Mental Illness--Debunking the myths/sharing some insight..
Mental illness. It is an often misunderstood series of brain disorders that often nurses roll their eyes at, decline to care for, or do so under duress. If a nurse takes a moment to really think through some of the more commonly seen disorders, it can change the way that mentally ill people are treated in the health care setting.
Mental illness is a most misunderstood illness. The brain is an interesting organ, and reacts differently to/or lack thereof chemicals to make it work properly. Mental illness can be a difficult thing to treat. It can be equally challenging for a nurse to provide care. However, here are some common myths/insights surrounding the mentally ill that will perhaps make a nurse take pause the next time you are given an assignment of someone suffering from mental illness.
1. Schizophrenics ABSOLUTELY believe their delusions to be true. They don't make this stuff up. They believe that the government is watching them as much as one believes the grass to be green. So by saying "Oh, that is NOT true, stop it" you are not helping. To help in a alternate way, saying something like "let's talk about right now, and what we need to do now" can be enough to direct a schizophrenic patient into the present to be on task. It can be hard to keep a schizophrenic on meds. For the chronically long term schizophrenics, it is the only "normal" they know.
2. "I think I am having a nervous breakdown". Mentally ill people who are chronically and severely mentally ill believe themselves to be perfectly sane. It is the rest of us who are "crazy". Anxiety disorders are the most common cause of "I think I am dying/going crazy thoughts.
3. Mentally ill people are not ignorant, less intelligent, or unable to live a "normal" life. Mental illness does not equate stupid. It is not a character defect.
4. "I don't understand why you are depressed. There's a heck of a lot of suffering in this world and other people are coping JUST fine". People don't ask for depression. People can not just "snap out of it" or believe me, a number would. Most people who are depressed would do just about anything to feel well again. It is an exhausting illness.
5. People who are bipolar can tend to lean toward mania. The feeling of being on top of the world. A number of patients who abuse uppers are in fact bipolar. Reasoning includes not enjoying the downward spiral that a bipolar patient experiences. Another mentally and physically exhausting mental illness. Support for drug addicted patients should include a consult to rule out bipolar disorder.
6. Post Traumatic Stress Disorder is a multitude of symptoms under one heading. One of the most "dreaded" for some is the personality disordered. This is a tough one, however, if the nurse can keep in the back of their mind that in fact PTSD is the effect of trauma. Severe enough to cause the personality portions of the brain to not function properly. These patients have seen horrors that only most of us can ever imagine. That they have the fortitude to be alive is telling. That they can act child like is equally as telling as to when their abuses began. There are members of our armed forces that have severe PTSD. Again, remember--horrors that we can only imagine.
7. Children who are mentally ill are not automatically products of poor parenting. "Well, that kid could use a rule or 2 and a swat on the behind". That can't happen. People can not hit their children into submission, nor should they. If a child's brain is not functioning as it should, rules are gibberish. Support and coping skills for parents are equally important. Team meetings detailing support and exactly how parents are to re-enforce learned coping skills are a must.
Nursing mentally ill patients can be a big challenge. Often, if we change how we see a patient who suffers from mental illness it can make leaps and bounds on how we can help each patient reach their full potential.Last edit by tnbutterfly on May 4, '13
About jadelpn, LPN, EMT-B Guide
From 'USA'; 50 Years Old; Joined Nov '08; Posts: 5,278; Likes: 14,021.May 4, '13 by VivaLasViejas, ASN, RN GuideWhere's the bowing smilie when you need it........THANK YOU for this excellent essay!! As a nurse, I appreciate your understanding of the science behind brain disorders; as a patient, I appreciate your understanding, period.May 5, '13 by NurseDirtyBirdThank you for including point #4. It's the one that irks me the most. I can't count how many times I've heard, "just think happy thoughts" BS, like it's supposed to make everything magically better.May 5, '13 by LadyFree28, BSN, RNAWESOME ARTICLE!
I am #6... with the trait of #5. I did well with my trait, having up to 3 jobs at one time...when #6 entered my life, it certainly changed.
#6 for me, is a separation from the world... life is truly different, a spectator amongst the living...like being encased in a time-warped bubble that feels as though there is no chance of popping.
Everyone has some form of a trait, and mental illness is not relegated to psych wards, and won't "go away" and can be "ignored" while we are supposed to treat our patients.
I find myself more in tuned where someone is coping from, and have led to a transformational shift of how readily a person will take a medication, help with discharge planning, etc. In the midst of my own health, I realized how it made me a better nurse.
