“Behavioral Health”: Appropriate and Compliant

by Stephanie Bova

My five encounters with the public mental health system in Milwaukee County (which we mental health consumers call just “County,” with some trepidation and distrust) were degrading and dehumanizing. If you had ever been there, you would know what I mean. If not, take it from me—I was not fixed by the “treatment,” such as it was. The last time I was there was in 1995. Perhaps it has changed some, but I doubt it. Units are being systematically closed due to budget cuts. I was actually very involved with a huge conference (800 participants) initiating a change in their treatment paradigm in 1994 to “The Master Plan,” rather ominous sounding. There was more input from people with mental illnesses, both inpatients and non-patients on how the place was run, but that’s another story.

Mental health units are essentially screwy places themselves, with all kinds of unraveling taking place and not much healing conversation instead a lot of daytime television, waiting for the medications to work, boredom, disconnection, and bad food.

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Trying to be genuine and authentic, mental health consumers bump right up against the words “appropriate” and “compliant” from mental health professionals. I detested those words. “Appropriate” was irrelevant. What did it have to do with anything? My friends and I often joked about being inappropriate. “Appropriate” was a weight, conformity to someone else’s idea of proper behavior. I tended to act like a smart aleck at County once I somewhat accepted that I would have to be there.

“Compliant” means you do as you’re told and take your medications. Doctors don’t have time for explanations. When I was the most ill, in a deep depression following a psychotic, manic episode in 1987, my psychiatrist said I had “mixed up thoughts,” an explanation for a six-year-old, and put me on Haldol. It made me feel so bad I tried to kill myself with a lithium overdose.

I have had to educate myself about my condition. I pored over many, many self-help books and critiques of the concept of mental health systems. Manic depression was mixed up in there with my strict upbringing and the Catholic Church, my mother and extreme shyness, and it all had to be sorted out.

“Mental health” became “behavioral health” somewhere in the last decade or so. I don’t know what behavioral health means. Is conformity a cure for being screwed up? If you try to behave normally, whatever that is, and you know that you are not “normal,” you are being phony. A lot of mental health consumers have quirks and eccentricities. It’s easy to spot us on the street sometimes. We are often fearful and stigmatized. When we get together for “consumer conferences,” it is very exciting. We know we belong. We don’t have affectations or all the social niceties that normal people seem to have. Or so we think. Being around your own kind is a breath of fresh air.

Or was. I don’t feel the need to attend support group meetings or conferences anymore. I made some great friends there. I spent a good ten years involved with the Depressive and Manic-Depressive Association, as a member, officer, president, and editor of its newsletter. Eventually it dissolved. By then I was not sorry to see it go. I enjoy all kinds of people now that I’m no longer shy, in my writing class, on my job, including some of my old DMDA friends.

I have always had a pigheaded need to just be myself. The mortal threat of psychotropic medications is that they may change who you are. That is terrifying to someone who has to take them. No matter how messed up, we don’t want to turn into somebody we don’t know. We are precious to ourselves, familiar to ourselves. We certainly have the right to our inner selves, do we not?

Dr. Phil says we need a soft place to fall. He also points out that communication is only 7% verbal, the rest nonverbal. At County, there is no soft place to fall. The nonverbal communication is that you are defective. You are starved for comfort. You are not the “boss of yourself,” nor do you feel respected. They try out some drugs on you. Psychiatric medications are notoriously difficult to get right. Many trials may be involved, maybe for years, until something maybe works. That waiting is extremely frustrating, to say nothing of excruciatingly painful. Statistically, 30% of depressed people are not helped by medications. (Mine generally did not work.)

County doctors and nurses (and probably the ordinary person on the street) are “true believers” in the efficacy of psych meds. I know that often meds alone are not nearly enough. You have to do an awful lot of work on yourself. Your recovery is greatly aided by working with a competent therapist and a competent psychiatrist you like and who like you. You don’t usually get them on the first try.

I have found that whenever I have been hospitalized at County, I am usually worse when I get out. I have been so traumatized just by being there. You are a nothing when you are in there. You are in a fight for your life. I isolate myself when I get out, so recovering from treatment usually takes a long time, months or even years. Once it took me more than four years (1995-1999) of sitting around smoking cigarettes, fat (I had gained 60 pounds), anxious and depressed, feeling no feelings, before I could get back in the swing of life. Just prior to that interminable stretch, I was in jail for several months in both Minnesota and Wisconsin, (awaiting trial for 11 counts of reckless endangerment for driving the wrong way on the freeway, when I was psychotic). I spent a month in Winnebago Mental Health Institute (one of Wisconsin’s two state mental hospitals), a facility with a scary reputation. Eventually I was acquitted of all charges by reason of mental disease or defect and put on ten years’ probation, which has turned out to be good for me. I am connected to a private nonprofit agency, Wisconsin Community Services, Inc., which does wonderful work with ex-offenders and some non-offenders, all with mental illnesses.

I do have one good story. When I was released after a month-long December 1990 stint at County, I had my estranged but considerate (and hurting) husband deliver me to a male friend’s flat. He is a mental health consumer I had fallen in love with in my support group. (We are now buddies--not lovers-- and I am divorced.) It was very cold in his flat, and we stayed crowded together in his little single bed in our thermal underwear and bathrobes under blankets and comforters, just sleeping, for two weeks, getting up only to eat and go to the bathroom. It was intensely soothing, comforting, healing. I gradually came back to life just breathing in a rhythm with a sympathetic spirit. Restoration to an ambulatory state in a mere two weeks is unheard of. County can’t provide that breath, that life. With the budget cuts, it may even disappear. I can’t say I’ll be sorry.