by Jack Bragen
My first psychotic episode was a risk to life and limb, my biggest test up to that point, my family’s big test and a precursor to what was to come in the succeeding 43 years and running.
In some respects, a second or third psychotic break isn’t as hard as the first. When I had my first extreme psychotic episode, I had no notion of what was happening to me. Consequently, I created grave danger.
When you have a brain disorder, many will believe you are on drugs, and they will see you through a dehumanizing filter and conclude you are not a person. When a psychiatrist sees a person exhibiting psychotic symptoms, often they react by medicating and, if needed, restraining them.
A person who develops something that organized medicine considers a brain disorder doesn’t receive respect for their personhood, not from the public and not from treatment professionals. A person receiving psych treatment is within an unacknowledged minority. Psychosis itself is a grave danger to people and property, and it can put an individual on a bad trajectory for their ensuing time on this Earth. And the attitudes of most Americans toward mentally ill people make life much harder than it needs to be.
In 1982, when I received a diagnosis and prognosis from the head of inpatient psychiatry at Kaiser Permanente Martinez, my mother was devastated, and I didn’t believe the doctor. Over a span of decades, I discovered that I truly needed treatment, and still do. Yet, I also realized that prescribers often invalidate the minds and hearts of patients receiving medication.
I need medication and someone to prescribe it more than they need me. I have to take my meds and take my lumps just like anyone. Still, psychiatrists presume too much about their patients, which creates a significant barrier to patients accepting treatment that is widely overlooked.
The verbal output of our minds and hearts, in other words what we say, is taken in the context of the nonsense spoken by a crazy person. Thus, we aren’t heard.
The prevailing attitude among psychiatrists and psychiatric nurse practitioners’ attitudes toward patients is that our minds, bodies and lives don’t matter. Our mental capabilities go unrecognized, and our opinions are devalued.
We are given medications that in the long run are often the ruin of our old age. We aren’t giving any kind of “informed consent.” When we aren’t being told what the meds will do to our minds and bodies in the long term, this is not “informed.” When we are required to take them, we haven’t given our “consent.”
Psychiatrists and medical doctors have power over us. As patients, we are at a legal disadvantage and a practical disadvantage if the doctor refuses a prescription or orders a prescription for something we can’t tolerate.
I have told psychiatric practitioners outright, “I’m not taking this.” I might be allowed a certain number of refusals. If I refuse everything or refuse to take an antipsychotic in general, the psychiatrist will quit, leaving me without a psychiatrist. In turn, I’m automatically labelled a noncompliant mentally ill person, and treated like a criminal, which can lead to homelessness.
As patients, we are obligated to work with the prescriber, whether we like it or not. If we have an issue with a specific medication, we must negotiate a solution with them in the hopes that they value our well being.
When a psychiatrist prescribes a controlled substance, they aren’t doing us a favor. Yet psychiatrists I’ve known will prescribe drugs that would be considered illicit without a prescription. Without the psychiatrist’s Rx, this can cause legal jeopardy for the consumer.
A psychiatrist once said in a group, “Valium is good for schizophrenics.”
Valium and other benzodiazepines, like numerous other prescription medications, affect driving adversely. In this age of medical disclaimers, this isn’t the psychiatrist’s problem, as they wouldn’t be liable if someone taking Valium got in a crash.
Psychiatrists have much discretion as to which antipsychotics to prescribe us. I have taken antipsychotics with truly unbearable side effects. I had to urgently tell the psychiatrist what was happening to me. Usually, they revert to the earlier drug, because I’d been able to tolerate that. If it isn’t broken, don’t fix it, as the saying goes.
But psychiatrists often seem to be uncaring about us suffering side effects. Many years ago, I had complained about a dry mouth, and the doctor suggested hard candy. Another time, I complained of blurred vision, so the same psychiatrist suggested reading glasses. I was only 20 years old—reading glasses were not in my plans at that age.
Psychiatrists are not necessarily looking out for our best interest. A lot of their duty is about preventing us from causing disruptions in society. They have devalued our lives, and this filters down to the prescription pad. Psychiatrists and other doctors will prescribe drugs that are a danger, often glossing over the risk.
Celebrities or wealthy clients who see a psychiatrist will receive preferential treatment compared with low income or middle-class patients. If a famous singer needs to be able to perform, this presumably entails a superior level of psychiatry. You can’t go on stage while doped-up on Haldol. If you are a movie star, the power dynamic with a psychiatrist would be the reverse of what an ordinary person would experience: A multimillionaire can fire a psychiatrist in a second and hire a new one a few minutes later.
Everyone I know uses Medicare and/or Medicaid to pay for psychiatric care. So almost universally, the treatment we receive will be structured in a certain way. The mental health treatment systems are designed to impose restrictions and controls upon the mentally ill population.
Lower income people, middle class and below have to take what is dished out for us. And while this is sometimes painful, what choice do we have?
Jack Bragen is an East Bay-based, independently published author whose books are available on lulu.com.
