Mental Health in Pharmacy

Crazy does not mean anti-social. Crazy does not necessarily mean unkempt, unsanitary, offensive or mean-spirited. Crazy is not silly, laughable or entertainment. Crazy is definitely not stupid.

Ever since Ronald Reagan said, “We will no longer warehouse our mentally ill”, the pharmacy is the place where they get the gear needed to navigate in the world. We call it Clozaril, Seroquel, Abilify and Zyprexa… among others. The problem is that “chemical warehousing” with the best agents is ridiculously expensive. No insurance and the crazy person is hung out to dry. Think homeless.

Marilee called me out front and introduced herself to me with these words, “I am just your neighborhood insane person.” She looked for a reaction and got nothing from me. After four plus decades, there is very little short of child abuse that can get a rise out of me.

Marilee went on, “I hope that you will be patient with me. I try really hard not to but I can get a little obsessive with my drugs. I ask lots of questions.”

I assured her that it was okay, that my job was to answer questions and there were plenty of questions. After awhile, she lightened up. Maybe she began to trust me. I treat Marilee just as I treat anyone else. No prejudice against the crazy. No snide remarks to the tech. No hidden laughter.

One day, I looked out and watched Marilee for awhile. There was something not right. I walked out front and sat beside her. “Are you okay, Marilee?”

“I am crazier than Jack Nicholson today. I hate days like this.”

“Oh,” I said. What do you say to that?

“You can’t see him, but that dumb sunuvabitch keeps telling me to do stupid things.”

“Are you having a schizoid episode, Marilee?” I have suspected other people at times, but this was the first time that a patient reported directly that she was having hallucinations.

“I am crazy today, Jim.” I asked her if she needed to discuss her medication with her psychiatrists.

“There is nothing they can do. I can’t afford the good medicine. I’m in the donut hole.” The Part D shame.

She explained that her hallucinated person was forceful, clever and, get this, more real to her than I was. She had learned what was which and who was who.

What do we do as a culture, a society? What can we do as an individual practitioner? Will voting rights help? Or do we just look away and think about the squash court reservation? We have a duty. We all took an oath.