Mental Health: Our Useless Rights

For this post’s purpose, I define a severe mental illness as a chronic medical condition that affects behavior, insight and judgment.

Picture it:

A filthy young man, confused and raging on Market Street, collapses at an intersection and rolls into traffic.

The police arrive.

An officer drags him to the curb and asks him if he has plans to hurt himself or anyone else. The young man shakes his head no.

The officer asks if he knows his way to the local soup kitchen and homeless shelter.

The young man shakes his head, yes.

Because he affirms that he is not an immediate danger to himself or others and claims he knows where to get food and shelter, the officers have no legal basis to mandate treatment.

The police drive off, and the young man rolls back into traffic.

The police cannot stop a sick and confused young man from obstructing traffic because it would violate his rights.

In 1963, President Kennedy signed the visionary Mental Health Centers Act, which authorized funding for a community-based care system in every state and county.

“I am proposing a new approach to mental illness and to mental retardation. This approach is designed,   in large measure, to use Federal resources to stimulate state, local, and private action. When carried out,  reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability. Emphasis on prevention, treatment, and rehabilitation will be substituted for a desultory interest in confining patients in an institution to wither away.” President John Fitzgerald Kennedy

In 1965, Congress approved the Medicaid Act, which offered higher reimbursement rates for community-based care, later the Supplemental Security Income (SSI) program provided financial support for people with mental illness who were trying to live in the community.

Passed in 1967, the Lanterman Petris Short Act prohibits involuntary civil commitments for the mentally ill in California unless a person is an immediate danger to himself and others, or is gravely disabled, generally defined as unable to access or make use of food and shelter.

The Community Mental Health System was supposed to replace or serve as an adjunct to State Hospitals.

By 1967 most cities in the United States had an active community mental health system.

That changed in the 1980’s.

The Lanterman-Petris Short Act fails in seven of its nine intents.

It does not end the inappropriate involuntary commitment of persons with mental health disorders because inadequately staffed for-profit prisons replaced the State Hospitals.

It does not provide prompt evaluation and treatment of mental health disorders because treatment resources are underfunded or don’t exist.

It does not guarantee or protect public safety.

It does not protect persons with mental health disorders from criminal acts because homelessness increases crime risk.

It does not provide services in the least restrictive setting appropriate to the needs of each person receiving services because there are no services.

In theory, people with mental illnesses have the ‘right’ to the services and supports we need to live like people without disabilities, but we can’t access services and supports that don’t exist.

For people with serious mental illnesses, the Lanterman Petris-Short Act is an excuse to deny treatment, and the Americans with Disabilities Act is a joke.

We don’t need access ramps; we need access.

Schizophrenia and Alzheimer’s disease have a similar set of symptoms, but no one would say an Alzheimer’s patient has a human right to wander our cities in a daze.

No one would say an Alzheimer’s patient deserves to suffer.

Mental illness is not a civil rights issue.

Mental illness is not a moral failure.

Mental illness is not a result of toxic thinking.

Mental illness is not a choice.

© Rob Goldstein 2020

Dissociative Identity Disorder: A Week in the Valley of Shadows

This article is also published on Surviving My Past

Repulsion and Trauma

First posted 2/24/2016-Revised October 2018

Decompensation: Psychology, a loss of ability to keep up normal psychological defenses, sometimes resulting in depression, anxiety, or delusions. Dictionary.com

A favorite literary description of a psychiatric decompensation is in the 1933 short story, Miss Lonely Hearts by Nathanael West.

Miss Lonelyhearts is an advice columnist who slowly loses his mind from the suffering he reads. This passage is toward the close of the story:

“After a long night and morning, towards noon, Miss Lonelyhearts welcomed the arrival of fever. It promised heat and mentally unmotivated violence. The promise was soon fulfilled; the rock became a furnace.

He fastened his eyes on the Christ that hung on the wall opposite his bed.

As he stared at it, it became a bright fly, spinning with quick grace on a background of blood velvet sprinkled with tiny nerve stars.

Everything else in the room was dead–chairs, table, pencils, clothes, books. He thought of this black world of things as a fish. And he was right, for it suddenly rose to the bright bait on the wall. It rose with a splash of music and he saw its shining silver belly.

Christ is life and light.

“Christ! Christ!” This shout echoed through the innermost cells of his body.

He moved his head to a cooler spot on the pillow and the vein in his forehead became less swollen. He felt clean and fresh. His heart was a rose and in his skull another rose bloomed.

The room was full of grace. A sweet, clean grace, not washed clean, but clean as the inner sides of the inner petals of a newly forced rosebud.

Delight was also in the room. It was like a gentle wind, and his nerves rippled under it like small blue flowers in a pasture.

He was conscious of two rhythms that were slowly becoming one. When they became one, his identification with God was complete. His heart was the one heart, the heart of God. And his brain was likewise God’s.

God said, “Will you accept it, now?

And he replied, “I accept, I accept.”

He immediately began to plan a new life and his future conduct as Miss Lonelyhearts.

He submitted drafts of his column to God and God approved them. God approved his every thought.”

Miss Lonleyhearts by Nathanael West

My episodes are less dramatic, but no less frightening.

It’s frightening to lose the ability to sleep and concentrate.

It’s frightening to lose the ability to distinguish between reality and fantasy.

It’s frightening to wake-up tired and hopeless, thinking that it never gets better.

Decompensation is not necessarily a bad thing if it is part of the therapeutic process.

