For many people with a variety of mental illnesses (bipolar disorder, depression, schizophrenia, and others), medications can be a lifesaver. They may prevent distressing symptoms from fully expressing and in some cases, eliminate them nearly entirely.

But the downside is that even if meds work, the side effects might be so uncomfortable (or even debilitating), that some might be tempted to cheat-to skip a dose or two, or just go off meds all together.

Almost every week a friend of ours, Gabriel*, who we write a bit about in Therapy Revolution, visits us for Shabbat lunch or dinner. He prefers to come when we have no other guests so we can give him our full attention, though that isn’t always possible.

Gaberiel loves a home-cooked meal. Recently, for his birthday he requested, and got, a homemade chocolate layer cake,  6 inches high, piled with what C.R. calls “toxic amounts” of icing. (Not our usual fare).  Last year he requested brownies. Gabriel loves to eat, as long as no vegetables are visible — he pretty much lives on peanut butter and tuna sandwiches even though he does have other options.  In order to feed him properly, C.R. likes to hide veggies in soups, stews, and even desserts.

Gabriel is musically gifted; he composes heavenly melodies that light up the human spirit. He is an amazing mimic and has a great facility with languages and accents. He is enthusiastic, always willing to help someone in trouble or just lend a friendly ear. He is fond of jokes; he’ll call me whenever he hears a good one (he also makes up his own jokes, not for the P.C. inclined, here’s one: Where does a mentally ill person ride his bike? On the psycho-path.)

Gabriel is also floridly schizophrenic with psychotic episodes which meds, thankfully, largely control.

Last summer the program he lived in for many years was required by new government regulations to move him out to a higher level. He was moved into a “supported housing” program. Now a social worker visits him only twice a month and he is left mostly on his own.

Gabriel never liked taking baths or showers or doing laundry, so now that no one insists he take care of his hygiene, he’s deteriorated in this area. It was the first thing to go. It got so bad that I would call him and gently remind him to shower and wear clean clothes before he came to visit — and I was mostly unsuccessful. We felt that the giving him consequences (such as not being invited if he refused to shower) would be too painful for him, and probably wouldn’t be too effective anyway, so we opened the windows, sprayed Lysol, and coped as best as we could. He didn’t wash himself or his clothing for months.

I have to walk a fine line.  As his friend, I cannot “butt” into his treatment and tell his counselors what to do; as a professional, I see where he can and should be helped and therefore I encourage him to speak to his counselor.

A few months after his move C.R. pointed out that Gabriel wasn’t telling jokes anymore. Finally a few weeks ago, during lunch, he told me that his psychiatrist had lowered the dosage of one of his most important medications. Then he began to have frightening auditory hallucinations at the table, and quickly left.

After lunch, C.R. and I went over the events and realized that the possibility was strong that Gabriel had gone off his meds under his own volition. By telling us his doctor “lowered” his dosage, he might have been testing us, seeing what we thought about his medication levels.

We were right. That evening he called his counselor and asked to be admitted into a psychiatric ward of a local hospital. He had been off his meds for a few days (we still don’t know how many days) and had a psychotic break.

He spent three weeks recuperating under close supervision.  Now, thankfully, he’s being more closely supervised in general. When I asked him why he went off his meds he said that he just wanted to see if he could “go it alone.”  Also, his meds come with a heavy price tag; unpleasant side effects including lethargy, increased appetite, and weight gain, as well as potentially serious health concerns.

Last time Gabriel stopped taking his meds, about four years ago, it took him nearly a year to get back to his norm.

Gabriel isn’t the only person with mental illness who goes off his meds unadvisedly. The side effects of many medications can make even the dedicated patient long to feel more “like himself.” But the cost of going off meds is exorbitant–and the “loan repayments”, exponential.

*Gabriel is not his real name. He wanted his story shared.

Photo by JeffreyW, Flickr. Title: Brownies…Yawn…Boooring.