A patient in a mental hospital has a team. Some combination of psychiatrist, psychologist, social worker, and nurse. Together they make decisions for the patient based on what they see and hear and their cumulative training and work experiences. The ideal situation calls for a willing patient in the treatment process. But I imagine that if one is entering a mental health state institution under duress, initial trust and cooperation are hard to come by.
Actually, I don't have to imagine. For wildly divergent reasons, I have two close siblings in separate state hospitals. Neither experienced a smooth initial induction. Their specific issues required a necessary medication protocol. One is practically a graduate in her treatment and is working toward release; the other is yet an unruly infant unable to latch on. Under the best of circumstances, concocting the perfect drug cocktail for a given medical condition is tough. It takes time and patience and an understanding that there will be at least a few failures before the success hits. Often, the side effects which affect the body right out of the gate break down the will and endurance necessary to wait them out until the real work of the drug or drugs takes hold.
It is in this foggy area that my brother, Gary, has wandered in a rapidly decompressing state for a good ten days or so. Consequently, those of us in close daily contact with him are also feeling our way around, hands waving in front of our faces, trying to make out the shadowy figures in the haze of his mind. Though we all recognize the benefits of the hospital over prison, life in a mental institution is still highly stressful. In fact, the shock of leaving a rigid system and its combative social structure after roughly 18 years and being totally immersed in a less structured system with radically different social behaviors adds an entirely new dimension to the experience.
Besides the Bipolar II and PTSD diagnosis Gary was given back in late 2008, early 2009, there are behaviors he adopted that come with living in the streets and surviving in a jail and prison setting for more than half of his life. Doctors who treated him in spurts in prison considered adult ADHD; his psychiatrist at Napa has broached the subject with him this past week. There is a considerable amount of physical pain on his docket, too, and medications he was allowed in prison and jail are not used in the hospital setting; those were instantly removed from his treatment plan. Since he was a boy, Gary has struggled to sleep with any kind of regularity. Most likely this is connected to his bipolar disorder. Insomnia over long periods of time further affects brain chemistry. Three full days of lack of sleep is said to put people into full-blown psychosis.
Taking all of that into consideration, Gary and his doctor are locked in a back and forth discussion, often heated and frustrated on Gary's side, over what he should take and what it may or may not accomplish in the face of his multiple issues. His mounting anxiety coupled with his fear that they may drug him into a slobbering idiot have led to several behavioral stand-offs on his part. Head-bangings against the wall; aggressive door kickings; yelling and screaming; refusing to listen or respect other parties. He wanted a different doctor, a brand new team, thinking they might lift the restrictions he felt were being levied against him because he was only a scumbag, drug-using ex-convict not worthy of rehabilitation. Their chess move involved calling in the police to let Gary know if he couldn't settle down he would have to cool his heels in a jail cell for awhile until he was prepared to be cooperative. This only served to piss him off further and deepen his mistrust of those in authority.
Now, I've been calming him as best I can for years through letters and monthly 15-minute phone calls. The precious but rare in-person visits. His new life status allows us freedom of phone contact at just about any time of day. I listen. I talk. All without that precise female mechanized voice informing us of the time we don't have left to wrap up our brief discourse. I'm hearing him out and balancing his skewed perspective with a possible interpretation of why his team did what they did or why others do what they do. But even with thrice daily sessions and no time restrictions on 'Girlfriend,' my trusty iPhone, I could not break through to his common sense. It appeared to be lost in the thick fog of his overwhelmed brain. His ramblings were worse with every call. So much anger. So much distrust. So much fear. With each passing day, I surrendered myself to the reality of a suicide attempt or attack on a particular patient whose been pushing his buttons. I had done everything I could do to get him to this point, to this place. There was, and is, work that is simply his to fulfill.
On Thursday or Friday of this past week, he called me, asking if I would assist him in writing a positive incentive contract. It seems his psychiatrist caught on to the importance of drawing in Gary's life and the calming effect it could potentially have on his behavior while we all await the steadying of his psyche via lithium and other elements in his drug arsenal. (Perhaps the entire team pow-wowed over what they knew of him and came up with this plan.) She purchased art supplies through Office Depot and proposed a deal: if he would adhere to the points set out in his contract, he could have full access to the art supplies. Act up, and those items will be gathered up and out of there.
Since that day, there has been a marked improvement in his mood. He is trying to be patient with the long process of adapting to his medicinal protocol, realizing every body and brain is different and will react in varying ways to the same prescriptions. During our two phone calls today, he waxed poetic over the high quality of the Prismacolor Turquoise Pencils of various hardnesses which allow outstanding shading and outlining for his collage-like creations. I Googled Prismacolor as he described the Premier Illustrating Markers and woodless graphite pencils; I felt close to him, picturing him in his room, hunched over his manila envelope palette, as my eyes wandered over the various items on the website.
He was moved, and regretfully apologetic about his previous actions, because he realized that his doctor bought him the good stuff. That one action, insightful and astute in my book, bridged the roiling river of mistrust which has been coursing between Gary and the lifeline being offered to him for the past two weeks plus. In this case, the value of the purchase directly correlated to the value of his humanity in the eyes of this person who holds his life almost literally in her hands.
It is a significant step. Really, a giant first step. I'm hip to the fact that there will continue to be backtracking, but at least an inroad has been made. If I could mark it in the brightest Prismacolor Premier Illustrating Marker color available, I would do it, thus ensuring that Gary could make out its outline in those moments when the fog parts and visibility is possible.
At least I know where it is.
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