My Sojourn through Bipolar Illness – Intermixing with Police and First Responders

I am of the mindset that police and college campus police could do well with more training as to what constitutes a paranoid episode that is largely safe and what constitutes a paranoid episode that is largely unsafe.  I feel that the police serve in a hugely defining role as to whether someone experiencing an episode of bipolar illness should go the hospital or be incarcerated.  There is no such distinction for any other type of intervention that the police are called upon to mediate.  It takes a great amount of training about paranoia and how it operates particularly in the minds of our youth.  If psychiatrists are largely unable to determine when paranoia is linked with violence or not after days or months or years of working with that person, think what a challenge it is for a police man or woman intervening with no case history on the patient while being charged with the safety of that patient and all bystanders.  It is a huge responsibility that falls on the police and college police. 

I have worked through NAMI (the National Alliance on Mental Health) in their In Our Own Voice Program to talk with these First Responders and provide more insight into the patient’s point of view when these incidents occur.  I found the reception at that event quite welcoming as if the police or campus police had never had a conversation with someone prone to paranoia when that person was outside of that paranoia event.

In any case, I find the work of police and campus police to be a gargantuan task.  It almost requires the intervening police officer to be all-knowing and to be able to size up the situation in a matter of minutes as to whether the person before them is paranoid and a danger to others or paranoid, a danger to themselves and needing hospitalization.  I feel that additional training in differentiating these behavioral health outcomes should be mandatory both for crisis interventionists as well as medical and clinical professionals.  As a person who has experienced mania and being a danger to self and perhaps others, I readily do not see a clear line for police to follow from which to determine how best to intervene.  If I am unclear on that intervention after 30 plus years of managing (or trying to) the illness, I would imagine most police and campus police feel that they are overwhelmed and alone as First Responders in assessing the case of a behavioral health incident.

I feel for the police and the campus police and their courage in this line of work and believe that greater training like that of NAMI’s In Our Own Voice Program is extremely important.  I had one first responder come up to me at that In Our Own Voice presentation and thank me.  The officer had never talked to someone with a tendency toward paranoia when they were not in a paranoid state.  All he had ever seen was the patient at the height of a paranoid event – he must have assumed through no fault of his own that that state of paranoia was the norm for that person rather than a state that comes and goes and can be managed for the most part through medications and talk therapy.   

The First Responders should have some sort of script that allows them to assess if the danger is being directed internally toward the patient or if the danger is more generalized to people external to the person experiencing the breach of reality.  I do not claim to have the content to that script in full, but my current thoughts about how questions for this script might go is something like what follows.  This script below should be vetted by a team of first responders, therapists, doctors and other professionals and is only a “strawman” from the point of view of one patient.

 I am going to ask you a series of 20 questions.  I would like for you to respond to each question to the best of your ability. OK, are you ready?  First question: 

          1) What is your name?

2) Are you a student here?

3) Are you feeling OK?

4) What is the date today?

5) Are you feeling suicidal?                

6) Have you ever felt this way before? 

7) Do you have a mood disorder illness?   Have you ever been hospitalized for a mood disorder?

8) Are you hearing voices?

9) What are the voices saying?

10) Are the voices asking you or telling you to harm yourself?

11) Are the voices asking you or telling you to hurt anyone else?

12) Do you have a weapon?  Are you intending to use it? 

13) Where did you get it?  Have you had it on you for several days or just a few hours?

14) How long has it been since you took a shower?

15) How long has it been since you had a full meal?

16) Have you been using any mind-altering, recreational or prescription drugs?

17) If so, what are they?

18) Do you feel safer now that the paramedics are here and we are talking?

19) Is there someone in particular you would like to talk to? Your parent? Your friend? Your psychiatrist? Your therapist?

20) What do you need to feel more calm?    

If there had been such a script available for use by First Responders at the West Ferry airport back in 1985, perhaps my first episode would not have been so cataclysmic.  Perhaps I would not have been plagued by security concerns for several years after this first episode if that episode had been less threatening and less dramatic. 

My Sojourn through Bipolar Illness – Family Then and Now (part two)

After the postpartum period began to become more under control, my relationship with my own mother blossomed.  She was able to step in and care for my daughter when I was overwhelmed by postpartum depression.  In addition to her developing as a grandmother to my child, I felt that she over the years began to learn to let go of feeling responsible for my illness or for controlling my illness and was more able to be just “a support.”  She became someone to talk with about feelings and issues when needed.  At other times she was a person to bring the family together in a weekly meal at her house.

I attribute NAMI (the National Alliance on Mental Illness) to a lot of my mother’s development and understanding of behavioral health issues.  NAMI programs helped her just to be there for me as a Mom and a friend.  NAMI taught my mother I believe the importance of just being there – not necessarily doing anything but just “being there.” Granted there were times in the past that I felt that she wanted to be intimately involved in my care and in my therapy in a way that I did not want.  When she gave up this control and decided to focus on being a support, our relationship blossomed as did the growing relationship between her and my daughter. 

Over the sixteen years of my daughter’s life, my mother has become a great presence in our family interactions.  We get together most times weekly or more than weekly for a meal or a soccer game or both. Today in covid-19 times that has migrated to a daily phone call and some outside social time with masks and social distancing. 

My relationship with my husband James has also matured as my health has progressed.  We continue to have our favorite arguments, but in general we are on the same page of putting our daughter first including school time, school work, hobbies like Cross Country, Track and Chorus and her spiritual development.

My husband has continued to be one of my most staunch supporters but not in a way that is easily described.  More than giving me a safe harbor in which to rest my myriad of thoughts and perceptions, he has challenged me to find my rock bottom and work my way out of it.   He is no way gets involved in my illness but rather gently or sometimes not so gently reminds me that my illness is mine to deal with.   This expectation that I will deal with my illness is both verbal and non-verbal.  In addition to working though my illness, my husband has largely been accepting of the fact that a high paying job is likely not going to be something that I can stick with and maintain.   It is with his support that I have been writing this text off and on for the last several years.

In addition to my Mom and my husband in recent years and my sister in years’ past, my in-laws have been extremely supportive of me and my efforts toward financial security.  From the beginning of my relationship with my husband, they have provided fiscal support that has allowed me to work from home on a variety of health and health measurement concepts. Through this work, I have traveled for presentations in Zurich, Switzerland as well as in Brighton, England.  Work also has been presented at CJR School of Public Health.  Without the fiscal support of my in-laws, none of this work would have been possible.  

My family support over the years has grown in parallel to the understanding of the illness among the public and among medical providers.  My family always has provided me support over the years even through some of the most heart-wrenching episodes of my life including fits of blaming them for my troubles.