Are We Setting The Stage For Another Deinstitutionalization Debacle?

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Is the Justice Department setting the stage for another deinstitutionalization debacle  – this time by forcing group homes to close? Or will the Justice Department’s actions finally give us what we need: meaningful community based treatment, including housing?

I’ve been asking myself this question ever since I heard an inspiring story.

It was about a young man with intellectual disabilities who was able to move out of a group home into his own apartment where he didn’t have to share a bedroom or bathroom with random roommates for the first time in decades. He was able to do this because the state where he lived was forced to accommodate him by the Justice Department and what’s commonly called the Olmstead decision.

That decision came in a lawsuit filed by Lois Curtis and Elaine Wilson, who had mental illness and developmental disabilities, and were patients at a state run Georgia psychiatric unit. Doctors agreed that both women were ready to be discharged into a community-based program but no services were available so they continued to languish in the hospital. The women filed suit and on June 22, 1999, the United States Supreme Court ruled in Olmstead v. L.C. that unjustified segregation of persons with disabilities constitutes discrimination in violation of Title 11 of the Americans with Disabilities Act.

The Court held that public entities must provide community-based services to persons with disabilities when (1.) such services are appropriate; (2.) the affected persons do not oppose community-based treatment; and (3.) community-based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs of others who are receiving disability services from the entity.

The court said that “institutional placement” of individuals who can handle and benefit from living in a community “perpetuates unwarranted assumptions that persons so isolated (in institutions) are incapable of or unworthy of participating in community life.” The court added that “confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement and cultural enrichment.”

I agree with the court’s ruling so why is the Olmstead decision causing me concern?

The answer is our history.

The idea of community-based treatment was established when President John F. Kennedy pushed passage of the Community Mental Health Act of 1963 through Congress. That law and a series of lawsuits set the stage for the great deinstitutionalization movement that effectively emptied and largely padlocked state hospitals.

Unfortunately, the lofty actions of the federal government and the court quickly turned into a cruel joke. States seized the opportunity to close costly hospitals but did not reinvest those savings in community mental health. The result: thousands of patients were simply pushed out onto the streets without a safety net.

It has been 51 years since Kennedy’s call for decent community based services. Judging from the National Alliance on Mental Illnesses’ state report cards, most states still aren’t providing them. Instead, individuals with the most severe mental disorders often are stuck in a revolving door between jails-prisons-and the streets.

Interpreting the law and enforcing it are what matters to the Supreme Court justices and Justice Department. But if our federal government is going to aggressively enforce Olmstead through its Justice Department, and it should, then isn’t that same government obligated to work through its other departments to insure states have adequate funding to guarantee that individuals with mental illnesses and intellectual disabilities receive the housing and support that they need?

If not, we will simply be going through round two of another deinstitutionalization debacle – with the federal government pushing residents out of group homes while telling state government to provide services that most are unwilling to do. The result will be more hardship on the citizens whose liberties the Justice Department claims it wishes to protect.

Mike Wallace Asked Why Hospital Officials Were Discharging My Son

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FROM MY FILES FRIDAY:  When my son became ill, I thought about who I knew with clout who could help us.  Legendary newsman Mike Wallace, who struggled with his own mental illness, immediately responded.

 HOW NEWS ICON MIKE WALLACE HELPED MY SON  4/11/2012 USA TODAY

CBS newsman Mike Wallace might be remembered by most as a bare-knuckles broadcast journalist renowned for his tough interviews with the powerful, famous and rich, and a pioneer of the surprise “ambush” interview. But it is an incredible act of kindness to my family that I will always recall.

We didn’t start off as friends.

When I picked up my phone in 1986 and heard, “Hello, this is Mike Wallace of 60 Minutes,” I honestly thought it was a friend’s prank call. At the time, I was writing my first book, Family of Spies: Inside the John Walker Spy Ring.Wallace heard that I was the only reporter who had gotten in to see John Walker, and he asked whether I could help him secure an exclusive interview with the American spy.

Walker hated the news media and had no interest talking about how he had spent 18 years spying for the Soviet Union along with his son, Michael, his brother, Arthur, and his best friend, Jerry Whitworth, all of whom he had recruited as traitors. His arrest in 1985 was the biggest spy scandal since Julius and Ethel Rosenberg were convicted and executed in 1953.

I was flattered that someone as influential as Mike Wallace was calling, and I immediately agreed to help. I got Walker to agree to give Wallace an exclusive for 60 Minutes. While Wallace was interviewing the traitor, they took a break in filming and Wallace called me from the federal prison in Marion, Ill., to check facts. “This is great stuff!” he assured me.

