Minds on the Edge

Last week, a fantastic special on mental illness aired on PBS called Minds on the Edge that addresses many of the legal and ethical issues that people with mental illness (and their loved ones!) will face.

Although the whole show was fantastic (and is worth watching), it was the hypothetical story of "Olivia" that really caught my attention. While a college student, Olivia begins developing symptoms of mania, causing her friends and professors to worry. Olivia, however, thinks she is just fine, dammit, and wonders what the fuss is about. Her parents come for a visit and find her mental and physical state so disturbing that they bring her to the emergency room.

Except that's not the end of the tragedy, as it might be with a broken leg; it's just the beginning.

I couldn't embed the videos on the "Olivia" segment, but you can watch it yourself here:

Part One
Part Two
Part Three

Although this segment doesn't really mention eating disorders, I think it raises many of the issues that our medical and legal system fail to address in illnesses that are anosognostic. We are very used to assuming that people are aware and conscious of their own choices--and most of the time, we're right. But when we frame life-threatening brain diseases as just a series of tragic but stupid decisions, we're ruining lives.

There is no easy fix--one of the panel participants in this program called the mental health system the definition of insanity (though no doubt insurance companies would consider this a pre-existing condition). But we can't start with the fix until we start reframing how we think about all mental illness, eating disorders included. These illnesses aren't about unresolved conflicts or boundary violations, and although the behaviors frequently make sense to the sufferer and do have an adaptive function, they're not just a poor coping mechanism.

Be sure to explore the rest of the Minds on the Edge website and share your thoughts in the comments. There are also audio and transcripts available if you want to listen on your iPod or if you'd rather read it.

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Anonymous said...

**But we can't start with the fix until we start reframing how we think about all mental illness, eating disorders included. These illnesses aren't about unresolved conflicts or boundary violations, and although the behaviors frequently make sense to the sufferer and do have an adaptive function, they're not just a poor coping mechanism.**

Thank you, Carrie. I've tried so many times to make this very point succinctly, but you've said it beautifully.

I don't know how we--here in our dweeby household--missed this program, but thanks for posting about it. I thought my throat was going to close up during the part where Olivia was about to leave the emergency room and there was nothing anyone could do.

During the third part when the lawyer said we don't lock up heart attack victims, I was sitting here at the computer wanting to raise my hand to be called on! I kept waiting for someone to make the entire crucial point:

Mental illnesses arise within the body (last I checked, that's still where we all tend to keep our brains) and are just as biologically based and medically treatable as heart attacks, et al, but so often the inability to recognize that one is mentally ill and readily accept treatment is a SYMPTOM of the disease itself.

That's something that everybody "knows" but it seems few people "get".

I don't think it should be super-duper easy to force a person into mental health treatment against their will, but the answer isn't to make it as difficult and problematic as it currently is. After all, if the goal is autonomy, what better way is there to insure patient autonomy than putting the patient in a position to walk away unencumbered (or relatively unencumbered) by the disease?

I know the answer isn't easy, but surely we can do better.


Carrie Arnold said...

Don't worry, Malia, I had to watch most of the show online (it was, um, on the same time as House around these parts).

While watching the Olivia segments, I kept feeling like I was watching a B-grade horror movie and the protagonist is about to open the door and you're screaming "No! Don't!"

I agree- it shouldn't be easy to commit someone against their will, but it also shouldn't have to wait until they're going to die (or harm someone) for this to happen.

lostgirl said...

This made me cry. And made me feel sick. I'm bipolar (and anorexic.) I first tried to commit suicide at age 13 and had my first psychotic mania at age 16. I would go through both suicidal depressions and manias for years until I was finally diagnosed as bipolar in my thirties. Much of my life has been wasted and ruined because it was never treated. And I became a chronic anorexic before anyone noticed I was truly sick.

I have meds now but I'm horribly non-compliant. What a mix - anorexia and bipolar. The bipolar meds that help me (and when they work, they work miracles) I often won't take because of the weight gain fears and issues. The e/d really sabotages the bp recovery and vice versa.

When I was finally diagnosed correctly (most previous psychiatrists gave me antidepressants that made me insanely manic and then sent me on my way) my psych pointed out that I should have been diagnosed many, many years ago and if I had, my whole life could have been different. He didn't say it to be hopeless, but to get me to see that that's all gone. I was an Olivia, but I didn't even have a parent fighting for me. I slipped through the cracks at school, at home, and in the mental health system. But I can start life from here, now that I have the "right" help (when I can afford it, and I can't always afford it.)

BP is very much like anorexia in that one just does not see it. I didn't know I was sick when I was severely emaciated. And I didn't know I was sick when I heard voices telling me to jump off a nearby brige. Many times over the years my husband has tried to commit me, and he hasn't been able to because of my legal rights. I hate to admit it, but I think I would have been so much better off if that had happened.

I am all for legal rights and choices in the mentally ill. But how can we make honest choices when we don't even realize we are sick? The system fails us. No one likes forced treatment. But I can't help but think if someone had forced me into help so much earlier in my life, I'd have had a fruitful life that wasn't many years of absolute hell. I was forced into the hospital last year and once I started to feel a bit better, and supported, I stayed voluntarily and was helped with both the bp and the anorexia.

Every person who knows a mentally ill person, every person who parents a mentally ill person, and every person who is mentally ill should watch these heart breaking scenarios. They are so, so true.

My heart aches for the all the "Olivias" in the world. Civil rights are a great thing - but they don't mean a damn bit if a person is dead, on the streets or in prison. Time for the world to wake up to this issue.

Anonymous said...

Well, Carrie that explains it. We wouldn't watch the Second Coming live if was running opposite "House".

Lostgirl, I'm sorry you've struggled so. But I have to say that you sound very grounded and practical now. Your comment that you know you can have a different life going forward is telling. You certainly can, and good on you for recognizing that.

I know you weren't asking for advice, but this occured to me while reading your comment: maybe you could talk to an attorney in order to put something in place should you ever need interventional-type help again. I don't know why a savvy lawyer familiar with mental health laws couldn't come up with something to help grease the wheels if that were to become necessary. People execute DNR's all the time for hypothetical future circumstances where they may be unable to make their wishes known. My husband who was at one time extremely ill with the strong possibility of relapse has one--A DNR, that is. It's not a boilerplate document, it's been crafted very carefully and reflects both his individual health situation and his wishes. Perhaps you could have something that gave another party specific decision powers should your mental health go awry.

I wish you all the best.


Anonymous said...

I LOL'd when SCOTUS Justice Breyer jumped on the suggestion that he contact "Olivia's" parents. Awkward silence and stifled tittering ensued as it dawned on everyone else on the panel that one of the country's greatest legal minds DIDN'T KNOW THE LAW!

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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