Too taboo to be true

In the Emergency Room, I see patients that are having an acute psychiatric crisis.  For most of the patients, this is not their first visit to the emergency room.  I always ask what medications they have been prescribed before and when they last took them. I often get similar responses: they were feeling fine or they didn’t think the medications were doing anything for them.  During these times, patients are in such distress that it is not the time nor place to have a lengthy discussion about the specific rationale that went behind their decision to stop taking their medications. After their acute issue has become less severe, I am able to delve into this more. Many times a person is still not able to say the reason that is truly in their heart: “I’m not crazy.” Have you ever thought about how many ways you can say that? Crazy. Cuck-Coo. Whacky. Batty. Mad as a hatter. Nuts. Screwy. Unglued. Unhinged. Berserk. Luny. Out of your mind. Psycho. Mental. I can go on and on.  In a society where we pride ourselves in tolerating differences, it is interesting that being labeled ‘mentally ill’ is still not widely accepted.No one wants to be seen as abnormal.  I still question what true normal is, but for the sake of this piece, I will suppose it is not having to take psych medications.  The unfortunate reality is that medications are questioned much less frequently when they are treating Diabetes or Hypertension.  Perhaps it is because there is an objective test that is clearly defining these diseases. I know there are people who don’t take their medications and end up going into a diabetic coma or stroke. However, the people I often see in the emergency room can’t recall when they last took their medication to help with their mood, but would never miss a dose of their insulin.  Both depression and diabetes can have deadly consequences, yet the stigma of mental illness is just too strong.  I often tell patients what they would say if they had a sick child who didn’t want to take medications.  What if they had Diabetes or worse yet, Cancer.  Would you be able to watch as they became sicker and sicker? Now what if that child had Schizophrenia? Would you be ok  with them not taking the medication that may help them lead a productive life? Even as I write this, I know people will say, “But it’s not the same.” It is the same.  Mental Illness is a biological process, just like Cancer or Diabetes. There has been much more funding in research in the other diseases so much more is known.  So much more is now known about mental illness, but still so much more is needed to be able to objectively  diagnose it.  In due time, there will be a way.  And when the time comes, I hope my patients will be less ashamed, have more acceptance of their illness and more ownership in their recovery.  Until then, I am here trying to chip away at the perceived discrepancies.