By KEVIN SPURGAITIS
Treating mental illness in Bermuda is still a ‘Catch 22′ situation. Although mental health professionals try to prescribe the best medication for their patients, the side effects of many drugs are often impairing, sometimes even devastating to people’s daily lives. It can leave some individuals questioning what’s worse for them — the disease or the cure.
HAMILTON, Bermuda — There is a knock at the front door, but Carol won’t answer. Representatives from St. Brendan’s Hospital want to treat Carol with the psychiatric medication she’s refused for weeks. Carol just wants to be left alone. While awaiting to plead her case before the hospital’s review board, she is disturbed by the prospect of being admitted back to St.Brendan’s for further treatment. So Carol stays put, creating a stalemate with the nurses and doctor on her doorstep. “I’m aware of what I’m doing, what is reality and what is not,” she cries aloud.
Carol has bipolar disorder — or manic depression. The illness leaves sufferers navigating the depths of depression and the intense highs of mania. When left untreated, moods continue to swing from one extreme to another. Symptoms of the manic phase include restlessness, reckless behaviour and grandiose delusions. Tell-tale signs of the illness during the depressed phase are intense despair, a loss of appetite and possible thoughts of suicide.
Because of her mental illness, Carol has been admitted four times to St. Brendan’s for as long as a month each time. Her last visit was in August after a relapse late summer. The 32-year-old single mother has been on trial leave from the hospital for the past seven years, only required to attend monthly clinical appointments and undergo mandatory medical treatment.
Mental illness rampant — and random
Mental illnesses are one of the most common conditions harming people’s health today. They affect one in five adults, according to the American Psychiatric Association (APA). Depression, post-traumatic stress disorder and schizophrenia are the most common mental illnesses on the island, the hospital says. There are over 600 patients treated by St. Brendan’s — the vast majority being voluntary outpatients.
Carol’s first vision appeared in 1993 in her Southampton home. She can close her eyes and vividly see both demonic and angelic images — those she only read about in the Bible’s Book of Revelation. When she opens them, however, they are still eerily present in the room, she maintains. Carol describes later experiences as being a visual, oral and physical sensation. Not only can she see things but hear them sing and feel them gently tap her shoulder, she explains. “It’s a strange feeling, they don’t seem real, but they are.”
She recounts the presence of hovering shadows with faded, pale faces, as well as glowing, gold feet stamped across the ceiling. “… Tons of them, just lighting up the place.” She sometimes feels as though she’s dreaming, but is later convinced her sightings are palpable. She used to become frantic, telling close family members all about it. Her episodes have led to repeated calls to St.Brendan’s by her mother. Here, unsightly apparitions are superceded by the many faces of doctors and nurses peering down at her — equally distressing, according to Carol.
“I believe in such things, although a lot of people don’t. The Bible talks about them, it’s not me making it up.”
Sitting in her one-bedroom apartment, Carol flips through a stack of old photographs, snapshots of those “happier times” with family, close friends and former partners. But she shamefully points out her weight gain in the photos taken after her diagnosis. Her metamorphosis from a slim-figured, lively woman to a slightly heavier, lethargic thirty-something is still frustrating, Carol says.
“I just want to go on with my life and get off of it,” she says of the medication that’s created persistent pains in her head and chest.
The most common side-effects of anti-depressant and anti-psychotic treatment, according to the APA, include decreased muscle control and constant drowsiness, as well as periodic nausea and headaches. In addition, Carol’s reflexes and sense of smell are not as strong as they should be. She also oversleeps, trying desperately to stay up at 7:30 a.m. only to fall back into a slumber until early afternoon. “It’s making me worse, I can’t even function. I can’t even wake up and start my day. I feel sleepy and drowsy. I can’t even brush my teeth as fast as I want.” She maintains she wasn’t always like this.
Carol’s disorder means a steady regiment of such pills. Because manic depression and schizophrenia usually require ongoing inter-muscular shots and oral tablets, St. Brendan’s has treated Carol longer than the average 12-month therapeutic period. “And they say I have to take this medication for the rest of my life,” she cries. “I know it’s the medicine, because I feel entirely different when I’m on it. I cant even move, I’m not even a real person.”
The ill effects of Carol’s medication have resulted in her dismissal from two retail positions, she alleges. Her sluggish demeanor and uncontrollable, bodily movement eventually took its toll on Carol — and her employers’ patience. The experience propelled her desire to “get off of the drugs.” While off medication, she’s held down secretarial duties and courier responsibilities at a Hamilton employment agency.
