Since our minister at church is on vacation, I had the honor of conducting the sermon yesterday. My topic was, of course, mental health. I posted this earlier, but unfortunately the link was broken. So, here it is without a link. I hope you enjoy reading it, and please give me some feedback.
I’m Not Crazy, I’m Just a Little Unwell
July 21, 2013
I didn’t grow up in the happiest of homes. There are many reasons why, but one was having a mother who suffered so severely from depression that she would lock herself in her bedroom for weeks at a time. She would only come out occasionally, to get something to eat. Frequently her meals would be as simple as a piece of bread in a bowl of milk. When she was doing well, Mom and I would be the best of friends, yet other times we both would explode into unprovoked fits of rage, which at times involved smashing dishes while screaming at each other. One day I found her sitting on the sofa crying and she begged me not to have a life like hers and to please be happy. I made that promise not realizing that I would be incapable of granting that wish on my own.
Many of you may wonder, “Why didn’t she just cheer up.” Or “Why didn’t she just get over it.” Or “everyone gets the blues, but it passes.” Rev. Peter Morales, our current President of the Unitarian Universalist Association said the following in a sermon about his mother, and I quote “Believe it or not, depressed people spend enormous amounts of energy to cheer up. Events in their lives did not make them depressed. They were not depressed because their lives were hell — their lives were hell because they were depressed.” End quote.
I was such an unhappy child that I would run away from home about every other week. Fortunately we lived on 7 acres of land, which gave me plenty of time to rethink my idea by the time I reached the end of our driveway.
Generally I was depressed, but sometimes my behavior would be best described as erratic, rather than unhappy. When I was a teenager I would occasionally walk around my neighborhood naked at 2 in the morning. And there were many times that I would stay awake for days at a time, sometimes to the point that I would hallucinate. Decades passed before I looked back and thought to myself, “That really wasn’t typical behavior”
The first time I was hospitalized for my mental health was after chatting with an acquaintance. Apparently I said more than most people would share with a person they hardly know. I didn’t know he was a psychiatrist. He determined from our conversation that I was suicidal and had some friends take me immediately to the hospital.
I was diagnosed with depression and was held at Cedars Sinai for 7 days. When my week was over I expected to be released, however, my doctor told me I could not go. He could not let me leave because he was unable to find a county clinic that would take me as a client. Having no insurance, I already experienced being turned away from the clinics. I told him he was going to have a difficult time finding one. I was correct.
After a total of 10 days I was told a clinic was available and I could go home. I lived in Hollywood at the time, yet, the clinic where I was assigned was located at the far end of the San Fernando Valley and was over a three hour bus trip each way. On my first visit I was assigned to an intern. The process of receiving therapy from her was disheartening. She had a booklet that would tell her what questions to ask. When I would respond she would then turn to the appropriate page to ask the next question. When she finished she excused herself and left the room. Apparently all my responses took me to all the right pages because she returned with a prescription for anti-depressants. Although the prescription was signed by a doctor, I never was given the opportunity to speak with one.
I continued to try to get into other clinics, but was consistently told no. In fact, since I was already assigned a clinic, they wouldn’t even put me on a waitlist. Eventually I stopped going on my long bus excursions. I don’t recall it being a conscious decision. This is common amongst those with mood disorders or other forms of mental illness. After taking the proper medications for a while we start feeling better and stop taking our medicine. Why continue to take them when we feel so good? Most of us end up bottoming out again, and end right back into the system trying to get help.
Our country does not have a good track record for treating the mentally ill. North America’s first public mental health hospital opened in 1773 in Williamsburg, VA. Named the Public Hospital for Persons of Insane and Disordered Minds. The treatments given were nothing short of torture. One procedure involved submerging patients in ice baths until they lost consciousness. One means of expelling the illness from the patient included inducing vomiting. And, of course, there was bleeding. Bleeding was common, at that time, for treating many types of ailments, but unfortunately, in the mental institutions, this inhumane practice normally resulted in death. Although the colonial era’s methods of handling the mentally ill are considered barbaric by today’s standards, most people were content because the mentally ill were out of sight. Not much changed for over 50 years, until one woman helped to make sweeping changes across the nation.
Born in 1802, Dorothea Dix was the first child of an impoverished family. Her father was a Methodist preacher who was an abusive alcoholic. Her mother struggled with depression and suffered from acute headaches. As a distributor of religious pamphlets promoting a hellfire and brimstone theology, he continually moved his family from place to place. As a child Dorothea was required to stitch and paste the small pamphlets together for long hours. Feeling abused she ran away when she was 12 to live with her grandmother in Boston.
Dorothea began her religious life as a Methodist. When she moved in with her grandmother she attended the Congregational church with her. She was not satisfied with either religion. She decided to attend a Unitarian Church service and quickly became friends with William Ellery Channing, the foremost Unitarian preacher of that time. In his preaching’s she did not hear of a Jesus who had to die on the cross to save her from an eternity in hell. Instead she learned of a Jesus who lived a life of love and compassion and called upon all people to do the same. Dorothea became a Unitarian.
In 1841 Dorothea was asked to lead a Bible Study class for women at the Cambridge House of Corrections. It was here that she discovered that the mentally ill were unclothed, in chains, and were being thrown into prisons with criminals in unheated, unfurnished, and foul-smelling cells. When asked why the jail was in these conditions she was told, “those people were mentally ill and didn’t understand anyway” That became her defining moment and the cause to which she devoted nearly all of the remaining forty-six years of her life. She proceeded to visit other jails, and soon her investigations extended over the entire state of Massachusetts. She carefully prepared and took the case to the state legislature where she won support for the expansion of Worcester State Hospital.
