Along the Tracks

Wednesday, August 06, 2003

Mental illness, involuntary hospitalization, and suicide

I just ran across Rich Lowry’s column on mental illness from last week. It is superb, and makes a crucial point I also have emphasized: Mentally ill people are ill. A heartbreaking facet of that illness, for many (if not most), is the incapacity to judge their situation as an illness. They see the problem as a personal failure, not a disorder. Thus, they do not seek help until they “hit bottom,” if at all. Many never accept that they are ill, never tap into the help available, and simply choose to end their suffering by committing suicide. My brother-in-law Patrick chose this route.

This is the lens through which I look at mental health care in America, 2003. It adds shades of sorrow and bitterness, even anger. It also adds an urgency.

Our family spent last summer trying to convince Pat that he needed help. Our efforts - most especially, and heroically, by my wife and two elder daughters - were cautious, loving and sincere, and ranged from backyard evening discussions to walks around the ponds with the kids to all night absorptions of the pain and anger he would sometimes release with a flurry of hard words.

We all knew Pat’s problems were bigger than any of us were qualified to address, and so we tried to nudge him toward treatment. He refused time and again, and was so fearful we would attempt to commit him involuntarily, he once jumped out of the car while we were stopped at a light, and walked the six miles back to our house, refusing to be driven.

Finally, he agreed to an “assessment” with First Call for Help - completely voluntary. His week there showed little progress, although a “quicky” check by a qualified doctor resulted in a prescription. My wife sought information from the “counselors” at First Call, especially when Pat seemed even more depressed and moody, but they offered her little but an assurance that this was “normal.”

Pat’s regimen of “counseling” and weekly five-minute checks by a psychiatrist did nothing but add to our family’s confusion. He went through at least two different “counselors” (I don’t remember for certain if there were more, and I’m away from our records), and when a new psychiatrist saw him (for five minutes), he changed Pat’s diagnosis and prescription.

Pat made a week-long visit back to his home state of Colorado to see a friend, and on his return, we all noticed his demeanor had seemingly improved. He was more talkative, less isolationist and even began to plan for the future - I helped him prepare his resume. He seemed ready to take on the larger world. Meanwhile, his “counseling” and doctor visits remained mysterious to the family, as our few contacts with the “professionals” - all initiated by my wife - revealed little about Pat’s present condition or his prognosis. They seemed happy with his progress, and that was about all we knew.

Yet, there continued to be troubling signs - wild swings toward a black depression, anger at his own “failings” and a variety of other activities which seemed in sharp contrast to any “progress” the “professionals” saw.

Finally, after a day of anger and despair, he went out to our garage - something he did several times a day, as he had made it his place of solitude and refuge - and hung himself.

As my family continues to search for answers, and healing, I cannot help but feel that Pat would be alive, and most likely recovering, today if we had indeed possessed the power to place him in involuntary treatment. Forcing him to make the choice - a choice he couldn’t make because of his illness - cost Pat his life. I often wonder how many thousands more die each year for the same reason.

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