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Maybe, Maybe Four Large Glasses of Water
Psych hospitals are remarkably different from one another after you pass through the commonality of mental illness. The first one I ever saw was in New Orleans and suffice it to say, resources were poor. I remember giant, schizo-affective Lionel grabbing my arm and me hoping he didn’t break it. I was astoundingly scared at my helplessness in his grasp ( 6’2″, 260, all muscle). One day Annie somehow managed to stand up, normally an easy feat but she was in four-point restraints and had a bed frame running the length of her posterior, arms, and legs out like DaVinci Man. She robot-walked toward me exclaiming, “gonna rape you white boy.”
Two weeks later, Lionel was a cuddly bear and Annie was wanting to get back to her kids. Psychiatric meds are expensive, have substantial side effects, and require access to the medical system. They can also turn insanity back to some semblance of normal.
The intake lobby had this white woman, in a 100-person sea of black women, seek me out and manipulate me in to helping her. She hid her craziness and hoped her charm and race would influence me. Sadly it did and an older black nurse pointed out where I was missing something in her history. But she also indirectly showed me I wasn’t immune to racial bias in my actions, a lesson I’ve kept close to me.
Senior year of medical school I had a fun tour of the US for a few rotations. One was the psychiatry department at UC Davis outside Sacramento. I remember a gorgeous college girl in Mill Valley named Simone, with a convertible Triumph no less … but that’s another story as is lying to the cops about firearms when they woke me from sleeping it off in my old Bronco 2.
Bobby had a closed head injury. He was 49, looked 65, and was a meth addict who pissed off the wrong person and was irreparably damaged by the man who used his skull like a basketball. He was tied at the waist but his arms were free, nervously fingering the brain surgery scar and plotting escape. “You got any scissors, man? We can go to my mom’s, she’s got cold Cokes, you like cold Cokes, my mom’s got cold Cokes.”
Marge was an Indian, I’m unsure which tribe. She was 55 and not at all connected with reality in many areas, especially regarding fluid intake. She came into the ER with critically low sodium and they instituted the usual fluid restriction protocol. She was hiding the fact that she had psychogenic polydipsia, aka compulsive water drinking by mentally ill people with defective thirst centers. Nobody realized she was crazy until her sodium kept dropping and they found her drinking water out of the toilet like a dog. Water was cut to the room and she slowly improved. I saw her when she was on the mend, although I was pretty sure she’d be back, given her line of reasoning. “Hey doc, you know what I’d love? One large glass of water. Actually maybe two, maybe two laaaarge glasses of water. Maybe three, maybe three laaaaarge glasses of water. Maybe, maybe four laaaaaaarge glasses of water….”
“You’re not going to stop are you?”
“Maybe, maybe five laaaaaaaaarge glasses of water.”
Ah, maybe she’s in heaven now. Marge is at Lake Lebarge perpetually guzzling away for eternity, never satisfied but always doing what she craved.
I left the room. I was always good at psychiatry, perhaps it takes one to know one theory of life. I almost considered it until I met all the psychiatrists. Oof, they’re a nutty lot.
The difference between a neurotic, a psychotic, and a psychiatrist: The neurotic builds castles in the sky, the psychotic lives in them, and the psychiatrist collects the rent.
Published in General
Now I understand your reference to glasses of water.
I’ll be honest, I would not have guessed that you were mentally ill from your Ricochet posting. My exposure to mental illness is mostly limited to encountering random homeless people, one of which I carefully walked to the Cook County Hospital while trying to avoid setting him off, and various bizarre internet communities like “Gangstalking” and other weird groups. There was also the time I suffered from what I can only imagine was fever delirium, and thought my hand was turning into a claw. It was like part of me knew it was fake and part of me knew it was really happening. Utterly terrifying – if that’s what a hallucination is like, keep the LSD away from me!
I don’t see any of the 2 + 2 = corndogs style of thinking on display in any of your posts. It’s nice to know that at least some people are able to recover from that illness with proper treatment, as opposed to just cycling through hospitals and the streets until they die. It’s pretty awesome, actually.
Getting into recovery is real, and for about 1/3 of people with this diagnosis, you can never tell. The later in life, and the less often episodes occur increase the good prognisis. If we could ID and stop the very first break before it happens, we would be better off.
This article from the Atlantic contains excellent information on the prognosis for people diagnosed with schizophrenia and the importance of getting early treatment when hallucinations first occur.
Some people (about a third of those diagnosed) can live completely normal lives on a small maintenance dosage of an antipsychotic, with symptoms recurring only as a result of some other stressful event such as a heart attack.
The problem with the existing long-term treatment regimens is that people gain weight, which can cause diabetes and heart issues. The medication alone is insufficient care. The second big problem is the self-imposed isolation, which diminishes the sufferer’s social skills. We need to work on that too.
What happens to people who suffer from untreated schizophrenia is that their perceptions of events unfolding around them are screwed up, and over time, their cognitive and memory abilities decrease. Thus it gets harder to treat over time.
I noticed in the article cited above that it says that about 10 percent of schizophrenics commit suicide. Thirty years ago, it was 50 percent. We are making great progress. For the last ten years, we have seen an increase in severely mentally ill people reaching retirement age. This is a miracle. But it presents new problems.