“…anxiety and panic symptoms are almost invariably “feeling flashbacks” triggered by a relatively benign event in the here-and-now, such as being alone in a room at twilight.” The Work of Stabilization In Trauma Treatment

The basic skills a trauma patient needs are these:

  • Grounding and centering techniques

  • Coping strategies for dealing with suicidal and self-abusive impulses

  • Contracting for safety with themselves and others

  • Learn to anticipate stressful or triggering events

  • Learn  to calm the body and mind

  • Learn to distinguish past from present reality and how to stay “in the present”

The Work of Stabilization In Trauma Treatment

If trauma symptoms include dissociative alters, the alters must know about and communicate with each other.

This is not easy, and recent attempts to communicate broke through memory barriers and lead to this most recent period of decomposition and regression.

Regression is an unconscious defensive process by which the patient reverts to a previous level of functioning, usually to a certain infantile or juvenile stage.”

One of the best portrayals of regressive decomposition is in the film Repulsion by Roman Polanski.

Catherine Deneuve portrays Carol, a sexually conflicted young Belgian woman.

Carol lives in London with her older sister. .

The film suggests that either Carol’s father or some other man sexually abused her as a child.

I first saw Repulsion when I was in my 20’s.

Watching it again this week during an episode of decompesation was a revelation.

Polanski shows us Carol’s anguish and her rapid decline with brilliant accuracy; when her Sister leaves for a week-long holiday we enter the territory of Carol’s mind.


“…the most common effect of sexual abuse is Post Traumatic Stress Disorder. Symptoms can extend far into adulthood and can include withdrawn behavior, reenactment of the traumatic event, avoidance of circumstances that remind one of the event, and physiological hyper-reactivity.” Psychology Today

We see these symptoms when Carol’s boyfriend tries to kiss her. She reacts with disgust, runs into her apartment in a panic and obsessively brushes her teeth.

Among the trauma symptoms depicted in Repulsion is loss of time
which begins almost as soon as Carol is alone.

We see her increased sense of disconnection from her environment.

Later, as her paranoia and hyper-vigilance escalates Carol re-lives her assault.

By the end of the week Carol is lost to herself and the film closes with a snapshot of Carol as a child, gazing angrily at her Father.

Kim Morgan of the Huffington Post calls Repulsion one of the most frightening studies of madness ever filmed.

My emotions were everywhere this week.

My decompensation was not as dramatic as Carol’s; it certainly doesn’t
have the narrative edge.

It involved lost time and laying in bed watching Repulsion followed by
non-stop episodes MST3K.

Thank God for that show and for the part of me that comes out to watch it.

The most difficult thing about surviving is surviving.

If you have a counselor or psychotherapist let that person know what is happening if you think you entering a crisis.

You can also call the National Suicide Prevention Hotline: 1-800-273-8255

Remind yourself that memories are just memories; it is more normal to remember a trauma than forget it.

When you have a panic attack stop and pace your breathing.

If you start to relive the past remind yourself of the present.

When you can’t sleep don’t lie in bed thinking or worrying; get up
and enjoy something soothing or pleasant.

If you have difficulty concentrating, give yourself time to focus on what
you need to do.

People with PTSD and CPTSD also have depressive episodes.

If the acuity lasts for more than a few days seek help.

If you think you are a danger to yourself or others call 911 or go to an emergency room.

Rob Goldstein 2016 revised October 2018

Video clips and still shots are from the film Repulsion and used here for educational purposes.

Disclaimer: I am not a mental health professional. I write about my personal experience. What works for me may not work for you. If you think you are having a psychiatric episode please see a professional.

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The Alternate Universe of DID

There is a discrepancy between what I feel is true and what I know is true.

What I feel is that my body is populated by other people; people who are alike yet different; with different needs, points of view, ideas, and biases.

I’ve mentioned in other posts that Second Life is an extension of my
inner life
.

Some of my alternates are friends with each other.

Almost all of them like to dance, and when they use dance animations in Second Life they re-create real dancing by choosing animations based on the beat of the song.

My alternates dance with each other as a form of soothing, especially as each comes to terms with the abuse and pain that brought them to life.

So, the answer is yes, they talk to each other and they collaborate on the illustrations that we use for the poems and stories we write.

When the child alternate feels frightened, Matthew or Sara brings  them into Second Life to comfort them.

The pictures below show different skill levels in composition and photo-processing.

We knew nothing about photography, composition or Photoshop in 2009.

Over time our skills improved and we dispensed with reality based sets and backdrops since reality has no meaning for us, not in Second Life which
is now little more than an extension of my inner world.

Mateo and Sara 2009
Mateo and Sara 2009
Bob and Bobby 2010
Bob and Bobby 2010
Mateo and Bobby- 2013
Mateo and Bobby- 2013
The Narrator and Sara -- 2013
The Narrator and Sara — 2013
Bobby and The Narrator - 2014
Bobby and The Narrator – 2014
Bobby and Sara - January 2014
Bobby and Sara – January 2014
Bobby and Matthew - 2013
Bobby and Matthew – 2013
Bobby and Sara - February 2014
Bobby and Sara – February 2014
Mateo and Sara - September 2014
Mateo and Sara – September 2014
Bobby and Sara - January 2014
Bobby and Sara – January 2014
Matthew and Sara - 2014
Matthew and Sara – 2014
Bobby and Sara - July 18, 2015
Bobby and Sara – July 18, 2015
Matthew and Peter - 2014
Matthew and Peter – 2014
Matthew and Robby - 2013
Matthew and Robby – 2013

(C) 2013-2019 Rob Goldstein All Rights Reserved

 

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