Tag Archives: Medication

#Depression: What It Feels Like to Me

I have had experience with low moods since I was a child. Nonetheless, until a few months ago, I was never diagnosed with depression. During the last round of diagnostic revisions, my psychologst decided to diagnose me with depressive disorder NOS along with dependent personality disorder and borderline personality disorder traits. I am not sure I agree and my psychologist admitted at first that it was more her needing to give me a diagnosis on axis I to warrant me staying in the institution than my actually needing treatment for this.

Today, Aspiecat described what depression is like for her. I could relate to some of these experiences, but nto others. I am going to describe what it’s like to be depressed for me.

Let me first say that low moods are my default. I am pretty sure that dysthymia, ie. chronic but mild depression, is a more useful diagnosis for me than depressive disorder NOS. Apparently though my psychologist doesn’t feel I meet the criteria for that. Really not remembering a prolonged time when I did not feel low makes me wonder whether I’m truly depressed or just pessimistic. I know that depression and optimism do not mutually exclude one another, but I tend to gravitate more towards the negative than the positive.

Then there is the state, as opposed to the trait, of being depressed. Like Aspiecat, I experience two forms of depression: the first in which I feel numb and inert and the second in which I mostly feel despair, sadness and often anger. The former tends to last longer and be harder to overcome. During this state, I sleep more than usual, eat irregularly but usually more than normal, am slower than usual and generally unmotivated. I don’t usually experience the extremest of dark thoughts in this state. Rather, I worry and feel a bit anxious. I may experience suicidal ideation during this state, though it’s rarer than when I’m in my state of despair. I am also less likely to act destructively, unless you count binge eating. When I do experience suicidal ideation in this state, it’s more of a logical, thought-based kind focused on self-hate rather than an active wish to die. I just can’t be arsed to care about life.

In the state of what Aspiecat refers to as meltdown, I, like her, experience all kinds of negative emotions. I think I may be somewhat alexithymic (unable to read my own emotions) too. I often express my emotions as anger when I’m in this state anyway, even though I think I experience many other emotions. I am more likely to experience suicidal thoughts and to engage in destructive behaviors in this state. I am usually agitated rather than slow.

Unlike Aspiecat, I prefer the state of despair to the state of numbness and inertia. There are several reasons for this, one of which may just be the fact that I’m currently numb and not liking it. Any emotion seems better than this state of inertia now. I however also feel that my despair is more actionable, because it tends to be more situational.

Other people also tend to understand my state of meltdown more than my state of inertia. They see me lying in bed all day as a choice, whereas when I’m in meltdown, they see my despair. They may not accept my agitation in this state, but at least they notice that I’m not doing well. My medication also tends to help with this state more than with numbness. I do take an antidepressant in addition to an antipsychotic, but I’m not so sure it helps with my low moods. The antipsychotic and maybe the antidepressant too do take the edge off of my agitation.

Unfortunately though, people see my state of despair as more needing treatment than my state of numbness. This may be because I don’t tend to respond well to psychotherapy and medication-wise, there is simply more to be done against agitation. I take a high dose of an antipsychotic on a daily basis. I also have a low-potency neuroleptic, an anti-anxiety benzodiazepine and a sleeping pill (also a benzo) as PRN medications. All of these can be seen as depressants. Like I said, I do take an antidepressant too, though in a low dose. I am not so sure it works, but then again it isn’t a great medication for the kind of atypical depression I experience. By this I mean that it isn’t shown to be too effective with depression that is characterized by inertia, eating and sleeping too much and general anhedonia (numbness). This kind of depression is particularly hard to treat.

Because other people are more bothered by my meltdowns than by my state of anhedonia, I also feel they tend to want me to be numb rather than agitated. I mean, of course they don’t actively want me to be numb, but they see it as less of a problem, because it causes little disruption to others. I go along with this and have never asked for more help, medication-wise or otherwise, with my inertia-based depression. I am not so sure that I should.

X – #AtoZChallenge on Mental Health

Welcome to the letter X post in the #AtoZChallenge on mental health. I have two words for you today, so this is a short post. Here goes.


