Differently About Antipsychotics than any Other Type of Medication

by Joseph Merlin Bowers

When a doctor prescribes medicine for heart disease or diabetes or any disease of almost any bodily organ no one argues or even considers not taking it. When a doctor prescribes an antipsychotic for a brain disease, however, many people do argue and many ill individuals refuse to take it. Why is medicine for a mental illness any different than medicine to treat any other kind of disease?

The first answer that comes to mind is the well known bad side effects of many antipsychotics. Listen to the commercials for Cialis some time. Talk about a scary list of potential side effects. All medications have side effects. We, nevertheless take our medicine for any other type of disease.

There are a number of other reasons we hesitate to take antipsychotics that may not be apparent to anyone who has never had a mental illness and been put on an antipsychotic.

When a psychotic individual is initially put on a large dose of an antipsychotic it is debilitating. We have difficulty walking and talking and want to sleep all the time. This zombie-like state is disconcerting to ourselves and others. But the state is only temporary. Once the psychosis is under control, a lower less debilitating dose may be sufficient. Also, our bodies adjust over time.

Because we grow up believing there is something shameful about mental illnesses, we are much more reluctant to accept that we have one than any other disease even a fatal ones. Accepting that we need medicine is acknowledgement that we have a shameful disease.

Today we know that mental illnesses are not indicative of weak or defective character or caused by bad parenting. There is actually nothing more shameful about a brain disease than any other kind.

Some of us when psychotic find ourselves in an awesome fantasy world where we are far more important and significant than we really are. The false reality is far more desirable than actual reality. Accepting the need for meds requires accepting the falseness of the fantasy world. Taking the meds makes the fantasy world disappear assuming they are effective.

However attractive the fantasy world may be, we must live in the real world to meet our needs and function with any sort of success. Accepting the falseness of my fantasy world when being treated was always a hard step for me to take but a necessary one.

My daughter who was on Ritalin once asked me if her success in school was her doing or the Ritalin’s. Does a medication that changes the way our brains function fundamentally change who we are? We all want to be our real selves. Do I become someone else when I take a med that alters brain function?

In my opinion, it is the disease that fundamentally changes who we are. The medication restores our real selves.

There is always some desire to get of an antipsychotic even when doing well and realizing that one is doing well probably largely because of the medication. That is because this type of medication effects brain function. It is very hard and maybe not even legitimate to separate self from brain. It is much easier to look at any other organ as just something psychical not constituting self. Few of us struggle to feel positive self worth because a kidney doesn’t work right-not so with our brains. I have been dealing with my disease more than fifty years. I know both that I am more than my brain and that my brain really is just another organ. I’ve gone off my medication a couple times since we found the one that is really effective. Going off didn’t go well. But I still can’t shake the reality that I would feel better about myself if I thought I could go off the med and maintain. For all intents and purposes, I have beat my cursed disease. I am pretty much as high functioning as before I got sick. But I’ll probably never feel I have achieved total victory as long as I am on the med.

Taking an antipsychotic shouldn’t be thought of any differently as taking insulin for diabetes or aspirin for heart disease, but rational or not it is. In this blog I have tried to explain why..

Stigma

by Joseph Merlin Bowers

Some of us call it stigma. Some prefer prejudice or discrimination. Whatever one calls it most would agree that people with serious mental illnesses often are looked upon and sometimes treated unfavorably. Many of us with such diseases have been denied jobs, friendships, admission to college or grad school because of our illnesses. The denier may have called it something else, but we knew why. We learn early on to be quiet about our illness. It’s been said that we should speak out but only if we are over 65 and retired.

The reason for stigma is partly ignorance but only partly. A major reason is the dangerous and /or bizarre behavior we engage in mostly when untreated. When a seriously mentally ill individual is involved in a much publicized violent act people are repelled. Many advocacy organizations, eager to highlight the plight of families dealing with serious mental illness who have largely been abandoned by society, stress the danger to society of not treating the mentally ill. While this may help the cause it contributes to the stereotype of the violent lunatic.

Those people not convinced that every crazy person is a serious threat to become violent, are put off by bizarre behavior. The behavior may be upsetting, inexplicable or distasteful. People may be repulsed as some have said because they fear something similar happening to them. This may be why some refuse to believe mental illness actually exists. Whatever the reason, people are put of by our behavior when psychotic.

In a perfect world, education would be the key to ending stigma. Just cause it to become widely accepted that the bizarre behavior is a manifestation of a disease of a bodily organ not the intrinsic nature of the individual behaving bizarrely. It is the disease in control, not the person with the disease. It is only a small subset of the seriously mentally ill who become violent. To get the vast majority of the population to understand this and start regarding us with understanding and sympathy, I think, is unrealistic until our distasteful or dangerous behavior becomes much less common. How do we do this?

Treatment. Treatment. Treatment. Most of us will respond positively to some appreciable degree to treatment. There will, for the time being, be a need for asylums (in the best sense of the word) for those who will not yet respond well to any known treatment. Currently, many, many mentally ill people are not in treatment. How much stigma would there be if we were all being treated, dangerous or bizarre behavior was drastically reduced and those unresponsive to treatment were in asylums and not bouncing back and forth between life on the streets and jail?

Certainly education, understanding and the compassion granted those with diseases of any other organ is needed. I believe, however, that a key to ending stigma is much more treatment.

