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medicalmiracle · 6 years

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Rotation wrap-up: PSYCHIATRY

Psychiatry was a laid-back, super chill rotation. My placement was at a Veteran’s Administration (VA) hospital, which is funded by the federal government and treats U.S. veterans and their families. What I did: ~8:00-8:30AM: I would roll in, coffee in hand. I would snag a computer (they were in short supply between the residents and medical/PA students), log into the crappy EMR, and read about the current patients or any new patients which may have been admitted overnight. There was no pre-rounding, just a huddle at 8:30 which students didn’t really participate in. My team rounded right after huddle, so as long as I was there before 8:30 it was cool. 8:30AM til whenever: Rounds. The rounding team consisted of the attending, resident, medical student, PA student (myself), and social worker. In the beginning, the resident led rounds and the attending would occasionally jump in. When the students got comfortable enough, they would lead the rounds interviews for the patients they were following. The social worker would also ask questions and work with the patient on psycho-social issues. Housing was a big component of this; most of the veterans on the psych ward were homeless and had substance abuse problems which often required close outpatient followup or residential treatment. 12:00PM-1:00PM: Lunch. Lunch was didactic lectures twice a week, and free time the remaining two days. If you program offers these, make every effort you can to go, because they are great reviews for end-of-rotation exams. Topics included: emergency psychiatry, traumatic brain injury, psychopharmacy, geriatric psychopharmacy, PTSD, sleep problems, addiction medicine, involuntary commitment, and legal liability, among others. 1:00PM-4:00ish: Students were pretty much on their own. That does not mean you are free to fuck around. During this time, it was expected that we will complete tasks assigned during rounds. Things I did included: calling consults for medical issues and coordinating care with the medicine teams, putting in orders for imaging or labs or whatever else, performing focused physical exams for things like MSK pain or neuro assessment, doing psych exams like MoCA and Beck Depression Inventory, and spending time with the patients I was following to get extra history or whatnot. ~4:00ish: Peace out, y’all. Days were pretty short unless there was a late admit, which my team was lucky enough to never catch one. Also, if the resident on your team was post-call and the attending rounded in the morning and didn’t have anything for you to do, students were generally allowed to leave after morning rounds. I was always gone before the words were fully out of their mouths.

ROTATION #: 1 OVERALL GRADE: A+ IMPRESSION: Y’all... I absolutely LOVE psychiatry... I might work in psych after I graduate. Mental health is MORE important than physical health because you can’t MANAGE your physical health if your brain and/or emotions are jacked up. Plus, it’s so challenging to find the right combination of things to help your patients, it’s like the best possible puzzle ever.

