What Happens When Mental Health Patients Run out of Meds? A Person with Bipolar and Schizophrenia Answers
Note from Daisy: Mental illness is a sensitive subject. The fact that Bob was willing to share the brutally honest truth of his reality is to be admired. There’s so much we can learn from his interview. I know that most of you will give him the usual warm welcome offered to those featured here on this website. For those few who opt to be judgmental: You’re welcome to agree or disagree, but personal attacks or insults will not be tolerated and your comments will be removed. Thank you. ~ D
By Sandra D. Lane
I’d like to do a lot with this interview. I’d like to dispel the fears that all mentally ill people are dangerous or deranged killers. I’d like to address the stereotypical image that schizophrenics are all serial killers and that every manic bipolar person is like Charles Manson. I hope to separate fact from fiction and provide a modicum of truth in regards to mental illness as a whole.
And I’d like to provide a warning.
In the Diagnostic and Statistical Manual of Mental Disorders (DSM), just about every single person has some type of mental illness. This is a truth. Your phobia of spiders is a type of Anxiety Disorder, which of course is a mental illness. So is your totally rational fear of dogs after being bitten by one. Now, I’m not knocking the fields of psychiatry or psychology – I think they can provide much-needed insight into, and management of, our daily problems ranging from interpersonal relationships to depression and grief. And when it comes to the more severe psychological problems that people may have, usually through no fault of their own, like Dissociative Identity Disorder, Schizophrenia, Manic Depressive Disorder, full-blown Sociopathy, and Psychopathy, those in the psychiatric and psychological field have some answers and tools to help.
But the common behavior of those around us – our fellow workers, parents, extended family, and even close friends – to the mentally ill is one of polite avoidance, mockery, or worse – indifference.
People with mental illness face unique challenges during SHTF situations.
Even so, in a grid down SHTF scenario that lasts a long time, not only will we have to contend with criminals that can’t be contained in prisons, but the mentally ill who are ultimately released from hospitals because they can no longer be cared for or held safely. This is something we should all consider as a possibility, and while it may be easy for some to put a bullet in the head of a rapist or murderer that can no longer be confined due to lack of electrical power or Rule of Law, taking down a mentally ill person should be more difficult; as it may not be the right thing to do.
I’d like to introduce you to a person we will call “Bob”. Bob is a man in his thirties that I’ve known all his life. He is very special to my husband and me, as we’ve watched him grow up, and our door is always open to him. Bob is a Paranoid Schizophrenic who suffers from Manic Depressive Disorder as well. He hasn’t been able to hold a job in fourteen years and relies solely on disability and money from family. He takes quite a bit of medication daily for his mental illness and has therapy and psychiatric sessions he keeps.
Now, before I jump into the interview, let me explain that there are several different types of Schizophrenia, and there are four different kinds of Bipolar Disorder. And, there is a mental illness where a person can have both the symptoms of schizophrenia and the symptoms of bipolar. This is called Schizoaffective Disorder. Bob has Schizoaffective Disorder Bipolar Type. I know that’s a mouthful, but essentially what it means is Bob is schizophrenic (paranoid type) with manic episodes (mood disorder). What that means is Bob has periods of time where he has many, many wonderful ideas accompanied with little to no sleep for days (manic), and is very productive, followed by a period of time where all he does is sleep and barely functions with bouts of hallucinations. Those hallucinations can be auditory (hearing voices), visual (seeing things/people that don’t exist), or tactile (sensory feelings like bugs crawling on the skin, itching, etc.).
Why am I doing this interview?
Because if more people can understand mental illness, especially one that has so many negative stereotypes attached to it, the more people will be prone to accept a person who has it when the medicine runs out. And, the more people might give credence now to the importance of a moral code later.
As I look at Bob, he’s wearing a sleeveless shirt and shorts. The medication he takes prevents his body from regulating his temperature normally, hence he usually wears shorts and sleeveless shirts. He also has to avoid sunlight religiously, otherwise, he’ll overheat. Bob lives alone in his own apartment and struggles often with the desire to have a family of his own and the knowledge that he could potentially pass his illness on to any children he might have. Genetics does play a part; psychiatrists just aren’t sure how.
Scattered around him are various reference books on programming languages, of which he knows several, and on one of his computer monitors is his classwork for his next semester. Bob has his degree in computer science and is working on a Bachelors degree in programming. All of it was obtained in an accredited online school, and he hopes to one day beat his illness and work a regular job in IT. But while he is proud, and has a right to be, of his computer skills, I’m more interested right now in his illness and how he handles it.
