Bipolar 2 From Inside and Out

Posts tagged ‘politics’

Is Stigma a Problem? Is Systemic Breakdown?

Some people who have mental illnesses say that stigma is a problem. Others say that’s not the real problem – a lack of social or political action is. I say, why not combine the two?

Stigma Fighters (https://stigmafighters.com/) and other organizations such as the International Bipolar Foundation (ibpf.org/), the National Alliance on Mental Illness (NAMI) (https://www.nami.org/Get-Involved/Pledge-to-Be-StigmaFree), and even Facebook groups, promote the eradication of the stigma surrounding mental health issues. They say that mental illness is stigmatized in our society – some even deny that it exists – because people don’t understand it. This happens when churches say that mental illness is a sign of sin or refuse to welcome people with mental problems into their congregations or have any kind of outreach to them. It happens when a person is honest about having a mental illness and tells her boss or friends about it and receives negative feedback, incomprehension, or the back-away-slowly-and-don’t-make-eye-contact look.

People who believe that stigma is a problem say that stigma is one of the largest reasons that people refuse to seek treatment for their mental disorders. Being seen going into a psychiatric clinic, people finding out that the person sees a psychiatrist, and being ignored or discounted when talking about mental illness are seen as ways that stigma propagates.

People who believe that stigma is a problem promote education as the main solution. If more people understood what mental illness is and how many people suffer from it, they would be less likely to discriminate against those who have mental conditions. Stories about celebrities who have mental dysfunctions or whose relatives do are considered inspiring and helpful. Stars who speak out encourage others to seek treatment (though it’s increasingly true that public expressions of mental illness diagnoses are tied to specific online therapy businesses).

People who believe that political action is necessary also try to effect changes in people’s thinking, but, more importantly, support changes in the systems that are supposed to provide services to the mentally ill. These systems include schools where mental illness plays no part in the curriculum; lack of beds for psychiatric patients in hospitals; the response of police to calls regarding people with mental disturbances; the number of medical schools that provide no information to doctors; the lack of psychiatrists, especially in rural communities, which mean people must wait a long time for services or have no access to them at all; politicians who put mental health issues low on their list of priorities; law enforcement that reacts with deadly violence to calls involving persons with mental illnesses; and health insurance and EAP (Employee Assistance Programs) that treat mental illness differently than physical illness or even addictions. NAMI promotes grassroots activism as one facet of the appropriate response to such problems (https://www.nami.org/Advocacy/Advocate-for-Change).

People advocating for political change also see education as one partial solution to the problems caused or exacerbated by insurance companies, educators, medical schools, media, law enforcement personnel, correctional facilities, and politicians. Political action is seen as the right course to take to improve conditions. (Though it should be noted that people have sent books about the breakdown in societal responses to mental illness to politicians and receive only standardized, unhelpful “thank you” letters that are mostly signed and sent by staffers rather than the political figure.)

I say that education is the best response to both of these problems. Education of the general population about the realities of mental illness will lead to less stigma. Education of the voters, their representatives, and their local communities will help to lessen the inequities and difficulties that now abound.

This will not be easy. Education about the realities of mental illness is hard to convey to either citizens at large or politicians and others who have some degree of authority. Until it touches their own lives, people will largely be blind to the problems. Educational campaigns and the testimony of celebrities may help educate individuals. But politicians are likewise only affected by the aspects that touch their own lives, such as the public revelations by those like Kitty Dukakis (wife of former presidential candidate Michael Dukakis), who has been quite open about her mental difficulties and her ECT treatments (https://www.amazon.com/Shock-Healing-Power-Electroconvulsive-Therapy/dp/1583332839).

What I fear is that these individual occurrences will motivate only a small number of people enough to make a change in society as a whole. It’s easy enough to say, “Oh, Catherine Zeta-Jones has bipolar disorder. Too bad for her, but that doesn’t affect me” or “Someone in my family has a mental illness, but my constituents won’t support legislation to benefit the homeless mentally ill or to provide halfway houses in their neighborhoods. Better to spend my time and influence on stopping terrorism or drugs.”

But until or unless something changes, mental health will still be swept aside or ignored outright. People at large need to understand that just because mental illness hasn’t touched their lives so far, it still could in the future. Public officials and public servants need to believe that mental illness issues are vital to their communities and something that can be made better if only they have the courage and compassion to make the necessary changes.