ROTATION ADVICE: - Know your pharmacology, because you will be asked. - Study addiction medicine. We only had like two addiction lectures during didactic year and they didn’t really cover treatment, just what is addictive, how to tell when someone is under the influence, and how to treat overdoses. Addiction is a huge part of inpatient psychiatry because so many mentally ill people self-medicate with psychoactive substances. - Learn how to keep a poker face. Psych patients will tell you some jacked-up shit and you can’t wig out or they will shut down. - On the flip side, try not to become overly involved. I struggled with this SO HARD. I just wanted to do all the things for all the people, and it became sort of exhausting. Plus, transference and counter-transference are real things and can lead to trouble. - Relax and have fun. Psychiatrists and people who love psych are usually quirky/odd ducks who see the world a little differently. Come to the dark side, we have SSRIs and comfortable offices. OTHER COOL SHIT: My program offered a lot of really great experiences outside of our regular hospital work. Some of the things we did... - Observed ECT. Electroshock therapy isn’t at all what is portrayed in popular culture. Patients are under anesthesia and the current isn’t enough to require restraints or cause the body to heave. Only enough current to cause a seizure is given, and tonic and clonic phases are only observed via lower extremity motion. It is very effective for treamtnet resistant bipolar dperession or for people who are so severely depressed that they cannot care for themselves or are catatonic. These people don’t have the time that SSRIs require to be effective. It was really fascinating and the doctor took the time to show me all the cool EEG strips and explain what was going on in each one. - Listened to a recording of “voices” aka auditory hallucinations made by a psychiatrist who struggles with psychosis. We were given small tasks to complete like filling out a job application whilst listening to the recording. It really helped me empathize with what my schizophrenic patients were dealing with. - We attended a Behavioral Court session. This was a county court-run diversion program for people with mental illness who had landed in legal trouble because of their illness. As long as they followed treatment plans and the other rules set forth by the program, they stayed out of jail. The clients told us their stories and it was really sad but really amazing at the same time. The judge told us that they had been granted money to hire a doctor to better manage the medical end of the program such as better diagnosis and prescribing, but no doctor wanted the job. We immediately raised our hands and asked them to expand the written language to include advanced practice providers like PAs and NPs. Physical physician supervision is not required, only chart review and availability for consult. If there are holes to fill, APPs are glad to fill them! The judge made a written motion to follow our suggestion, and that was pretty fucking cool. - Psych ER. We all got to do shifts at our local Level I trauma center, which is also the safety net hospital for our metropolitan area. It was AMAZING. Involuntary commitments out the wazoo, prisoners from surrounding jails, and people in acute crisis. Very cool, but limited resources made the work challenging. No medical social workers to be found. They supposedly existed, but I never saw one. - PSTAR clinic. This was an outpatient treatment resistant schizophrenia clinic. These people had tried so many medications, and were still struggling with their symptoms. The clinic’s main MOA was to push for early clozapine use, which evidence has shown to lead to improved long-term functionality in persistently psychotic patients if used earlier in treament than it traditionally has been. It was also very cool. One patient who used to be in and out of the psych ER with psychotic breaks and suicidal ideation was so well recovered that she had regained custody of her daughter and was talking prereqs for nursing school. So fulfilling. We also had the option to choose outpatient peds psych or women’s psych, but I picked this because schizophrenia is fucking fascinating. - Attended an Alcoholics Anonymous meeting. I can’t say that I got much out of this because it was a bunch of upper class women sitting around a table in a church reading passages from the 12 step book with the occasional vague reflection about something that was read. It was weird and felt awkward.

So far, clinical rotations are pretty fucking rad. I’m enjoying myself immensely and it’s so great to be out of the classroom and actually doing things. Hold on, y’all, it will get better... I promise.

#PAschool #clinical rotations #inpatient psychiatry #pablr #medblr

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scriptshrink · 7 years

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What would therapy be like for a man (he's 25, not sure if that matters) on suicide watch in a psych ward/hospital? He lives in England, but I'm not sure if that matters either... He attempted to overdose but was found by his boyfriend and brought to hospital by ambulance.

It actually does matter, a lot! The British healthcare system is WILDLY different from the American one, and I’m not very familiar with how it works. Luckily, some of the Scriptshrink consultants have had experience with it! Their answers are after the jump.

CW: mentions of a suicide attempt, overdose, & medications

nothowiplanned

I mean my first response is that those circumstances absolutely do not guarantee hospital admission.

No NHS psych beds means they’d most likely give him physical treatment at hospital and then send him home after an assessment with the crisis team.

Crisis teams - at least in my part of the country - don’t like to be regularly involved in care for more than a few weeks so he would probably be discharged from them quite soon.

They might make a referral to adult mental health services but more likely they would refer him to IAPT - improving access to psychological therapies - who would put him on a waiting list for CBT*

*Is my bitterness showing :/

I honestly think the only way that character would end up in a psych ward in those circumstances is if he could pay for private treatment and I have zero knowledge about how that works.

Charlie

Alright, so first things first - it is difficult to be admitted inpatient in the UK. An overdose is not likely to result in an admission. Usually ODs are seen as “less serious” attempts, once you’re medically cleared you see the liaison psych team. Liaison will then decide the next steps, whether a person needs to be hospitalised or can be sent home.So for realism, I’d change the overdose to something else. BUT I said difficult, not impossible, so it’s not really necessary.