Let’s talk to Bob about what it is like to experience mental illness.
Me: Hi Bob. (I smiled) Thank you for agreeing to this interview. I noticed you have a ‘bugout’ bag. Do you consider yourself a prepper?
Bob: As much as I can be. I don’t have the funds to do extensive prepping like canning or dehydrating, nor do I have the room, but I do try to put back canned veggies and fruit when I’m able, and I have the bugout bag that I’ve set up in case I need to leave here and go to my safe location.
Me: Obviously then you’ve accepted that something could happen that would change everything we know to be ‘normal’. How do you feel about the reality of potentially living in a world that’s becoming even more unstable, especially now, with your condition?
Bob: It’s frightening. There’s a lot of things I take for granted that I wouldn’t have if something happened. For example, my medicine, possibly being all alone and not having anyone around that I know for verification, constantly fearing people are out to get me for something I have or what I can give to them.
(Bob has what’s known as a “Constant”. This is a real person that he can turn to that can verify if someone or something is real or not. Without this Constant, he would find it extremely difficult to function because he wouldn’t know for sure what was real and what wasn’t. There has been talk of a support animal but the expense is more than he or his family can afford.)
Me: How would describe yourself, when it comes to people you don’t know, in terms of being violent or passive?
Bob: That’s a bit tough to answer because I feel both ways. There are definitely violent ideations and thoughts, but I try to be as passive as possible – that way I don’t feed the violent thoughts, making them harder to control.
Me: What do you mean by control?
Bob: Not acting on them.
Me: Are you able to prevent yourself from acting on them?
Bob: So far, with God’s help, yes.
Me: So you’re a man of faith?
Bob: Definitely. (Bob nods emphatically) If it wasn’t for God, I would be in a lot worse situation than I am right now.
Me: How so?
Bob: There have been times that I pray during homicidal and suicidal ideations, and the thought enters my head that it would be worse for my family, worse for the people I physically hurt, and I believe that thought comes from God answering my prayers.
Me: You just stop and pray? Like, kneel?
Bob: No, in my head. It’s hard to explain; I just talk to God in my head during those moments.
Me: Ok, I understand. Can you explain to our readers what homicidal ideation means?
Bob: The way it’s been explained to me is homicidal ideation is the urge and thought process before the planning stage of how it would happen.
Me: Have you ever gotten past the thought process to the point where you planned a murder?
Bob: Yes. (Bob was clearly uncomfortable answering this.)
Me: What stopped you?
Bob: My faith and morals. I knew it was wrong. I had nightmares for months after that and still do occasionally. They aren’t something that just goes away once you have committed yourself to that action. In my head, I’d already done it.
Me: Have you ever gotten to the point where you planned suicide?
Me: What stopped you on that?
Bob: Again, my faith and the realization of how it might stop my suffering, but how much more it would hurt my family, and hurting my family wasn’t what I was going for.
(We had to pause here because speaking of the ideations and recalling past thoughts caused him extreme discomfort. I decided to attempt to lighten the mood.)
Me: What is your funniest visual hallucination?
Bob: (he chuckled and flashed a big grin) I was at a local Walmart and I had a hallucination of a person that is a regular character named William, and I started talking back to him to get his attention, and he walked into a frozen section divider. (Bob chuckled again) William started cursing and seemed embarrassed and I think, minus the cursing, that’s how I would have reacted.
Me: Tell me about these figures in the hallucinations that you see often. Are they all people?
Bob: Not all, no.
Me: Tell me about the figures in the hallucinations that you see often. Are they all people?
Bob: Not all, no. There’s a man who calls himself William, like I said, an old man with a long beard using a cane who’s never introduced himself – I call him ‘Old Man’, there was a woman that was just sitting in my computer chair, and a few ‘monsters’ if you will.
Me: Are any of them mean or cruel to you?
Bob: Not the people. William is the person I see the most, and he’s just there. He’s never a malevolent character, never encourages me to do anything wrong or bad. He just shows up and bugs me then leaves.
(For the record, I myself have been around when Bob sees William. The psychiatrists/therapists have told Bob to ignore William so as not to confuse reality.)
Me: Can you tell me about the monsters?