Stigma-fighting or political action? Both are problems that need solving and education is at least part of the solution to both. And it appears that it’s up to us, those who have mental illnesses, to do the educating.

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Category:

Mental Health

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Mental Illness or Autism?

The other day I inadvertently created a firestorm on facebook. Someone posted: Question: What makes schizophrenia a mental illness and autism not a mental illness? Answer: Politics, advocacy, and marketing.

I didn’t understand the thrust of the post, so I asked a question: “Are you saying that autism should be classed as a mental illness or that schizophrenia shouldn’t be?”

Then the floodgates open. There were over 100 responses to the post, of which mine was just one. They ranged from “autism is not a mental illness” to “autism is a form of mental illness” to “autism is a developmental disorder” to “schizophrenia and autism are both neurodivergent conditions.” Few, if any, seemed to address the original question of politics, advocacy, and marketing. (I have no knowledge whether any of the responders were medical or other professionals; persons with one or the other diagnosis; or family members of those with the, let’s call them conditions for now.)

Some people responded that the term “mental illness” should not be used, because it was inaccurate, or stigmatizing, or both. They found the phrase “mental illness” offensive. “Mental disease” was suggested as a better alternative, though for the life of me I can’t see much difference between them. To me, “illness” and “disease” mean basically the same thing. One can go down the rabbit hole here. Is MS a condition or an illness or a disease or a disorder? Is a broken leg a condition? It’s certainly not an illness – unless it gets infected – or a disease. Someone said that mental illness implied a permanent condition, rather than a challenge that can be treated. My bipolar disorder can certainly be treated, and is. But it is also a permanent condition.

Some of the phraseology that was most often used to define autism were neurodivergent, neurological condition, developmental disorder, neurological condition that often presents with mental illness like anxiety. But neurodivergent was also used to described schizophrenia, which was sometimes linked to brain anatomy and genetics. Some classed them both as “disorders of the brain.”

Others pointed out societal or functional differences or other definitions – schizophrenia can be used in court for a “diminished capacity defense”; autism is listed in the DSM-V (Diagnostic and Statistical Manual, considered by many the gold standard for definitions and symptoms of mental illnesses); the age of onset for autism is three, or three to 18, while schizophrenia is usually diagnosed at 18 and over, but not always; autism used to be called childhood schizophrenia; schizophrenia is caused by over-pruning of the neurons, which disrupt the normal growth of the brain; ASD could be a result of disruptions in normal brain growth. Someone pointed out that with both autism and schizophrenia, there are different levels of severity.

Various books and articles were cited. Challenging questions were asked: Do those who insist that autism is not a mental illness think having a mental illness is shameful, whereas having autism is not shameful or perhaps is not an illness at all. Others considered treatments: Medications can help with mental illnesses but are not generally prescribed for autism. People with one or the other condition do not qualify for treatment.

And some responses were entirely cryptic: B careful what you wish 4.

But back to the original post. I think the poster was trying to say that the autism community did a better job of spreading the word about the condition and thereby defining it, in this case as not-a-mental-illness.

And it’s true that – whatever you think of them as an organization – Autism Speaks has gotten the word out about autism. They excel at awareness (of themselves as well as autism). They organize huge charity walks. They have numerous TV commercials. Their puzzle piece symbol – again, whatever you think of it – is for many the easily identifiable graphic that says, “autism.”

Mental illness, whatever you prefer to call it, does not have that same kind of presence in the public eye. For one thing, there are so many different conditions that it’s hard to choose one to spotlight. Depression seems to be the condition-du-jour. The conversations around it are that anyone can have it and there is help available, which is all well and good. But the vast majority of these messages come from people who are selling or associated with medications or call-a-therapist lines – money-making operations. Nor do the ads always get depression right, many making it seem like no worse than a mild hangover.

SMI (serious mental illnesses such as bipolar disorder and schizophrenia) are only now entering the public discourse, and again, mainly for advertisements of drug treatments. The ones for schizophrenia seldom discuss any symptoms of the disorder – they just show a happy person playing a guitar or some such desired outcome. They don’t convey much about the condition of schizophrenia, its symptoms, how it affects families, or much of anything else.

