“I Wouldn’t Hurt a Fly” Globe and Mail Feb.14, 2006 by Tu Thanh Ha

On Dec. 14, 2005, Francios Pepin fired a high power rifle through his closed apartment door, killing Constable Valerie Gignac, who was there in respond to complaints from his neighbors.

He was well known to both the police and the justice system and was repeatedly order to seek psychiatric help. His behavior was erratic and he was clearly experiencing paranoid delusions and feelings of persecution, but he would obstinately refuse to seek help. And the courts would constantly stop short of ordering involuntary treatment.

Sadly it is clear now that if he had been forced to receive the appropriate treatment, the young police officer would still be alive today, and Mr. Pepin’s life would be far better now than it ever was.

Involuntary treatment is a thorny issue. Pierre Marchand, one of several legal aid lawyers who represented him, says that is hard to force someone to seek professional help. The bar for such actions is set very high because “otherwise, if you didn’t like your neighbor, you could have him institutionalized.”

Guy Davis, a University of Montreal criminologist and psychologist, who did not treat Mr. Pepin, but who was familiar with such cases said that many professionals do not like court appointed cases because the individuals are often uncooperative.

There is now an onus upon governments to establish clear guidelines regarding involuntary treatment, and those guidelines must also exist within the framework of the Charter of Rights, so that the guidelines will not be abused.

Most mental illnesses are now believed to be biological brain disorders that disrupt people’s thoughts, emotions and behavior. The only sway to safeguard the rights of the mentally ill and the public are the use of medications that have been demonstrated as effective in treating such illnesses.

Such legislation must be careful not to criminalize mental illness. Most people who suffer from a mental illness are not violent or dishonest. At the very worst, they can merely be a nuisance. Involuntary treatment should not be considered a punishment, but rather as necessary intervention to help people who are to ill to seek help on their own.

Developing the Negative

Schizophrenia has both positive and negative symptoms. Positive symptoms are those that are there, but shouldn’t be (delusions and hallucinations). Negative symptoms are the absence of certain behaviors (social withdrawal and lack of motivation).

The positive symptoms have always been the most apparent and well known, but I know from personal experience that the negative symptoms can equally as devastating, if not more, to an individual’s life. Even the simplest of tasks can seem overwhelming, and become more and more daunting the longer they are put off. For a person with brains, talent and ambition but without the will to use these assets, my lack of progress was very frustrating.

Lack of motivation is often seen as laziness. Many people believe the best way to treat the symptom is to force the individual to work, and to see any serious concerns about the job as mere excuses. The constant unsolicited advice from others and lectures about how I was “wasting my time” couldn’t cure me. It just wasted my time.

Symptoms of schizophrenia are of a biological origin and cannot be cured by a stern talking-to. Schizophrenia is a genetic disorder that leaves many people unable to work, through no fault of their own, and it could be harmful to their health if they try. Failure can leave a person worse off than if they never tried. Too much stress can often trigger a relapse. Such practices make just as much sense as forcing an individual with a heart condition or a spinal cord injury to work.

It is a common assumption that the treatment of schizophrenia is all about preparing the patient to return to the workforce, and that a patient can only truly be well when employed. Treatments that focus on improving the patient’s quality of life stand a much better chance of succeeding. Quality of life begins with acquiring essential skills to help a person lead a relatively normal life and learning strategies to cope with symptoms and to create positive changes in their life.

Having said this, it is also important for patients to find ways to occupy their free time. This is referred to as “leisure time” Having too much time on their hands is often worse than not having enough. Quality of life can also be improved by helping them find fulfilling and challenging activities that can engage their interests and their skills. This can help them motivate themselves, rather than needing to be motivated by others.

This is my editorial for Information Matters , the December 05 issue of the journal of the Schitzophrenia Society of Nova Scotia. More can be found at their website. www.ssns.ca

DARE TO CREATE

I know from first-hand experience that writing and art can be problematic activities for those suffering from delusions. After investigating the literature on the subject of art and mental illness, I am also aware of a number of specific problems that are often raised. Much is always made of the tendency for delusional people to have grandiose ideas about the importance of their work. There is the problem of the unrealistic belief by the patient that they might be able to make a living from their work, which sets them up for failure time and again. Often there are warnings about the potential negative impact of having their work on display for the public (or published) and attracting unwanted attention to the patient and their illness.

In my experience, creative activity can provide many benefits if the person thinks about it in a reasonable fashion and has the proper social support. Creative output allows an individual to express to others their unique worldviews and give the public some indication of what suffering a mental illness is like. Sometimes the work can be signed with a pseudonym or anonymously if the artist wishes to maintain privacy. Having work published or on display can also be a great boost to their self-esteem, even if it is presented with a pseudonym. Consistent use of the same pseudonym can create an identity for these artists and it will be associated in people’s minds with their individual styles.

Common concerns about mental illness and creative activity can be easily addressed, and mental illness survivors have a lifestyle uniquely suited for creative work. Many have a great deal of time on their hands and the lack of challenging and fulfilling ways to fill that time can hurt their mental health. It is the kind of activity that encourages people to create the necessary structure in their lives themselves, instead of having it imposed on them by others.

Creative practices can work wonders when combined with supportive social activities. Having hosted a creative writing group at Connections Clubhouse for several years now, I have seen the benefits to their mental health first hand. There are no lessons or assignments; the members share what they have written with the group in a non-critical and non-judgmental environment. They can attend without reading anything, and sometimes they can bring material they find inspiring from books or magazines they have read.

Being involved with these social support groups has allowed me to see an amazing thing happen: given a chance to express what they really thought and felt within a unstructured environment gave them the courage to discuss what mental illness was actually about.

Creativity is a practice that teaches us to surpass our limitations and enter into a kind of dialogue with the community at large. Creativity need not be discouraged; it can be a very healthy activity if managed properly. We all have a voice that needs to be heard. The voice of mental illness survivors is seldom heard, and it has something very important to say.