Young people who are diagnosed with this problem have an excellent prognosis. And there are fantastic rehabilitation facilities around the country such as this one at Boston University.
I hope we see some progress in developing better medications than are now available. We have no way to control the amount of dopamine coursing through the human brain. The antipsychotics now being used simply close the doorways so that the flood can’t get into all of them all at once. It is hard to believe we can actually do that and hard to fathom why all of the doorways are not closed by the antipsychotics when we do that. It truly is rocket science. But it is really imprecise.
The opposite of schizophrenia is Parkinson’s disease, which results from too little dopamine in the brain. The amount of dopamine is the problem. If we figure out one, we’ll have the answer to the other.
Neuroscience, rather than psychiatry by itself, now holds the keys to this research. Functional magnetic resonance imagery (fMRI) promises to help us see what areas of the brain light up when we are using them. I read a great book on this subject a couple of years ago that concluded with the news that an fMRI-like contraption that can be worn like a baseball cap or a visor has been developed now that will allow researchers to see how the brain is lighting up in the normal course of a person’s day. The contraption costs a mere $100–as opposed to having to have a patient sit in an expensive fMRI machine at $1,000 a picture.
We really are on the verge of some exciting breakthroughs.
Medications for bi-polar have the same side effects. I have a relative who has been fighting this for years now, and it’s not easy.
I’m sorry to hear that.
The medications are not as great now as they will be in the future.
One psychiatrist described schizophrenia to me as “a disease of the initiative.” So accurate.
The similarity of the two disorders is that left untreated, depression can be the incipient stress that causes schizophrenia. I’m glad these two areas of psychiatry are working together. We really need to see serious depression as the biochemical phenomenon it is.
I see these issues as being very similar to fevers or sweat or a racing heartbeat or anaphylactic shock. The human body goes into overdrive for various reasons. These responses are usually beneficial, but some of them, left unchecked, can kill us.
Thirty or forty years ago–this research has been replaced a thousandfold by now–one event that kept coming up in the lives schizophrenics was extreme child abuse, specifically people who had been punished by being locked into dark closets as young children.
It wasn’t until the use of Haldol–now considered a very poor antipsychotic–that psychiatrists were actually able to talk with schizophrenics and start to construct a credible medical history for them.
One avenue to explore with anyone who is having trouble with an antipsychotic is the use of an antianxiety drug such as Klonopin along with the antipsychotic. Also, doctors are starting to pair a beta blocker with the antipsychotic for older patients. Both help with daily-living stress.
The important thing in treatment is to keep trying. If the patient is not feeling better or is experiencing side effects that he or she doesn’t like, it’s time to get back to a doctor, not stop taking the medicine. There are answers to most of the problems. The important thing is to listen to the patient and keep the patient optimistic that the side effect problems have solutions and they are not the patient’s fault. People with severe mental illness are far more easily discouraged than most of us–see the description of the disorder as a “disease of the initiative,” which I mentioned above–which is why they often stop taking their medication.
It’s important to catch it before it becomes a way of life. Just as some deaf people actually enjoy their special status, the same is true of some schizophrenics. We all cope and adapt as best we can, and schizophrenics do that too. It is very tempting to say “That’s just the way I am.”
Beautifully written essay, DocJay, thanks! Makes me think of my father, a psychiatrist, who passed away from lung cancer in 2000. He would have loved Ricochet; he kept a copy of the Columbia Encyclopedia next to his easy chair so he could research any topic that interested him, faithfully watched Firing Line every week for its entire run, and crafted well-argued letters to the editors of the Wall Street Journal and New York Times whenever he disagreed with published articles.
My dad was Chief Resident at the Institute of Living in Hartford (a private psychiatric hospital) in 1961 when an extremely troubled, suicidal 17 year old female patient was admitted. She repeatedly burned her wrists, cut herself wherever she could reach, and when they put her in a seclusion room to try to calm her, banged her head violently on the walls and floor.
There were no effective medications or therapies to treat the teen at the time though apparently psychiatrists there tried everything they knew. My father somehow reached the young woman during her time at the Institute, though, and he convinced her that she was worthy and deserved to live.
Now fast-forward fifty years. In 2011 Dr. Marsha Linehan, a well-regarded psychologist and the developer of Dialectical Behavioral Therapy for Borderline Personality Disorder, returned to the Institute of Living and discussed publicly for the first time her mental health struggles as a teen and the time she spent at the Institute of Living in 1961.
“In the 1960s, the psychiatric community did not know how to treat patients with this [borderline personality] disorder. However, Dr. Linehan credits John O’Brien, MD, the IOL psychiatrist who cared for her, with saving her life. “He was the first person who loved me. This kept me alive,” she said.” (Can’t link to the hartfordhealthcare.org article on my iPad but the quote is from page 20)
I see from her bio that Dr. Linehan is a devout Roman Catholic and so was my dad and wonder if that is how they connected. Isn’t it beautiful that my father, who didn’t know how to heal Marsha Linehan’s illness in 1961, was able to care enough, love enough, not give up on her in that locked psychiatric ward long enough that she survived to develop a very effective treatment for others like her? I know my dad is smiling down from heaven knowing he made a difference.
It’s times like these I wish Ricochet had a “Love” button!
Me, too…Or, at least: Like to Infinity!