Chronic Illness and Us:
Part IIIA: On Mental Health
First, a disclaimer. I have posted articles about helping friends who have either serious or chronic illnesses and what, in my experience, helps and works, and what doesn’t.
In the next few articles, I’ll be addressing mental illness. In no way am I an expert. No certifications, no degrees. I worked in the field at one time in my life, but that was long ago. I am n t writing this as an article based on a clinical perspective, but more on my personal observations on societal and cultural attitudes concerning mental illness I’ve seen and made note of throughout the years.
So, these are merely my opinions and, where applicable, facts, to support my observations. However, if it’s just an opinion, a belief, hey, I’m open to being dead wrong. And I’ll try and be careful and clear about which is which. Based on a lot of life experience, I think I have some things to say worth listening to. CYA: fait accompli.
At a Glance
There are no constraints on the human mind…except those we ourselves erect.~Ronald Reagan
Two women sat in a small diner, facing each other, but in separate booths. The windows were spotless and huge — a perfect view of a huge mountain peak, not too far in the distance.
One woman smiled at the other as their eyes met.
“Magnificent, isn’t it,” she said, indicating the giant formation in the distance. When she looked back at the other woman opposite her, she hadn’t noticed her eyes until that moment: bloodshot, weary, heavy, with dark bags underneath. The grief hung on her like a dark and pregnant storm cloud.
The woman with red eyes looked out the window at the mountain as she spoke.
“’Magnificent?’ It’s a monster. They officially called off the search for my husband and two sons this morning. They are presumed dead.”
***
So which woman is correct? Is the mountain “magnificent”? Or a “monster”? Well, I guess it all depends on which booth you’re sitting in. But the truth of it is, it can and is both, all at once.
Just like the human mind.
Magnificent Monster — Monstrous Magnificence
The human mind is magnificent. But to people who suffer from a mental illness, it can be a monster. We know so very little about the brain, its capacity, as well as its limitations, that the medical field of psychiatry, and different specialties within the mental health field as a whole, has been called an “inexact science.” That’s a polite way of saying that although psychiatric medicine and the study of human psychology knows a lot about the human brain, brain chemistry, and the many ways it can go wrong, yet there is no such thing as a sure-fire approach to anyone who suffers from a mental illness. For those who medicate to correct dysfunction, it’s an educated guessing game at best, and a shot-in-the-dark-Hail-Mary at worst. For those who deal in therapy, such as psychologists, social workers and other mental health professionals, it is an excavation to find key elements within an individual’s psyche that can or could lead them to root causes of certain problems and behaviors that impact the patient’s life in a negative way. So yes, for many mental health professionals, it’s indeed a monster, one they tangle with daily, to help the suffering live and have productive, healthy lives.
I asked a local neuro-psychologist, a man who has worked with the human mind for over 40+ years — I asked, “Why don’t they refer to mental illness as a neurological disorder?” He told me it’s because they don’t have an exact etiology for many mental illnesses, but then he went on to say that he feels the divide in the fields, which used to be more unified, has done a disservice to people. He further bemoaned the divide between psychiatry and psychology, which he also feels should be inextricable.
According to the National Institute of Health’s website:
During the 20th century, however, a schism emerged as each of these fields went its separate way. Neurologists focused on those brain disorders with cognitive and behavioural {sic} abnormalities that also presented with somatic signs — stroke, multiple sclerosis, Parkinson’s, and so forth — while psychiatrists focused on those disorders of mood and thought associated with no, or minor, physical signs found in the neurological examination of the motor and sensory systems — schizophrenia, depression, anxiety disorders, and so on.
During this time, conflicting theories emerged and a divide in the fields led to huge chasms in treatment theory and diagnostics. This led led to incivility, polarity, and the end of collaboration within the opposing fields. Those who opposed the divide, those who were for a more holistic approach to the treatment of brain, were ousted from both communities and eventually had to pick a side, or move on.
However, with recent advances in technology, the fields are once again converging, and the lines between neuroscience and psychiatry are becoming blurred and imprecise. This is good news for those suffering with mental illness, because for too long, when someone presented with a mental illness, in order to get diagnosed, it involved simply a meeting with a psychiatrist, reliance on self-reporting symptoms, and then a guessing game to finalize a diagnosis. That, or a crisis that forced hospitalization and treatment.
Even though there have been several diagnostic manuals attempting to harness the vast spectrum of mental illness and disorders, the DSM series has been replaced by the ICD-10 (International Classification of Diseases).
As with any physical illness, mental illnesses also present on a spectrum, relying heavily on not only biological factors, but environmental, cultural, co-morbid disorders and illnesses (not necessarily mental), chemical factors, and many other exigencies as well. To cover all the permutations would take too long, and is not the focus the mental health portion of my illness series.
Very quickly, here is a list of the main categories within the ICD-10 from Chapter V, focusing on “mental and behavioral disorders”:
- F0: Organic, including symptomatic, mental disorders
- F1: Mental and behavioral disorders due to use of psychoactive substances
- F2: Schizophrenia, schizotypal and delusional disorders
- F3: Mood [affective] disorders
- F4: Neurotic, stress-related and somatoform disorders
- F5: Behavioral syndromes associated with physiological disturbances and physical factors
- F6: Disorders of personality and behavior in adult persons
- F7: Mental retardation
- F8: Disorders of psychological development
- F9: Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
- In addition, a group of “unspecified mental disorders”.
