Cris Alarcon, with contributions]
I have been seeing a phycologist for the last year! I have suffered from clinical depression since childhood, but I never asked for help, even after being hospitalized. I just “Manned up” and dealt with my problems myself, often with a bottle. It was easier to deal with being an occasional drunk, than to admit there was something up in my head. Why? The Stigma…
Mental illness is highly stigmatized. Dr. Jeffrey Lieberman gives us this little thought exercise imagine that you were invited to celebrate your boss’s 50th birthday party and you were picked to give the toast but on the day of the event you got sick and you had to cancel. When you called to cancel would you prefer to say that:
you couldn’t come because you had a kidney stone or that you were depressed and suicidal;
would you rather say that you threw out your back when you’re having a panic attack;
would you rather explain that you were having a migraine headache or you were strung out on prescription pain medication?
If you would prefer the former to the latter, in each case you are affected by Stigma.
Just over two years ago I was hospitalized for seizures and diagnosed with epilepsy. I made several lifestyle changes in response. I stopped drinking any alcohol, stopped all-night work binges, stopped exercising to exhaustion, and stopped poor eating habits. That help reduce seizures, but I did not realize those were some of my coping mechanism for dealing with life’s stress. Since I no longer had those, I was freaking out under the stress. I realized that I needed to ask for help. Help to learn new, healthy coping mechanisms… Now asking for that help was hard!
Stigma shames us into silence. It prevents us from seeking help. And in some cases, it takes lives. But there’s good news. Stigma is 100% curable. Compassion, empathy, and understanding are the antidote.
During May, NAMI, and the rest of the country are raising awareness of mental health to fight stigma, provide support, educate the public, and advocate for policies that support people with mental illness and their families.
Dr. Jeffrey Lieberman, Professor and Chair of Psychiatry at Columbia University and past President of the American Psychiatric Association, envisions that breaking down the barrier which arises from our stigmatizing mental health would result in better treatment for millions of individuals.
“brain on the other hand is a three-pound corrugated massive tissue composed of over 100 billion neurons which make over 30 trillion connections and form an intricate array of a myriad number of neural circuits which simultaneously orchestrate functions as basic and vital as breathing temperature regulation hunger coordinate movement but also form what your personality is and who you are as a person the brain gives rise to consciousness and creativity and it also houses the human spirit it’s no wonder that it’s taken us so long to understand the brain and appreciate how it relates to behavior and mental illness. Now stigma is not unique to mental illness we’ve seen it associated with illnesses throughout human history: tuberculosis; leprosy; cancer; the most dramatic example that I know of is AIDS in the late 1970s”
“effective treatments treatments don’t just eliminate the symptoms of the illness they also eliminate the prejudice and the stigma now we’re still learning the causes of mental illnesses but we already have effective treatments which have helped millions of people around the world in many cases these eliminate the symptoms of the person’s illness but in some cases they actually transform their lives”
“we don’t have treatments for every disorder and not all patients respond well but make no mistake there is indisputably a world of difference between modern mental healthcare today and what existed for all human history prior to the latter part of the 20th century so I find it particularly ironic that while people suffered from mental disorders throughout human history because of the fact we had no knowledge and limited or no effective treatments, in the 21st century when we do have treatments the biggest barriers are lack of awareness, lack of access to care, and stigma”
Transcript
I know we’re only just meeting for the first time but I’d like to ask you a question and it’s a rather personal question how many of you suffer from or know someone who suffers from a mental illness well think about it your family your friends your classmates in school your colleagues at work I’ll bet that virtually everybody knows someone with a mental illness now maybe I should explain what I mean by mental illness commonly thought of conditions like depression schizophrenia bipolar and anxiety disorders and also intellectual disturbances like autism and learning disabilities and ADHD and addictions to alcohol and drugs all of these conditions affect the same areas of the brain and disturbed by varying degrees the mental functions of cognition perception and emotion regulation so we’re not talking about the worried well here or problems in daily living the World Health Organization has Presta mated that 20% of the world’s population suffers from a mental disorder at some point in their lifetime that’s one in five people over 70 million Americans a billion people worldwide so if you do the math everyone should know someone who