Bipolar 2 From Inside and Out

Posts tagged ‘unhoused’

“Why Don’t They Just Take Their Meds?”

That’s maybe the most common reaction to hearing about the unhoused mentally ill. After all, there are medications that lessen the effects of schizophrenia, mania, and bipolar delusions. Why wouldn’t a person take advantage of them? Don’t they want to be mentally healthy? Why wouldn’t they do something that can alter their lives so dramatically?

Anosognosia is frequently the answer.

What Is Anosognosia?

If you look in the DSM-5, you won’t find anosognosia listed as a separate illness. Instead, it’s a symptom of another illness, often called “lack of insight.”

But anosognosia is so much more than that. It’s the reason that a sufferer doesn’t even realize that they have a disorder. They aren’t able to comprehend that there is anything wrong with them, that they have a serious mental illness that affects the choices they make and the way their brains work.

This is not mere denial. Someone in denial realizes on some level that they have a problem. They just keep pushing it away. A person with anosognosia does not understand that they have a disorder, that their mind is affected by it, and that their behavior is shaped by their condition. It might instead be called “brain-blindness.” The schizophrenia or other condition itself prevents the person from perceiving that there might be something wrong with their thinking, emotions, and behavior. As far as they’re concerned, they have no illness.

The Medication Question

Schizophrenia was once considered an untreatable illness. All that could be done with a person suffering from the disorder was to put them away—lock them up so they couldn’t harm anyone. After all, the diagnosis of schizophrenia at the time was synonymous with violence. In the minds of many people, it still is.

So, if their disease is so severe and there is a medication that will help, why don’t they just take it?

Let’s think about this. If you didn’t have a serious heart condition, would you agree to take Inderal or Plavix? Would you just mind your doctor and take it anyway? Or would you decide you didn’t need it and stop taking it?

What if you took the Inderal and you experienced unpleasant side effects? You should tell your doctor that it’s having side effects that you can’t tolerate, such as dizziness, stomach pain, sexual problems, or vivid nightmares, and ask for something else. But you might be tempted simply to stop taking it without your doctor’s knowledge or input.

It’s the same with medications for schizophrenia. Many of them have very troubling side effects, including uncontrollable muscle movements (tardive dyskinesia), which may not go away if you take the medication for a long time. Weight gain, sexual dysfunction, sedation, or dizziness are other possible side effects. Stopping the meds might seem very attractive, especially if you don’t believe you are ill.

The Blame Game

It used to be that when the public saw the unhoused, the sick and suffering, they might think “But for the grace of God, that could be me.” At some level, they recognized the people they saw as human beings and knew that they, too, might someday fall prey to illness, financial reverses, or other disasters. There was empathy, or at least sympathy.

Now, that reaction has turned to “othering”—denying their common humanity. The “unfortunate” are to blame for their circumstances. They “choose” to live on the streets. They make bad decisions that lead to their problems. And they don’t take their meds. It’s all their own fault. They’re not like us.

Empathy only comes when a problem touches a person directly. Unless they have a schizophrenic or unhoused family member, they don’t think about how people get into dire circumstances. They separate themselves and continue to believe “it will never happen to me.”

But as the population ages, many people must deal with older relatives who have dementia, who sometimes become combative or violent, who may resist taking their medication, and who don’t realize that they have a condition that makes them confused, less capable, and in need of specialized kinds of care.

Unfortunately, that understanding seldom reaches the schizophrenic people who experience many of the same difficulties. And anosognosia is a big reason. If you’re not aware you need help, you’re not likely to get it.

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mental health

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Brian Kilmeade’s Apology

On Sept. 10, Fox News host Brian Kilmeade was having a discussion with his co-presenters on the show “Fox & Friends,” discussing the death of a woman in North Carolina, who was said to have been stabbed by a man who was both living in a homeless shelter and reportedly mentally ill at the time.

Kilmeade’s cohost, Lawrence Jones, expressed the opinion that people like the accused man who refuse treatment for mental illness should “be locked up in jail.” Kilmeade replied that they should be subjected to “involuntary lethal injection.” Euthanasia, in other words. Death not for the murder, but simply for the “crime” of being mentally ill and unhoused.

Refusing treatment for medical conditions, including mental illness, is still a right, although there is an alternative in place in many locations—AOT, or Assisted Outpatient Treatment—a procedure with safeguards and rules that benefit a person who doesn’t recognize their own incapacitation. Apparently, Kilmeade has no knowledge of such programs—nor, I suppose, should we expect him to, as he’s one of the hosts of an entertainment talk show.

The talk of getting the homeless mentally ill off city streets is in service of the growing clamor to get rid of “useless” people by one means or another—jail, “wellness farms” (as proposed by Secretary of Health and Human Services Robert F. Kennedy, Jr.), institutionalization, or, apparently, summary execution. The unhoused and mentally ill are seen as a drag on society, consumers of resources who do not produce anything of value. Their problems are attributed to “bad choices.” They are thought to be not worth the money that society spends on them and their indolent, nonproductive lifestyles.

I don’t know about you, but I took this personally. I’m far from homeless, and I have been productive and earned a living, but I am mentally ill. And it’s only a short step from threatening the unhoused mentally ill to threatening the mentally ill themselves with involuntary euthanasia. (I’ve read the Martin Niemöller poem. They could conceivably come for me, too.)

Mr. Kilmeade apologized during another episode of “Fox & Friends” and posted a video of the apology on social media. “I am obviously aware that not all mentally ill homeless people act as the perpetrator did in North Carolina,” he said. “And that so many homeless people deserve our empathy and compassion.” (Not all, note.)

Sorry, but that’s too little too late. Forgive me if I doubt the sincerity of the apology and attribute it to a backlash from the public, or maybe from his bosses realizing that he had stepped over a line.

I, for one, do not accept his apology. It doesn’t contain the elements of a valid apology: admission of a fault, recognition of why it was offensive, a promise never to make that transgression again, and action that will help repair the fault or prove the sincerity of the apology. For example, Kilmeade could have said that involuntary lethal injection was appalling and inhumane (indeed, illegal) and that most unhoused mentally ill people pose no physical threat to the populace. He could have said that he had learned his lesson and would never again talk about the homeless mentally ill in that cavalier manner. And he could have made a donation to an organization that helps people who live on the streets or people with mental illnesses.

I was taken to task for expressing this opinion on the timeline of someone who posted that the apology was sufficient and laudable, that it gave Kilmeade an opportunity to learn, grow, and do better. While I admit that I should have kept my opinion on my own timeline rather than responding in that person’s space, I still don’t agree that forgiveness is required. In my opinion, the person who has been injured (or, in this case, insulted and threatened) has the option to accept the apology or not. Forgiveness doesn’t come automatically just because you said, “Oops, sorry.”

And if there’s any doubt that Kilmeade made a sincere, lasting apology and learned his lesson, he recently said that “what we need to do is either leave the U.N. or we need to bomb it. Maybe gas it?…we need to destroy it. Maybe can we demolish the building? Have everybody leave and then we’ll demolish the building.” The other program hosts could be heard laughing.

I suppose it’s laudable that he pulled back from suggesting demolishing the building while it was occupied, but that’s what he first proposed. Apparently, human lives mean nothing to him unless they’re people that he approves of. And that approval is conditional, based on the people’s utility and their agreement with his political stances.

And that’s simply not enough for a sincere apology.

Category:

mental health

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