I have said this when discussing “survivor” in my letter S post, but many patients have endured traumatic experiences while in psychiatric care. As such, many are happy to be freed from psychiatry. There is a movement called the C/S/X movement. The C stands for “consumer”, ie. those still in psychiatric care. The S stands for “survivor”. Once consumers/survivors have completely freed themselves from psychiatry, many feel comfortable only with the label “ex-patient”, which signifies they are no longer involved with psychiatric care.


Xanax, the brand name for alprazolam, is one of the strongest benzodiazepine tranquilizers. Xanax is commonly used to treat anxiety or panic. Other benzodiazepines are also used as sleeping pills, but I’ve never heard Xanax being used for this purpose.

Benzodiazepines are highly controversial drugs because they are often overused and they can become addictive. In the Netherlands, for this reason, people can only get benzodiazepines covered by insurance if they have epilepsy, an anxiety disorder for which they’ve tried at least two antidepressants, or if they have severe mental illness requiring high doses of benzodiazepines (for chemical restraint). On this last ground, many severely mentally ill people take benzos on a daily basis. Worse yet, people without mental illness can get only one prescription for ten sleeping pills, to be used over the course of ten weeks, and even then they have to pay for them out of pocket. People in the psychiatric hospital almost always take sleeping pills much more frequently and many take them everyday. When patients are in the psychiatric hospital, benzos are paid for by insurance. I wonder whether I’ll get my benzodiazepines covered once I leave the institution. Depends on whether my condition is seen as a severe mental illness requiring high doses of benzodiazepines.

M – #AtoZChallenge on Mental Health

Welcome to the letter M post in my #AtoZChallenge on mental health. We’re finally halfway through the challenge. It’s proving pretty hard for me. Particularly, I’m finding it hard to comment on others’ posts regulalry. Sorry about that. This letter was an easy one.


Medications are usually believed to be an essential part of treatment for severely mentally ill people. The most common psychiatric medications used are antipsychotics, antidepressants, mood stabilizers and benzodiazepines. I will discuss benzodiazepines separately.

Practically everyone on a long-term inpatient unit takes an antipsychotic. It seems every psychiatrist has their favorite medication of first chooice, though a large number of patients take clozapine. This is not the antipsychotic of first choice, since it can cause potentially fatal side effects, but many people on long-term units are treatment-resistant. Other well-known antipsychotics are aripiprazole (Abilify), risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel).

Commonly-used antidepressants include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). These belong to the newer class of antidepressants, called SSRIs. Venlafaxine (Efexor) is an example of an even newer class, called SNRIs. It isn’t as commonly used though. (Efexor in partiuclar was heavily promoted by big pharma in like 2008 but it seems it’s not the wonder drug originally thought.) When people have treatment-resistant depression, they may get older antidepressants (tricyclics of MAOIs) or an antipsychotic (particularly Abilify) may be added. Mood stabilizers are primarily for people with bipolar disorder. Lithium is th most well-knwon mood stabilizer, but anticonvulsants (originally intended for people with epilepsy) are becoming more and more commonly used.


Mindfulness is one of the recently hyped-up treatments for mental health problems. There are mindfulness workbooks for everything from depression to bulimia to obsessive-compulsive disorder. Mindfulness can be a great part of psychotherapy, but of course it isn’t for everyone.

Movement Therapy

Movement therapy utilizes exercise, yoga or other movement-based techniques in the treatment of mental illness. Exercise can alleviate depression and anxiety. Relaxation techniques are also used in movement therapy. Often, a movement therapy session consists of first doing an exercise and then talking it through with the therapist. Movement therapy can be done both in group and individual settings. I have experience with both and it’s been a help in channeling my irritability..

Music Therapy

Like movement therapy, music therapy is a form of non-verbal therapy for mental illness. I have never had music therapy, because it wasn’t offered at my old institution, and I get the impression that most people here use it to learn to play an instrument. For some though, merely listening to music can be healing and may be part of music therapy.

I – #AtoZChallenge on Mental Health

Welcome to the letter I post of my #AtoZChallenge on mental health. This was a hard letter again, but I stil have a few words for you. Here goes.

Intramuscular Injections

Antipsychotics can be taken by mouth, but many can also be injected in a patient’s muscle. That way, they need to be administered only once every week or two rather than taken daily, because in a muscle, they’re absorbed slowly and steadily. Intramuscular injections, also caled “depot medication”, are often used on patients who refuse oral medication.