Then it would depend on whether the character was a voluntary admission or detained under the Mental Health Act - being detained in the UK is commonly referred to as being “sectioned” after sections 2, 3, 4, and 5 of the act, which outlines the legislation allowing a person to be detained.

https://www.rethink.org/living-with-mental-illness/mental-health-laws/mental-health-act-1983

As for the actual inpatient care, it depends. We don’t really call it “suicide watch” but instead “observations”. You have different levels depending on your need: 2:1, 1:1 arms length, 1:1 eyesight, 10 minute, 15, 20. 2:1 means two members of staff (usually psych nurses or healthcare assistants) are by the individual at all times. 1:1 means there’s one staff member with them, either within arms reach or in their field of vision, and 15-20 is minutes. Again, the amount of observation will depend on whether the character is there voluntarily or not. A risk assessment will be carried out the night of arrival and they will decide from there what level of supervision the character needs.

If the character is very high risk they may transfer them to an intensive psychiatric care unit, but this is unusual and is only if it’s believed they can’t even be kept safe with 1:1 or 2:1 constant observations. In IPCU, you don’t get much in the way of therapy - it’s all about managing risk and stabilisation first of all.

And again, you’re unlikely to get much therapy if you’re on constant observations, even if you can be in an open ward (aka not an IPCU).The actual schedule and therapy varies from unit to unit, but usually there will be group therapy, art therapy, occupational therapy and individual therapy. Each day starts with breakfast and medication, you have a morning snack, lunch, afternoon snack then dinner and an afternoon snack, then night meds.

There’s a ward round once a week where your allocated psychiatrist comes around and tells you how you’re doing and updates you on your situation. Here’s a pretty good example of an inpatient schedule:

http://www.fourwindshospital.com/about_four_winds/westchester/pdf_schedules/lodge_core.pdf

Snail

When I was 25 I was admitted into a psychiatric hospital in England following an overdose. I was admitted as an inpatient because I was already under the care of the crisis team, but still kept making suicide attempts (the other ones were a type that is perceived as “more violent”, although the last was an OD) so it became clear that I wasn’t safe without being admitted.

As Charlie said, the therapy that your character would receive in hospital varies a lot.

For “suicide watch” (observations), I was under 15 minute obs. The way this worked during the daytime was that as the nurses did their rounds they made a note on their charts when they saw me, and they would go looking for any patients who weren’t accounted for. At night, they shone a torch through the window in the bedroom door, waited until they saw me breathing/moving, and then would move on. I sometimes like to sleep with my sheet over my head, so that meant that the nurses would come in, pull the sheet off my face and shine the torch on me to check.

In terms of therapy, there was not much available. We didn’t have any group therapy or individual sessions, but there was occupational therapy - this consisted of the art room being open for an hour and a half in the mornings Mon-Fri, when patients could go in and do drawing, painting, or colouring. There was also a programme of activities in the afternoons or evenings - max one activity per weekday, lasting approximately half an hour - of things like bingo, a crossword puzzle, a quiz. These occupational health activities were all completely voluntary, and took very little time. Most of the time people were either in their rooms, or sat in the common room with the telly. I was determined to be a Good Patient™, so I did every single activity that was offered, but I was an outlier in that respect, and there were plenty of patients that one would only ever see at meal times - the rest of the time they sat alone in their rooms.

Being in hospital was a case of being under obs while they waited for meds to kick in - they were looking to stabilise patients rather than trying to heal them (inpatients are expensive).

“Review meetings” were the main point of focus for the patients I spoke to - at these meetings, led by the consultant psychiatrist, your case was discussed with you and bunch of other people (like representatives from other agencies), and decisions would be made about your medications, the status of your section, discussions about day release, etc. People basically spent their time waiting for these meetings, because these were the only times when we could find anything out about going home. One thing that was difficult was not knowing when the review meetings would be. I was lucky - I had one a week, but other patients had gone 2-3 weeks without one and without knowing when they could expect to be seen again (I expect that the nurses’ and OHs’ reports were part of the process for deciding if it was appropriate to schedule a review meeting - financially, it doesn’t make sense to gather all those people only to say “yeah, nothing needs changing, we’ll leave everything the same”).

