by Charles O'Meara, RN Mental illness is a disability. And, like all disabilities, it appears in mild, moderate and severe forms. It may be helpful to think of mental illness in the same terms as another common disability: bad eyesight. If you wear glasses, you have a visual disability. But, thankfully, a disability that's easily corrected (and even a bit stylish if you get some cool frames). If you have a more severe visual disability, your vision may not be easily correctable, or it may require thick, expensive and cumbersome lenses which call attention to your face. And, finally, there are people whose visual disabilities are extreme. For them there is little or no help. They may go blind, or, in some cases, have extremely impaired vision that's only one step away from blindness. But back to mental illness, which follows the same continuum as visual disabilities. Some forms of mental illness respond really well to low doses of drugs. And some patients have a generally positive outlook on life in the first place. They come into treatment with a supportive family behind them and private insurance. But as we move along the continuum and symptoms become more severe, we eventually reach a point where patients suffer constantly from their symptoms and get little or no relief from medication. I once had a schizophrenic patient on my caseload who, was always dirty, smelly, disheveled and wearing ripped and worn out clothing, even though his mother kept buying him nice new clothes. This patient - let's call them X - couldn't count money, tell time or hold a conversation. X was always busy mumbling incoherently or looking around the room at "the shadow people". X lived in a nice apartment with his parents but spent every day scavenging for cigarette and cigar butts to smoke. Over the years X's psychiatrist tried one antipsychotic medication or combination of medications after another. Absolutely nothing made a difference. X was unchanged and exactly the same. While the scenario above is extreme it's by no means uncommon. Yes, there are lots of patients who respond to medication, but they won't take it or take it regularly. And there are others who have wild, uncontrollable episodes, even when their medication is generally working, because it's only, say, 70 or 80% effective. Different people respond differently to different doses of different medication. That's true for all humans and it's true whether we are talking about cancer treatment, vitamins, antidepressants or antibiotics. If you've ever seen someone in anaphylaxis caused by penicillin, then you know that what cures one patient can kill another. But one thing patients with serious mental illness all have in common is poverty. Do we really need to ask why? I mean, who the hell is going to hire someone who shows up for the interview two days late because they are disoriented to time, wears smelly clothes and talks non-stop about the CIA and the pope kidnapping them and installing a digital chip in their nose? And even if you were inclined to hire that person, what are the odds they'd show up and actually do what they were assigned to do? So...no job. And no money. Many psychiatric patients spend years (literally) drifting in and out of treatment. They are tried on a variety of drugs, none of which they take as prescribed once they're out of the hospital, so the reappear over and over in the emergency room. Patients in this category - and there are many - go from the psych ward to the street to the emergency room and back to the psych ward, over and over and over. When psychiatric patients live like that during their late teens and twenties, they arrive at a point where they have no job skills, no work history, probably no valid ID, most likely no fixed address, no transportation of their own, crappy clothes, straggly hair, poor hygiene, lousy teeth and, to quote Bob Dylan, "no direction home, just like a rolling stone." So, how are they gonna work? Answer: they can't and don't. So they end up on some type of financial support at the taxpayers' expense. When I was young it was called "welfare." You were "on welfare." My family was on welfare and we got food stamps. Over the years the name for this type of financial support has changed: state aid, subsidized income, department of social services payments, whatever. Some people get 'welfare' checks and food stamps and social security disability benefits or veterans benefits or a combination of these. These are the checks and supports conservatives bitch about constantly, using phrases like "I'm sick of my taxes going to help these people. It's my money, I work for it, why should I support them? They could work if they wanted to. I see 'em buying cigarettes, they don't look crazy to me. I wish I could get paid to do nothing all day." No you don't. I've spent the last seven years of my career as a psychiatric nurse working in the community, going into patients' homes and apartments, going to see them in homeless shelters and halfway houses and congregate housing. If you think they've got it made, I suggest you rent an apartment in their neighborhood and spend a month living on their income, not yours, and see how "easy" they've got it. In the vast majority of cases, they live in neighborhoods that are run down, dangerous, vermin infested, and ugly. The streets and sidewalks aren't cared for, grass grows through the pavement, slumlords don't fix up the crummy buildings and the city doesn't tear down the abandoned and rotting ones. I once made regular visits to a patient who had no kitchen floor, only the beams beneath it. You had to step from beam to beam to keep from falling through the ceiling into the apartment below. Sometimes you knock on an apartment door