Involuntary commitment

Like I said in my letter D post when discussing danger, patients who are a danger to themselves or others can be committed to a psychiatric hopsital involuntarily. In the Netherlands, there are several ways a patient can be committed involuntarily. In acute situations when a patient is a grave danger to themselves or others, they can be taken into care with the mayor’s approva. Usually, this takes the form of a simple phone call by a psychiatrist to the mayor (or their substitute), who will almost automatically give the go-ahead. A judge will see the patient committed this way within a few days and approve or deny the involuntary commitment. An acute section lasts three weeks and can be prolonged with another three weeks once.

If a situation is less of an acute problem or after at most six weeks on an acute section, a patient can be brought to a judge for a longer section. A patient does not need to be an immediate and grave danger to themselves or others; merely being a danger suffices.

There are two newer forms of commitment too. First, there’s the observation section, which lasts three weeks and is meant for people who haven’t yet been diagnosed with a mental illness and aren’t a grave, acute danger either. A patient on an observation section can’t be subjected to force. A patient who realizes they might become a danger at some point, can file for self-commitment, indicating they will be admitted to a hospital and treated if certain criteria have been met, whether they want to at this time or not.

A patient can’t at this point be forced into outpatient treatment unless through a provesional section, threatening involuntary inpatient treatment if they don’t comply with their treatment plan while in the community. The government is trying to change the law so that patients can in fact be forced into any form of mental health treatment.

Milestones in My Mental Health Recovery

This week #theprompt celebrates its 100th edition. I was guessing at the prompt for this week, as I often do, and this time, I was right: milestone. There are many milestones in one’s life. Birthdays, particularly important ones like eighteen or thirty. Graduations, be it from preschool, high school or college. Getting married, the birth of a child or grandchild, and the list goes on. When I thought of the word “milestone”, however, I thought of the milestones in my recovery from mental health problems. I am going to share them here. I include steps I’ve taken in my journey with autism here too.

1. Realizing I have a problem. In a way, I was always aware of my being different, but I didn’t realize there might be somethng really, clinically “wrong” with me till I was fifteen. Then I realized I may be autstic. Or something else. I quickly developed quite the obession with about half of the DSM-IV. Then, when I was seventeen, my parents talked me out of thinking I was autistic or otherwise anything other than blind and extremely intelligent and oh maybe a hypochondraic. Never mind that hypochondriasis is a real mental illness.

2. Admitting I need help. I first admitted this the day after I decided I might be autistic, so when I was still fifteen. Then again, I was too shy to tell my parents or my teacher or basically anyone that I really needed more than a teacher with a social skills checklist telling me all that I was lacking in terms of social skills. I remained too shy to directly ask for help for years. They were other people asking for help for me. First, it was the teachr with the social skills checklist calling the blindness rehabilitation center for me. Then it was my staff at independence training calling mental health services. Then it was the police calling the crisis service after I’d made a suicidal threat in public. I still have a problem asking for help directly.

3. Starting counseling. My first experience with counseling was at the blindness rehabilitation center I went to after high school. That wasn’t all that successful. Then, at the mental health agency where I was diagnosed with autism in 2007, I started sessions with a community psychiatric nurse. This was quite helpful. It was probably my most successful counseling experience so far.

4. Starting medication. I first started medication in the summer of 2007. That wasn’t a success. I hadn’t expected the psychiatrist I saw to suggest I go on an antipsychotic, because the nurse I mentioned above was suggesting a benzodiazepine on an as-needed basis. I did end up taking said antipsychotic, but stopped taking it again several months later. The second time I went on medication, another antipsychotic this time, I was extensively educated and got plenty of time to think it through and make a decision. I consciously decided I wanted this medication and it’s been a great help (with an antidepressant and several PRN meds added later on).

5. Checking myself into a mental hospital. Of course, it wasn’t literally that I checked myself in. I didn’t take the initiative to call the crisis service or my treatment provider, which I didn’t even have at the time. After all, I’d moved a few months prior and the new mental health agency was doing the diagnostic testing all over again. Nonetheless, I consider it a major milestone that I agreed to be admitted into the psychiatric hospital.