It was great. Wallace’s interview with Walker was mesmerizing. In one memorable scene, Wallace eviscerated Walker by asking him how he could be so heartless as to groom his only son to be a traitor, leaving the arrogant spy speechless. Wallace won an Emmy for that interview, one of 21 Emmys that he collected.

And what of my book and me?

Wallace never mentioned either. He and 60 Minutesbasked in the limelight.

I felt duped.

Then, a second phone call

As fate would have it, Wallace called me again two years later after he read another of my books. I told him that I felt deceived because of how he had handled the Walker story. What happened next shocked me. The powerful Mike Wallace apologized. He explained that he had been going through an extremely tough period in 1986 and that he had done some things he later regretted.

More than a decade later, my college-age son, Mike, was arrested after he developed a mental illness and broke into a stranger’s house to take a bubble bath. I managed to get him into a local mental ward, but his psychiatrist telephoned 24 hours later and said the hospital was going to discharge him in the morning because our insurance company didn’t want to continue paying his bill.

I was desperate, so I faxed a letter to Mike Wallace’s office because he was the most influential newsman I knew. Within 15 minutes, Wallace called and we spent an hour on the phone. I knew he had suffered from clinical depression, but I hadn’t known how ill he’d been.

He told me about how he’d become exhausted by the pressures that he was under at 60 Minutes, especially because of the infamous lawsuit against CBS by Gen. William Westmoreland. CBS had alleged that Westmoreland and others deliberately underestimated Viet Cong troop strength during 1967 in order to maintain U.S. troop morale and support for the war. Wallace mentioned how he talked openly on the air about how he had considered suicide in 1986 — the very year when we met.

He urged me to “have hope,” and then he did something truly incredible. Now that he has died, I can reveal it. At the time, he asked me to keep it private because he didn’t want CBS executives to hear about it. Journalists are not supposed to use their influence to intimidate people.

Mike Wallace called the hospital where my son was a patient. He asked the administrator there why he was discharging my son when his own psychiatrist didn’t think he was ready.

The result: My son wasn’t discharged. He got the help he needed.

A friendship forged

Although he was busy, Wallace telephoned me several times after that to ask about my son. We became friends and, in one of those calls, he mentioned the Walker story and how he had not given my book or me any credit.

He jokingly told me that he had repaid his debt.

I told him that what I had done for him paled in comparison with what he had done for my son and for me.

Mike Wallace was a hero of mine in journalism long before I ever met him. But for those of us with mental disorders or with loved ones who have mental illnesses, he will be best remembered for his courage in speaking out about his own personal struggles with severe depression and suicidal thoughts — and by doing so, fighting stigma and prejudice.

 

Readers Respond: What Makes A Great Psychiatrist?

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9-22-14 Earlier this month, I asked: What makes a good psychiatrist?

Many of you responded with insightful comments and poignant stories. I asked my daughter, Traci, who earned a Masters Degree in mental health counseling this year, to help me review the emails and prepare today’s blog.  Here is her analysis.

Being a psychiatrist is a challenging job.

As one reader put it, psychiatry is “not an exact science.” Psychiatrists cannot rely on tests or physical exams when trying to treat an illness. Their skill at prescribing a treatment for an illness hinges on their ability to assess symptoms reported by their patients. Psychiatrists then must manage both a patient’s symptoms and possible side effects, while working to find the medication, or medications, that work for each individual patient.

What works for one, may not work for the other.

For many individuals who have a mental illness or for the loved ones helping that individual, it is difficult to know where to even start. So before we get into deciding if a psychiatrist is a good fit for you, lets begin with where you should look for a good psychiatrist based on tips from readers who have navigated mental health care.

1. Follow professional word of mouth and don’t be afraid to shop around. K.P. wrote: “The first step is to ask your primary medical professional. Often times they may have a therapist or counselor that they refer patients to.”

2. Ask your friends and family members if there is someone they know or someone they personally like. If that specific psychiatrist is unable to take you under his/her caseload, then ask for a referral for another psychiatrist.

3. Look within your insurance network, but also consider a psychiatrist who offers sliding scale fees. R.T. writes, “If you’re lucky, you’ll be able to find someone good in-network. I think that’s unlikely. If you have out of network coverage, use it. You can ask for a sliding scale fee. If you don’t, it may be worthwhile to pay out of pocket for a good initial consultation, especially if it’s for medication that won’t require much follow-up once it’s been stabilized.”