and it dislodges a few dozen roaches who suddenly come bolting out of every crack. Sometimes the patient lifts their shirt or pant leg and asks "What's this?" and you look at their skin and say nonchalantly "Oh, those are bedbug bites. You should tell the landlord. If the itching gets really bad, call your doctor and ask what they recommend." Sometimes, if you do visits after dark (which comes early on the east coast in the winter) you see rats. Sometimes there are vicious dogs. Once I entered an apartment looking for a patient and was waved back toward the kitchen by a young man who was cleaning a gun. His friend was sorting and bagging marijuana. I wasn't worried about them - after all, they let me in - but I was worried that on my way out I might literally walk into the line of fire if a competing drug dealer came looking for them. Oh yeah, sometimes, in the winter, you slip on the uncleared snow or ice and fall on and hurt yourself. Man those poor people have it made! Food? Well, see, here's the thing. If you don't have a lot of money, you buy what's cheap. This usually means the least healthy frozen foods and microwaveable meals and budget cold cuts and lots of soda. Or fast food. Grease. Salt. Sugar. If you're broke, you shop at the closest store, which, in a poor neighborhood, means high prices and limited choices. If you're poor and symptomatic, you don't get on a bus and travel out to the suburbs to shop in the nice supermarket. Yes, you can make a pretty nutritious meal buying nothing but chick peas, kidney beans, bulk rice and one or two veggies, but eat that night after night after night and see how much fun it is. Besides, it takes a certain amount of awareness to put food in a pot and cook it without burning down the apartment. You know how to cook, but you're not mentally ill and hallucinating, are you? I've seen patients giving over their monthly check to landlords who rented them structures that were only a couple of steps above being huts or caves: fifty year old motor homes that let every cold breeze blow through in winter and keep all the hot air trapped inside in summer; glorified storage sheds consisting of one 14 by 14 foot room with a toilet in the corner; a plywood walled corner of an auto repair shop measuring 8 x10 feet; century-old Victorian houses converted into dozens of makeshift efficiency apartments complete with cracked plaster, crooked creaky stairs, no lights in the hallway, broken doorbells, and rickety old appliances that look like they were hauled out of a ditch behind some shack in Appalachia. And speaking of Appalachia or Nowhereville, Idaho or West Dumptown, Missouri...the rural poor have their own set of problems. Being poor in the city increases your chances of being raped, robbed or beaten up. Being poor out in the country increases the chances that, if it snows, your nurse might not be able to get to your house to give you your medication. Being poor in the city means that if you get stabbed, you'll still probably end up in a hospital ER and survive. Being poor in the middle of nowhere means that if you overdose or have a heart attack, you might well die before help can reach you. This is how you live when you're really broke and if you're seriously mentally ill, you're almost assuredly broke. You hang around the public library scratching your crotch and talking to yourself on cold or rainy days because where else can you go for free? Libraries and bus stations and subway stations and other public places cost nothing and are usually warm (or warmish) in the winter and air conditioned in the summer and dry all year round. Most homeless shelters require the people who stay there to be out by about seven in the morning. The doors are locked and don't reopen again till about four or five, when it's first come, first housed. Didn't know that, did you? I grew up poor and those of us who 'made it out' and have good vocabularies are able to give you some vague idea about what it's like. But trust me, you have to experience poverty as an ongoing situation to really understand how debilitating it is. It removes your dignity, it limits your options, it makes you think less of yourself and less of all the people who seem to 'have it made' compared to you. It hurts when people stare at your shabbiness, and it fills you with hopelessness, with fear, with anxiety, with worry, with self doubt. You don't ask someone out on a date if they have money and live in a nice house and you don't have the price of a pizza. I can remember showing up for job interviews thinking I looked quite presentable only to realize that, compared to the other candidates in the waiting room, I looked like a kind of a bum. Now add hearing voices or serious depression or uncontrolled flashbacks of being sexually assaulted and tell me that the mentally ill 'have it made.' What helps? Drugs. Alcohol. Alcohol is easier to get, more freely available. And it has the added advantage of making freezing to death less painful, which is something that happens to psychiatric patients regularly in the winter time. Homeless, despondent or both, they roam the streets on a January night drinking cheap vodka or rum until their feet hurt and they lower themselves onto the ground under a highway overpass to rest. But they've had too much to drink, so they slowly doze off and, also slowly, their body temperature drops until they pass away. In the morning, someone sees an arm or a leg and calls the police and they are given a free ride to the morgue. What a deal. |
charles o'meara, r.n.I have worked as a registered nurse for more than two decades, ninety percent of that time as a psychiatric nurse. Archives
June 2017
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