the trouble with mental illness, part two

Not too long ago, I wrote about mental illness and why it's much more difficult to treat than other conditions we come across.  I wrote about how some people respond to certain treatments better than others and how it's rare for people to find the right treatment.

My pharmacist and I had a conversation the other night that demonstrated more reasons why mental illness is so much more difficult to understand.  This conversation was the end result of me discovering that I could look up people in the main software and see what was going on with them based upon nurses', doctors', and counselors' notes.

I discovered some of the more interesting clients we had were interesting for far more serious reasons than I had initially understood.  The things that they had been through were far and beyond what I could've imagined, much less understood.

For example, people go through rough patches in relationships all the time, they go through custody issues all the time.  Mostly it's just a simple case of two people no longer liking each other and trying to be spiteful towards one another.  Well the case I was looking at was different in that the couple was engaged, but one was accused of felonious assault of a child and instead of seeing each other through the ordeal, they've been torn apart by it.

I don't want to get into too many details for a number of reasons, but this case shows how someone can appear to be better off than they actually are.  I would never guess that the client was going through the things that they're dealing with.

What I learned from the discussion I had with my pharmacist though was how taboo mental illness is.  You see/hear all the time with people dealing with cancer, or diabetes, or most other types of diseases how families band together, friends come to the person's side, and everyone hopes for the best.  They send cards, they visit the person, they show all the support in the world.

Mental illness?  They scatter.  They disappear.  They want NOTHING to do with the person, treating them as if they had the plague.  They make fun of the person, or act like the problem can just be changed.

How many times have you seen someone tell someone suffering from depression "just don't think about it, or think happy thoughts."  How many times has someone tried to make it seem like it was an easy problem to fix, that they just have to "think differently"?

The problem is, it isn't that easy.  Someone who is depressed or mentally ill can't just flip a switch.  Some can fight through it for the most part, but it can still catch up to them after a while.

Mental illness and treatment works the opposite of traditional diseases as well.  Generally, if someone has high blood pressure, cholesterol issues, or diabetes, you can find a treatment relatively easy and implement it.  In rare cases, it isn't easy and the person struggles through multiple treatments.  If they fail, it's usually because they decide (rationally) they don't need the medicine.

With mental illness, it's rare that the solution is found right away.  Usually several combinations of medicine and therapy are tried before the absolute right treatment is found (additionally, you generally won't need therapy for high cholesterol), and that's if it's found.  Most people never find that combination and trudge through life, barely hanging on.  It's sad and it's generally ignored.

One of our more troubling clients, who additionally is battling alcoholism (and losing badly), is an example of what happens to people when they start to lose control.  Their own family abandoned them until recently.  The client's sister hadn't seen her in years, yet had the nerve to yell at us for not doing more for the client.  In my head, all I could think was "where were you for the last several years," but you can't say that.  Instead, you have to bite your tongue.

That's what happens though.  Family either disappears or become completely overwhelmed by having to take care of the client.  Some end up devoting years upon years to take care of someone, but this is mainly because no one else wants to deal with it.

After going through some of the notes in the computer, it's become more and more clear to me that mental illness is an even bigger problem than I had already imagined, and I knew it was a big problem.  These people need all the help they can get, but they don't get it.

In fact, the states are cutting funding for mental health treatment so much that people are being left behind because there aren't enough hours allowed anymore to provide people the help they need.  Meanwhile, rich, healthy men and women are doing all they can to prevent tax increases on them so they can continue to live lavish lifestyles while those who need the money most continue to slip through the cracks.

Look, I'm not sitting here saying that throwing more money at the problem is going to fix it.  Mental illness isn't just because someone goes through a rough patch and needs assistance.  A lot of it is genetics and there isn't much you can do about that.  But those that can be helped need more than they're getting.

It's a problem, but will anything happen to help change that?

the trouble with mental illness

A lot of people probably remember when Tom Cruise jumped up on a couch and proclaimed that depression wasn't a myth, that it was a made-up disease so that drug companies could make money off of unsuspecting people who *thought* there was something wrong with them.

