"We seldom get into trouble when we speak softly. It is only when we raise our voices that the sparks fly and tiny molehills become great mountains of contention."
- - Gordon B. Hinckley
September 27, 2013
Honesty and Mental Illness
by Sarah Hancock

Okay, let’s be frank. When a person has a mental illness, it’s automatically assumed that he cannot be trusted. For some reason, it is as though one of the actual symptoms of mental illness is dishonesty.

However, contrary to popular belief, this is not a symptom listed under every diagnosis in the most recent edition of the Diagnostic Statistical Manual (DSM V), America’s reference for diagnosing mental illness. Neither is it listed as a symptom under every diagnosis in the most recent International Statistical Classification of Diseases and Related Health Problems (ICD-10), and yet, as a society we have determined that if someone is mentally ill, he cannot be trusted. He Lies.

Why is that?

Perhaps it’s because there are several illnesses (psychotic illnesses) that involve psychosis and delusions, where a person experiences an alternate reality. Maybe it’s because as a society we cannot wrap our brain around the fact that just because someone thinks differently than we do, doesn’t necessarily make him a liar.

Linguistically speaking, in writing case notes (documenting information after a doctor or counselor visit) the professional must document what was discussed. When I began working in an office with clinical case notes, I was appalled at the language used in case notes. There are some questions that clinicians ask people with schizophrenia or schizoform illnesses, involving whether or not the person is hearing, seeing, feeling, smelling or tasting things which others do not.

Of people who are severely depressed, clinicians ask if the person is suicidal or homicidal. If patients states that they aren’t, it’s recorded in case note that the clients “deny” such thoughts. Deny — implies that really the client is lying.

Regardless of how much we deny it, language affects our thoughts and behaviors. If a clinician or doctor writes case notes for 10 people a day, stating each time that the client “denies,” symptoms, little by little he create an image within his head that clients essentially lie to him, regularly. I’m not trying to paint all professionals in this light, but I sure have met my fair share.

We’re all familiar with the story of the boy who cried wolf. How do you treat people who lie? You begin to lose trust in them and begin to ignore them. Unfortunately, there are people in the profession of helping people with mental illness who pave the way for society to follow their lead, ignoring the opinions of those with mental illness.

You may think my blanket statement is an extremist one; I wish it were. But chances are, if you are one of those who think it’s an extremist statement, you have never experienced your valid opinion being brushed aside by someone in authority.

Let me share with you just one of the many examples I’ve experienced.

After three days of not sleeping, I called the crisis line to connect with my doctor. I just needed to know what medication I could take so that my brain could rebalance itself. I was in control, but cognitively, I was aware of how continued sleep loss would erode my ability to make sound decisions.

I called the crisis line at 2 a.m., but the crisis line was down. The call rang through to someone else within the corporation who wanted to know how on earth I got their number. I explained I’d called the 800 number; I got screamed at and hung up on.

I called the crisis line again and was connected to another person associated with my health care service, who as you can imagine was not happy that I call at two in the morning. This person, too, was extremely agitated and hung up on me.

In the eight years that I’d used the crisis line, I’d never had problems, so I proactively verified that I was calling the right number, and called the crisis line a third time where once again it routed me to a random angry person asking me how I got the number. Finally, in desperation, I called the ER. They asked me to come in, which I dutifully did.

After telling them what had happened, they reassured me that the crisis line does not have problems and admitted me for being awake for three days and “delusional.” What would it have taken to call the crisis line?

The following day, my doctor came to me asking why I was in the hospital. I told him the situation and that I’d just needed a medication adjustment to sleep so that I would be able to reset my brain chemicals. When I told him about my crisis line experience, he laughed, nodding his head. He told me they’d never had problems with the crisis line. I asked him to check the crisis line “just in case.” He walked away, smiling and nodding his head. What would it have taken to call the crisis line?

The next day the same thing happened. Later that day my social worker came to visit me. I’d never impressed with the level of care that she provided, but I told her that about the crisis line’s dysfunction. She also kind of smiled, nodding her head and left. What would it have taken to call the crisis line?

I am very familiar with the smiling head nod. I’ve seen regularly since I was diagnosed 15 years ago. It’s the nod that says to someone, “Yeah; right.” To me that nod also means, something along the lines of, “I’m just going to smile and act like I’m listening long enough to leave.”

I got the same smiling head nod when I told the inpatient doctor that I was in a master’s program at the local university. Smile. Head nod. I told him that I was serious. In fact, my professor was so impressed with my work ethic and critical thinking that she hired me as her graduate research assistant.

My inpatient doctor responded, “Oh, right Sarah,” Smile. Head nod. As he walked away, I caught up with him, giving him my business card. He went to shove it in his pocket, but I asked him to look at it. There was a long exhale. He stared down at the white piece of paper in his hand. With wide eyes, he said, “You’re in school? Where?”

Sadly, frequently people who are aware of my diagnosis, and who knew me when I was sick, have much the same response, regardless of my nearly four-year remission. I don’t know why. I was never the boy who cried wolf. I don’t believe I ever purposefully lied about anything happening in my life, and yet people aware of my diagnosis often brush me off as though my opinion and observation are invalid and without value.

Maybe if people could stop and listen to those around them, regardless of circumstance, we might just be able to prevent something referred to as “learned helplessness.” Unfortunately, many people with a mental health diagnosis stop taking initiative, taking care of their symptoms, because they feel that regardless of their efforts, nothing will change. Regardless of their efforts, no one listens. Maybe if we start listening to one another, maybe we can lift one another above learned helplessness, empowering people to make a change.

Going back to the crisis line, my third and final day in the hospital, the doctor came to see me and told me that he’d figured out why things were so slow. Evidently my social worker actually called the crisis line and discovered it wasn’t working. At last, someone took me seriously, or at least serious enough to check — just in case. My opinion of her changed in an instant. She listened.

“It’s a good thing she caught that,” my doctor continued. He wasn’t being ironic. He was just stating what he believed was a fact. “Can you imagine?” He shook his head. “What would have happened if someone called it in crisis?”

I just smiled, nodding my head.

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About Sarah Hancock

Sarah Price Hancock, a graduate of San Diego State University's rehabilitation counseling Masters of Science program with a certificate psychiatric rehabilitation.

Having embarked on her own journey with a mental health diagnosis, she is passionate about psychiatric recovery. She enjoys working as a lector for universities, training upcoming mental health professionals. Sarah also enjoys sharing insights with peers working to strengthen their "recovery toolbox." With proper support, Sarah knows psychiatric recovery isnít just possible ó itís probable.

Born and raised in San Diego, California, Sarah served a Spanish-speaking and ASL mission for the LDS Church in the Texas Dallas Mission. She was graduated from Ricks College and BYU. Sarah currently resides in San Diego and inherited four amazing children when she married the man of her dreams in 2011. She loves writing, public speaking, ceramics, jewelry-making and kite-flying ó not necessarily in that order.

NAMI San Diego's Fall Keynote Address: Living in Recovery with Schizoaffective Disorder

Having recently moved into a new ward, she currently serves as a visiting teacher.

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