Wednesday, January 14, 2015

The lovely wife on the psych ward

I have one thing to say about Mark Lukach's essay, "My lovely wife on the psych ward."  That one thing is: Read it!  It's beautiful.  Mr. Lukach does a masterful job of describing his feelings as he plows through two months' long episodes of psychosis with his wonderful wife. When a friend gives him a copy of R.D. Laing's The Divided Self: An Existential Study in Sanity and Madness, Mr. Lukach learns about the world of anti-psychiatry and psychiatric survivors.  He struggles through with wanting to be a good husband, to help his wife get better, but he questions whether what he is doing is right, and he stumbles through with his own guilt.  And when his wife gets better, they struggle with the bitter aftertaste of what it meant to be her caretaker, to be in control.  The story isn't all pretty, but the writing and the description of the conflicts is beautifully done.

Yet Laing ripped through a conception I had of myself that I held dear: that I was a good husband. Laing died in 1989, more than 20 years before I picked up his book, so who knows what he really would have thought. His ideas about mental health and its treatment could have shifted with the times. But in my admittedly sensitive state, I felt Laing saying: Patients are good. Doctors are bad. Family members botch things up by listening to physicians and becoming bumbling accomplices in the crime of psychiatry. And I was an accessory, conspiring to force Giulia to take medication against her will that made her distant, unhappy, and slow, and that silenced her psychotic thoughts. That same medication enabled Giulia to remain alive, so everything else was secondary, as far as I was concerned. I never doubted the rightness of my motives. From the beginning, I’d cast myself in the role of Giulia’s self-effacing caregiver—not a saint, but definitely a guy working on the side of good. Laing made me feel like I was her tormentor.


Anonymous said...


With all due respect, you left out some important information that makes the discussion more nuanced than just an issue of being pro vs. antipsychiatry and the same with meds.

""Unsure how to deal with this and frankly exhausted by our regular fights over taking her prescriptions and seeing her doctor, I called Sascha Altman DuBrul, one of the founders of the Icarus Project, an alternative medical health organization that “seeks to overcome the limitations of a world determined to label, categorize, and sort human behavior.” The Icarus Project categorizes what most people consider mental illness as “the space between brilliance and madness.” I didn’t feel great picking up the phone. I wasn’t seeing the brilliant side of Giulia’s behaviors, and I wasn’t eager for more judgment and guilt. But I needed a new way to think about our struggles. DuBrul instantly put me at ease. He started by arguing that each person’s experience with mental health is unique. This may sound obvious, but psychiatry, to some extent, has been built on generalizations. (That’s part of the critique from Insel, Frances, and others: Psychiatry, as it exists in the DSM, is just a directory of catchall symptom-based labels.) DuBrul didn’t like the idea of people’s singular experiences being stuffed in one of a handful of available boxes.

“I have a diagnosis of bipolar disorder,” DuBrul told me. “While that term can be really useful for explaining some things, it’s lacking in a whole lot of nuances.” He said he found the label “kind of alienating.” All that resonated with me. For Giulia, too, none of the diagnoses seemed quite right. In her first psychotic break, psychiatrists ruled out bipolar disorder; in her second, three years later, they were certain she was bipolar. Besides, DuBrul said, no matter the diagnosis, psychiatry “gives you terrible language for defining yourself.”
The doctor took Jonas from Giulia, handed him to me, and took my wife away.

As for medication, DuBrul said that he believed that the answer to the question of whether or not to use pharmaceuticals needed to be far more nuanced than yes or no. The best response might be maybe, sometimes, or only certain medications. For instance, DuBrul shared that he takes lithium every night because he’s confident that, after four hospitalizations and over a decade with the label bipolar, the medication is a positive part of his care. Not the whole solution, but a piece.

All this was very comforting, but I really perked up and started paying careful attention when DuBrul introduced me to the concept of mad maps. Like advanced directives for the dying, DuBrul explained, mad maps allow psychiatric patients to outline what they’d like their care to look like in future mental health crises. The logic is: If a person can define health, while healthy, and differentiate health from crisis, that person can shape his or her own care. The maps are not intended to be rejections of psychiatry, though they could be that. The maps are designed to force patients and family members to plan ahead—to treat a relapse as possible or even likely—in order to avoid, or at least minimize, future mistakes.""

The only problem with the last part of the advice is many psychiatrists still ignore advanced directives which is another discussion.

Anonymous said...

It's a good story, but controlling behaviors don't work for me. The more controlling someone is with me, the more I will withdraw and flee.

Several years ago, I was sick and my parents would ask me if I was taking my medications and sent a letter to my psychiatrist behind my back. My psychiatrist told me my parents sent a letter and that they were concerned but would not tell me what their concerns were or what the letter said. I still don't know what the letter said because my parents would never tell me either. I'm not sure how I was supposed to address the concerns if no one would even tell me what they were. All of these kinds of controlling behaviors, while well intended, only further distanced me from my parents. I stopped seeing that psychiatrist shortly thereafter and told my parents even less about what was going on.

To prevent what happened in the past, I have not told my parents the name of the psychiatrist I have been seeing for the past couple of years. I don't want him receiving any letters behind my back. My parents have also stopped asking me if I am taking my medication, because they have realized that treating me like a child not only doesn't help, it makes things worse. I'm not a child.


Andrea said...

I enjoyed reading this article. It is an interesting perspective. I have been single for most of my adult life and it was up to me to sort out my psychiatric treatments myself, with the help of various psychiatrists and therapists. It would have been really comforting to have the support of a spouse at times, but I am glad that I have been completely in charge of my treatment. Now, I am finally enjoying good mental health. I am 44 and was diagnosed when I was 19. I am engaged to be married and my fiance understands how important it is for me to make my own medical decisions. I appreciate feedback from my fiance, but I am also glad that I had to take complete responsibility for my mental health for a long time. I have learned a lot about myself and also about psychiatry and psychotherapy.

Unknown said...

I blog at Mad in America, a site frequented by critics of the psychiatric establishment. One can find a range of opinions there, from anti-psychiatric survivors, to science writers like Robert Whitacker and practicing psychiatrist who are searching for ways to reduce our reliance on psychiatric medications. Dr. Dinah here seems to be more nuanced in her approach than E.Fuller Torrey at the Treatment Advocacy Center, who recommends a brutish and paternalistic approach to controlling those labeled with "mentally ill." Along with Torrey and Congressman Tim Murphy out patient commitment laws are popping up around the country. And it is no coincidence that these laws are running parallel to and inflaming passions against the "mentally ill" as scapegoats for Sandy Hook and other tragedies. I look forward to catching Dr. Dinah today at 10:45 on CSPAN Book Tv.