Although I may sound like I am being negative in this reply, I know that I am extremely fortunate to have access to free healthcare, and to have access to interventions for mental health at all!

Disclaimer

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veteransystem · 7 years

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Plural Friendly Fire: It Sux 4 Evry1

So, I was going to leave it for the night, but against my better judgement I read our entire dash, including this ask and response (in a series of angry anons). And this segment of the anon rant stuck with me:

“actually also u can help being what u are! just stop pretending! its so easy when ur not traumagenic bcuz it actually isnt an illness u suffer with!”

Because this statement, and the attitude behind it, is why most systems don’t last a year out of the closet. Of all kinds: endogenic or traumagenic, neurogenic or spiritual, fictive/factive or split or walk-in or any variation, past or present. In every category of plural there is, systems that have recently come to terms with the fact that they do not experience life as one mind in one brain have been bombarded with the message:

1) you must perfectly match this particular extremely strict model, primarily defined in negatives, stereotypes, and impossible catch-22s (e.g., “all systems with fictives are fake,” “traumagenic systems have just been brainwashed by their shrinks,” “you’re not real unless everyone can front on demand BUT if people front for any reason other than ‘just feeling like it’ they’re fake”, etc.)

2) if you do not perfectly match the model, you are either fake or mistaken,

3a) if you are mistaken, you can stop being mistaken instantaneously by obeying the first total stranger to yell at you in ALLCAPS, or

3b) if you are faking, you can stop faking by Deciding Not To Fake Anymore, and this is an easy, painless process which you can do Right Now and will cause you absolutely no harm.

The number of systems who have had to check into psychiatric hospitals for suicidal ideation over “failing” at 3b is larger than you’d think. Trying to force yourself to Stop Being Plural tends not to work. The damage done to cooperation, in-system trust, and whatever we’re calling co-consciousness this year can take years to repair, and will leave serious scars.

And the thing is, much of this is aimed at a perceived “enemy” category, but primarily hits vulnerable systems of the same subcommunity.

Here’s another statement, drawn from this angry ask from the same series as before:

“go get a brain scan and tell me if ur amygdalar and hippocampal volumes are around 15% smaller bcuz of childhood abuse and trauma like DID systems are”

Now, the research backing up or refuting this statement, I’m going to leave to @solipsistful and @lb-lee, since they’re old hats at it. What I’m going to do is break down is how this statement, though aimed at a quoigenic system, is not exactly a helpful thing for vulnerable traumagenic systems to come across either.

First, “go get a brain scan”. What kind? CT? MRI? PET? In the US, a medical doctor would have to place the request for imaging, and most trauma-certified therapy specialists do not hold a professional medical degree, so the request would have to be placed by a psychiatrist working closely with your therapist.

Are you a traumagenic system with DID or OSDD on Medicare because dissociation, flashbacks, and other symptoms of severe trauma prevent you from working? Medicare Part B only covers “medically necessary” clinical diagnostic laboratory tests—”medically necessary”, in this context, means “is it an essential, non-optional requirement for diagnosis or treatment?” Since the diagnostic criteria for DID and OSDD in the DSM-V does not require brain imaging for diagnosis, Medicare will refuse to pay for this procedure. You definitely do not have between $2000-$5000 to pay for it out-of-pocket.

Are you prepared to fight over the phone every day for months trying to get the United States government to recognize the medical necessity of finding out the size of your amygdala and hippocampus relative to a control subject when it’s not part of the diagnostic criteria for a particular illness? You probably already know the miserable process of being rejected for disability income and having to repeal the decision in court.

Second, “tell me if ur amygdalar and hippocampal volumes are around 15% smaller”. Now a neurologist is going to have to be involved, since 15% is not a dramatically obvious difference to a non-specialist’s eye and even your psychiatrist is probably going to have a little difficulty with this one. You’ve got three professionals and an extremely expensive yet “optional” test involved to satisfy an angry system on the internet. Finally, though, you go through all of this and come out the other side with confirmation, rush to Tumblr to tell them...