4. If you do not have insurance, pursue care from the local Community Mental Health Center. Community services boards, if you are in Virginia, or community mental health centers can provide proper care for you or your loved one if insurance is an issue. K.P., points out “one of the barriers to care is insurance. If you have good private insurance is would be rather easy to find a good private psychiatrist.  However, most individuals with psychiatric problems have either Medicaid or seek care from Medicaid funded programs.” Look into what kind of programs are offered within your community for persons with mental illness and contact these programs. They will likely be able to answer your questions in regards to not having insurance and can point you in the right direction to getting the help you or your loved one needs.

5. Contact the National Alliance on Mental Illness and speak to members in your local NAMI group. They can tell you who is and isn’t good. D.J. noted that the best psychiatrists are often doctors who have a family member who has a mental illness. They have first hand experience.

6. Consider psychiatrists who are a part of a therapeutic team. You will likely find a psychiatrist working as part of a team if you pursue care within a community mental health center. Other times, private therapists and private psychiatrists will work together to provide comprehensive care for individuals. M.M., suggests, “a team approach may be most helpful in getting your loved one accessible and more affordable care (psychologists and social workers may be able to provide some sensitive counseling more affordably and save some of the more expensive appointments with the psychiatrist for medication management).”

7. Seek out research trials or contemplate going to a leading psychiatric unit, such as the National Institutes of Mental Health. When M. L.’s son was sick, for the first five and a half years of her son’s diagnosis she struggled to find an appropriate psychiatrist to work with her son. She eventually took matters into her own hands, did research, and found a psychiatrist who specialized in her son’s diagnosis and was one of the leading researchers in the field. After advocating continually for her son, she was able to secure an appointment with the leading psychiatrist’s partner. She credits her sons success to these doctors and offers the following advice: “follow research on your/your loved one’s diagnosis or symptoms and look for research trials that will allow you or your loved one to be comprehensively evaluated and treated by our nation’s leading researchers psychiatry. If you are within a 3-5 hour drive of a leading psychiatric research unit, strongly consider scheduling an appointment, as many researchers will consult with local psychiatrists. Consider entering yourself or your loved one in research studies.”

Now you’ve found a psychiatrist, but is he/she a good fit? How would you know? Here are your suggestions.

1. You just know.  R.T. says, “at least, you know if it’s a bad fit”. Follow your intuition, if it feels like it is not a good fit then move on.

2. Good psychiatrists listen to your concerns, input, perspective, opinion, questions, and are willing to discuss any and all of those with you and they are empathetic when doing so. It’s true that your psychiatrist went to medical school and is likely armed with vast knowledge of mental illness and medication, but you know yourself and your loved one best, and you are the one who has to deal with the side effects of the medications. R.T. advises, “If what you’re looking for is someone who will listen to you, then make sure the psychiatrist you meet with actually listens. He or she should be able to accurately paraphrase your concerns. He should not be in a hurry. If your doctor doesn’t get enough information in one session, he/she should schedule a second without hurrying to write a prescription. You should feel comfortable. You should feel able to disagree and be taken seriously. If medications are a possibility, you should be able to ask as many questions as you have, and you should be asked your opinion and your preferences. You should be clear on what to do if you have questions after you leave. Basically, you should be treated like a person, not a checklist.”

3. You are included as part of your treatment.  If they listen to you, then they should include you when making treatment decisions. Your psychiatrist should be willing to collaborate with you and come up with plans that work for both of you. The psychiatrist should not be making all the decisions and should offer you the choice and ability to make decisions in regard to your treatment. For instance, K.B. wrote of a wonderful psychiatrist that she credits helping her in her recovery and whom she now works with and said, “She always listened to what I had to say and gave me a say in what path my treatment took.  If I felt like I was overmedicated she backed of my med.  If I thought a new drug was needed she didn’t always change it but she always gave me the chance to discuss it.  When I took the idea of VNS therapy to her with my research, she agreed to train to help me succeed.”

4. If you or your loved one has a serious mental illness, then your psychiatrist should have experience treating serious mental illness.  Check to see what kind of experience the psychiatrist has and inquire about their specialties or areas of expertise. If they specialize in working with those with depression and you or your loved one has schizophrenia, it might not be the best fit. M.M. states, “Not all psychiatrists do, or want, to treat persons with mental illness, so do not assume just because of the degree the provider is experienced.”