6. Moving to a resocialization unit. I spent sixteen months on a locked unit, largely because my meltdowns and emotional outbursts were too severe for any less restrictive unit to want me. Finally, however, the resocialization unit did want me after I half lied myself into being accepted. I think this was a major step, as I got much better care on the resocalization unit than on the locked unit. After spending over four years there, I moved to my current unit, which is also rehabilitaiton-oriented but doesn’t have as strict guidelines on how long you can be here. Not that they were followed by the other unit either. I really went here to be closer to my husband, whicch I currently am not anymore since the move, but oh well.

7. Discharge. This milestone is to come this summer. I’m going to move out of the psychiatric instituttion and live with my husband. I’ll continue to get some form of psychiatric treatment, but of course this is a step towards recovery of a “normal” life.

You Baby Me Mummy

Six Discoveries Made on a Psychiatric Unit

On The Mighty today, there’s an interesting article on little discoveries made at a psych ward. I seriously thought I had invented playing card games as a life saver, but apparently I haven’t. Having spent eight years on one psychiatric unit or another, I can add a few more discoveries to this list.

1. The smoking area is the coziest spot on the ward. I don’t sit in the smoking area nowadays anymore, because I don’t want to associate with my fellow patients that much. On the acute unit though, I spent hours in there as a non-smoker just because it was the best place to have good conversation with patients.

2. Not just picky eaters like me despise the food. We had relatively good food when I was first admitted in 2007, but as budget cuts took over, the quality of the food declined sharply. Now we’re lucky if we have noodles, because they are pretty much the only food that isn’t too bland to be real. If someone with a specil diet or who is a vegetarian is admitted to our unit in the middle of the week, too bad. Food is delivered in bulk quantities, so no-one gets to choose what they want to eat anymore. If you’re a vegetarian or have a special diet, you can only hope that the staff will remember to order your food specifically. By the way, the vegetarian food is the worst of all kinds.

3. “Therapy” means you’re stuck with an adult coloring book. “Work” means going to the industrial arts department. I still don’t understand how people can call day activities their “job”.

4. On most wards, you can’t access the kitchen cupboards with food in them or even get a drink outside of meal times. I am fortunate to always have spent time on wards where you could get food or drink freely, except for coffee, but an increasing number of units are locking patients out of the kitchen or its cupboards. The reason is patients often make a mess. I remember a long time ago this locking of kitchen cupboards being discussed at the intensive care acute unit (not a unit I ever resided at). One nurse rightfully said that the patients on this unit have hardly anything they can control, so why should the times they eat be controlled too? Unfortunately, he didn’t get his way and the cupboards were locked.

5. People manage to argue over the remote even though everyone has a TV in their room and there are three TVs in the day rooms. Seriously, a fund founded by one patient’s parents provides TVs for everyone in their rooms, and still oftentimes the same soap opera is on on each of the three shared TVs.

6. Every doctor has their favorite prescription medication. I am still surprised the psychiatrist at the resocialization unit didn’t prescribe Ritalin to me, because he prescribed it to practically everyone. Benzodiazepines, of course, ar handed out like candy, except to me, because I told the psychiatrist I have a family history of benzodiazepine addiction and personal experience of its withdrawal. I am 100% confident that most of the other patients on benzos are effectively addicted, but apparently they’re too unwell to ever get off their pills anyway. Did you know that “severe psychiatric illness which requires high doses of benzodiazepines” (ie. chemical restraint) is one of only a few grounds to get the drugs covered by insurance. The other three are epilepsy, anxiety disorders when a person has tried at least two antidepressants unsuccessfully, and last but not least, palliative sedation in end-of-life care.

Then and Now: A Timeline of My Mental Health

It is often hard to see how far we’ve come on our journeys in life until we look back at where we came from. I am no exception to this. I tend to feel that I’m not improving in my coping with my mental health issues. There’s still this hurricane in my mind, after all. It is also hard because, whenever I seem to improve in my behavior, people’s expectations rise even higher. To shed light on the positive changes I’ve made on my journey through life with mental illness, today I will write a timeline of events related to my mental health.

2007: I was hospitalized on the acute ward on November 3 of this year. I was not allowed to leave the ward without someone accompanying me. For the first few days, I even had to have a nurse accompany me. After those first few days, any adult could accompany me, but they had to sometimes assure the nurses I was safe with them.