suffers from a mental disorder and the fact that many of us may think we don’t reflects three inconvenient truths that we lack an understanding and awareness of what mental ill this is that were reluctant or ashamed to admit it and that mental illness is highly stigmatized now stigma literally means dishonor or disgrace it’s the Mark of Cain in the Bible it’s the a on the dress of Hester Prynne in the scarlet letter and it’s the yellow stars that were emblazoned on the clothing of Jews in Nazi Germany so why should mental illness be similarly stigmatized well to show you how insidious stigma can be let’s do a little thought exercise imagine that you were invited to celebrate your boss’s 50th birthday party and you were picked to give the toast but on the day of the event you got sick and you had to cancel when you called to cancel would you prefer to say that you couldn’t come because you had a kidney stone or that you were depressed and suicidal or would you rather say that you threw out your back where we’re having a panic attack or would you rather explain that you were having a migraine headache or you were strung out on prescription pain medication if you would prefer the former to the latter in each case you my friends are affected by stigma now I experience stigma every day as a psychiatrist the profession to which I’ve dedicated my life is the most denigrated and distrusted of all medical specialties there is no anti cardiology movement that’s trying to stamp out cardiology and there’s no anti oncology movement that’s trying to ban cancer treatment but there’s a virulent antipsychotic movement that claims there’s no such thing as mental illness and wants to eliminate psychiatry now if we thought of mental illness like we do heart disease then symptoms like depression would be like chest pain or anxiety would be like shortness of breath or psychosis would be like an arrhythmia in the former case symptoms emanate from the brain in the latter case they emanate from the heart but the brain is infinitely more complicated than the heart or any other organ in the human body for that matter the heart is basically a pump composed of four chambers a dozen blood vessels and comprised of two billion muscle cells the brain on the other hand is a three-pound corrugated massive tissue composed of over 100 billion neurons which make over 30 trillion connections and form an intricate array of a myriad number of neural circuits which simultaneously orchestrate functions as basic and vital as breathing temperature regulation hunger coordinate movement but also form what your personality is and who you are as a person the brain gives rise to consciousness and creativity and it also houses the human spirit it’s no wonder that it’s taken us so long to understand the brain and appreciate how it relates to behavior and mental illness now stigma is not unique to mental illness we’ve seen it associated with illnesses throughout human history tuberculosis leprosy cancer the most dramatic example that I know of his AIDS in the late 1970s I was an intern at st. Vincent’s Hospital in the Greenwich Village section of New York City when the first cases of AIDS began to appear I remember seeing patients come into the emergency room with terrible infections and we couldn’t figure out what was wrong with them and we had no treatments and they invariably died now this by itself would have been enough to stigmatize this illness but the fact that it was occurring predominantly in discriminated groups including homosexuals and intravenous drug users made its victims virtual pariahs but then an amazing thing happened the AIDS advocacy group and community aggressively gout they expanded awareness and they pressure the government to fund research and within five years 1984 two scientists isolated the human immunodeficiency virus the cause of AIDS by 1987 AZT was introduced the first treatment for AIDS and now aids is like diabetes it’s a chronic illness but you could live a pretty normal life with treatment contrast the outcome of Rock Hudson who was diagnosed with AIDS in 1984 and he was dead within a year – Magic Johnson who was diagnosed with AIDS in 1991 and he’s still alive living a normal life I saw my TV the other day with treatment that is the power of science leading to knowledge and awareness and effective treatments treatments don’t just eliminate the symptoms of the illness they also eliminate the prejudice and the stigma now we’re still learning the causes of mental illnesses but we already have effective treatments which have helped millions of people around the world in many cases these eliminate the symptoms of the person’s illness but in some cases they actually transform their lives earlier in my career I treated a young mother named Sarah and she suffered from panic disorder which had kept her house bound for ten years because she was afraid to go out a condition called agoraphobia to start I had to make house calls and visit her at home and when she opened the door to her home in our first meeting I saw before me this woman in a long black shapeless tunic with dark glasses and long dark hair she looked like Morticia from the Addams Family I began with exposure therapy and then gradually introduced medication and within a couple of months she was able to come to see me in the clinic but