Surviving Schizophrenia

"We do not understand why they say what they say and do what they do." Dr. E. Fuller Torrey, M.D.

Dr. Torrey describes the problem with Schizophrenia to be a lack of sympathy. How can people sympathize with a person who is possessed by unknown and unseen forces?

He explains "With sympathy, Schizophrenia is a personal tragedy. Without sympathy, it becomes a family calamity; for there is nothing to knit people together, no balm for the wounds. Understanding  Schizophrenia also helps demystify the disease and brings it from the realm of the occult to the daylight of reason.  As we come to understand it the face of madness slowly changes before us. From one of terror to one of sadness. For the sufferer, this is a significant change."

Where the Police Are Part of Mental-Health Care
Jenny Gold


It’s almost 4 p.m., and officers Ernest Stevens and Ned Bandoske have been driving around town in their black unmarked SUV since early this morning. The officers are part of San Antonio’s mental-health squad—a six-person unit that answers the frequent emergency calls where mental illness may be an issue. 
The officers spot a call for help on their laptop from a group home across town.
"A male individual put a blanket on fire this morning, he’s arguing with them, and is a danger to himself and others, he’s off his medications,” Stevens reads from the blotter.
A few minutes later, the SUV pulls up in front of the group home in a run-down part of the city. A thin 24-year-old sits on a wooden bench in a concrete lot out back, wearing a black hoodie. His bangs hang in damp curls over his forehead.
“You’re Mason?” asks Bandoske. “What happened to your blanket?” Eight years ago, a person like Mason would have been heading to the emergency room or jail next. But the jail in Bexar County, Texas, where San Antonio is located, was so overcrowded—largely with people with serious mental illnesses—that the state was getting ready to levy fines.
To deal with the problem, San Antonio and Bexar County have completely overhauled their mental-health system into a program considered a model for the rest of the nation. Today, the jails are under capacity, and the city has saved $50 million over the past five years. 
These officers seem more like social workers. Stevens says that’s a huge change from his early days on the police force.
The effort has focused on an idea called “smart justice”—basically, diverting people with serious mental illness out of jail and into treatment instead. It is possible because all the players in the system that deal with mental illness—the police, the county jail, mental-health department, criminal courts, hospitals and homeless programs—pooled their resources to take better care of people with mental illness.
In San Antonio and cities across the country, police officers often serve as de facto mental-health workers. When a family confronts an emergency with a loved one in a state of psychosis, they usually dial 9-1-1, and the police respond.
Sometimes the resulting confrontations can have disastrous results, such as a case last year in North Carolina, where police shot and killed a teenager in his home after the family called for help during a schizophrenic episode.
More often, the person ends up in jail. Across the country, jails hold 10 times as many people with serious mental illnesses as state hospitals, according to a recent report from The Treatment Advocacy Center, a national nonprofit that lobbies for treatment options for people with mental illness.
San Antonio’s new approach starts with the kind of interaction Bandoske and Stevens are having with Mason. The troubled young man is hunched over, and his eyes dart back and forth between the two officers. This article uses only his first name because he was in the middle of a mental-health crisis. He mumbles answers to their questions, sometimes stopping to stare at a spot in the distance. For outsiders, it’s hard to know what’s going on, but the officers can tell Mason is hallucinating. Bandoske kneels in front of him, trying to maintain eye contact and get Mason’s attention.
“Are you hearing some voices right now? You are, aren't you? What are the voices telling you?” he asks. Mason is silent, but Bandoske persists. “Hey Mason, you’re seeing something that I’m not seeing. What is it?”
Bandoske, left, and Stevens are part of the San
Antonio Police Department's mental-health squad. 
(Jenny Gold/KHN)
Finally, Mason responds. “I’m seeing Jesus.”
“Jesus and what else? It’s OK, you can tell me.”
“My heart hurts,” says Mason.
Mason acknowledges that, yes, he’s hearing voices. And, yes, they’re telling him to do bad things to himself. Officer Bandoske also spots a dime-size scab on Mason’s face. “Hey Mason, is that on your face from a cigarette? What’s it from?”
“I cut it,” says Mason. “With my finger.”
“Do you ever feel like something is crawling on you?” asks Bandoske. The answer is yes—a sign of tactile hallucinations.
These officers seem more like social workers. Stevens says that’s a huge change from his early days on the police force.
  
