Oh goodness, here we are again watching the media and “experts” speculate on the mental health of a celebrity. After nearly two decades working with a population deemed to have “severe and persistent mental illness,” I’d like to weigh in a bit. The term “severe and persistent mental illness” is a catch-all for serious mental health conditions from bipolar disorder to schizophrenia and everything in between.
I’ve worked with a variety of clients over the years, many of whom refused medication, though their psychosis caused them to have extreme paranoia and terrifying visual hallucinations. I’ve also worked with several folks that have been under a guardianship, which is equivalent to a conservatorship in California.
As I watch the media, fans and professionals speculate about whether a celebrity needs to be hospitalized or placed in a conservatorship, I often wish they had a better understanding of what severe mental illnesses looked like. Not only that, but what constitutes a concern and what’s just normal for that person. But let’s be real for a minute. The media continuously guessing if you’ve rounded the bend is likely enough to be the cause of a mental breakdown, even in a mentally stable person.
So here’s what I wish people understood about these severe and persistent mental illnesses. When people enter a psychiatric facility against their will, it’s a trauma. The effects of that trauma can stunt brain development and create coping mechanisms that may seem a bit odd to others. This doesn’t mean that they’re off of their medication or need to go back. It just means they came out of it a little differently than they went in and we have to adjust.
Everything about their behavior isn’t related to their mental wellness. I’ve seen this a lot with families after a loved one gets released from the hospital and is doing well. If the client gets upset because someone ate all of their favorite cookies, instead of looking at the cause of the person’s anger, immediately the thought goes to, “They must not be taking their medicine.”
The same happens when it’s just plain silly behaviors, like Britney Spears getting the human equivalent to the zoomies and talking in a fake foreign accent. Suddenly it’s front page news and people are concerned, but if you take away the information of her being previously hospitalized, the concern would likely be nonexistent.
There’s also a misunderstanding about what can actually be done if someone is in need of acute psychiatric care. There are generally two reasons someone can be hospitalized against their will: if they’re a danger to themselves or if they’re a danger to others. Outside of it being the person’s first psychotic break, it’s extremely difficult for someone to be forced into help and there’s good reason for that. No matter your mental health status, you’re entitled to autonomy.
Back in the olden days (think the 19th century), husbands could commit their wives because they got too sassy or independent. Parents could drop off their children or family members with mental disabilities, just because they found them difficult to care for. Do you know what happened to those sassy independent wives? They got lobotomies to make them more docile. Others deemed mentally unfit were sterilized against their will.
This is why it’s difficult to commit someone, and while it makes my job more difficult sometimes, I’m happy it’s hard to do. Even when I know a client is reaching the point of danger but still doesn’t meet the criteria, I’d rather make a safety plan with the family than make the committal process easier where ill-intentioned people could take advantage.
The public speculating on what warrants intervention or not mostly comes from a place of concern, but it’s often incorrect. There are licensed therapists that struggle with identifying it as well because we have different areas of expertise. While I couldn’t tell you all the ins and outs of treating an eating disorder, a therapist that specializes in eating disorders could. My area is psychosis and other severe mental illnesses, so I stick to what I know when speaking authoritatively.
Specializing in psychotic disorders has taught me more about the human condition than anything else. Getting to know the incredible people that hear voices that I cannot or believe things no one else does has been one of the most fulfilling experiences of my life.
People living with severe mental illnesses still deserve respect and basic human autonomy. They’re allowed to be weird. They’re allowed to be silly. They’re allowed to be angry. They’re allowed to be boring. They’re allowed to just be and we should let them.