5. The psychiatrist does not shut family members out. This can be a tricky area for the psychiatrist to navigate. They have to adhere to both patient confidentiality and HIPAA, while looking out for the best interests of their patient. Families can become heavily involved in the treatment of persons with mental illness and this is something that M.M. says psychiatrists need to keep in mind. When looking for a good psychiatrist, she asks “does the psychiatrist recognize family members are desperate to help their loved one and offer them strategies to assist in care without compromising patient privacy (this includes making contact available to express concerns and alert healthcare providers to their patient’s history, medication response and worrisome behaviors)?” For reader M.R. this meant that the psychiatrist listened to her input when it came to her son’s medications. The psychiatrist noted the parents’ perspective and was able to help the son stop hearing voices for the first time in five years.

6. You should not be made to feel ashamed of or blamed for your illness. Reader A.P. tells a story of coming to the realization that she had depression, and not admitting it to anyone expect for her husband and three health care professionals. One psychiatrist whom she opened up to informed her that she had no idea what depression really was. This response put A.P. back into a place of hiding her depression and not asking for help. When she spoke to a pastor of her problems, he blamed her childhood abuse on her. Again, A.P. was embarrassed and ashamed, avoiding asking for help until much later.

      Stories like these remind us that not all professionals are as compassionate and empathic as they should be. Your psychiatrist should not make you feel embarrassed about your mental illness or reluctant to seek help for yourself. In fact, your psychiatrist should do the opposite. K.B. had such an experience. For K.B. her psychiatrist “helped me to not take my illness so seriously that I was seeing it as a death sentence.  She gave me hope that I could recover and I have.  But she always reminded me that I had to stay in treatment and make a commitment to recovery or it just wouldn’t work.”

7. The psychiatrist remains focused on you, the patient. Everyone has bad days, even psychiatrists. They may be experiencing some trouble in their personal life or going through other problems. However, the appointment should not center on their problems. A little self-disclosure from the psychiatrist may be appropriate at certain points in the relationship, but this should not be the entire session. A.P. brought up a psychiatrist who was able to help her with medications, but “spent our sessions talking about her problems and me giving her advice”. You are paying for a service, not for your psychiatrist to unload his or her problems onto you.

8. A great psychiatrist goes above and beyond. A good psychiatrist is all of the above, but a great psychiatrist goes beyond the call of duty. For many readers, this meant being available to them in a crisis. M.J. states, “I never hear “call 911 or go to your local emergency room,” when I call between appointments when my son is in crisis. I am connected to my doctor or the doctor on call for her. I have her mobile phone and have had direct access for virtually the entire 15 years.” K.B. testifies that her psychiatrist separates herself from others by truly caring and following up with her patient, for example, the psychiatrist went out to find a client who had missed a shot because she knew how important it was.

9. The appointment is not rushed. A psychiatrist should not be in a hurry or spend only a short amount of time with you. K.S. tells us, “a good psychiatrist does not diagnose you with something after your first appointment. They spend good quality time with you or your loved one. Anything less than 15 minutes is a joke…Don’t settle for someone who will get you in next week only to spend 5 minutes with you, diagnose you with bipolar disorder and then send you along with a laundry list of medications. You will be doing yourself or your loved ones and injustice.” The overall consensus is that short, 5-15 minute appointments are not helpful, and may actually be harmful. If you are making the time to see a psychiatrist, have them make the time to see you too.

Overall, K.B. summarizes a great psychiatrist as “ psychiatrist that cares, is dedicated, stays on top of advancements in the field, is knowledgeable about medications, advocates for his or her clients, and, most of all, helps them find their voice.” 

 Even with these tips, bear in mind that there may still be some trial and error in finding a psychiatrist for you or your loved one to work with. A.P., said it best when she wrote, “There are some really great counselors, therapists, and psychiatrists out there.  Some might be great but just clash with your personality.  Some just outright suck and should be parking cars with little human interaction of any kind.  Keep searching.  Your life depends on it.  And the happiness of your loved ones depends on it, too.”

 

FROM MY FILES FRIDAY: Vladimir Putin — Russia’s Egotistic Thief

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9-19-14 FROM MY FILES FRIDAY: In February 2011, I wrote a blog that described Russian President Vladimir Putin as a common thief. His recent foray into Ukraine is a testament that Putin is much more — he is a dangerous and pompous threat to freedom loving people. 

The World’s Biggest Thief 

Advocating for better mental health care is a top priority to me, but it’s not my only interest. I took time last week to have lunch with a friend of mine who works for a U.S. intelligence agency and our conversation quickly turned to Russia.