...and they don’t believe you. “You’re just saying that; what’s your proof?”

Now you need to show them your brain scan. Maybe you’re lucky and were given a disc with the data on it. Maybe you’re also lucky enough to have a computer powerful enough to handle the software necessary to analyze that data visually. You throw yourself into it and figure out how to use this software just well enough to take a screenshot of your “amygdalar and hippocampal volumes” and toss that up with a scan of the neurologist’s written assessment for good measure.

Even if the original anon accepts it, someone at some point is still going to go, “Nope, it’s fake, you totally got that off Google Images.” You, already exhausted and dealing with mental illness, have just spent ridiculous amounts of effort getting an extremely expensive scan of your brain and putting it on the internet in order to prove you are Really McReal when the mere fact that the scan is on the internet will render it suspect.

"This is a strawman argument,” you might say. “That’s an absurd series of hoops no one would ever go through.”

But that is my point. I will be extremely surprised if there are more than five traumagenic systems on this site who have had brain imaging where the data has specifically been analyzed regarding the size of various volumes relative to what a neurologist would generally expect. Most traumagenic systems do not know how their specific brain compares to research findings, because most have not had this kind of imaging done for this purpose. Some may have had imaging for other diagnostic purposes, but then it hasn’t been assessed in this very specific way. They likely don’t have a personal copy of their own brain imaging data, and if they did, where are they going to find a qualified, verified, and trustworthy DID/OSDD-friendly neurologist to assess it for free?

It’s a near impossible qualification for most traumagenic systems to meet, to have jumped through all the hoops to acquire this very specific knowledge about their brain to meet this extremely specific criteria unrelated to the actual diagnostic criteria of DID and OSDD, but it’s being thrown at a quoigenic system as if it were Something All Traumagenic Systems Know.

A very newly out system could read it and think, “Oh no, we don’t have a brain scan and we can’t get one. Everyone’s going to think we’re fake!” or even “Gee, we’ve never had a brain scan. Our therapist didn’t say anything about needing a brain scan. If he doesn’t think we need a brain scan, maybe our trauma wasn’t that bad? Does he think we’re faking? Are we faking?” or “Oh god, one day we’re going to be the ones being screamed at and torn to pieces and who the fuck even knows what it’ll be for. I mean, brain scans? Fucking BRAIN SCANS? I can’t fucking handle this, guys. I can’t fucking handle all of us having to walk on eggshells Or Fucking Else, we’ve got to go”.

All three lead to genuinely traumagenic systems quietly fading out of the community, never to be seen again. Because someone decided to Protect The Vulnerable by Attacking The Enemy without thinking about splash damage.

Meanwhile, most endogenic systems probably just looked at it, thought “pfft what a nutter” and went on with their day.

Hate whoever you want to. It’s not like I can stop you from thinking or feeling a particular way. Just remember that your actions can hurt people you don’t want to hurt in addition to the people you’re taking aim at, and if you’re not careful, you might even hurt them more than the ones you hate.

—Ilya

#ilya authorship tag #fake fake systems #plural community shenanigans #the genic wars #dissociation mention #anti-endogenic content #anon harassment content #medical red tape discussed at length #suicide mention #psychiatric hospital mention

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yes-dal456 · 7 years

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Looking Back At My First Psychotic Break: My Speech At Thresholds' Gala In Chicago

Roughly twenty years ago, in March 1997, I had no job, no girlfriend, no friends and no more goals.

I had just finished a draft of what would become Strikeout at Hell Gate, a novel that had taken me about a year to write, and I had just run and completed the L.A. Marathon for the second straight year.

I had met those two goals in spite of the fact that I was battling severe depression and was in the early stages of psychosis. I would later be diagnosed with schizophrenia.

Unlike the poet Robert Lowell, who believed that his writing benefited from his mania, I was never manic, and my psychosis and depression presented only obstacles to my prose.

