I was in the hospital and I needed to take a nap. I have severe obstructive sleep apnea, so I needed my CPAP (no, dearies, not a Comprehensive Psychiatric Emergency Program, but a Continuous Positive Air Pressure machine—it blows air up your nose to keep the airway from collapsing). Psychiatric inpatient staff are very big on control. They had decided to control me by restricting my access to my CPAP machine. Instead of leaving it in my room, they made me come ask them for it.
I was tired, and therefore irritable. I asked. They refused. They were busy. I had to wait. After while, I got really pissy and started threatening them. I said I’d report them for denying me appropriate medical care. Then the whole situation got out of control. They did a lot of nasty stuff and I lost it and yelled some things. They drugged me up, I filed a complaint, there was an administrative investigation, maybe somebody got fired, who remembers?
When I was explaining all this to my doctor, he said sadly, “And all you needed was a nap.”
I was in a homeless shelter (actually, the shelter was not homeless; the people in it were) and I became listless, unresponsive, disoriented and confused. The staff called their people to take me to the hospital. The men in the van ordered me to sit up—yeah, right—then, as I lay half-passed out on the back seat, I listened to them talk about me. They decided that I was probably stoned on drugs—just another crackhead. In fact, I was dehydrating into a coma because I couldn’t get proper treatment for my kidney disease.
Lack of fluids, food and sleep cause psychiatric symptoms. We recognize that in children. When did we stop assessing for it in adults?
I volunteer on a support line. Whenever I get a new caller who’s talking crazy, I start with a body assessment. When did you eat last? How much have you had to drink today? How are you sleeping? Do you have any major medical problems? Are you drunk? The last thing I want to ask is “Have you got issues with your mother?”
One day I spoke with a woman who called regularly to talk about her relationship with her mother, who was terminally ill. The caller went on at great length, talking about all the psychiatrically appropriate issues pertaining to separation from parent, and death and dying. But she didn’t sound like her usual off-the-wall self. She sounded off a strange new wall. She was confused and disoriented—was she becoming psychotic? In the process of telling me how her mother told her that soon after her mother died, the caller would die because she couldn’t take care of herself, the caller referenced the fact that she hadn’t eaten.
I began a routine survey. It was around noon and the caller hadn’t eaten anything since the night before, when all she’d had was half a tuna fish sandwich. What had she had to drink? She couldn’t remember when she’d last had anything to drink. I asked her simply and specifically what liquids she had in her refrigerator. Milk, water and grapefruit juice were the answers. I told her I’d hold the line while she went and got a glass of juice. She did, and as we talked and she drank, her speech became clearer, her expressed thoughts became more rational, and her mood became more cheerful.
After that, I led her through a very concrete discussion about what and where to eat. She had nothing in the apartment that she would eat, didn’t know if she had enough money to order out, and was afraid to count her money for fear of discovering she was too broke to survive. I told her I’d hold the line while she counted her money, then we could deal with it together. It turned out that she had more than thirty dollars, so we decided that she would order out for her favorite eggplant Parmesan with a side salad and bread—enough for two meals.
I asked her to call me back later (which we’re not supposed to do on the line) because I felt she was still at physical risk. If she didn’t follow up and get the food, I might have to intervene again.
She ate, called me back full of eggplant Parmesan, vitality and clarity—and bitched me out for treating her like a child.
But here’s the fact: we all have a child’s need for proper hydration, healthy food and enough rest. When we don’t get these things, our emotions become unbalanced. These are small representations of how our bodies create the appearance of mental illness.
In greater ways—ways of bipolar disorder, schizophrenia, and psychosis—mental illness is also of the body. It is not a matter of immorality, irresponsibility or lack of self-discipline. It is wrong wiring and imbalanced hormones. And, like being black or gay, mental illness is simply a physical difference about which society makes nasty judgments.
So stop it, okay? We are who we are. Accept us in all our wonderfulness and weirdness and difference. Those of us with diagnosed psychiatric disorders are not bad, we’re just different.