“We had absolutely no training 20 years ago in the police academy on how to deal with mental-health disturbances,” recalls Stevens.
Back then, Bandoske adds, police responded to mental-health emergencies the way they would to any other call: They used the tough guy command voice they’re taught to handle criminals. “Police are notorious for the A personality type. They walk into a situation. They gain control of it. It’s their call now. They’re in charge,” he says.
And more often than not, the officers ended up taking people like Mason with serious mental-health issues to jail. “They would be arresting them for just minor misdemeanor offenses such as trespassing or criminal mischief or just disturbing the peace type calls,” says Stevens.
The other option was to take the person to a hospital emergency room. But in San Antonio, the police were waiting an average of 12 to 14 hours in the hospital until the person could to be triaged; that often made jail seem like a much more appealing option. 
There’s still the problem of where to take patients like Mason, other than jail or an emergency department.
“You can book somebody in the jail in 20, 30, 45 minutes tops, especially if you have a partner to help share the paperwork load, and then you’re back out on the streets,” says Bandoske.
The police were arresting the same people over and over again; many not only had a serious mental illness but were also addicted to drugs or alcohol and were often homeless. And whether they went to the jail or the ER, it was expensive for everyone—the jails, the hospitals and the police department that had to pay for overtime while cops waited at the hospital. And it meant that fewer police were available to work the streets.
San Antonio’s response was to require all officers to take a 40-hour course called Crisis Intervention Training, to learn how to handle mental-health crises like the one with Mason. The course includes visits from families of people with mental illness, who come in to tell their stories. And while some officers, like Bandoske and Stevens, specialize in mental health, all learn de-escalation techniques and how best to interact with someone in a state of psychosis.
The effort to train police to handle mental-health emergencies is gaining steam across the country. Fifteen percent of police departments nationwide offer the program.
But even with strong programs, there’s only so much that training alone can do; there’s still the problem of where to take patients like Mason, other than jail or an emergency department.
San Antonio tackled that problem, too.
“I’ll be honest with you. When it first came out, I was very skeptical. I thought, well this is ridiculous. If somebody’s breaking the law, if they’re public intoxication, they should go to jail,” says Bandoske.
People who commit a felony still go to jail, regardless of their mental status. And those who need extensive medical care are still taken to the hospital.
The center is saving the police department at least $600,000 a year in overtime pay.
But for patients like Mason, San Antonio built another option: the Restoration Center—a totally separate facility with a 16-bed psych unit, a medical clinic and a “sobering room” where police can drop off people who are intoxicated.
The Restoration Center was built with cops in mind to allow them to drop off their charges as quickly as possible. There’s a work station for paperwork, free coffee and a nurse available to provide medical clearance for people who are arrested, even those without a mental illness, to save the police a trip to the ER whenever possible. The center is saving the police department at least $600,000 a year in overtime pay.
Restoration Center nurse Catherine Riojas checks Mason in immediately after Bandoske and Stevens arrive with him at the center.
Mason seems more settled now, as she collects all of his property—cigarettes, jewelry and a folded piece of construction paper with a poem. She gives Mason a physical and helps him get settled in the 48-hour inpatient psychiatric unit.
And then, about 15 minutes from the time the police walked through the door of the center, they’re heading out again, ready to get back on the street.
“OK Mason, good luck. OK buddy? Hope you feel better,” Stevens calls to him, and waves. 


Jenny Gold writes for Kaiser Health News. Her work has also appeared on NPR and in the Washington Post.

Mental Health Basics

The images evoked by the phrase “mental health” are too often based on false stereotypes and misconceptions. One of four people suffers from mental illness, but it is not apparent or obvious. Most are certainly not homeless or disabled by a severe psychosis that requires inpatient treatment. Minding Your Mind is fielding programs to dispel false images. We do not stigmatize a child who has severe asthma or juvenile diabetes. He or she is given sympathy, understanding, treatment and support. We should view someone with a mental health disorder in the same context; as someone who has a physical ailment that can be treated successfully given today’s range of therapies. An individual with a mental health disorder is normal, just like the individual who suffers from diabetes or asthma.

Minding Your Mind

STEPHANIE’S STORY

I deal with depression and anxiety on a daily basis, some days being more bearable than others. It can literally hit me from one day to the next. And what's truly amazing is how quick it comes on. It's almost like changing the filter lens on a camera. Sharp and clear become slightly blurred and hazy. Nothing is focused right; my head hurts from straining to get some type of focus back. My muscles become harder to move; slow is the new fast. A new sense of reality sets in and depression becomes so familiar, that it feels just as good as a warm embrace from the people whom I care and understand me the most. Depression becomes home and happiness is a visitor. It’s astounding how comfortable it becomes, almost like a bad habit (and you know what they say about bad habits right?)

