Social stigma around mental illness is real, our current psychiatric system is inadequate, and yet there is always hope. I am thankful for the opportunity to share my story of recovery.
Brief summary: I have schizo-affective disorder, a thought disorder similar to schizophrenia, as opposed to a mood disorder like bipolar. The symptoms that are most troubling for me are negative psychotic effects, such as lack of motivation, anhedonia, avolition, severe anxiety and depression, suicidal ideation, and a markedly decreased ability to plan and execute life goals.
Positive symptoms such as hearing voices, hallucinating, and various delusions were very troublesome when my condition first hit when I was 28 and in the middle of law school. However, over time I have developed powerful meditative techniques that dramatically reduce their sting. I am beyond lucky to have been blessed with this capacity.
I was also lucky to be able to secure prompt psychiatric and medical care through San Francisco Mental Health and later MediCal. I was further lucky because my mother provided a phenomenal safe recovery space, was beyond patient with me, and absolutely excelled at being a primary support person. Finally, I was gifted with insight allowing me to aid in my own recovery. But even with all these lucky breaks, the devastating process of trial and error to find the right medication regimen for my specific body chemistry led to several years of unemployment, even with a JD diploma hanging on my bedroom wall.
Problems with our mental health system are so numerous, I limit to a few key observations.
First, the lack of access to treatment is a huge barrier. The vast majority of people who lack substantial wealth must go through months of process and paperwork. These tasks are difficult for people without diagnoses and daunting for those with. The process needs to be simplified and streamlined to avoid psychotic breaks which can turn violent and lead to costly involuntary commitments or incarceration.
Second, understanding is lacking in our society, because these battles are fought inside the mind and are never seen. Behavior that appears sloppy, lazy, bizarre, or irresponsible is too easily categorized as a character flaw rather than a symptom. If I lost a limb my disability would be immediately recognizable. Not so with mental illness. Exchanges such as this help people understand the insidious way in which psychotic symptoms operate. Twenty years ago the HIV community was similarly stigmatized, but education improved our understanding. I hold the same hope for mental illness.
Third, there is an acute lack of mutual decision-making between patients and clinicians regarding medication regiments. Too many psychiatrists blindly prescribe powerful anti-psychotics with severe side effects (I gained 60 pounds in one month when placed on Olanzapine). Psychiatry is an inexact science, and it is a long process to discover which specific medication works for each individual. Since many meds take four to six weeks before relevant data can be gleaned, there is a huge risk that a patient will discontinue meds due to side effects, or be unable to provide relevant feedback to assist their clinicians. The lengthy amount of time between appointments exacerbates this issue. Also, doctors often do not effectively explain risk/benefit analyses, nor do they display genuine respect for their patients and allow them to be involved in choosing medication regiments. This contributes to at-risk patients forgoing professional care in favor of self-medication through substance abuse, or at minimum failing to seek treatment.
Finally, I find there is a bias against spirituality among clinicians. The old adage is "Talk to God, you are religious. God talks to you, you are schizophrenic.” Admittedly, this is a fine line to walk, as many delusional beliefs have religious overtones but, as an issue of respect, clinicians must recognize that individuals who value spirituality and faith cannot simply excise that part of themselves out with a psychological scalpel. For those to whom faith and spirituality are important, seeking community and personal power within such beliefs can be a phenomenal non-med source of recovery. Not enough clinicians inquire "what" the "voices" are saying and asking whether these experiences are healthy or harmful. Instead, the mere fact of a psychotic symptom is often the impetus for a harsher medication regiment that is not objectively justifiable.
In summary, substantially more funding for mental illness is necessary to promote access to care. The world needs to be educated that these illnesses are just as debilitating as brain injuries, cancer, etc. And policy-wise, a far greater emphasis needs to be placed on ensuring that mutual decision-making between patients and clinicians is standard practice. These policy goals will take time and money to accomplish, but they are attainable. In the interest of a more just society, it is our obligation to fight for such changes.