2008: I started out the year with a setback: I was given a seclusion plan, which meant I could be secluded if I was a burden to other patients or staff. By early February, however, my privileges were finally extended so that I could go off the ward unaccompanied for fifteen minutes. By early March, my privileges were quite suddenly extended to four hours of unaccompanied time off the ward, which is the maximum you could get at that unit. If you had this privilege, you could ask for extended leave if you had a reason for it. My seclusion plan was also lifted, only to be reintroduced again by June. Fortunately, I never had to actually be secluded, but the nurses frequently used it as a threat. The plan was lifted again in September, but only so that I could be moved to the resocialization unit.

2009: I transferred to the resocialization unit in March of 2009. I did mostly okay until September, when I had a major meltdown which elicited another patient’s aggression. The possibility of moving me to the locked ward for a few hours if I acted out was introduced into my treatment plan.

2010: I was sent to the locked unit for the first time. This did lead the staff to consider medication, and I agreed. I started on a low dose of Abilify, an antipsychotic, in late February. It had to be increased to a moderate dose by the summer and by September, Celexa, an antidepressant, was added. Both helped calm my anxiety and irritability. In November of this year, I was diagnosed with dissociative identity disorder and PTSD.

2011: I was on the waiting list for an autism-specialized group home and went there to stay over for a week-end in October of 2011. Unfortunately, the group home had changed its target population and there was too little support by the time I stayed over there. I didn’t end up going.

2012: I started planning to live with my husband by this time, originally pretty much solely because I didn’t have any suitable alterantive. I don’t mean this to insult my husband, but I didn’t feel I should be burdening him with care duties if at all possible. We moved into our aparetmetn by December. Meanwhile, I was trying to get treatment for my DID/PTSD.

2013: I had an intake interview with a psychiatrist who thought she could treat my DID/PTSD. She ultimately ended up turning me down. It had nothing to do with me, but she was too busy with her physician duties. I moved to my current institution, where i was soon diagnosed with borderline personality disorder. I started schema-focused therapy, but this had little effect. My Abilify also got increased some more.

2014: I continued to struggle, but for the most part was quite stable. My Abilify had to be increased one last time in late 2014 (I am now at the highest dose). I did improve in my behavior and got a more cooperative relationship with my staff. I spent a few times in seclusion, but always voluntarily.

2015: I decided I wanted to live with my husband for real this time. We have been making arrangements, though it’s been slow-going. We will be moving to the tiny village sometime in December, so concrete arrangements cannot be made till then. I have been trying to get a med review for a few months now. Though my mind is still very unquiet, particulalry as my discharge out of the institution draws closer, I don’t tend to act out as much as I used to. I was in seclusion for a while last Monday, but before then it’d been over six months.

As I look back, I see that sometimes I take steps back and sometimes I take leaps forward, but in general, I’m moving up. I’ve never had to be moved back to a more restrictive unit, though I’ve sometimes wanted it. My medication did have to be increased a lot, but I don’t see that as entirely negative.

I am linking up with the 1-word blog challenge hosted by Lisa and Janine. The word choices for today are THEN and BREAK.

Tips for Coping with Suicidal Thoughts

Screw you, #BEDN. I screwed up the day after I planned to continue writing everyday this month. Yesterday was a bit stressful. I baked an apple pie to remember the eighth anniversary of my psychiatric institutionalization, but I also felt overwhelemd with memories from the day of my crisis. In addition, yesterday was designed to be plan your epitaph day by the inventors of weird holidays. I only found out through this week’s #TuesdayTen. I was originally planning on writing a post on tips for coping with suicidal thoughts for #TuesdayTen, but the pressure of having to think up ten coping strategies and the doubts as to whether it’d fit in, made me skip the occasion. The idea stuck around though, so I’m going to write down some coping tips today.

The first important key is realizing when depression or despair sets in before you reach rock bottom. When you are acutely suicidal, most of the tips I’ll mention below will sound completely useless. However, if you’ve realized you are depressed or otherwise severely distressed, you may be able to enlist the help of others in staying safe. Here are some tips that can help you through some suicidal ideation. When you are actively planning suicide, these tips may no longer work and you’ll need to go to the emergency room or psychiatric crisis service.

1. Enlist the support of family or friends. Like I already said, supporters, such as family may be able to help you remember why you want to live. If not, they may be able to intervene to keep you safe whilst getting a mental health professional involved. When I was in my crisis in 2007, I had no support in the city I was in at the time. That is, I had my parents, but they weren’t particularly helpful (and I honestly can’t fully blame them) at the time.

