The Ottumwa Courier

October 8, 2013

Seeing past mental illness

By MARK NEWMAN Courier staff writer
Ottumwa Courier

---- — OTTUMWA — It’s not laziness, weakness of character or loose morals that drives the actions of those battling mental illness, say local mental health professionals and their patients.

Social worker Angie Fiscella said she’s still surprised at the way, even in the 21st century, the public acts toward those with mental illness. They may not understand that it’s just what it says: An illness, usually involving brain function. And yes, she said, that can affect how a patient speaks, acts and thinks.

“People see someone in a wheelchair, and don’t expect them to get up and do stuff,” she said Tuesday. “But there’s not that level of understanding with mental health.”

Fiscella was helping at the Promise Center in downtown Ottumwa, a type of clubhouse where those with mental health issues can be in a safe place with others who won’t be judgmental. The voluntary “drop in” center is funded by Southern Iowa Mental Health. There are games, videos and snacks, but the most common activity is visiting; sitting on one of the many couches or chairs and chatting.

Just like other disorders, mental illness can be mild, moderate or severe, Fiscella said. And depending on medication adjustments, that level can change. Which means that someone you might never think of as having any health issues whatsoever could become agitated one day as their body adjusts to the change. That, and normal changes in brain chemistry can cause good or bad days.

“You may ask yourself, ‘Oh no. What have I done?’” said Fiscella about seeing a co-worker or friend get upset.

A simple comment may trigger rage, with foul language or slamming of doors from someone who never acts that way.

“Don’t take it personally,” she said, explaining that at that moment, it’s a matter of control, or lack of control.

For some patients, only correct medication and therapy that teaches good coping techniques will help. The disconnect may not be able to be defeated through willpower.

“For them to be manic and you tell them to calm down, it’s not going to happen,” Fiscella said, though some people can be walked through an episode. Depression requires more, too, than telling a patient to cheer up.

“There’s a feeling of hopelessness: ‘My family doesn’t want me, society doesn’t want me and I don’t like me the way I am,’” she said.

And it’s never going to get better, says a voice inside them. With a healthier individual, they may be able to tell that voice, “I can make things better.” It might even work. But, a patient treated for depression told the Courier, when I counter with positive self talk like that, telling myself that I am going to succeed, a voice says, “No you won’t. Ever. You should just kill yourself.”

That usually sounds like their own voice. For those dealing with delusions or psychosis, however, the talk may sound like it’s someone else.

“It can start off as whispering,” said Don, a member of the Promise Center whose last name is being left off due to medical privacy laws. “And it’s just as if someone were standing behind you, whispering, or talking in a normal voice.”

“If it is a voice,” added Andrew. “Sometimes, it’s a noise,” he said, imitating a repetitive grinding sound. “It’s very distracting.”

He knows that because he and Don have been two of the presenters of “Hearing Voices,” a program purchased by SIMH , they said. It’s an educational exercise that allows participants to experience a bit of what someone with certain mental illnesses might experience.

“I didn’t think I’d find it so disturbing,” said Andrew. “It’s what they call auditory hallucinations. I was totally caught off guard.”

Don described multiple “stations” where volunteers like he or Andrew play the part of an emergency room psychiatrist, a therapist or a social worker asking questions. Don typically asks participants to put together a small puzzle. The “psychiatrist” asks questions to determine the patient’s mental state.

“But while they’re doing [the stations], they’ve hearing voices; they’ve got headsets on,” said Andrew.

So the therapist may be asking a participant to write some answers down, and a sudden voice starts telling the participant how worthless they are, that they’re doing the project wrong, that they’re too stupid to understand.

“It’s very authentic,” said Don. “With the voices you hear in the headphones, you can experience what a voice-hearer hears.”

Since it’s coming from headsets, it should be obviously “fake,” an advantage a “voice hearer” does not have. But it does draw one’s attention away from the task at hand at times. Especially the whispering. For sufferers from this particular brain disorder, the volunteers say, it’s easy to be distracted because it’s like someone walked up behind you to tell you something.

“I could not do any of the tasks,” said Andrew, “and I didn’t have to go through eight stations to figure that out. I recommend it — but it’s very disturbing.”

Don said people that experience the program are less likely to tell someone with a mental illness that they should just calm down, ignore the voices, stop thinking that way, get over it or just calm down. It’s rewarding to see people begin to understand what it’s like to have difficulty getting one’s own brain to cooperate.

“How would you like it if you were in a job interview, and someone standing behind you was making disparaging remarks,” he said. “It might be distracting.”

“Yet there are people who go on with their lives,” added Andrew, “who find a way to cope. It’s like someone who has a physical handicap. It’s not like it goes away, but you somehow learn to deal with it.”

Follow reporter Mark Newman’s Twitter feed, @couriermark

This week is national Mental Illness Awareness Week. To contact the Promise Center, call 641-683-6680. For information on the National Alliance on Mental Illness, NAMI, visit