Recovery and Service
Mental IllnessMost of my patients don’t know or care that I have a mental illness. They are appropriately much more concerned with the problems and symptoms they hope I can help them with. It helps that I’ve spent 35 years in the same community taking care of their neighbors’ friends and families. I now have the privilege of taking care of the babies of people I took care of when they were babies. If I can hold on a few more years there will be grandchildren. Through a series of accidents I wouldn’t have chosen, including a psychotic break 4 years out of my residency, the fact that I have mental illness is not a secret and has been known to anyone who cares to know it throughout my career.
Doctors are a much bigger problem than patients. I had a surgeon tell me as a medical student that he knew who I was and that he was going to treat me as if I were normal. I did my best to act that way. Even with doctors, especially if you can go ten, twenty or thirty years without being hospitalized, your mental illness doesn’t have to be the most important thing about you.
I started writing about mental illness before I thought about becoming a doctor. My original, now 45 year old, diagnosis was Schizophrenia. Having been profoundly paranoid and suffering three breaks in quick succession gave me a guarded prognosis. But I did well and started writing, was able to do landscaping and then substitute teaching at Barnstable High. I cleared up gradually and regained some of the thirty pounds that had melted away during the not eating or sleeping parts of the illness. I was promoted to ‘a schizophrenic who might do well on Lithium’. The verbiage around psychiatric diagnosis and treatment was then and still is a distraction and a mess.
Back then it became clear to me that 90+% of what I had believed and everyone else still believed about mental illness was utter nonsense. I thought a good first person account of psychosis would lead to definitive tests and better treatments. I was excited about the medical model as a way to get past all the shame, blame and stigma involved. If had thought I was just writing a pretty good book, I might not have bothered.
A couple of articles got published. Curiously, my ability to do math and science which had started drifting away in high school came back and it occurred to me that if it hadn’t been for my illness and the 1960’s I should have been a doctor. I went to U. Mass Boston and did well.
A few Medical Schools wanted to interview me and were much more interested in that I wrote well enough to get articles published than my spotty undergraduate record. If my mental health was mentioned at all, they were quite sure I wasn’t schizophrenic. I knew enough to not argue.
There was a lot wrong with the idea that I might become a doctor besides having had three psychotic breaks. How was I going to explain being 6 years older than most of the other applicants? And what about those truly bad undergraduate math and science grades? I was most definitely trying to compensate for having been mentally ill and overly fond of how I would look with a stethoscope around my neck.
Had I mentioned applying to Medical School – MEDICAL SCHOOL – back in the hospital they would have cancelled my day-room privileges and upped my medication.
When I talk to patient and family groups I usually say, “If nothing I say sparks any interest, it’s possible you’re taking too much medication. If it’s the greatest talk you’ve ever heard, maybe you should take a little more.”
There shouldn’t be any stigma around medication. The point is to have a good life. Whether or not you need medication should be a relatively minor detail. My experiments, optimism and hope that I won’t need medication someday have yet to pan out but in the clinically invaluable words of Yogi Berra, “The future hasn’t happened yet.”
Psychiatric medications have serious side effects so you’d be crazy to take them if you don’t need them but even crazier to not take them if you do need them. I don’t mind the word crazy and have reservations about calling patients ‘clients’. It makes it sound like there’s something wrong with being a patient.
There is a long, mostly honorable, history of doctors who were drunks, addicts and otherwise unbalanced who were also excellent physicians. There are many sub clinical and full blown bipolar medical students, residents and physicians. Drive, ambition and not needing to sleep much has advantages. I honestly don’t know know how people without loose associations and flights of ideas get much done.
Two nurses whose children I took care of saw me actively psychotic, one when I was in four point restraints and boxer shorts. She said she hoped I got better. I told her I was doing my best and asked how her son was doing. A nurse who worked at the hospital I was taken to had six sons I took care of. She very helpfully told me I was a good diagnostician before I get sick and would probably be a good diagnostician when I got better and that maybe an AA meeting would be helpful. The amount of Jack Daniels I had been using as a mood stabilizer had gotten out of hand.
The honor people give me by trusting me to take care of their children and the opportunity to work hard at it has made my recovery possible and worthwhile. It’s not easy to hike up your sorry self and get back into the game after ending up in a psychiatric hospital. If you’re a doctor it gives you more reasons and ways to get better than are available to most people.
Some of the stigma surrounding mental illness would go away if the many people who recover well enough to pass for normal didn’t do such a good job of it. That path was not open to me. Right before we went on air an interviewer asked if there were any subjects she should stay away from.
“My father and mental illness.” I couldn’t help saying. We both laughed after she gasped and turned color for a little bit.
From a practical point of view having a famous father is more of a distraction than having mental illness.
“I’ve read everything he ever wrote.”
“Great. Is there any diarrhea or fever and how long has your child had this hideous rash.”
So if you can manage to graduate and take the best care you can of two, going on three, generations of kids in the same community, having mental illness is no big deal.
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