Question: What is the beach at low tide?

Answer: It’s a crowded beach.

Low tide at the beach was so pretty until I noticed all those people with their auto repair accoutrements like wrenches and screwdrivers, kitchen tools, gardening shovels—shovels I say! People?! Shovels! —all picking, poking, and killing off the last tide pool life here on this little planet Earth. There is a frailty in our ecosystems, both in our physical and psychological.

That day, I felt a sense of mourning. And I might have been catastrophizing a little when I said, “the last of life,” but it feels like Mother Earth, Gaia, is groaning – a cornered, beautiful creature, unable to escape what we are doing in this human impact.

All these choices we make brought my mind and thoughts into the office, where I met with Frederick. He – who had once been on the verge of hospitalization due to affective instability, then stabilized with medication. However, now he came to me partially treatment adherent. What is partial treatment adherence? Partial treatment adherence looks like missing one day here and there—maybe more—of treatment. For whatever reasons, we all have good ones, not to take our meds. Frederick told me, he was irritable. I could feel the irritability, in fact, coming off him in waves; something physical but not seen. His irritability spoke at me, hit me, and brought memories of what he was like when we first found his treatment and stabilized on it.

Frederick’s struggle with partial treatment adherence mirrors the environmental metaphor with the tide pools – harmed by small, cumulative actions, lapses in mental health treatment. This creates vulnerabilities, leading to relapses – progressive deterioration in the conditions, fewer star fish to see. There is a complexity in treatment adherence as well as in consistently helping our earth.

Fred told me that he had been doing so well, he just forgot to take it every day. His pill dispenser became a confusion of days—some filled with pills, some empty. He didn’t know when he had last dosed. But he was trying. It just was. No good reasons. It just was. And as his irritability found him, I remembered those poor tide pools being slashed and hacked, Mother Earth groaning trapped beneath a shovel, like Frederick unable to escape one’s mental illness. Fredrick was in a sense cornered too.

Mental health can be like that: where we find our beauty again with treatment, become a horizon with clear skies, clapping waves, the tide pulling back. We are thrilled to see the rocks and sea life surface. Then treatment nonadherence hits us, and it feels like—no matter what—it’s just the way the Earth turns, the population interacts with us, and we are vulnerable to our own selves not taking medication.

There are no quick solutions. For example, Frederick was doing good things for long term health, like using his pill dispenser. He was educated, and he wanted care. It wasn’t like he was trying to lead his own treatment plan. His lapse in adherence just seemed to happen, like population growth, pollution, and the inevitable damage of our tide pools. There is room for compassion.

As I walked on the beach, passing these layers of families and individuals and the crazy toys they were using in the crevices of the tide pools, I wanted to stop and explain, “Please don’t touch.” Please don’t harm. Please stand and enjoy the ambiance that nature provides—the sensory privilege of seeing color and life that you had nothing to do with except not to harm. But much to my children’s relief, I did not. I walked on the grounds of Gaia filling my ears with her groaning, a cornered creation with nowhere to escape. Remember Romans 8, “All of creation groaning in earnest expectation…”.

I was there, at least, seeing our humanity in action.

And I thought of Frederick. What can I do for him except restart him on his meds and routine dosing? I felt that internal conflict of knowing when to act versus when to observe and reflect. Frederick’s partial adherence to treatment was floating in the gap between knowledge and action.  But then I also thought that suffering beside Frederick, letting him know that someone understands—that his mental illness comes back without treatment, and I’m not blaming him for it—is enough. That’s something I can do. I’m just standing with him as his body suffers, as his identity suffers, as his relationships suffer, and I sorrow with him. I bear witness.

Treatment adherence is not easy for anyone. Knowledge doesn’t always create change considering all the forces.

The other day, when walking on a much emptier beach with my daughter—newly minted in her own oceanography experience from a summer on the Puget Sound—she happily relayed to me, “Mom, we are making a difference. The ocean is slowly recovering. The measurements people are taking show that the reefs and tide pools are healing.” Both the tide pools and Frederick’s mental health journey are dynamic systems subject to cycles of harm and healing. Progress is possible, even if setbacks occur.

So I juxtapose this to what I saw: this crowded low tide, surplus of people and their tools. I think of Fred, his own relapsing condition. And I think treatment does make a difference. He has had a period of stability worth celebrating. And when, inevitably, he—like so many of the rest of us—becomes partially treatment-adherent and when he starts having symptoms again, we can remember that treatment is making a difference.

The ocean is healing in contrast with despair.  Consistent, mindful efforts—whether in environmental conservation or mental health—we can stand and bear witness to the pain, suffering in the journey and we can still hope.