I remember watching the lunacy, then reading the follow-up remarks he made about it with a sense of disbelief, that someone as smart as Cruise would make those remarks.

Then I found out he followed Scientology, and it all came into focus.

This isn't about them though.  I don't even like to acknowledge that they actually exist.

This is about the fact that mental illness is very real and a big problem, not just in this country, but around the world.  This is about the fact that when people are treated properly for it, they stand a chance of getting better.  This is about what happens when they don't receive proper treatment, or fail to follow their treatment plan.

This is also inspired by a client here.

When the pharmacy first opened, this client, we'll call him Mr. Kitty since he loves his cat so much, was in bad shape.  He was ornery, he didn't like anyone, and if his meds weren't ready when he was, he was particularly cranky about it.  It got to a point where I would dread seeing his name come up on the refill report.

He was one of those that demanded brand name, demanded three months at a time, and demanded that they be ready when he was ready to pick them up.

In short, he wasn't in great shape.  You could tell from looking at him that he wasn't happy.  When he wheeled by (Mr. Kitty is in a wheelchair), he wouldn't say anything to anyone who happened to walk by.

Then one day he went out and got a kitten.  At the same time, some of his meds were changed up every so slightly, just enough to tweak his mood a little bit.  Combine this with the kitten, with whom he reportedly played with constantly, and you could see his mood almost immediately start to change.

Fast forward more than a year and the change is incredible.  He comes in and has a smile on his face.  He says hi to everyone, making sure to stop by each pharmacy window to talk to all of us that are here.  He and the courier have become especially buddy-buddy, sharing stories and talking about his cat.

One day he sat and played a card game with a little kid that was here for counseling, telling the kid about some of the things that he had endured.  He then cracked jokes with us before heading back to his counseling session.

The other day, he stopped the CEO and said he had a suggestion for a group therapy.  Now, the CEO is generally good at listening to all proposals to begin with, but you could tell that he was especially interested in Mr. Kitty's proposition.  When Mr. Kitty was done with his proposal, the big boss said that he thought it was a great idea and that they were thinking of doing something similar to begin with.  He then asked Mr. Kitty if he would be interested in leading the group session he suggested, saying that they wanted clients to take charge like that.

Mr. Kitty was ecstatic.

Now granted, this is a rarity.  Most people don't turn around so dramatically as he has. Most, if they show any improvement, only show a slight bit of improvement.  Some show no change whatsoever, and a few even regress further.

There are a lot of reasons, but very few solutions to that problem, which is what makes mental illness so difficult to comprehend.

Like all other things, what works for one person won't necessarily work for the next.  This is especially true when it comes to medications.  When you hear someone say that everyone responds differently to different medications, they aren't lying.  It's just how it is.  One person could take just Sertraline (Zoloft) and be fine.  The next could take it and become worse.  Sometimes it just takes adding one other drug to the mix, but on the other hand, that could make things even worse as well.

Treating mental illness is such trial and error that it's hard to come up with a simple solution, or "one size fits all" method of treating it.  Some people respond really well to counseling just because they need someone to listen to them, others don't.

I had one mother-son combination in the facility today that demonstrates this.  He was standing there, expressionless, while she dropped of his prescription.  As I was entering it, she started to ask him why he was so silent, if something was wrong.  He didn't react at all, not even a blink of his eyelids.  There was no acknowledging that she had even asked him a question.  I could look at him and tell something was amiss, but he was refusing to say anything.

She told him this was his problem; he had something bothering him, but he refused to talk to anyone about it, instead choosing to internalize it.  She asked him if things were moving too fast for him, and he mouthed "Yes." I didn't hear the rest of the conversation because they started to walk away from the pharmacy, but she had at least received a response from him, which is often the most difficult part.

The most common thing I've seen amongst the kids that come in here, particularly the preteens and teenagers, is that they have the earbuds in either listening to music or playing a game on their phone/Nintendo DS/PSP.  They've chosen to tune the outside world out, keeping everything to themselves for one reason or another.