Remembering Middletown state Mental Hospital from the Sixties

by Joseph Merlin Bowers

I recently read an article in Yahoo written by a psychiatrist who has taught at a major university for over thirty years. He referred to the old state mental institutions as “snake pits.” Many today believe they were squalid places where people were warehoused, abused and generally mistreated. I spent time as a patient in Middletown State Hospital twice in the sixties and that was not at all my experience.

The hospital was located in pretty country with spacious grounds and was always kept neat and clean. The staff in no way resembled Nurse Ratched. They always treated me kindly and seemed dedicated to helping in any way they could. During my first stay I was given a series of electroconvulsive therapy treatments. These sessions were nothing like what they portrayed in One Flew Over the Cuckoo’s Nest. Nor was it in any way punitive. I was given a shot which put me out beforehand, and I would come to sitting comfortably in the lounge area. I never so much as saw the room in which the electrodes were applied let alone experienced any pain. Best of all, the treatments seemed to work,

We had supervised outings including a trip to the New York World’s Fair. I got dental care. We had a movie theater and church services. There was a place to purchase snacks.

The second ward I was in had a ping pong table, a bumper pool table and a regular pinochle game each evening. Patients  that were able and staff participated.

We had a patient government with elected officers and conducted regular sessions following parliamentary procedure attended by patients ans staff. The staff were observers. Patients conducted the proceedings. Grievances and concerns of the patients were brought up and addressed when merited.

I was treated with the best known methods including medication, sessions with a psychiatrist and group therapy sessions. In neither stay was I kept longer than necessary. As an adult, (the second stay) I had to periodically sign a consent form for them to be able to keep me. Unlike what usually happens today, they kept me long enough.

My disease has twice resulted in my spending time in jail. There instead of being well and kindly treated I experienced physical restraints and solitary confinement. (Try doing solitary while experiencing a manic episode sometime.)

Nobody ever wants to be confined whether in jail or a hospital. At no time was I glad to be in a mental hospital, but for me it was much, much better than the streets or jail where many seriously mentally ill go today. Based on my experience, deinstitutionalization was a terrible mistake.

Thoughts on James Holmes

A psychiatrist who interviewed James Holmes has testified that Holmes was mentally ill at the time of the shooting, but legally sane by Colorado law as he was able to tell right from wrong. I have three reasons for wanting Holmes found not guilty by reason of insanity,

First: I am philosophically apposed to the death penalty under any circumstance for very many reasons.

Second: I object to legal definitions of insanity that hinge on ones ability to tell right from wrong, acting on an irresistible impulse or anything other than the question of would this criminal act have occurred without the existence of a brain disease. In this case that is not clear but that’s not the question being asked. The psychiatrist testified that Holmes was mentally ill. The logical follow up question to me would be was it this illness that led to the crimes.

Third: I object to people being punished for getting sick. This may be what is happening here. It wouldn’t be without precedent. We have had leper colonies and quarantine in cases of serious contagious diseases. It could sometimes be argued to be a practical necessity so that the society as a whole or the many must be protected. I would object to going so far as imprisonment in actual prisons or execution.

All this leads me to further thought. While I want Mr. Holmes to end up in a mental hospital being treated, I have severe misgivings about him ever walking free again under any circumstances in ten years, twenty years or thirty or more years.

I have no qualms about John Hinckley walking free. I am both a survivor of a serous mental illness and an advocate for all families dealing with serious mental illnesses, but James Holmes is a different kind of animal. Those of us with histories like mine tend to feel kinship and sympathy for anyone with any type of brain disease, but some distinctions need to be made. Most of us are completely incapable of such an act.

John Hinckley was clearly acting due to a psychotic fantasy when he attempted to assassinate President Reagan and has clearly responded well to treatment. He can reasonably be considered no threat to anyone or to go off his meds. Mark David Chapman who shot John Lennon could probably be effectively treated and safely allowed to go free one day. When the disease caused the crime and the disease has been effectively treated, this is only just in my opinion.

James Holmes strikes me as different. I am in no way qualified to diagnose the mental health of anyone, but have personal experience with mental illness. When Holmes couldn’t keep from nodding off at his hearing, I could relate. When one of my psychotic episodes passed some sort of climax, I would relax and struggle to stay awake due to having had very little sleep for a very long time. So I believed he had probably been psychotic. But that was the only similarity.

From the first I wondered at his ability to plan and prepare over an extended period of time, knowing that I could never have done that when sick. Then there is his discussion in his journal of his long standing obsession with killing and murder. He talked some to the interviewing psychiatrist about hoping someone would stop him from what he planned. He talked of gaining stature from each of his murdered victims.

When sick I committed some criminal acts, but always believed I was on the side of mankind and trying to save the world, not build myself up by destroying others.

I guess my concerns center around questions like, did the disease cause the crime? Is the disease something that can be effectively treated?

This is a case of great interest to me for many reasons. I hope to get answers to many of my questions as testimony continues to unfold.

In many cases where mental illness is involved, timely treatment could have avoided tragedy. In this case, I just don’t know. It wouldn’t have hurt.

Like most trails where insanity has been pleaded, prosecution experts will testify that the accused was legally sane, defense experts will testify that he was not and a jury of laymen with typically little or no knowledge, training or experience with brain disease will by charged to decide. I pity the twelve.