I could barely read. I lost my appetite. I could not sleep even though I lay in bed much of the day.

Finally, as I have written before, I drove down the streets of Marina del Rey early one March morning. I was looking for a hotel that had a sufficient number of floors so that, if I jumped out of a window, there would be a good chance that I would kill myself, like my paternal grandfather and two other relatives.

I can still remember pulling into the driveway of a hotel on Admiralty Way, bustling into the lobby at about 5 a.m. or so, and asking a clerk at the front desk for a room.

He punched a few buttons on his keypad, looked at a screen, then announced that he was sorry, that there were no rooms available.

I left the lobby and trudged to my car. While I did so, a police car drove up to the hotel entrance.

That spooked me. I feared that my plot to commit suicide was doomed.

I then drove back to my Venice apartment and phoned my mother. I told her that I had been thinking about hurting myself.

I ended up spending a week at the USC psych ward, where, at 31, I was the youngest patient. I played Ping-Pong with an octogenarian rabbi, who had probably been born in Eastern Europe. He did not speak much, but when he did, he mumbled with a foreign accent. He led us in services on Friday night, which was very moving.

Yet he seemed deeply mournful in spite of the exuberance that he showed when he played table tennis.

He reminded me of the rabbi in Pete Hamill’s Snow in August, a rabbi who questions whether or not there is a God. The rabbi at the psych ward, like the rabbi in Hamill’s book, had no doubt seen too much. I suspected that he had been devastated by the Holocaust, among other tragedies.

As I was leaving the USC psych ward, Dr. Michael McGrail, my then-psychiatrist, told me that he was 99 percent sure that I would recover.

He recommended that I spend time in a day-hospital. And that is what I did in New Haven, Connecticut, where I was born and had lived much of my life.

I flew back East with my parents, and I enrolled in a day-hospital program at Yale, where I had studied years before.

I did not know how I would handle the program. I was still extremely depressed and psychotic.

I was also still somewhat suicidal.

My mother drove me downtown for my first day at the hospital, but after that I drove myself.

It was an “in-your-face” program, as my primary clinician put it.

The ethos of the day-hospital was such that no one would make lunch for you, no one would hold your hand, and you had to provide frequent feedback to your clinician.

At the beginning and end of each day, we gathered in the front hall of the building and announced our goals and whether we had met them.

I will never forget how one of my colleagues, Tony, an ex-truck driver, slumped in his chair and spoke glumly about how he needed to “take it one day at a time.”

He uttered the cliché with such sincerity and soulfulness that his words rang true.

I did not speak the first week in group therapy because I was too paranoid to reveal that I had been paranoid.

Then, during the second week, I opened up.

I told everyone that I had had trouble a year before at a marketing company in Los Angeles, a firm that I had quit because I felt that some people had undermined me.

It was true that they had undermined me, but it was also true that I had undermined myself by working in a field to which I was not suited, business, as opposed to journalism.

As we sat in the group therapy room, Tony, my colleague, said, “I’ve got just one question for you, Robert. What are you going to do now?”

I said, “I’m going to be a writer.”

I completed my two weeks in the program in late March 1997, and a month or so later, I returned for a third week.

By then, in early May, I was starting to get better. I regained my endurance on walks. I recovered much of my appetite. I forced myself to read. And I slept well with the aid of medication.

My father told me that I had not given L.A. “a fair shot,” that I may have had an apartment in Venice, but that I had not participated in the life of the city.

He pointed out that, when he had gone to my apartment to help me pack my belongings before we headed back East, he had noticed a flier for Golden Boy, a Clifford Odets’ play about boxing, on the floor.

A local repertory theater had been staging that play, whose lead part, that of the star-crossed boxer, had originally been written for John Garfield, one of my favorite actors.

Incredibly, I had not known that the play was being staged at all, not until my father brought it to my attention.

That was a mini metaphor, a microcosm, for my failure to experience and take advantage of the city of angels.

With my dad’s encouragement, I decided to return to L.A. and did so on Memorial Day weekend of 1997, almost exactly 20 years ago.

