05/29/2011 11:26 am ET Updated Jul 29, 2011

With Heaven and Hell in Mind: Confronting the Reality of Mental Illness

What with all the talk of Rapture and "going up," I'm put in mind of the hellish experiences here on Earth, experiences for which there is no risk of "going down" further, only the fear that somehow there will be no reprieve from the depths. I had a glimpse of this hell the other day, in a hospital ICU where a young, vital man was out of his mind, even as his body required heavy sedation for safety's sake.

I know a little about involuntary commitment and mental health holds, but book-learning is clean and dispassionate compared with the complexity and suffering that imbues such situations. I had my first immersion in real-life experience as part of team seeking constructive outcomes. Nothing was simple. There were language issues requiring actual translation, as well as other communication issues concerning the unstated and unacknowledged. I was a witness, trying to ease the family's movements within "the system." Sometimes I was a negotiator, helping to maintain movement and hope. But mostly I was just there.

And I wasn't prepared. Not for the heartbreaking acknowledgement of a life's course so shaped by mental illness. Not for a mother's grief, nor the recognition that differentiating between volitional and un-volitional criminal behaviors is separate from, and yet inextricably linked with, the need to hold transgressors accountable. I wasn't ready for the layers and layers of paperwork, or the chains of communication that, by definition, defy accuracy. Like so many others, I hadn't previously encountered these realities, and so perhaps these confessions are easy to make and easy to excuse.

But I have other, less comfortable confessions to share, and perhaps these may be uncomfortable to hear. I was unprepared for the profound decency of the court-appointed counsel and jail officers. I was struck cold that I even noticed that the ER and ICU staff provided excellent medical care, compassionately and efficiently, without prejudice despite the circumstances. And, believe me, the circumstances of the admit were anything but pretty. I know they're supposed to behave that way, but seeing them do so was extraordinary. Put bluntly, I was unprepared for the absolute humanity that surrounded a man who wanted to end his human existence. The dignity others accorded to him, in the midst of his own hell, was uplifting and humbling. A cause for renewed faith in humanity, and a cue for deeper reflection.

There is nothing "fair" in the advent of severe mental illness. It simply happens, exacerbated by well-known risk factors for sure, but genes are the luck of the draw. And, today, in a time of diminishing personal and public resources, those without the capacity to function fully are even more compromised -- and, all too often, despised. The man I saw in the ICU desperately needs a bed in an in-patient psychiatric facility, but whether any vacancies exist remains to seen.

If he gets appropriate treatment, his family and friends will have a real chance at continuing to care for him upon discharge, and he will have a strong chance at a better life. If he does not get or comply with treatment, he may again seek the means to end his own life and risk irrevocable harm to others along the way. And there's nothing, nothing, to do right now other than try to find that bed and provide the medicines that support normal brain function.

The challenges are formidable and extend beyond basic issues of resources. His greatest obstacle is that he thinks his reality is "normal" -- and for him it is -- but it's not, at least not in a conventional sense. Like so many others with severe mental illness, he experiences his hallucinations as absolute reality. He lives in his own hell, and the question is whether he can come to understand that his hell is a mental experience and not his identity. And, can he come to trust his experiences while taking medication, in which he'll inhabit a more mundane world with all its attendant problems and, yes, its beauty? Because the beauty is among what's hardest to bear when rekindling the desire for life.

As for those of us who glance upon another's hell, what can we do beyond the obvious tasks associated with ensuring appropriate care and supporting the caregivers? We can stay mindful of others and ourselves. We can generate compassion for those who suffer and all who encounter such suffering. And, of course, we can remember that all people are bound together within a common humanity, and no person exists in total isolation. And this realization is our greatest strength and hope. Peering through the ICU curtains, I could see a little more clearly how the mind can access hell as well as heaven, right here on earth.