In the aftermath of the Newtown CT tragedy, we seem to be so busy trying to protect ourselves that we have forgotten about the people who are sick. Rather than trying to understand those among us who suffer from or will develop a mental illness, we are moving swiftly to take away rights.
We will achieve more if we can adopt an empathic and compassionate understanding of people with mental illness in order to help them and, in so doing, to help us all.
I have worked with several hundred people for long-term care of schizophrenia. In each of them, I try to understand the person behind the illness. Their lives have been up-ended by a process that neither they nor we understand. Distrust has often been sown by involuntary hospitalizations and arrests.
Most often, behind all this, is a person who wants help.
I work with people after hospital discharge, a setting in which they will ultimately decide to accept treatment or not. I need to offer treatment that they find sufficiently helpful so that they are willing to come back. Psychotic illness affects many aspects of a person’s life—relationships, housing, employment and physical health: we need to evaluate the effect of our treatment in many domains.
I get to know my patients very well.I respect the struggles my patients have gone through. Each of them is trying to regain some level of control over their lives. Sometimes we disagree over the treatment option to pursue, but I cannot say that my way is always the best way. I never stop learning from my patients. There are plenty of times I have admired them.
The most important thing I will establish with my patients is the relationship. It is the relationship that makes them come back for the next visit and accept my advice regarding treatment.
It is the relationship that allows me to tease apart subtleties that may lead to more effective approaches to treatment. And it is the relationship that frees my patient to discuss symptoms, such as suicidal thoughts, command auditory hallucinations, or worse, for which someone else might lock him up, but once discussed, understood and supported, can be overcome.
Building such relationships is an art.
Its foundation rests on respecting patient’s choices. People with mental illness are routinely stripped of choices through involuntary hospitalizations, medication prescriptions without their input and life decisions, such as where they will live, made under coercion.
While people experiencing exacerbations of symptoms may need their choices limited, their ability to make good choices will improve with treatment. The capacity to make choices must be nurtured at every level. The recovery movement is a patient-driven effort to encourage exactly this with its motto “Nothing about us without us.”
By listening to these patients’ voices we can learn to tune in our individual patient’s concerns, respect their values and build relationships.
Nearly everyone assumes, for example, that Adam Lanza was mentally ill, but no one really knows because no one from the mental health system had a relationship with him.
If we make the assumption that Adam Lanza was mentally ill, can we also have compassion for the suffering he would have been experiencing? Can we ask ourselves if we have provided services that are sufficiently welcoming and recovery-oriented such that he would have felt safe asking for help?
My fear is that we have simply labeled him a monster, and will not ask these questions.
Walter Rush is a psychiatrist on two Assertive Community Treatment teams in Minnesota and is on the Board of the American Association of Community Psychiatrists. He welcomes comments from readers.