she insisted on sitting next to an open door with her bike perched just side so she could – at a moment’s notice but within a year she changed her attire she was fashionably dressed cut her hair she was going out with her husband socializing with friends and picking her kids up at school when he ended treatment she came to our last session and she came up to me and thanked me and she said I feel like I’ve been let out of prison like I’ve been given my life back now not all disorders have good treatments witness Alzheimer’s disease and autism and not all patients respond as well as Sarah does a particularly difficult condition that psychiatrist street is called borderline personality disorder this affects young people and produces extreme mood volatility self-mutilating behavior and stormy relationships with people the noxious nature of the behavior drives away family and friends and even psychiatrists are reluctant to treat patients one such patient that I treated was named Lori she was in her early 20s a waif-like girl with short hair large glasses a very fragile demeanor that could explode into volcanic rage and propel her into aggressive or suicidal behavior I worked really hard trying to help Lori and control her mood volatility and stop her from these self-destructive acts but the treatments I used the medications I tried have limited effects and when she dropped out of treatment I felt I really hadn’t done very much and I worried about what would happen for her so we don’t have treatments for every disorder and not all patients respond well but make no mistake there is indisputably a world of difference between modern mental healthcare today and what existed for all human history prior to the latter part of the 20th century so I find it particularly ironic that while people suffered from mental disorders throughout human history because of the fact we had no knowledge and limited or no effective treatments in the 21st century when we do have treatments the biggest barriers are lack of awareness lack of access to care and stigma so if there were no stigma we could launch a public health initiative against mental illness like we’ve done before successfully such as with infectious diseases with heart disease with environmental toxins like asbestos lead and smoking and we would begin with two simple strategies the first involves early identification and intervention and this involves having screening mechanisms in place in primary care settings like family medical clinics Pediatrics offices obstetrical and gynecologic clinics and offices and also in schools and in universities and also in the workplace and individuals who are screened for being at risk for or having symptoms of a mental disorder would be referred promptly to a clinic that’s specialized in providing the array of treatments that would be helpful to their condition the goal of this is to get people engaged early before the illness has effects on their brain disrupts their lives and risks them doing something that will be harmful to themselves or others the second strategy would be an approach of providing community-based comprehensive care for people who were already at more advanced stages of the illness and had suffered some disability this would include medical management rehabilitative services and also residential facilities to support people who can’t care for themselves and prevent them for falling through the cracks and ending up on the streets homeless or in prisons or sequestered in state mental hospitals so we have the means to do this and this would provide extraordinary changes in people’s lives in many many ways people who are depressed whose studies have shown suffer from symptoms of depression for up to 7 years before they get diagnosed and received treatment would not have to endure this and also at the time at the same time we’re there waiting to be diagnosed and treated risk the possibility of hurting themselves through suicide attempts or becoming addicted to something through misguided attempts at self medication people who experience trauma from violent crime or accidents or natural disasters would be treated promptly before they develop symptoms as they’re treated for their physical injuries instead of waiting for their symptoms of PTSD to emerge and then have them having to seek treatment and for people like the first responders and military personnel who go into harm’s way routinely as part of their job there would be preventive and decompression treatments routinely administered rather than waiting to see who develops symptoms and has to overcome the embarrassment of speaking up and seeking help people who are abusing substances would be encouraged and supported rather than blamed and shamed to seek detox rehab and maintenance treatment before intractable addictions developed and one in four women expecting babies would not have to risk experiencing a pre or post part of mental condition but would routinely be treated as part of their pre and postnatal care and so that they wouldn’t have to potentially endure symptoms potentially harm themselves or even god forbid infanticide and children who have learning disabilities or attentional problems would be identified early in their educational course and they would not just have remedial education they would have cognitive training