The past fifty years have seen a huge change in society’s understanding and attitude toward mental illness, but stigma still remains. Just this past week, the news that caught my ear (since most of my news comes to me via NPR) was that lawmakers are attempting to make it easier to force people with mental illness into care and treatment.  These efforts are motivated in large part by the incidents such as Sandy Hook, and Adam Lanza, who seems to have needed treatment, and didn’t receive it.

I’m deeply sympathetic to this urge to force treatment on the severely mentally ill.  After all, my sister and I suffered years of instability because of our mother’s untreated bipolar disorder.

And, sometimes, mental illness really can look like Evil.

I’ll never forget one night, when my mother was in the clutches of one of her more manic swings, not sleeping, and becoming delusional, and she seemed to have confused me with my dead father, her ex-husband.  She repeated accused me, as my father, of raping her, and causing her indescribable pain and suffering (not something a daughter wants to hear, ever!).  She wouldn’t calm down, but rather, escalated.  It was after midnight, and my one thought was that my daughter, then about 5 or 6 years old, really didn’t need to wake up and witness this scene of complete chaos and anger!  (thank goodness my children all seem to sleep like logs, and it would take a hurricane or some other natural disaster to wake them, but not just screaming).  We ended up calling the police to have my mother escorted from our property.  Such a shameful experience, but families are left with few options.  Despite being clearly delusional and irrational, since she wasn’t at that point a danger to herself or us, she couldn’t be hospitalized.

A number of years later, my poor sister was faced with going before a judge to argue that our mother was not competent to make her own decisions (at the time, our mother was threatening to leave the security of the assisted living my sister had arranged for her, and seemed bent on living in the street).  As soon as our mother started talking to the judge (and making no logical sense), the decision to grant my sister guardianship was made.  But, that didn’t mean that she would agree to treatment to help her get back to some semblance of sanity.

Living with mental illness can be intoxicating – particularly when the mood disorder is mania, which makes one feel omnipotent, and able to achieve anything.  Schizophrenics can similarly feel that their delusions are a special gift.  I had a patient who would go off his medications, and then believed that he was communicating directly with Jesus.  He would go off and live in the woods of the parklands around Baltimore.  When he was on his medications, he was the most lovely, intelligent and interesting person.  I haven’t seen him in years, and I fear that the woods (and his disease) may have conquered him.

You can read the writings of prophets like Ezekiel, and, with a modern sensibility, it seems like these folks must have been high on some mind-altering substance, or their perceptions were altered by internal chemical imbalance.  And, it seems likely that many of the poor women who were murdered under suspicion of being witches in Salem, MA, may have suffered mental illness.

The conundrum is that most mentally ill people are not violent.  They may hurt themselves in many ways.  They often hurt their families, and cause tremendous exhaustion, stress, and economic cost.  It’s so difficult to argue that treatment should be forced on people when the treatments often carry with them intolerable side effects, and sometimes are of unclear benefit.

We need desperately to destigmatize mental illness.

We need more rational solutions to the problem of trying to offer help to people who may not want to be helped.  We need to offer support to their families.

And, we definitely need to work on the abuse and violence that can predispose people to have their brain chemistry altered early on and lead them to a life of confusion and disorientation.

I see it daily in my patients, and I have lived with it in my own family.

This post was inspired by Ruby by Cynthia Bond, an gripping novel about overcoming our past and embracing love in a racially charged rural 1950s Texas. Join From Left to Write on May 8 we discuss Ruby. As a member, I received a copy of the book for review purposes.