And while it all appears so comfy, the scary part is that you can’t get out. Imagine being shoulder deep in quick sand that you didn’t know you stepped in it until just that point. You know you need to get out to stay alive but you don’t know how, because it’s slowly sinking you into oblivion. It seems as though no matter what you do, you’re still sinking. You panic not knowing what to do. The only way you can be saved is if someone reaches out their hand for you to grab or if you stand still and think logically. Then when you’re finally out you swear you will never think like that again, continue on the path of life, being careful and avoiding any signs of danger until….you step into quicksand again.
http://bringchange2mind.org/stories/entry/stephanies-story

BLOG: DEPRESSION AND FEAR OF THE UNKNOWN 

BY ADRIENNE GURMAN

I’m not okay. These three small words may make some of you uncomfortable. Perhaps they’re scary enough to make you reconsider reading this blog. If so, I understand.

I’m not okay. That does not mean that I’m on the brink of losing it, or falling into a dark hole. What I’m telling you, at this moment, is I’m afraid of those things happening. There’s a profound sadness making its way throughout my brain, traveling south in the fast lane towards my heart. I can only compare it to the aura I get before a migraine – tiny sparks flying before my eyes, forewarning of the pain and misery of what’s in store for the following 24 hours.

I’m not okay. The melancholy with which I awoke this morning is a telling sign that an episode of depression is about to strike. Or, maybe not. I can just as easily get up tomorrow and feel fine. That’s the frightening part of living with a chronic illness. Any sign, (or omen as I call it), of an impending strike, evokes a primal fear – what if this is it? All rationality dissipates when I’m in this place. The years of bouncing back from hitting bottom don’t mean much when I feel the magnetic pull of the dark side. Will this be the time when I reach the point of no return? But maybe it’s only a fleeting bout of the winter blues. After all, the past months in the Northeast have been filled with icy polar-vortex gunk, turning the roads and streets into dangerous sheets of slippery, pot-holed frosty pavement. My instinct to hibernate is at an all time high.

Writing about it helps. Especially when my sweet dog Anya is sleeping soundly next to me. I’m not up for talking it through – analyzing and speculating why I feel so off and so terrified. As a seasoned therapy patient, I’m well versed in the Q&A of treatment and don’t feel the need or desire to make a call. The big red panic button seems off in the distance, yet I still worry that maybe by tonight or tomorrow I’ll be in my crawl space, hiding from the world.

I wonder if it’s possible to have Major Depression and ever live completely without the fear of it paralyzing me into oblivion. Then again, trying to surmise about my future is robbing me of my present. If I had a dime for every time I’ve been told to live for today, I’d have a boatload of coins stuck behind my sofa cushions.

Live in the moment. Breathe. Make a mental inventory of the objects in the room and welcome the sunshine pouring through the windows. Take another sip of freshly brewed coffee from the I Don’t Do Perky mug and relish in the early morning’s silence.

As if on cue, Anya shuffles over to the sunbeams hitting the wood floors and stretches out, making sure every inch of her long body fits perfectly in the rays. She’s closing her eyes and drifting back into a carefree nap. I doubt she’s wondering if she’ll be able to do the same thing tomorrow. I bet all my virtual dimes that she isn’t scared of having her water bowl stolen or losing her favorite blanket. For all of that lack of concern, she’s able to soak up the warmth and live in the present.

My sadness has not gone away, however the fear of spending my life in an eternal state of despair begins to lift a tad. Some days I’m convinced that I have a tight grasp on my depression - I walk with pride, and stand tall while bursting with enthusiasm. I tell myself “I’ve got this,” and lap up every minute. I’ve learned to never take a good day, or even a good hour, a good minute, for granted. None of us should. So when I wake up full of dread and impending doom, I must shift my thoughts to the here and now, just to survive. It’s times like this that simply not getting any worse is something I consider to be a success.

In many ways, chronic depression is similar to the weather. This week’s forecast is calling for more bone-chilling temperatures with no end in sight. But winter is only one of four seasons and as time passes, spring will gradually arrive.

I’m not okay. But I will be.