emotional support so they didn’t become so frustrated at their failure in school that they resorted to anti social behavior and potentially ended up in prison now you might be thinking yourself okay that sounds good how much is going to cost can we afford to do all this well the reality is is that health economists have found that providing this kind of proactive mental health care would actually reduce the cost of delivering health care and result in enormous savings in addition the families of people with mental illness speed would be relieved of tremendous emotional stress and also financial burden we would also have the benefit from the fact that many of the glaring social problems that royal our society would be reduced or eliminated and I’m speaking here particularly about the mass violent incidents that have increasingly occurred too many of these incidents have been perpetrated by young males largely who were mentally ill and manifests their symptoms long before they committed their crime they acted strangely they were in emotional distress they were socially isolated but nobody reached out to them for help instead they were shunned ridiculed or feared in some cases families friends do reach out to try and get their family members or friends help take the case of Guus deeds a 24 year old man with bipolar disorder his father senator virginia state senator craves desperately sought to have his son who was in the throes of a psychotic episode hospitalized but to no avail subsequently gus viciously attacked his father and then killed himself so senator deeds is now left with scars on his face and pain in his heart instead of his son so how can we stop the suffering the violence the stigma we have to begin by recognizing mental illness for what it is a medical condition that can be treated like we do physical illness if you look around you when you saw somebody next to you who was grimacing in pain or passing out or choking you would brush up to them or you would ask them is there something wrong or can I help you but we don’t do this when we see somebody who’s emotionally distressed or acting strangely or too often intoxicated but that’s what we need to do we need to be involved show our concern don’t be afraid to ask make it your business what’s the worst that can happen I mean they say to you indignantly mind your own business or I’m fine thank you but the best that can happen is you may be able to get somebody help and alleviate unnecessary suffering and potentially harm to themselves or others now that will work for those around us that are close to us or that were with but to have an effect on the whole population we need to influence the government in the media either individually or through advocacy groups we have to make them understand that mental illnesses are real medical conditions and that we have effective treatments and these must be made available to people I’ve been trying to do this by speaking out publicly including to audiences like you and writing articles for the lay public in the media when Robin Williams died I wrote an article about suicide and I received an email in response that was titled message from a patient from very long ago and I’d like to share this with you dear dr. Lieberman last night I read your article about the suicide of Robin Williams and recognized your name you probably don’t remember me but between the ages of 15 and 30 I was severely mentally ill with borderline personality disorder and depression I made many suicide attempts and was frequently hospitalized one of those times I took a large overdose and awoke in the intensive care unit of st. Vincent’s Hospital you assigned to be my doctor and I clearly remember how very much you helped me you probably didn’t see it that way as I know I gave you a really hard time with my acting out and self-destructive behavior however eventually with a lot of treatment I was able to get myself together I got married enrolled in nursing school and graduated as valedictorian for the past 22 years I’ve worked in psychiatric hospitals when I look back at just how mentally ill I was early in my life I would never have thought it could turn out so well how very fortunate I feel to have a pretty happy life and so I just had to let you know when I remember most from when I was your patient is that you genuinely seem to care about me and didn’t judge but I suppose the best doctors are always the ones with a most heart signed Laurie so this was the same Laurie that I treated and feared for so long ago I was thrilled to know that she had recovered and to think that maybe I played some small part in this but what really struck me most about her email was the fact that it wasn’t my medical knowledge or my clinical skills that she can be remembered it was the fact that I showed compassion for her and compassion is something that we all can show to people including those with mental illness so while science and medicine continues to pursue the causes and the cures of mental illness I ask that you join me to find the heart and muster the will to reach out to all people particularly people who may show signs of mental illness to raise awareness of the public of the government and of the media to end the stigma of mental illness thank you for listening
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