Bob: I’ve seen spiders that were about the size of tables crawling on my ceilings and/or walls, I’ve seen a creature that was half on the ceiling, half on the wall, that was screaming but made no sound. Its face was hollow where the eyes and nose should be, but it had a mouth. I had to get past that to get to my brother so he could help me know if it was real.
Me: That many huh?
Bob: Yeah. Then there was the giant hairless six-legged dog that I saw at my Uncle’s house that bit my right arm.
Me: Really! Did the bite hurt?
Bob: Yes. I also saw blood.
Me: So, the pain and the blood were part of the hallucination. How long did that hallucination last?
Bob: Well it was about 5 minutes after I saw it before it bit me, I shoved it away then looked at my arm… I’d say maybe 8 minutes tops.
Me: And it just disappeared?
Bob: Well, I went to get my Uncle for verification and when I got back it was gone.
Me: When was the wound and arm pain gone?
Bob: The arm pain was gone almost immediately. After my Uncle came back in with me and I saw the dog was gone, I looked down at my arm and it was normal.
Me: Television shows depict schizophrenics as clawing at their arms and yelling something like “Get it off!” Have you ever had anything similar to that?
Bob: I have. They’re called tactile hallucinations, and the worst of those in my case, you can actually see bugs crawling and burrowing in my skin.
Me: Television and other media also depict schizophrenics as violent to others perhaps more than themselves. Is this accurate?
Bob: In my opinion, people with my condition are more apt to harm themselves than others.
Me: Why do you say that?
Bob: I have more suicidal ideations than homicidal, and hurting others goes more against my beliefs than hurting myself.
Me: You are in therapy, right?
Me: How much medicine do you take a day for your illness?
Bob: I take seven different pills; some antipsychotics and some mood stabilizers – some once a day and some twice a day. So a total of nine a day.
Me: From what you’ve shared with me, and what I’ve experienced around you and heard from your doctors, you also have Bipolar Disorder in the form of Manic Depressive Disorder. How do you think you’ll handle this if there’s a future without mood stabilizers?
Bob: I think it’s gonna be tough. I think for a lot of it I would have to rely on my faith. Antioxidants seem to help with my moods; the medicine helps the most, and my faith has always kept me from acting on my rage.
Me: What about the insomnia that goes along with that?
Bob: I don’t know. Sometimes I’m able to hold back a pill a month that might help me with insomnia when my current medicine runs out, but after that, I don’t know.
Me: Apparently, according to what you’ve told me, you still have hallucinations of all kinds despite the medication. How do you handle them?
Bob: I ask people to verify if they are real or not, some of them are outlandish enough that I kind of figure they aren’t real from the start.
Me: Every time I see you, you almost always have headphones on or earbuds in. Tell me about them; How do they help?
Bob: For me, actual voices are duller and harder to hear when I have an earbud in, whereas auditory hallucinations don’t act that way. They are just as loud, with or without the earbuds. In order to hear true voices, I keep one earbud in as often as I can. Which irritates my mom because she has to repeat almost everything.
Me: Speaking of your mom, you plan to hook up with your family in an SHTF scenario, correct?
Me: In a world where there is no Rule of Law, and possibly no antipsychotics, would you feel you would be dangerous to others?
Bob: I feel I would have to fight to control my urges more often than I do now, so I could be dangerous to others but I don’t know. I’d like to believe, based on my history with my faith and morals, that I wouldn’t be.
Me: You told me a bit about a partial break in reality that you had a few years ago. I know it was frightening, and you would probably rather not talk about it, but can you skim over it on more time for this interview?
Bob: (Bob rubs his hand over his face and then leans his head into his knuckles, his eyes closed. It is very evident that he does not want to talk in detail about this event, but he agrees.) It was frightening. I was at my sister’s house when it started and I don’t even know why it started. Half the house just seemed to disappear. I could hear gunshots going on outside, I could see like explosions and fires outside even though walls should’ve been there, like there was a war going on or something all over the city. I had to have my sister with me at all times because I didn’t know what was real and what wasn’t, and even she had to gently touch me and make eye contact with me and talk to me quietly. When she left the room, I had to go too; I didn’t want to be left alone. I was totally lost and scared. My sister had to call my mom to come up and be with me – I wasn’t a kid by any means. I just needed my Constant. I needed to know what was real and what wasn’t.
Me: Bob what would be the one, most important thing a person should never do to a person with Schizophrenia/Bipolar Disorder?