I have been fascinated with the Kremlin and Moscow much of my life.  Perhaps, it started when I was a youngster living in Pueblo, Colorado when my mother began storing food items in the bathroom closet in 1962. The bathroom was the only room in our small house that didn’t have windows, which was why it was chosen as our family’s emergency bomb shelter if the Soviet Union attacked.

For those too young to remember, 1962 was when the Cuban Missile Crisis happened and at the elementary school that I attended, we did drills where we either hurried into hallways or ducked under our desks. That was supposed to help us if  bombs fell.

Being a cost conscious  minister’s wife, my mom didn’t want to toss out the stored food after the crisis passed so she decided one night to add water to the packets of dehydrated meat that could be kept without refrigeration. Eating that miserable tasting stuff made me more angry at the Soviets than their plans to install missiles off our shore.

I also remember a billboard near our house that showed an angry Nikita Khrushchev about to pound his shoe on the table. I still remember the wording on that poster. It said: “We will bury you!”  That image might have terrified other children, but it made me wonder what sort of people these Communists were. Only later would I learn that both the shoe pounding incident and the translation of Khrushchev’s words were in dispute. I’d also discover the photo on that billboard was fake.

Regardless, I jumped at the chance to visit Moscow in 1994 and 1995 while researching Confessions of a Spy: The Real Story of Aldrich Ames.  It turned out to be a fabulous time to visit.  Muscovites were adjusting to the collapse of the Soviet Union in 1991. While the nation was struggling with hyperinflation and the emergence of the Russia mob, most of the individuals I met and interviewed were wonderful folks, no different in many ways from you and me. They were eager to begin a new era of freedom. This was especially true of students and, of course, Russian journalists.

Although I’m certainly no expert on Russia, I still have several friends there and what has happened since 1991 is a tragedy. I suspect that historians will eventually describe it as a major missed opportunity to create a freer and modern nation.

Rather than helping his people rise to greatness, Boris Yeltsin turned out to be drunk who helped his Oligarch buddies loot the nation.  As the second Russian president, after Yeltsin suddenly resigned, Vladimir Putin took the reins with high U.S. expectations.  (Remember President George Bush’s famous statement – “I looked the man in the eye. I found him to be very straightforward and trustworthy. ..I wouldn’t have invited him to my ranch if I didn’t trust him.”)

While Putin re-established political and economic stability, as well as, the rule of law, it now is obvious that he also has taken the low road as a leader.

Putin has used his power to imprison his political enemies, muzzle the media and undermine the democratic system by installing a puppet president. Yes, he stripped Yelstin’s  Oligarchs of their stolen wealth. But he promptly turned his buddies lose to rape the country.

Russia has gone from being an oppressive regime to a shiny example of a kleptocracy, which is defined as being a nation “ruled by thieves.” 

What prompted this blog? A recent Wikileaks revelation in Russia and a comment by my lunch guest who told me that a recent U.S. intelligence assessment pegged Putin’s personal wealth at $20 BILLION.

$20 BILLION!

If that is accurate, then poor Putin may have actually lost money. In 2007, there was speculation in the English press that Putin’s worth was in excess of $40 Billion. And this week, the Russian version of wikileaks revealed that Putin has spent an estimated $1 billion constructing a secret palace for himself on the Black Sea. The website that contained that story was immediately shut down in Russia by the Russian government. Last year, Putin and the Kremlin said there was little money to give federal workers, such as teachers and doctors, modest pay increases. Yet, somehow Putin has managed to become one of the wealthiest men in Europe even though his yearly salary, according to the Russian government, is less than $63,000 per year.

The people of Russia, especially those who fought to end Communism, deserve better than this puny egotist.

Putin’s $1 billion palace under construction on Black Sea.

Health and HOPE: Are they linked?

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9-15-14  My former CIA friend and fellow author Robert Stephan sent me a fascinating article from The New York Review of Books entitled The Dying Russians. Over a period of time, Masha Gessen  noted that a large number of her Russian friends were dying.

The deaths kept piling up. People—men and women—were falling, or perhaps jumping, off trains and out of windows; asphyxiating in country houses with faulty wood stoves or in apartments with jammed front-door locks; getting hit by cars that sped through quiet courtyards or plowed down groups of people on a sidewalk; drowning as a result of diving drunk into a lake or ignoring sea-storm warnings or for no apparent reason; poisoning themselves with too much alcohol, counterfeit alcohol, alcohol substitutes, or drugs; and, finally, dropping dead at absurdly early ages from heart attacks and strokes.

