The Mentally Ill Have No Voice...(or a very loud voice no one hears)

I witnessed an interesting event yesterday at an inpatient psychiatric unit of a hospital. I had just walked on the unit and a patient began yelling very loudly,

"She has a razor! She has a razor! Someone better come get this razor away from her! She has a razor and is going to cut herself! Someone better take it away! No one ever listens to me! She has a razor!!!"

Well, a nurse, or social worker went to investigate and saw that this female patient had an object in her hand, which she assumed was a pull-tab of a zipper and tried to take it away because the client liked to eat metal objects. The nurse's fingers were cut badly enough that she had to go to the ER for first aid treatment. She tried to grab ahold of the razor, thinking it was something else, even though this other client was yelling right outside her door, "She has a razor!!! She has a razor!!!" I have heard that the mentally ill have no voice, and in this situation it was true. The message was clear. The message was based in reality. The message could have saved the nurse pain and suffering. But the nurse chose to ignore the message, possibly because of some notion that severely mentally ill people can't be right.

The mentally ill, even the psychotic/delusional ones, usually have at least one foot in reality and are aware of the reality surrounding them to varying degrees. We also shouldn't just dismiss what they say because they are mentally ill.

I know another client where I work who has been charged with very serious felony charges involving the Secret Service (something to do with forgery or counterfeiting). I guarantee that if he ever decompensated and ended up in a state mental hospital or inpatient psychiatric unit, they would say he was delusional if he began talking about being monitored by the Secret Service, but it is the truth. They keep very close tabs on him and are in frequent contact with his court-ordered therapy providers.

I was talking to my colleague about another client who lives on the streets. He is often afraid for his safety, and hypervigilant to any harm being done to him. He is worried his things will be stolen, that he might be beat up, that he might be harmed in other ways. Many mental health professionals would say he was paranoid and give him a mental health diagnosis. However, his behaviors are adaptive for his culture (living on the street). It is the same thing with criminals in the prisons and jails of America. It serves them well to be a little bit paranoid about other inmates. Because they hold to the criminal thinking that the system is set up for them to fail, instead of taking responsibility for their actions, and say they distrust the courts and public defenders, many mental health professionals would again say they were severely mentally ill and incompetent to stand trial. Again, this is not mental illness, per se, but an adaptive personality trait brought on by years of being caught up in the system. I guarantee that if you take a mentally sound adult, and place him or her in a violent prison environment, you will see that person become paranoid. It is the adaptive thing to do, and it might save their life. It is quite possible that other symptoms of mental illness are adaptive in some remote way (e.g., Schizophrenics withdraw when they are constantly overstimulated by external and internal stimuli).

Whatever you say about my job, you can't say it isn't interesting.