Once she had succeeded in Massachusetts, she traveled to other states and proceeded doing the same process. Although her health was poor, she managed to cover every state
East of the Mississippi River. Before her death in 1887 she helped found 47 mental. Their treatment methods at these hospitals were crude by today’s standards; but they were remarkable steps forward in the mid 1800’s. Upon her death, more institutions were built, and other advancements were made, especially in medicine, but no sweeping changes would be seen for 80 years.
In 1963 President Kennedy delivered a speech to Congress, where he proposed “…a national mental health program to assist in the inauguration of a wholly new emphasis and approach to care for the mentally ill….central to a new health program is comprehensive community care… …The states have depended on hospitals and homes…shamefully understaffed, overcrowded, unpleasant institutions from which death too often provided the only firm hope of release.” Deinstitutionalization drew enthusiastic support from fiscal conservatives interested in saving funds by shutting state hospitals. Civil rights advocates were enthusiastic because they believed that mental patients needed to be liberated. The Community Mental Health Centers Act was the last law President Kennedy signed before his assassination.
Liberty unchecked can come at a heavy price. The federal grants promised to the states for community mental health clinics barely materialized. Deinstitutionalization, was/and is a well-intended disaster. Many patients, in institutions, were released into the community. However, most communities did not have the facilities to deal with them. In many cases, patients wound up homeless or in jails. Currently, throughout the United States, there are three times more individuals with serious mental illnesses in jails and prisons than in hospitals. Los Angeles, Sheriff Lee Baca once said: “I run the biggest mental hospital in the country.” The good works by Dorothea Dix has gone full circle.
After my stay at Cedar Sinai, I was able to function as a productive member of society for a good number of years. Then suddenly, without warning, s began to fall apart again. This time it was different. Yes, I frequently felt depressed, however, my erratic behavior came back and was much stronger. As a result, I lost my job, and my insurance, began having seizures and I became agoraphobic. Once again I called the county mental health line and asked where I could seek help. The clerk on the other end of the line told me where to go and gave the following warning: “keep in mind that the county clinics are struggling for funding so the primary function of those who work in admissions is to not admit you.” He then proceeded with this advice, “when you get there you need to put on a good show and convince them you will kill yourself if you don’t get in.”
Apparently I am not a master thespian because I didn’t make the cut. They refused to admit me “because I was too high functioning.” I certainly didn’t feel like I was high functioning. Then the most discouraging thing anyone has ever said to me was “when you get worse, come back and we’ll see if we can get you in.” Clearly preventive care is a low priority – and perhaps, it’s not even part of the program.
At this point suicide was whirling in my brain on a regular basis. Then, one day, a friend became so concerned that she gave me two options: I could call an ambulance and have them take me to the hospital where she would meet me, or I could call my husband, Maurice, and have him take me immediately. Not wanting to cause more drama, I called Maurice in a panic and he came to my rescue.
I was taken directly to the psych ward, handed a hospital gown and a blanket and was shown a hard bench to lay on. Much later a doctor woke me and sat down to speak with me. She told me she had been talking with Maurice and determined he was supportive enough that it was safe for me to go home.
For the first time I didn’t ask for help. I DEMANDED it. I refused to take no for an answer and I told her I was not going anywhere. She was in shock. All I asked of her was a safe place to go and get the help I needed. I needed a guarantee. She walked away.
After a grueling amount of time she came back with a phone number. She assured me that if I called the number in the morning I would get the help I needed. She was going to make sure of it. I was skeptical. How would I know if I would get in? Should I demand to stay until an appointment had already been made? I took a leap of faith and left the hospital.
The next day I called the number and surprisingly I had an appointment. Not with an admissions person who would turn me away again. This time I was given an appointment with a real, honest to God, doctor. It was at this clinic that I was accurately, diagnosed as having bipolar disorder (manic depression) and therefore began to receive proper treatment.
According to the National Alliance on Mental illness, suicide is the third leading cause of death for America’s youth ages 15-24. Also, 1 in 17 adults lives with a serious mental illness like schizophrenia, major depression or bipolar disorder. So, what do we do? For starters, as it’s written, the Affordable Care Act (Obamacare) will allow more people access to mental health care. It will also eliminate being disapproved due to pre-existing conditions. But that is far from enough. Thankfully we have organizations such as The National Alliance on Mental Illness and other advocacy groups speaking on behalf of the mentally ill. But they can’t do it on their own. Not until the public demands that mental health care be treated equally to physical care will we see any significant changes.
Some of you may find it odd at how open I’ve been regarding my mental illness. I even blog about it on a daily basis. Coming out of the mental health closet was a scary, conscious decision. I quote newscaster Jan Pauley, who is also living with bipolar disorder. She said, “A diagnosis is burden enough without being burdened by secrecy and shame.” My decision to be open and honest about my mental health was made easier by all of you – a loving and caring congregation. I thank you.
Despite my struggle to get help, I am one of the lucky ones. I think of those who have no support system. I think of those who have fallen through the cracks. And most of all, I think of the 1 in 5 people who are bipolar who successfully commit suicide. I think of them nearly every day.