If more nurses were inclined to be holistic as we are supposed to be, we can truly empower mental illness, even if it means looking at ourselves in the mirror.May 5, '13 by dirtyhippiegirl, BSN, RNDon't agree with #2 at all but everything else was nice.May 5, '13 by TerpGal02, ADN, RNOh trust me #2 is very true. Maybe not with the mood disorders, but certainly with the psychotic disorders. If only I had a dollar for every time a delusional pt tells me, "No, don't you see, the police CAME into my house and left those three beans in my colander to harrass me, you must be Tue crazy one if you don't believe me". #1 is so true. If I had a psychotic disorder, I would rather have hallucinations than delusions. Hallucinations are far easier to treat with meds than delusions. Once we get into delusions, you're dealing with a person's core beliefs and damn if that isn't hard. Thank you for this. It's helpful to know people out there understand that the mentally ill don't leave their somatic issues at the door. In fact many of them get substandard somatic care because , "its all in their head". As a nurse and a person with Bipolar type 2, I thank you.May 5, '13 by Alisonisayoshi, LVNAs a number 6 I can tell you sometimes you don't even know what the horror was but it attacks every part of your life. Relentlessly. Well written.May 6, '13 by jadelpn, LPN, EMT-B GuideQuote from dirtyhippiegirlThank you. We can agree to disagree. And if was put best when stated that you are really attempting to change someone's core beliefs, and that doesn't always work out well. Top that with some grandiose thinking on the part of a psychotic disordered, and then you have a patient who truly and honestly believes that they are to "save the world" with their messages, and with extremely good intentions. So it becomes heartbreaking at times, as delusional patients most often will mean well, and the part of the brain that stimulates us when watching say a movie, the delusional can internalize and believe it to be anything from a hidden message to something they need to share with the world. Imagine being compelled to do so, and the "world" not believing you and you are left with the "what is WRONG with people" feelings that are overwhelming.....Don't agree with #2 at all but everything else was nice.May 6, '13 by DizzyLizzyNurseI would like to add to number 4 -
"What could you possibly have to be depressed about?" Depression is about how you see yourself, your perspective. And no, making decent money at a job doesn't mean you "don't have anything to be depressed about."May 6, '13 by morteSince most mental illnesses are considered chemical imbalances, more research needs to be done on the major supplier of chemicals to the body, ie food.May 6, '13 by NurseDirtyBirdQuote from DizzyLizzyNurseIf I could like this a million times, I would!I would like to add to number 4 -
"What could you possibly have to be depressed about?" Depression is about how you see yourself, your perspective. And no, making decent money at a job doesn't mean you "don't have anything to be depressed about."May 7, '13 by dirtyhippiegirl, BSN, RNQuote from TerpGal02From my purely ancedotal experience as patient interacting with other patients who were psychotic, I've found psychosis to be a lot more nuanced than the blanket statement that all psychotics believe all of their hallucinations and delusions 100%. It's like assuming that every 60 lb anorexic actually believes that she's 200 lbs. I've met - chatted with for hours during those long down periods during hospitalizations - plenty of psychotic individuals who would qualify as being chronically, severely mentally ill who, for instance, might believe in *some* of their delusions but understood perfectly that their hallucinations weren't real. I've met bipolar folks in the height of a textbook manic episode who *knew* that they were having a manic episode, even if they also thought that they were the president of the US. I talked with one patient who knew that he was having delusions, but thought those delusions were implanted by another delusion. (lol)Oh trust me #2 is very true. Maybe not with the mood disorders, but certainly with the psychotic disorders. If only I had a dollar for every time a delusional pt tells me, "No, don't you see, the police CAME into my house and left those three beans in my colander to harrass me, you must be Tue crazy one if you don't believe me". #1 is so true. If I had a psychotic disorder, I would rather have hallucinations than delusions. Hallucinations are far easier to treat with meds than delusions. Once we get into delusions, you're dealing with a person's core beliefs and damn if that isn't hard. Thank you for this. It's helpful to know people out there understand that the mentally ill don't leave their somatic issues at the door. In fact many of them get substandard somatic care because , "its all in their head". As a nurse and a person with Bipolar type 2, I thank you.
Within the justice system, it's how someone with a long history of severe mental illness can kill another person - often with the fixed belief that said person is "bad" or will be better off dead - but is still held accountable because they knew that actually committing the act of murder was wrong.
Duality of thought -- the skeptical believer, the apologist -- or normal, every day folks who become entrenched in abusive relationships or fall prey to things like Stockholm Syndrome are perfectly acceptable and even considered to be part of the human experience. Don't underestimate the severely psychotic individual's to also be part of that experience.May 7, '13 by jadelpn, LPN, EMT-B GuideUnmedicated psychotics as a general rule do believe their psychosis to be true. Medications do act as a buffer for most to clear the mind enough to distinguish.
And we shall agree to disagree, as part of the diagnosis of those who are anorexics do believe themselves to be obese.
NAMI | Anorexia Nervosa
Psychotic Depression: Losing Touch With Reality - Depression Center - EverydayHealth.com
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