For the past month or so, I've been living in a very nice one-bedroom apartment in an apartment building built for folks with psychiatric disabilities. Although it's located next to the mental health agency which sponsors it, there are no neon signs advertising "sick people" and from what I've seen so far, the "community" tends to regard our 24-unit dwelling with little more than the usual indifference. I guess I'm very grateful to have such housing; before being accepted here - my name had been on a waiting list for three years - I had been living with a roommate in an apartment which could be called inadequate at best.  Well, finally, at 44, I have my own place and am kind of content.

  Anyway, in the midst of this relative satisfaction, I think back to one wry comment made to me by a mental health worker about 10 years ago:" The mental health system has nothing to do with your mental health." The guy who made this statement was a fairly tough fellow, who had worked with chemical explosives in the army; he was pretty gentle with the folks at my community residence but didn't really buy into the local bureaucracy and its explanations. And  this seems to have been, unfortunately, one of the most honest statements that anybody has made to me in the 25 plus years that I've been in therapy, hospitals and assorted treatment in and out of the mental health system.  I really wish it were otherwise. And I don't know what one can do about it.

    Anyway, in this building, I only have to see a staff member once a month. If one keeps one's room reasonably clean and doesn't act "insane", pays the rent and follows the rules, you are left alone. Although this in some ways feels odd - after all, I really did want to find at least somebody to talk about my problems with in these places, especially somebody who could "do something"- in a way it's a relief. But I can't help reflecting on how the system, through various apartment programs, hospitals, residences etc., did everything but treat the things I had been complaining about: obsessive thoughts, problems with family (the mild, so-called neurotic kind though intensely so), depression from some real life losses etc. Funny thing how I never got any sane answers in 25 years, though 17 years into the process, I finally received the official diagnoses of OCD, which kind of related to what I had been complaining about anyway.

     Along the way, of course I had a slew of diagnoses: schizophrenia, schizoaffective disorder, manic-depression, psychotic depression, adolescent adjustment disorder, paranoid schizophrenia, schizoid/borderline/narcissistic personality disorder and a bunch of others which were equally unhelpful. Basically, since psychiatrists, even of the reputable variety, would usually come up with distinct - and often wildly varying - diagnoses rather quickly, I learned that this process was not a scientific one, for the most part, but a bureaucratic one: neurotics front and center, manic-depressives to the right, schizophrenics to the rear. And this was in so-called "good" hospitals, ones with private poetry therapists and tennis courts, daily individual sessions and art groups. Boy, I wish this were different.

   A few weeks ago, I was trying to tell my current therapist, a woman named Barbara, what this felt like. When I say "felt like", however, I don't really mean in the sense that therapists use eg we're all entitled to our feelings, though some of us have a , let's say, firmer grip on reality than others and perhaps more right to their feelings. I told her that the second I sat down on the chair in her office, she had - despite her being a very nice person - such an accumulation of biases and fixed ideas about me that the evidence for or against me was completely tainted. Well, I had to give her an example, I thought.

   So I told Barbara about my spending two and half years with a another woman (alas, I don't like being "angry" with women) psychiatrist who insisted that I was hearing voices. I had been seeing Barbara for a couple of months and told her that my problem was certainly NOT hearing voices, but rather painful obsessions before relating this. Then I told her what it felt like to be placed on thorazine and other lovely medications, which didn't do anything for my symptoms though somewhat relieved non-related stomach problems, without being able to argue my way out of it.   And then I informed Barbara that after this period, I saw a treatment team which had world-renowned experts on OCD, which took me off these anti-psychotics immediately because I obviously didn't need them. Barbara's reaction to this? She asked me if I was hearing voices....    Lest it seem like I was portraying myself too 'innocently' here, I should state that I entered the mental health system after a serious suicide attempt. I guess I was fortunate enough to enter a "good" hospital but unfortunate enough not to be listened to. This particular treatment team did not really believe much in the psychopharmaceutical model of mental illness: most of it was, in their point of view, due to "irresponsibility" , "rudeness", "bad choices" and a bunch of other culprits. In fact when I applied for grounds privileges and listed the medications (which had done me some good I guess) as being the most important thing in my treatment, my application was rejected - after a torrent of abuse from the chief psychiatrist, who had never met me face to face, about my "irresponsibiltiy", "bad decisions" (like not going to his group for a couple of weeks) and a bunch of other things because I had NOT said that the treatment I had received from the staff was in fact, the most important part of my getting better.

    I know I obsess about stuff like this and have done so, at times, for ten to fifteen hours a day. I know, despite what Barbara says, that such 'dwelling on the past' doesn't get me anywhere. But this is not a cognitive deficiency or any of the other bugbears that such professionals tend to believe it is. Basically, if you are a "good", "compliant", "obedient" patient, you get rewarded; if you question things or raise issues that they do not want to hear, you are punished, sometimes absurdly so. None of the treators at the clinic I've been going to for five years wanted to hear about my six and a half years in a community residence,  where typical punishments for a "bad attitude" amounted to things like being forced to clean a bathroom with soap and a toothbrush.  Yeah, I'm not joking. The originator of this particular punishment was a Harvard graduate in psychology (the victim was my roommate in this case, not me). And the residence itself received a glowing writeup in a major local paper  which consistently refused to look at the nastiness before their eyes. I guess it was enough that things "seemed okay" and that everything was kept spic and span...

    Anyway, about a year ago, I had an interview with a reporter from the same newspaper. I thought, since this reporter seemed very warm, honest, open and intelligent, that I could tell her about some of the negative aspects of the system she was reporting on - a beat she was actually new to. She asked me about my background and I told her that I had been a Magna Cum Laude graduate of a Most Competitive College, that I had exhibited my artwork and was a member of several internet high-iq societies. Then she asked me my diagnoses.  I gave her a very careful, reasoned explanation of what these diagnoses mean in theory and practice which it seemed,  she had absorbed.  Then it turned out, in a rather large article which resulted - which once again, completely ignored the psychological brutality of a lot of lovely treatment facilities (connections which I had given her by the way, and whose pros and cons I had fully evaluated)- she simply reported as a "fact" out of context that I had had ten diagnoses.  Boy, must have done wonders for my image in a fairly conservative county, not that anybody cares about such niceties..You look "guilty", you're among "guilty" people, now go clean your room!!     After all , isn't that the most important thing in the life of a psych patient -whether he or she keeps his or her room clean???

   Anyway, several of my psychiatrists have suggested to me at one time or another that I become a psychiatrist too. In other words, they flattered me that I wasn't a "crazy" or an "idiot." But , hey, I have too much conscience to do that. I''ll just write things as I see them, not put people into boxes as was done unto me. For whatever THAT is worth.

Paul Nachbar  
     

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