by Harold A. MaioIt is never OK to say there is a stigma to mental health issues, it is always OK to educate someone who does. It is, in fact imperative that we do, to end the harm such prejudice has caused.
Our approach to mental health issues overall has to change: We have to accord the illnesses we presently call “mental” the respect we accord all other illnesses. Only through such respect will we find the answers we need to both prevent and medically address them. And we are making progress in the research that will do that.
Through intense and worldwide medical research we are finding direct connections for these illnesses to the physical brain. Though we have not devoted this research the funds we devoted to finding a cure for polio, the funds we have dedicated are yielding results.
What we do know is worth emphasizing: We know that each of these illnesses is an illness of degree, ranging from extremely serious, to far less so, with a great many degrees in between.
We know that the most serious of these illnesses, schizophrenia, can leave a person unable to experience reality as we know it (that is the view with which most of us are acquainted), to people holding doctoral degrees and teaching at university, and every degree in between. Each of my acquaintances with that illness holds a doctoral degree. Elyn Saks is perhaps the most famous, she teaches law at USC.
Chronic depression arguably affects the largest number of people and, again, exists in degree, from wholly debilitating, to an interference that does not control one’s life. The most famous person to deal with severe depression, Winston Churchill, led his country through World War II despite it. He called it his black dog, it dogged him throughout his life, but did not control it.
Bipolar disorder, an illness that causes mood swings from manic-elation to depression also exists in degree, and in its milder form the highs can impel persons to success. Catherine Zeta-Jones and Carrie Fisher are two such people.
Each of these illnesses in its most serious forms can also kill, making it imperative that we continue to fund research, that we continue to search for answers, and that we show each of them utmost respect.
Harold A. Maio is a retired mental health editor
I feel that Harold Maio has a very important message. However, I feel that the title of this article and the first sentence do not contribute to that message. For years in medicine we acted as though our society did not attach a stigma to mental health. One small example was that primary care providers could not routine access the diagnoses or psychiatric portion of the chart of a person with a mental illness. We could only see a list of medications, not what they were being used for, not whether or not progress was being made nor whether or not the patient was stable. This was done to “protect the patient’s privacy” ( in other words, because of the existing stigma).
I think it has been critical to improving patient care to admit that there has been a stigma attached to mental illness, and to steadily work towards breaking down that stigma. Just as blocking the diagnosis of HIV was an impediment to the provision of care by providers “not in the know”, so we designed a system to block the diagnoses of mental illnesses which had similar adverse effects on those who suffer from these conditions. I believe that we need to continue to face head on the real stigma that still exists in our society and call it out for what it is whenever we encounter it.
As someone who has dealt with relatives with serious mental health problems, my observation is that we (as a society) do not put nearly enough resources into helping those with mental illnesses. Many of the mentally ill that I have been around have very limited resources. Some are living on SSI disability and some are living on the street.
From my experience, there is a serious shortage of psychiatric help including ongoing talk therapy to help mentally ill folks with limited resources. County mental health budgets are not nearly enough to meet the needs that I have seen personally.
With some ongoing assistance and mentoring, I believe that many mentally ill people can be productive citizens.
I often think to myself how different things would be if we (as a society) took a portion of the money we spend on pets (or some other discretionary spending) and directed it towards taking care of our mentally ill population.
TopCat
“I often think to myself how different things would be if we (as a society) took a portion of the money we spend on pets (or some other discretionary spending) and directed it towards taking care of our mentally ill population.”
As a health care provider, I often think to myself how different things would be if we did not consider health care ( both what we define as physical and mental) as discretionary at all. What it we considered full health care, from prevention through acute and chronic treatments for all conditions, as much a right of living in this country as we consider police or fire protection ?
Tia:
Yes, the provision of health care in the US is a mish-mash of various systems, many of which have huge inefficiencies. There is a tremendous amount of waste in the system; just think about the billions of dollars that are spent on keeping the medical insurance companies alive. Some estimates I’ve seen have said that 1/3 of health care spending goes to funding insurance and other non-medical functions.
We already have a large proportion of US healthcare provided by the government (Think Medicare, Medical, The Indian Health Service, The military, and healthcare for veterans). Perhaps some day we will move to a single payer system such as those that are reasonably successful in many other countries around the world.
The concept of “mental illness” is perhaps outdated. The same way that peptic ulcers were thought to be diet and lifestyle related but turned out to be caused by H. pylori, a bacteria. So ulcers are an infectious disease rather than a moral failing. You article yesterday linking autoimmune disease is only one part of a growing trend to explore the biochemical basis of mental symptoms. Conversely there is also a lot of work in trying to understand how our mental processes control our biochemical nature. Psychoneuroimmunology (PNI) has demonstrated that is possible to think yourself into physical sickness.
quielo
I agree with you that the concept of “mental illness” is outdated. Unfortunately unlike with ulcers, there was a single cause with contributing factors. We are as far away from discerning the many potential causes of the variety of conditions that we group, sometimes rather arbitrarily as “mental illness”, as we are from sorting out the many potential contributors to the cancers of various types.
One dramatically different approach from the one we are currently using would be to stop policies that limit the number of researchers and that pit one team against another for research funding. In my opinion, medical research should not be reduced to a competition for funding, a competition to publish and a competition for marketable products. Instead all researchers should be payed a living wage and have their ideas and findings put forward in real time just as the Zika team did. This approach, while it would not make any one researcher, investor or company rich, would certainly be a major benefit to humanity over all.
The bigger problem in my opinion (note that omission of humble) is that most research is driven by the desire to create IP, or a product that can be sold under patent protection. If there is no IP to your research you will have a hard time to raise money.
There is also the operational problem of defining and measuring endpoints with mental symptoms. ALZ research has been very expensive for this reason. Finding biomarkers and better yet finding animal models will go a very long way.
quielo
As will mapping the involved areas of the brain with ever more sophisticated imaging.