Bob: Actually, for me, there’s two. The first I would say is don’t intentionally scare or sneak up on me because it causes my fight or flight to kick in, making me tense my muscles up to fight. The second would be don’t try to convince me that I should do something when I’ve repeatedly said I don’t want to. It causes me to question my own resolve and trust in myself, which is already fragile in my mind.
Me: Were you on your medication during the period of time when you had the partial break in reality?
Bob: Yes. I always take the medicine no matter what. Some people go off their medicine – they feel better and think they don’t need it anymore. I can’t afford to do that.
Me: So, looking forward, how do you think you would handle your hallucinations without the proper medicine?
Bob: While I’m on medicine I have a small splattering of each type of hallucination. Without medication, it’s usually just auditory and visual.
Me: What would be good advice for people on how to approach a schizophrenic or bipolar individual that might not have medication?
Bob: Give them room and be patient. They need to be able to trust that you’re real and don’t intend to harm them. We aren’t usually what’s seen on tv or in the media. We usually just want to be treated as equals. The majority of us aren’t going to go grab a gun and shoot up a mall or something.
Usually what calms me down if I’m on edge or paranoid is calm voices, specifically calm female voices for me. And approach me from the front. Most of us don’t like surprises or to be caught off guard, so coming to me from behind me is almost threatening.
Me: You say “us” – Do you feel a kinship of sorts with other people who have the same disorder or illness?
Bob: In a way, yeah. We know what each other goes through, how it feels to be us.
Me: Can you elaborate a bit?
Bob: You know how, on television or in movies, they show some bad guy that’s done something really evil, like robbed a bank and killed people? (I nod.) Then, the police on those shows automatically call the bad guy a ‘schizo’ or something like that; we’re (schizophrenics) usually nothing like that at all. And mood disorders don’t make a killer, it just means we have extreme mood swings. At least for me. Most of us just want to be left alone to live our lives like everyone else.
Me: Quite a few television shows and/or movies do tend to lean in that direction; you’re right. So, what shows do you like? Comedy maybe?
Bob: No, I don’t watch TV.
Me: At all?
Bob: Not really. (I gave Bob a quizzical look and he smiled.) I’ve watched tv and the faces melt or change, or the tv seems to talk to me personally. And I know that’s not real now, but it’s not fun to see so I just choose not to watch tv. It’s easier that way. I watch videos on YouTube quite often though. The difference is that I can control what I watch, I can feel out before I even open the video if it’s going to be one that triggers me or something benign, and the videos that interest me are of people talking or reacting to each other, not to me.
Me: What about going to movie theatres?
Bob: (He nods) I do go to the movies with my Uncle sometimes, but usually I’d just rather stay home. I don’t like crowds at all, so a full movie theatre isn’t something I’d prefer. But I’m not exactly antisocial either, so don’t think that. I love being around my family and extended family, and really dislike being alone.
Me: So, you’ve been hospitalized a few times for your condition, right?
Bob: Yes. Two times if I remember right. The first time was when I was diagnosed.
Me: How did that happen? Did they think your behavior was off or something?
Bob: I knew something wasn’t right, so I told my mom. I was only about 19. We had a mini emergency family meeting and agreed I should go to the hospital to get a professional opinion.
Me: Were you scared?
Bob: Yes, but my family was with me; they took me. I wasn’t taken by the police or anything like that.
Me: How long did you stay?
Bob: It was about a week. Those hospitals, the mental ones, haven’t been like the tv or movies show either. Their main goal is to present an initial diagnosis, get you on the right medication and stable, then send you home with a psych appointment. They don’t want to keep you. But I will say they aren’t fun either.
Me: What would you have done had there been no hospital to diagnose or provide treatment for you?
Bob: (Thoughtful for a moment.) I don’t know. The voices were bad back then, telling me that I was no good, that people were trying to hurt me or poison me. And yeah, at one point I thought I was talking to God Himself – which I soon realized with medicine that I wasn’t. But I think I would have handled it eventually. I know I would have because of my faith and my family. And I have my Constants; people I can trust.
Me: A thought just occurred to me; What do you do when you have a hallucination and you’re in public?
