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She was kicking and screaming at the nurses.  Food and obscenities were flying everywhere.  I had been sent in by the psychiatry team to check for mental health issues, and the poor woman seemed a doorway diagnosis.  She was so thin and wasted that her skeleton stood out like an anatomy model beneath her pale grey skin.  She looked to be in her 50’s, nowhere near the 35 years of age that her chart said.  Her HIV infection had progressed rapidly to AIDS, she had been “non-compliant” with her medications.

The best bet was to be friendly and approach personal questions with caution, although even this might get me thrown into the same category as her nurses.  Luckily, she calmed down.  She was sorry for causing trouble, but was tired of vomiting and would rather not push more food down today.  Her mood was rotten, and her anti-depressants had not done much.

I then opened up the can of worms.  Her mood was rotten, she explained, because her mother had given her advice on how to “clean up her act.”  She sobbed that she felt terribly guilty for ignoring her mother’s advice and getting the HIV virus.  When she described that the worst part was how hurt her mother was to see her at each visit, she was crying so hard that she barely got the words out.

It was time to say something comforting, but all the words slipped away.  Instead I stood dumbstruck, paralyzed by an awful sadness and by sudden questions.  Wasn’t this woman’s behavior now slightly more understandable?  Is it still mental illness when it seems justified?  How would anyone handle a day in her shoes?  Lying helplessly in a hospital bed, dying slowly at age 35?  I would be throwing fits at innocent nurses too.  Poor decisions be damned, this woman had my sympathy.  At that instant, her AIDS seemed far more curable than her guilt.

Our society still secretly views mental illness as a pseudo-disease, lacking a physical cause and mostly the patient’s fault.  But is it really that simple?  Most of us could no more change our thoughts and patterned responses than we could coax our bodies to produce more insulin.  The brain is also more complicated than the rest of our organs.  Bad brain chemistry can cause unhealthy thought patterns, but unhealthy thought patterns can cause bad brain chemistry too.  Attitudes influence behaviors, but behaviors also influence attitudes.  This woman’s HIV played a role in her mental condition, but her mental condition may have also contributed to her getting HIV.

Mental illnesses are disabling inappropriate or unhealthy thought or behavioral patterns, even when these seem reasonable given terrible circumstances.  Does it follow that almost all of us could develop a mental illness if thrust into a bad enough situation?  It is so easy to blame this patient for her HIV, her non-compliance, and her depression.  But just like her, we all make mistakes and have no idea how we could have been so stupid in retrospect.   Some of our mistakes are big and some small, but just like her, we all pay for our mistakes sooner or later.  The least we can do is recognize the complexity of mental disease and have a little compassion.  As the old saying goes, there but for the grace of god go I.