2. If you don’t have family or friends to support you, there are support sites and telephone hotlines for people in crisis around the world. While again, if you are in acute danger, you need to go to the emergency department or psychiatric crisis service, when you are still able to talk it through, do so.

3. Think of what your goals are, what you want to get or avoid with suicide. Obviously, religious beliefs about an afterlife aside, you won’t gain anything from suicide. That doesn’t mean it doesn’t seem like it. Some people believe: “At least I’ll be able to rest then.” In this sense, what you want to avoid through suicide is important too. Discuss with your family or a mental health professional how you can reach this goal while remaining alive. For example, I knew as I was talking to the crisis service psychiatrist in 2007 that I didn’t really want to die – I mean, who wants to? -, but that I couldn’t cope with my life as it was anymore.

4. Think of the people you’ll leave behind. No, I don’t mean thinking of them having to make funeral arrangements and how selfish you are for leaving your family with the financial burden. That is not going to be helpful. Just for your information, as a family member, don’t ever burden a suicidal relative with this kind of crap, no matter how confident you are that they are “just doing it for attention”. However, if you do have people you still care about when you’re in despair, thinking about them can help lift your mood. Despair is an incredibly lonely feeling, but there are people who care about you.

5. Be careful about chanigng medications or other treatments for depression while you are actively suicidal. Though electroconvulsive therapy (ECT) is relatively safe for severely depressed people, antidepressants carry the risk of increasing suicidality. Always be sure to discuss suicidal ideation with your mental health professional and don’t change your medication regimen without close supervision, preferably from a psychiatrist.

What My Mental Illness Feels Like #Write31Days

31 Days of Mental Health

Welcome to day 29 in the #Write31Days challenge on mental health. Phew, we’re almost done. I truly find it a challenge and unfortunately don’t find it particularly rewarding.

Today, I’ll give you a glimpse into my unquiet mind by describing what it feels like tohave my mental illness. I have been diagnosed with borderline personality disorder, which is characterized by self-regulation difficulties. It also overlaps with other disorders.

Once, years before I had been diagnosed with any mental illness at all, I read a description on a Dutch site of the “borderline feeling”. It described a starting point at which you are feeling fine, or at least appearing as though you are fine. Then, a minor annoyance occurs. You start feeling frustrated, angry, infuriated. Then you feel sad, depressed, depserate. Fear and then panic also comes in. Finally, all feelings tumble over each other and create a big emotional whirlwind. That’s what the experience of BPD is like.

I can illustrate this with an example. This afternoon, I was feeling slightly on edge because it was time to make afternoon coffee and no-one was available to assist me. Then, when I noticed the nurses were flipping through some seemingly unrelated photos at the nurse’s station, I completely lost it. They had told me they were busy and now they were just chattering! I can’t even remember how the situation progressed, but within minutes I was banging my head, screaming and then ran off. When I came back to the unit (I had the sense of rationality to find my way back myself), I accused the nurses of faking being busy and ignoring me. They had truly ignored me (or been oblivious to me at least) when i stood at the nurse’s station and I still cannot be sure what thing was keeping them so busy. That being said, I couldn’t politely ask them whether they truly didn’t have time to help me make coffee.

We had a group discussion, in which I was again relatively calm. Then we had dinner, after which I went on the computer for a bit. I still was feeling slightly on edge but not over the edge. I wanted to talk to the nurse, so made use of my daily talk time to discuss my tension. However, I couldn’t get it out clearly what I was feeling and why. At that point, all emotions started coming together and I became angry and depressed and fearful at the same time. I went outside, accompanied by the nurse, to blow off some steam.

Usually, this feeling I had in the evining for me is triggered by some flashbacks or relivings of past “trauma”. I put that between scare quotes because the events I am reliving can be relatively minor. However, they can cause distress nonetheless.

During such episodes I also often feel dissociated. I used to completely regress into a child mode, but now I just feel as though I’m small and start speaking or babbling incoherently but don’t fully act like a child.