Her co-worker and supervisor, Mary-Anne Scott, has been supportive of Carol since her arrival last November. Carol is very good in her present position, always presenting an “ear to ear” smile to everyone she encounters, says Ms. Scott. “Those people are hard to find.” Since starting with the company, Carol has promptly arrived to work every morning. But despite Carol’s diligence on the job and inherent good nature, her real ambition is easily discerned by those around her. It’s obvious it’s not what she wants to be doing, according to Ms. Scott. “Her sales clerk job was one of the most important jobs of her life. She felt she was making a positive contribution with respect to her work life,” she says. “She is a person you can like very easily because she is very sweet and child-like in her thinking. You have a tendency of wanting to be protective of her.”
The confrontation in Carol’s home continues. “We just want to help you,” the hospital’s psychiatric team pleas. “No, just leave me alone,” the patient cries back. According to the hospital, protocol carried out by the outpatient service is one of easy-tempered care and in non-compliant cases a call to police. For Carol, the prospect of forcible detention at St. Brendan’s appears far worse than adherence to the hospital’s order. Because she doesn’t want to jeopardize her upcoming appeal, she finally concedes to take her medicine on the spot.
According to Dr. Harrison, the hospital’s “hands are tied” when a patient does not co-operate with them. “When people don’t have insight into their condition, they may feel as though they don’t need treatment. Sometimes, the hospital has to implement the Mental Health Act to ensure they receive the treatment they need.” He says the hospital holds regular reviews of its practice.
Tell-tale symtoms
The Mental Health Tribunal, overseen by members of the Ministry of Health, is present to assess applications to discontinue therapy. In addition, an ombudsman with the patient’s advocacy service further investigates claims a patient or family may have concerning treatment. Dr. Harrison says he doesn’t look at the tribunal as an adversarial process; patients uncomfortable with their treatment can trust their case managers, doctors, nurses and the tribunal itself. “People will listen to patients,” Dr. Harrison asserts. The very thought of people abandoning therapy alarms Gerald Caisey, St. Brendan’s mental health program manager.
He says some people may require on-going examinations and subsequent treatment. He compares mental illness sufferers to diabetics. The stabilization of the disorder requires constant medication in order to maintain a person’s wellness. “It essentially depends on the severity of the symptoms the illness. You have to have ongoing affinity with the mental health services. Overtime, you’ll get people functioning to a point where they can effectively pursue ordinary interests and opportunities.”
Additional medication, he points out, can be prescribed and administered to counteract side-effects of anti-psychotic medication. “Once they get back onto their feet, they decide they don’t need it anymore. But another life event or trauma may take place making them susceptible to another psychotic episode.”
Carol’s mother, Alice, worries what will happen to her daughter if she elects to go off her medication again. She’s seen the before and after portraits. She painfully recalls her daughter’s hallucinatory episodes before therapy, and her bouts with midday sedation and muscle spasms during treatment — but worse, Carol’s withdrawal from therapeutic medicine altogether. After abstaining from prescription drugs for almost a year, her daughter was observed having severe insomnia, irritability and hyperactivity — symptoms associated with the discontinuation of most psychiatric medicine, according to the APA.
A history of mental illness has troubled Alice’s side of the family. Her father suffered from a depressive disorder. Her son has been treated for being delusional in the past. She now contends with an emotionally disturbed daughter who zealously reads the Bible in order “keep the demons away.” Carol relies on religion as opposed to science in order to get well, according to her mother. “She thinks she doesn’t need medicine, but she does. She is in denial. She doesn’t want to admit she’s gotten sick again and needs to go on medication,” charges Alice. Her struggle with her daughter has deteriorated from heart-filled pleas to routine reminders of her drug intake. However, Alice sympathizes with Carol’s aversion to almost all the drugs prescribed to her. And she admits she would like the hospital to try something else. “They really should.”
Steadfast in her liberation from treatment, Carol maintains the next time she “see things,” she will keep it to herself. “Why even bother if no one believes me,” she asks. This attitude adopted by some patients concerns Dr. Harrison. “If people are experiencing symptoms that are distressing them, they should seek professional help and be as honest as they can be about the symptoms. That’s the only way the people in the mental health profession are going to be able to help them,” Dr. Harrison explains. “They need to communicate exactly what they are experiencing.”
The benefits and disadvantages of psychiatric therapy have left both parties with conflicting ideas of what’s good for Carol. She argues that she’s no longer afraid of haunting visions. She fears another wrap on the door from the hospital’s community check-up group. She neither wants to be treated with anti-psychotic medication or to be escorted back to St. Brendan’s. Rather, Carol longs to re-integrate into a world free of drug-induced sedation and crippling side effects. But that fate is in the hands of the Mental Health Tribunal.
“They tell me (the drugs) are for my own good, but I don’t think so,” she says rather defiantly. “You know, I’m perfectly fine now. I just have to convince them that I’m better.”
Originally published in the Bermuda Sun, October 2000