Adrienne Gurman has over 20 years of experience in advertising, marketing and magazine publishing.  She is currently the Vice President of 1212-Studio, a product design company in NYC.  A native New Yorker, Adrienne lives with her husband and their vivacious chocolate lab, Anya.  Adrienne began volunteering for Bring Change 2 Mind not long after the organization was founded, and has since been a leading advocate for fighting the stigma that surrounds mental illness. She has lived with Major Depression since the age of 12. Adrienne writes a weekly blog for esperanza magazine and continues to be a growing voice in the anti-stigma community.

Blog: Only the Lonely 

by Henry Boy Jenkins

There’s a joke that goes, “You’re never alone with a schizophrenic,” based on the mistaken belief that having schizophrenia is the same as having a split personality. It’s not. That would be dissociative identity disorder, a rare psychological condition defined by distinct and recurring alternating personality states which control one’s behavior. To clarify: schizophrenia is a chronic and debilitating mental disorder characterized by a breakdown in thinking which significantly impairs an individual’s thought processes. The ability to assess one’s surroundings and to interact with others becomes distorted. Isolation gets to be run-of-the-mill. This is not by choice. This is the illness. It is a lonely place.
Two months ago I attempted suicide. I suffered through a psychotic break, resulting in emergency medical intervention. I’d hoped that my symptoms had abated, but they seem to have left a vapor trail. Residual audio and visual hallucinations persist. I find myself preoccupied with them. I feel ashamed for not recovering sooner. I’m confused and haunted. When questioned, I act as if nothing ever happened. It’s not denial, it’s more like a memory wipe. In psychiatric terms, I am experiencing post-psychotic depression. With an unusual side-effect: I came to believe that I had no friends.
I approached the idea in much the same way that one might act on the notion of Spring Cleaning. I removed numbers from my phone, and I purged my friends list. I was getting things done and it felt good because getting things done always feels good. There’s that sense of completion and renewal. By actively eliminating all those names, I believed I was getting mentally fit. These were just names, after all, and how can a name be a friend? It’s random letters strung together. Meaningless. Without caller ID my phone was a brick. My newsfeed cruised without memes and cat pics. Cleaned out, like the closet. No mismatched socks or tatty jeans. Orderly. Like the hospital.
Days passed. The phone would ring and I would ignore it. A jumble of unfamiliar numbers. A text from the Twilight Zone. I could exercise or write or play guitar or paint, and nothing and no one was there to bother me. Something felt off, but I couldn’t put my finger on it. I started not sleeping again. I skipped my therapy sessions. I found myself living in a ghost town. I only jogged on days when it was pouring down rain to avoid seeing people at the track. The Brother From Another Planet had become The Boy In The Bubble. I wondered if I was lonely, but I knew that wasn’t possible.
Because you’re never alone with a schizophrenic.
If there’s an art to living with a mental illness it’s learning to ignore the dismissive paint-by-number forgeries hung by ignorance and prejudice as truth. Like in that movie where everyone laughs at the quiet girl with her Goth tapes and black lipstick. At the anorexic geek with his comic books and action figures. At the stressed-out veteran experiencing flashbacks. The bag-lady talking to shadows. Depression, anxiety, trauma, psychosis. You laugh along with the audience because you want to blend in, but it hits too close to home. It’s wrong to laugh, and you know it. You know it because it hurts. Something needs to change. That change begins with you.
It starts with an honest conversation. It continues with active listening. Speak to the words between the words, and to the ones tucked in behind them. Listen to the words that no one will dance with, to the words that never get a goodnight kiss. It really is a two-way street. This is how the conversation starts, and this is where the healing begins. A glass pressed up to the adjacent wall, listening intently for signs of life. Who is in there, and how do we get to know them better? Our words are the trail of breadcrumbs we follow to get out of the forest of loneliness.
It’s up to us to speak our truths and become a part of something bigger. We need to be seen and we want to be heard. We are not ciphers, cute off-the- wall characters in a situation comedy, or newspaper buzzwords when reporters get hasty. We are not punchlines. Mental illness is no laughing matter.
Confronting the stigma head-on, it would be more accurate to say, “You are always alone if you have schizophrenia.” But I tell you what: I am resolved to make - and keep - every friend that I can, no matter how many times I need to humble myself and surrender to the fact that I live a life in a world that no one else can understand. That is, until I start the conversation.

