What does it mean to have an SPMI? Oh, what’s that you ask? An SPMI is shorthand for Severe and Persistent Mental Illness. We are the ill of the ill, the ones who become revolving door patients with chronic admissions. Some of us wind up in state hospitals. I am fortunate to have the means to afford good mental health care, including hospitals with caring doctors, nurses, and techs. I shudder to wonder what my days of being a revolving door patient would have been like without the doctor who took care of me in the hospital. There was even one day when I was discharged, only to be readmitted later that day. Things were not good.
To answer your immediate question: what qualifies me to speak about SPMIs? Well, I know a thing or two. What do I suffer from? I have schizoaffective disorder, bipolar type, PTSD, and PMDD. Huh? Schizoaffective disorder, bipolar type, is a kind of unhappy marriage between bipolar (also known as manic depressive disorder) and some of the symptoms of schizophrenia. PTSD is Post Traumatic Stress Disorder (aka shell shock or battle fatigue), a response to a traumatic event. PMDD, also known as Premenstrual Dysphoric Disorder, causes extreme irritability, depression, and/or anxiety a week or two before the onset of one’s cycle.
For me, just existing is hard some days. My schizoaffective diagnosis, bipolar type, means that I have a manic depressive disorder (now commonly called bipolar) AND that I hallucinate. My mania has been under control for a long time. I have fleeting glimpses of hypomania (a kissing cousin of mania, but far less intense), and they scare the ever-loving shit out of me.
At my lowest point, I had a summer of intense mania, and a LOT of bad things happened. So much so that I have never, ever entertained the idea of going off my meds. People most often go off their meds for two reasons: first, they are prohibitively expensive, and second, because they make people feel “off” or “blunted.” Now, do my meds sometimes make me feel off or blunted? The long and short answer is yes, yes, they do. When I feel that way, I work with my doctor to adjust my meds so that they are effective but not numbing.
As part of my schizoaffective disorder, I hallucinate. I’m doubly lucky – I have hallucinations and a mean-ass inner critic: admittedly, it took a long time to be able to differentiate between my inner critic and the voices. I have always had a nasty inner critic. The refrain I hear is: “worthless, useless, hopeless, failure.” And if that isn’t bad enough, The voices add to the fray: “You are a waste of oxygen,” “You don’t deserve the air you breathe,” “You should kill yourself,” and just plain, “Kill yourself.”
I come by my diagnosis of PTSD honestly – and no, I haven’t served in the military. These days, anyone can receive the diagnosis, military or civilian. As for my PMDD, it was diagnosed after my therapist put together the fact that I am almost always admitted to the hospital the week before my period starts.
A nod to history: those with SPMIs have not been treated well. Too often, people with SPMIs were shut away, hidden from view. We fear what we do not understand. Those with SPMIs were institutionalized and forgotten; the stigma of having a relative with a mental illness was so intense that they were often written off and forgotten. Nazi Germany was no exception: Hitler practiced mass euthanasia of patients at mental institutions during World War II. Somewhere in the ballpark of 200,000 people with mental illness and/or physical disabilities were killed.
Today, the vast majority of the homeless (the ones we pretend we don’t see, soliciting us on street corners) have mental illnesses; many have SPMIs. Having an SPMI(s) is no joke. It ruins relationships, it ends careers, and it can even kill. I wish I could say I had an SPMI, but unfortunately, while people with them may experience remissions, there is no cure. I’m lucky that my schizoaffective disorder, PTSD, and PMDD are controlled via medications and therapy.
But they do not and will not continue to work indefinitely – meds will have to be adjusted, and additional work will need to be done in therapy. I am one of the lucky, one of the precious few with an SPMI who is able to access good, quality psychiatrists and therapists – and can afford necessary therapeutic interventions my insurance doesn’t cover. I am probably luckiest that I have a healthy fear of my SPMIs – it is that fear that keeps me on my medications and attending my medical and therapy appointments. Maybe someday meds won’t make you feel different or off; maybe someday we will have real, lasting cures that don’t have an expiration date. Until then, I’m going to stay on my meds and in therapy.
Comments