When an episode is severe, I may resort to self-destructive behaviors such as binge eating or self-injury. Usually, these behaviors temporarily relieve the tension but obviously they aren’t the solution. I often relapse soon after I engaged in destructive behaviors. With PRN tranquilizers, especially benzodiazepines, the same used to be true: they temporarily calmed me down, but when they wore off, I was increasingly agitated. Research shows that borderlines often become more agitated and may become aggressive when given benzodiazepines, because benzodiazepines reduce their anxiety and thereby their impulse inhibition. I do not personally experience this.

My (Somewhat Hypocritical) Opinion on Force in Mental Health and Developmental Disability Services #Write31Days

31 Days of Mental Health

Welcoem to day 25 in the 31 Days of Mental Health. Today, I’m inspired by yet another question from the 30-day mental illness awareness challenge. For day 25, the question is about your opinion on force or coercion in mental health.

I used to be a strong opponent of any form of coercion in mental health. I remember once in late 2007, when I was still on the acute unit, a fellow patient being medicated against their will. I saw this as a particularly nasty violation of the patient’s human rights, worse than for example seclusion. Now I know that for some people, if they have to choose between seclusion and rapid tranquilization, their choice is not always seclusion.

I used to believe, in my naivety that there is always an alterantive to force in mental health. I still believe there is in most cases. For example, studies of involuntary outpatient treatment don’t compare the programs to the same level of care but without the component of force. If they did, maybe it’d be shown that there is no advantage of forced treatment, and it is just the intensity of care that makes the difference. In this light, I remember one particularly poignant interaction I had with a nurse on the acute unit. She said that I’d be secluded if I needed more care than they could provide. Indeed, involuntary outpatient treatment is generally seen as a way of averting hospitalization. Now I’m not a big fan of psychiatric hospitalization, but I cannot help but believe involuntary outpatient treatment is just a convenient (for the providers and the government) way of saving money. So are most forms of force in mental institutions, as my interaction with the nurse illustrates.

Of course, a few people cannot be kept safe even with constant one-on-one attention, assuming the government would allow this. A notable example is the case of Brandon, a young man who had been restrained in his institution for people with developmental disabilities for years when the newspaper got word of it in like 2010. I was infuriated at such inhumane treatment as restraining a person for years, but my husband and many other people I spoke to countered that there simply was no alternative. Medications hadn’t helped (and besides, that’d be another form of force) and Brandon was so aggressive that he’d attack anyone coming close.

That being said, still, in many cases, force in mental health and developmental disability care is used as an alternative to proper care. I remember one example that I read about at the time Brandon’s case was in the news. A proponent of electroshocks as aversive therapy for people with severe self-injurious behaviors presented the case of a person who was hitting his eyes so vigorously that he was at risk of becoming blind. He described the situation of the nurses conferring at the nurse’s station while the man was blinding himself in the next room, adding something like: “And what quality of life does a person with an intellectual disability who is also blind have?”

I cannot begin to tell you all the things that are wrong in this situation. Nurses sit at the nurse’s station conferring (or drinking coffee) way too much rather than taking care of their patients. We do not know whether one-on-one attention would’ve prevented this man from blinding himself, because there was none. INstead, his treatment team chose to set him up with a shock machine. In addition, I totally understand a sighted, intellectually capable person’s judgment that an intellectually disabled person who is blind has no quality of life. However, the proponent of shock therapy hardly considered the effect whatever causes this person to self-injure has on his quality of life, possibly multiplied by the effects of electroshocks. We do not know whether the person in question had a painful medical condition. I assume the cause of his self-injurious behavior was unknown or could not be taken away, but I’ve heard parents and professionals advocating for aversives or restraints when the cause of problem behavior is known and can be removed.

I do use some double standards though. Being in a mental institution myself, and especially having seen some of the more severely mentally ill people, I have lost some of my naivety regarding forced treatment. Perhaps less self-righteously, when soemone bothers me, I’m happy to have them secluded, restrained or medicated. There are some people on my unit who are very regularly verbally aggressive or simply very annoying when psychotic. In those cases, though I would like to say I oppose force, I’ve actually been relieved when the nurses gave these people some PRN medication, often with only some sembleance of consent. I would like to believe that the guys who constantly talk to their voices are actually helped by a low-potency neuroleptic, but at least I do not know whether these people are bothered by their voices and if so, whether the PRN medication actually quiets their voices. I should care, but when it’s past 10PM and I want to sleep, quite frankly I don’t.