As for other psychiatric conditions, there is much silence. PTSD is discussed, but only of the “wounded warrior” variety, not the kind that can result from other traumas. Anorexia/bulimia, OCD, social and generalized anxiety, narcissism, and the whole spectrum of personality disorders get little to no screen time.

There is growing discussion about things society – and especially first responders – should know or do about people with psychiatric conditions, but those are largely at the talking stage and a few pilot projects. When the subject hits TV, it is usually triggered (sorry) by an individual incident and is more likely to involve unorganized protests rather than coordinated efforts to address the larger problem. And at times, it seems that no one is listening.

Especially to the people with “forgotten” mental conditions – those that don’t have drug treatments or celebrity proponents or coordinated responses. It’s not that I think autism doesn’t deserve the attention it gets – though clearly there are more discussions to be had around the subject. I just sometimes despair of getting attention for mental illnesses.

But to go back again to the original post, mental illness and autism are two different things that cannot be easily compared. But it is true that autism, at the moment, has an organization with a loud voice behind it. Mental health, not so much.

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Mental Health

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Mental-Illness-and-Drug-Abuse

One thing I’ve noticed about all the political rhetoric about plans to deal with mental illness is that they always lump it in with drug abuse. Like the two were the same thing. Like the solutions are the same. Like the causes are the same. Like the two are somehow related.

It’s true that many people with mental illness have substance abuse issues. And lots of drug abusers also have mental disorders. But people with varicose veins also have acid reflux. That doesn’t mean they’re related.

Of course there are similarities. Drug abuse seems to be controlled by the pleasure or addiction centers of the brain. And mental illness has to do with a malfunctioning brain. But just because the same organ is affected doesn’t mean the causes – or the treatments – are related. The causes and treatments for the lung ailments cystic fibrosis and asthma are not the same.

The various conditions that we call mental illness may be centered in the brain, but we’re a long way from knowing exactly where. Serotonin receptors? Maybe. Other neurotransmitters? Possibly. Drug treatment seems to work by trial and error, at least in my experience. Every time I’ve asked a psychiatrist how a psychotropic medication works, the answer is invariably “We don’t know.”

Treating drug abuse with other drugs is counterintuitive. Besides, it largely doesn’t work. Antabuse merely makes alcoholics so sick when they drink that they prefer to remain sober. Narcan can pull an opioid abuser back from an overdose, but it does nothing to prevent the next one. And methadone has its problems as well, especially since it’s an opioid too.

Many people break the chains of alcohol or drug addiction with the help of 12-step groups. Such groups have no effect on serious mental illness. Even therapy groups have limited results with people who suffer from psychiatric brain disorders. Support groups can help some of them cope with the problems associated with mental illness, such as loneliness, frustration, fear, and, well, lack of support. But healing is a hard thing to come by, and seldom is found in a circle of people with similar severe psychiatric conditions.

Part of the 12-step approach to addictions is surrender to a Higher Power – not technically the Judeo-Christian God, but the functional equivalent for most. God has not proven to be a reliable cure for mental illness, though of course prayer can help sufferers deal with their suffering and find comfort amid their troubles.

So why do politicians make the assumption that what will be good for one condition will be equally effective for the others? That funding directed at mental health problems and drug abuse can be used for the same types of treatments and treatment centers? Admittedly, politicians are not generally well educated about either mental illness or drug addiction. That’s why they have advisors, who should be able to explain the differences and the nuances to them. And that’s why there are organizations with members who have studied the problems – or who struggle with the conditions themselves – who can inform those who control the pursestrings as well as the general public about what is needed.

It’s convenient to want to deal with mental illness and drug addiction in the same way. Treatment centers, hospital beds, and halfway houses may play a part in dealing with both problems. But hospital beds for detoxing, for example, are different from hospital beds needed for those with serious mental illnesses such as schizophrenia or psychosis, which may necessitate a long, difficult stay.

This is not the place to discuss involuntary commitment or AOT (assisted outpatient treatment, also called “outpatient commitment,” a form of involuntary treatment in the community) for severe mental illness, except to say that involuntary commitment is not an option applied to drug abusers, however much the conditions are conflated. They are complicated issues, and ones that I am not qualified to speak to.

But until we can convince people, and especially those who pull the political strings, that alcoholism, drug abuse, and mental illness are separate subjects that need different kinds of attention and support, we won’t make sufficient progress on either problem.

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Mental Health

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