Gessen decided to learn why and with a keen eye examined possible scientific explanations, studying and comparing fatality rates caused by smoking, heart attacks, cancer and other typical illnesses before she eventually reached an unexpected conclusion.

Russians were dying at much higher rates because of a lack of hope.

Hope might have persisted after the Soviet Union collapsed—for a brief moment it seemed that this was when the truly glorious future would materialize—but the upheaval of the 1990s dashed it so quickly and so decisively that death and birth statistics appear to reflect nothing but despair during that decade.

Hope is one of those intangibles the medical profession has been unable to quantify. But I believe it is essential to recovery from a mental illness. I am not a Pollyanna. I believe severe mental disorders are cruel illnesses that all too often destroy lives. Much like cancer, not everyone will recover.

However, none of us is so wise that we know who will recover and who won’t. That is why it is important for us to do whatever we can to encourage and offer hope to someone who becomes mentally ill.

To quote Hal Lindsey:

Man can live about forty days without food, about three days without water, about eight minutes without air…but only for one second without hope.

From My Files: Why Don’t You Take Your Medication?

9-12-14 FROM MY FILES FRIDAY:  In a blog that I originally published on March 12, 2010, I tried to explain why my son resisted taking medication for several years after his first break.  “Why won’t my son/daughter take their pills?’ is still the question that I am asked the most. Much of what I wrote remains germane. 

“Why won’t you just take your medication? I take pills for my cholesterol every night and its no big deal.”

“Every psychiatrist we’ve seen has said you have a mental illness. Why won’t you accept it? Why would the doctors tell you that you’re sick, if it weren’t true?”

“Let’s look at when you were doing well and when you have gotten into trouble. What was the difference? Medication. It was the difference. When you were on your meds, you were fine. And when you weren’t, you got into trouble. Can’t you see that?”

These quotes may sound familiar to you if you are a parent and have a a son or daughter with a severe mental illness. I’ve said everyone of them to my son, Mike. It often is frustrating for us – parents — to understand why our adult children will not take anti-psychotic medication or take it only until they get better and then stop. The remedy seems so clear-cut to us, so simple – and watching them experience the mania, depression, and delusions that happen when they become psychotic is heartbreaking and horrific.

Early on, I tried every trick out there to get Mike to take his pills. Those of you who have read my book know that during one of his first breakdowns, I crushed his pills and mixed them into his breakfast cereal only to be caught by him. That damaged our relationship.

I snuck into his room and counted his pills too one day and when I discovered that he had stopped taking them, I followed the advice of a therapist who had told me that I needed to practice “tough love.” I told Mike that if he didn’t take his medication, he had to move out of my house. He did – that very same day. Again, that hurt both of us.

Another time, I offered to pay him to take his medication —  $1 per pill.

It was my friend, Xavier Amador, author of the book, “I’m Not Sick, I Don’t Need Help” who finally convinced me to back off. “I can promise you, Pete,” he said, “your son knows exactly how you feel about medication. You don’t need to ever mention it to him again.”

And since that day, I haven’t. Not a word.

So why do persons with mental illnesses refuse to take their medication or stop taking them as soon as they become stable? I am asked that question more than any other after I give a speech.

Let’s skip the obvious reasons –that some anti-psychotic medications can dull a person, make them feel physically lousy, kill their sex drive, cause them to gain weight or send them to bed exhausted even though they are already sleeping for 16 hours a day. Let’s ignore the fact that no one really knows the long term health impact that medication can cause on a person’s body.

Is there a deeper reason?

One day, I asked Mike to explain to me in writing why he had struggled so much when it came to taking his medication.

Denial was a strong factor in my understanding and even when evidence of my own madness would be presented, my mind would find a way to weave out of the circumstance and an obtuse reasoning would somehow form that would keep my own pride intact. Always two steps ahead of the truth, my brain would tap dance its way into a room where I was not at fault, where it was everybody else versus me, where I was some sort of prophet or special medium who was undergoing visions, not hallucinations, and I was important, not a victim.

It is very hard to understand that one’s own credibility is broken. There is a lot of personal shame one undergoes when they realize that they are no longer in line with society’s understanding of sane. It makes one doubt one’s own instincts and second guess the movements and decisions that one makes. Suddenly, the veil of confidence and ability has been lifted and one is a wreck, struggling to piece together the remnants of what are left of one’s self image.

I learn a lot from my son. One lesson he has taught me is recovery involves much more than simply having a pill given to you.  For many it can be a bedrock to stability but it is a starting point, not an ending one. Our loved ones need and deserve much more.