Bob: When I have auditory hallucinations in public, I try to argue with everything they say non verbally – in my head- but at times I do mumble stuff like shut up or that’s not true. Which draws a bit of attention to me. Luckily when that happens, I tend to have one earbud in so I just point and mouth “sorry” to whoever heard me, hoping they’ll think I’m on the cell phone. For the visual hallucinations I can normally judge by other people’s reactions to whatever I am seeing to tell if it is real. There are some problems with this as I never truly know if the people whose reactions I’m judging are real themselves or not either. But to be quite honest I try not to think about that in those times. However, if I see a big meteor crashing down through the sky (which I have) and no one else reacts, I know it’s not real.
Me: Thank you, Bob. You’ve been a great help and I’m sure our readers can take a lot away from hearing about some of your experiences and thoughts in your own words.
Bob: You’re very welcome.
Here is what you should know about schizophrenia.
In all honesty, as I watched him throughout the interview, it is quite difficult to tell Bob even has a mental illness. His leg would shake up and down a few times, which he called ‘tremors’ – a side effect from the medication he takes – but he seemed real and down to earth. Had I not already known he suffered from Schizoaffective Disorder I would have never guessed it during the interview.
But that was with medication. Would we be able to recognize Schizophrenia/Bipolar Disorder, or indeed any severe mental illness, when the medicine is gone? It actually depends on the person.
Some people are aware of the symptoms or know how to find the symptoms, and so they can attempt to hide it for a while; That’s exactly what Bob did, but not because he knew what was wrong with himself, but because he was confused and afraid. Ironically, his mantra for many, many years has been “Fake it to Make it”- and that helps him get through life.
There are, however, some things you can’t fake. As Bob has already admitted, sometimes he responds to his hallucinations, and sometimes he vocalizes a response to voices in his head. (By the way, Bob attempted to show me what those voices felt like – he stood very close behind my chair and talked to me, not in a whisper, but not at a normal level either. It was very unnerving. I couldn’t see him, only hear his voice.)
People who have schizophrenia and are not being treated can display various behaviors. According to Psych Central, the behaviors can consist of any of the following, either separately or together: Delusions (believing things that are not true – remember when I mentioned that Bob thought he was actually talking with God?), hallucinations of any sort, disorganized speech like frequent derailment of a conversation or talking incoherently, agitation – which could mean easily aggravated (it takes a lot of concentration to listen to multiple voices in your head AND people talking to you around you in reality), a lack of motivation or initiative, and possible social withdrawal for fear of being discovered and made fun of.
If you think about it, a person with schizophrenia may see someone, that really isn’t, there do something funny. Like Bob did when William ran into the frozen food divider. If Bob had laughed out loud, and anyone had noticed, they might think he was exhibiting strange behavior. And what if Bob had grown bolder with his delusion where he was carrying on a conversation with God, and thus began speaking out loud? Yep, people would immediately take notice. (Please, understand that I’m not saying anything about prayer or someone who talks to God in their walk of faith – I’m speaking of delusions, not reality. Reality, scripture, says to speak with God in private – in a closet to be specific.)
What can we do to help someone with schizophrenia when the medicine is all gone?
According to Healthline, there are quite a few approaches that can minimize the side effects of the illness. Folic acid, C and B vitamins, and Glycine, which are all found in leafy green vegetables, such as spinach, citrus fruits, beans, bread, whole grain cereals, rice, and pasta, eggs, red meat, poultry, and fish… In other words, a healthy diet.
There are also other things like simply talking, or rather – listening, to the person with schizophrenia. All types of therapies, from group to single, from art therapies to aromatherapies, are said to work for different people. The key is that each individual, while suffering from the same illness, is unique, and so different therapies work for different people. Bob has one particular ‘activity’ that helps him. Sleep. If he doesn’t get at least 8-10 hours of sleep a night/day, he has more hallucinations, and sometimes worse hallucinations. Bob is also very sensitive to stress.
So once you know that someone has schizophrenia/schizoaffective disorder, there are ways you can help them. Most I’ve listed are common sense. Others can be learned by listening to them and observing them; showing an interest in them.
Finally, the warning I spoke of in the first part of the article: A schizophrenic’s reality is skewed at best. They don’t ever really know what is real and what isn’t. If you want to help a schizophrenic, don’t ever lie to them. If you do, it undermines everything they thought they could believe, and you will never be trusted again.
Thank you, everyone, for reading this very long interview/article, and many thanks to Bob for agreeing to help us understand more what it’s like in his world.
Sandra is a published artist, photographer, fellow prepper, and animal advocate.
About the Author
Sandra is a published artist, photographer, fellow prepper, and animal advocate.