As I have written before, I got a traffic ticket on my first day back in Venice, but curiously I was not paranoid.

I sent out resumes to a few Hollywood marketing firms as well as a number of daily papers in New York City.

I did not realize it at the time, but in composing my resume and cover letters, meeting with a former employer and phoning companies, I was demonstrating that I was healing, that I was taming my severe depression and psychosis, which previously had stripped me of interest in doing anything.

I received no offers from the companies to which I applied in those early days back.

I knew that I had to get out of the house, but I did not know that my best job prospect would come from my next-door neighbor, Peggy Lake, who worked at L.A. Weekly in the graphics and advertising department.

At the end of June 1997, within a month of my return to Los Angeles, I got a job as a proofreader at L.A. Weekly. Peggy had recommended me to Connie Monaghan, then the proofreading manager, and I had taken a proofreading test and done very well on it.

A month later, I started dating Barbara, my angel and a retired schoolteacher, whom I had met the year before in a UCLA writing class.

Like President Emmanuel Macron of France, I must have seen the wisdom in dating a goddess, a former schoolteacher, who evoked Cleopatra and Rosalind, Shakespeare’s two most sublime heroines, whose age cannot wither them, nor custom stale their infinite variety.

Twenty years later, Barbara, my ageless beauty, to whom I have been married for 16 years, and my writing career remain the pillars of my life.

Work and love, as Freud said, have obviously played a huge role in my psychic health. So have therapy, medication, a will to survive, dear friends and an appreciation for play.

Play, of course, takes different forms for different people. For me, play can mean listening to Bob Dylan with Barbara, who introduced me to his music about 20 years ago, shortly after my first psychotic break. Play can also mean enjoying what Barbara has termed “tasty meals,” or reading stories to Ava, our 5-year-old granddaughter.

While my life has improved, I have never forgotten what a social worker at the Yale day-hospital told me. She was not my primary clinician, but she had taken an interest in me. She said that she had read or heard that creative people always need to be working on more than one project at any given time.

I took that advice to heart and have written approximately 300 newspaper articles in the years since I got a job at the Weekly. I have also written a good amount of fiction during that time, which I am only now finishing.

Whether I am writing or giving speeches at wonderful organizations like Thresholds, I always emphasize that everyone has free will and that we can subdue deep depression, psychosis and suicidal feelings.

I say this as one, who was diagnosed with schizophrenia in the late 1990s, who comes from a family with a history of suicide, and who received a 20 on the Global Assessment of Function (GAF) score when I had a relapse in January 1999.

That I have recovered from the deepest depths of psychic despair and dysfunction tells me that just about anyone can recover.

And it is organizations like Thresholds that are leading the way in helping people with mental illness get better.

Thresholds has a beautiful mission. All of you who work here know that your goal everyday is to advocate on behalf of people with mental illness, to aid us in our recovery, to help us find jobs and housing, and to enrich our lives, so that we too can benefit from productive work, love and play.

I recognize that I am lucky in many respects. I live at a time when psychotropic medication is readily available, something that was not the case as recently as a few decades ago.

It is also true that the stigma against people like me, people with mental illness, has lessened in recent times. I would like to think that all of my articles and speeches have contributed to the reduction of this stigma.

I may not be running marathons anymore, but I have a good life now.

I hope Tony, the ex-truck driver at the Yale day-hospital, and the octogenarian rabbi at the USC psych ward have fared well too.

They were good men, struggling to survive on this planet, struggling to make it through each day.

They had endured much trauma, much anguish.

But they were showing signs that they too could recover. They were seeking treatment at psychiatric hospitals, opening up in therapy, playing Ping-Pong.

In so doing, they were sharing their lives with others and making contact with the world.

Through such activity, through such contact, they were giving themselves the chance to succeed, to subdue their illnesses and to function at a relatively high level once again on this planet.

This article is adapted from a speech I gave on Thursday, May 11, at a gala event for Thresholds, a mental-health support organization, based in Chicago.

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imreviewblog · 7 years