Chances are, they've never tried to talk to anyone about what's bothering them, or if they have, whoever they tried to speak to just didn't care or listen very well, thus destroying any confidence they might have had in talking to someone about their problems.

**Column Intermission**

Every now and then, someone finds a way to surprise you, albeit in a not-so-satisfying way.  Right now there is a client in the waiting room who looks like they are ready to let loose with the contents of their stomach.  It happens to be one of the dependency clients, which makes me wonder just what's causing the queasy look.

One of the perks of having a job like this is being able to see what everyone is here for, not to make fun of them, but to understand better why they're here and why they're on the meds they're on.

**End Intermission**

The sad truth about mental illness is we still don't understand it well enough to properly get a handle on it.  With many other conditions, such as high blood pressure or diabetes, you can find a way to effectively control the problem without too much of a hassle (of course this isn't always true, I know that better than anyone else).  Try a couple different things and 90% of the time, you're good to go.

Not so with mental illness.  First you have to figure out what the specific problem is before you can even start giving out meds, and even when you do, it's not likely you're going to nail it on the first try.  In a lot of cases, it takes trials with a few different types of meds before you find the magic combination that makes a person feel better.

I dated a girl many years ago who epitomized this problem.  When I met her, she was taking Cymbalta for her depression and Adderall for her attention issues.  Of course, some of her problem was created by herself because she didn't take the adderall the way she was supposed to.  She was on the extended-release capsule, which is supposed to last all day as long as you take it right.  Well, she was opening the capsule and taking the contents directly, giving herself an immediate boost, but it didn't last as long.

This was directly related to the fact that she could NOT get up in the morning until she took her medication, which was only made worse by her reliance on the meds themselves.  In essence, she took a minor problem and made a major one out of it, which ended up becoming worse because of her reaction to the Cymbalta.

She ended up developing severe bruising, which is one of the rarer side effects of Cymbalta, which combined with her developing Ovarian Cysts, made things rather testy for a while.  She wasn't getting the help for her depression like she needed because the bruising made her uncomfortable, her ADD wasn't being treated properly because she wouldn't take her meds right, and she had cysts on her ovaries to complicate things more.

After it was determined that her Cymbalta was causing her problems, she was switched to Wellbutrin XL, which helped with her mood tremendously.  She felt good and was more alert than she had been in a long time.  This came with one drawback though; her libido didn't just go down, it completely disappeared (a common side effect amongst anti-depressants along with drowsiness and weight gain).  In short, she had no desire to have sex, which ended up causing her depression to return.

Then shit hit the fan with her after that.  She got into a fight with her mom's best friend, I ended up getting fed up with all the different things going on, and we went our separate ways and I figured that was the end of it.

A few months later we somehow ended up chatting again and she told me how she finally was on a medication that not only made her feel better, but didn't kill her sex drive or make her overly sleepy.  She had started dating someone else and was finally starting to feel happy with life overall.

It took over a year of trials, tribulations, and errors for her to finally find a combination that worked for her, which is what my main point is.

Trial and error is such a big problem with treating mental illness and is why a lot of people never get the help they need.  They give up because nothing's worked and they feel nothing will.  They stop listening because everyone that's been telling them things will get better have been wrong to that point.  They stop caring because, well, they don't care.

They feel lost and alone.  Some end up angry, some end up sad, some end up some freakishly scary combination of both.

Now this doesn't apply to everyone.  As I've said, everyone's different.  Everyone's circumstances are different.  What one person considers to be terrible, someone else might think "eh, that's not that bad."

In the long run, there isn't much a pharmacy technician can do.  We can fill their scripts, answer their questions, and listen to them when they try to talk, but ultimately, we're just a person behind a counter.  We don't have all the answers and we can't give them all the help they truly need.

Maybe one day we'll figure out a way to help people in a much easier fashion, but I doubt it.

Unless that day comes, all someone like me can do is fill their script quickly and hope they take it like they should.