Henry Boy Jenkins is a Seattle artist, writer, and musician living with schizophrenia. He received his diagnosis in 2010 and has been managing his illness with a passion ever since. He is currently writing a memoir chronicling his experiences with schizophrenia and trauma in the hope that people living with a mental illness - as well as those who love and care for them - will find something in his story that compels them to share their own. Publicly open in his advocacy for awareness and change, Henry focuses on education and communication as the most effective tools in any superhero’s utility belt. Honesty and courage work hand-in-hand to combat stigma.

Myths & Facts About Mental Health Often people are afraid to talk about mental health because there are many misconceptions about mental illnesses. It's important to learn the facts to stop discrimination and to begin treating people with mental illnesses with respect and dignity. Here are some common myths and facts about mental health. Myth: There's no hope for people with mental illnesses. Fact: There are more treatments, strategies, and community supports than ever before, and even more are on the horizon. People with mental illnesses lead active, productive lives. Myth: I can't do anything for someone with mental health needs. Fact: You can do a lot, starting with the way you act and how you speak.You can nurture an environment that builds on people's strengths and promotes good mental health. For example: Avoid labeling people with words like "crazy," "wacko," "loony," or by their diagnosis. Instead of saying someone is a "schizophrenic" say "a person with schizophrenia." Learn the facts about mental health and share them with others, especially if you hear something that is untrue. Treat people with mental illnesses with respect and dignity, as you would anybody else. Respect the rights of people with mental illnesses and don't discriminate against them when it comes to housing, employment, or education. Like other people with disabilities, people with mental health needs are protected under Federal and State laws. Myth: People with mental illnesses are violent and unpredictable. Fact: In reality, the vast majority of people who have mental health needs are no more violent than anyone else. You probably know someone with a mental illness and don't even realize it. Myth: Mental illnesses cannot affect me. Fact: Mental illnesses are surprisingly common; they affect almost every family in America. Mental illnesses do not discriminate-they can affect anyone. Myth: Mental illness is the same as mental retardation. Fact: The two are distinct disorders. A mental retardation diagnosis is characterized by limitations in intellectual functioning and difficulties with certain daily living skills. In contrast, people with mental illnesses-health conditions that cause changes in a person's thinking, mood, and behavior-have varied intellectual functioning, just like the general population. Myth: Mental illnesses are brought on by a weakness of character. Fact: Mental illnesses are a product of the interaction of biological, psychological, and social factors. Research has shown genetic and biological factors are associated with schizophrenia, depression, and alcoholism. Social influences, such as loss of a loved one or a job, can also contribute to the development of various disorders. Myth: People with mental illnesses cannot tolerate the stress of holding down a job. Fact: In essence, all jobs are stressful to some extent. Productivity is maximized when there is a good match between the employee's needs and working conditions, whether or not the individual has mental health needs. Myth: People with mental health needs, even those who have received effective treatment and have recovered, tend to be second-rate workers on the job. Fact: Employers who have hired people with mental illnesses report good attendance and punctuality, as well as motivation, quality of work, and job tenure on par with or greater than other employees. Studies by the National Institute of Mental Health (NIMH) and the National Alliance for the Mentally Ill (NAMI) show that there are no differences in productivity when people with mental illnesses are compared to other employees. Myth: Once people develop mental illnesses, they will never recover. Fact: Studies show that most people with mental illnesses get better, and many recover completely. Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life. For others, recovery implies the reduction or complete remission of symptoms. Science has shown that having hope plays an integral role in an individual's recovery. Myth: Therapy and self-help are wastes of time. Why bother when you can just take one of those pills you hear about on TV? Fact: Treatment varies depending on the individual. A lot of people work with therapists, counselors, their peers, psychologists, psychiatrists, nurses, and social workers in their recovery process. They also use self-help strategies and community supports. Often these methods are combined with some of the most advanced medications available. Myth: Children do not experience mental illnesses. Their actions are just products of bad parenting. Fact: A report from the President's New Freedom Commission on Mental Health showed that in any given year 5-9 percent of children experience serious emotional disturbances. Just like adult mental illnesses, these are clinically diagnosable health conditions that are a product of the interaction of biological, psychological, social, and sometimes even genetic factors. Myth: Children misbehave or fail in school just to get attention. Fact: Behavior problems can be symptoms of emotional, behavioral, or mental disorders, rather than merely attention-seeking devices. These children can succeed in school with appropriate understanding, attention, and mental health services.  By Post: SAMHSA ADS Center 4350 East West Highway, Suite 1100 Bethesda, MD 20814 By e-mail: promoteacceptance@samhsa.hhs.gov