For Want of a Nail

There is an old rhyme that begins “For the want of a nail the shoe was lost. . .” Elders refer to the poem to illustrate the importance of the tiniest of details in any given project or process. My Grandfather referred me to the saying long ago when I was railing against some outlandish requirement that my mother had asked of me.

The lore has been illustrated several times in the last while in different situations. I recently tried to convince members of a government agency that it was important for people to have complete access to all medications. No one, I remonstrated, knows whether some drug will benefit a person with mental illness until it actually works. If it doesn’t, that person, in conjunction with their doctor, will have to search for another. But the rub here is that very few people just have a mental illness, most have some accompanying bodily complaint that requires a remedy. If they can’t access the medication or service for that ailment it may affect their sleep or their anxiety level and bring on a relapse. An otherwise effective mental illness strategy may be thrown out for want of the least consequential element.
 
Many people with mental illness also carry the burden of having an addiction. If they can access treatment at all they are unlikely to be able to find a system that will deal with both sides of the dual diagnosis. The result all too often is they fall into a cycle of rehabilitation and re-addiction because the root cause of mental illness and self-medication is not identified or the addictive behaviour is underestimated and treatment is thwarted because of drug interactions.
 
Another factor in effecting recovery/management of a disease of the brain is the cooperation of the ill person. People we care about have difficulty in this aspect for a variety of reasons. First they have a disease which the self doesn’t recognize. A cancer produces symptoms that the brain can evaluate and structure into a cohesive condition. When the brain is diseased the evaluation process is short circuited, literally, so no cohesion is possible and the brain says ”If it cannot be visualized it cannot exist”. Next there is the whole stigma issue. No one wants to admit they have this disease that the world largely doesn’t recognize and/or openly discriminates against. It’s not yet socially acceptable to be crazy. Third these are cyclical diseases which will allow for periods of ‘normalcy’ which are often interpreted, many times for the above reasons, as recovery; medications or treatment regimens are set aside. They are then not in place to augment the brain’s natural ability to cope when new stressors come around, as they inexorably do. Finally, the strong support networks that seem to automatically come out of the woodwork for other life changing serious events are not usually found in dealings with this type of brain disease. Without these, the isolation becomes just one more sign that no one cares and hope gradually falls away.
 
There are not many nails holding a horse’s shoe in place. Those who deal with mental illness have a more complex system to help them ‘hold’ their place in the world. Unfortunately, the loss of one ‘nail’ can result in the war being lost in both situations.