There are more specific subcategories within each of these classifications. Also, the ICD includes personality disorders in the same domain as other mental disorders. This is different from the former DSM Axes classification system.
When I worked in the field, we used the DSM-IV. I was fairly adept at the terminology and systematic break-down of different diseases and disorders. Out of the loop for so long, I’m not as up to speed as I once was.
But I want to touch on things in these next few articles that directly impact us as a society, culture, and inter-personally, as well. First, some stats and a little history.
Rabid Diagnoses or Rabid Mental Illness?
I once heard a woman exclaim, “It seems like everyone has some kind of mental problem these days.” She was frustrated. And it might seem that way to many. We are frustrated, because nothing really seems to be working.
The truth is, 1 in 5 Americans experience a mental illness in a given year. Approximately 1 in 25 American adults will experience a serious mental illness in a given year that profoundly interferes or limits their functionality.
The reason it seems so prevalent now is because mental illness is now recognized by the AMA, among other medical associations, and they are continually trying to parse out and delineate causes, treatments and symptoms. With the advent of technology, information is at one’s fingertips. Mental illness is now recognized culturally and spoken about openly, so it may seem like some sort of weird outbreak. I know a lot of people with conspiracy theories about it: processed food; medications; pollution; the Illuminati. Welp, sorry to disappoint folks, but there are as many mentally ill people now per capita as there were in ancient times. We just know about it now thanks to Google and Buzzfeed (among other things…) That’s a joke. Lighten up, Francis.
The people who think mental illness is over-diagnosed “these days” are usually in one or more categories: 1) they don’t, and never have, suffered from a mental disorder and don’t know anyone who has, 2) they do, have, and are in denial, or 3) they don’t know their history very well. (Hint: #1&2? Yeah, kinda the same person.)
Mental illness has been around since the beginning of time, and early human beings kept records of “madness,” but used different language and beliefs to deal with it — or rather, explain it.
There was a time when those who suffered from mental illness were treated as prophets, “touched” by the gods. They spoke both the truth, and gibberish. (Read “Revelations,” KJV. Kidding, Believers, carry on.)
Then, as years, decades and time passed, those who were “touched” were believed to be “bedeviled” by Satan himself. At least those who were frightening and challenged their community in some way. The “treatments” were horrific and torturous — as well as ineffectual — because they weren’t treatments at all; they were usually things used to cure the sufferer’s “spirit.” And then others, who became hyper-religious within their mental illnesses were called “prophets.”
Some skeptics have called religious mystics who presented with symptoms of the stigmata, simply people with mental illnesses: everything from delusional to dissociative identity disorder, OCD, and even people suffering conversion disorders.
By the mid-1800’s, people who presented with mental illness were generally institutionalized in facilities akin to prisons, and treated just as cruelly.
Women were especially targeted for their mental “instability,” doctors citing a variety of causes such as:
-Menstruation-related anger
-“hysteria”
-pregnancy-related sadness
-post-partum
- disobedience
-anxiety
-chronic fatigue
-frigidity (Yes, it was the woman’s fault her husband couldn’t figure out “foreplay” or find her clitoris.)
After WWII, chemists began experimenting with medications to calm the mental “imbalances” in people. However, hospitalization was occurring at a staggering rate.
By the 1950’s, Mental illness was something that happened to “other people.” I remember a comic I read long ago, the name of the artist escapes me, but he wrote “When you have money, you are eccentric; when you don’t, you’re crazy.”
It wasn’t “polite-company talk.” People who were high-functioning and who suffered with mental illnesses often self-medicated — as a matter of fact, self-medication was and still is a widely-practiced way for people without access to medical care to treat their symptoms — or rather, mask or ameliorate them.
History cites many “eccentrics” who, at the time, and now, were and are considered “genius,” but were “touched.” There is a fascinating book by author Dr. Kay Redfield Jamison called “Touched with Fire,” about the many creative and artistic people throughout history who are and who have been, post-mortem, diagnosed as having a specific mental disorder, or more specifically, a mood disorder.
The 1960’s ushered in a pervasive push toward talk-therapy among individuals who were not impaired enough to need to be institutionalized, but who recognized they had a problem. People began exploring holistic methods of treatment, and the saying “get my head together” was de rigueur among people who sought a spiritual cure or treatment for what ailed them.
Labels emerged.
The mid-to-late 1970’s ushered in a new era of the Self-Help book market. In 1980, the book Feeling Good: The New Mood Therapy, by David D. Burns M.D. sat on every person’s shelf in America. We all wanted to fix what ailed us, in the privacy of our own homes and minds.
But people soon discovered that you can’t “think your way happy” if you have a true mental illness. The old “pull yourself up by your bootstraps” stoicism from our hard-working predecessors didn’t — and couldn’t — work for seriously ill people.
Major depression was surfacing in the public mind in the 1980’s and people were starting to talk about it. Actress and mental health advocate, Patty Duke, brought bipolar disorder to the country’s attention in the late ‘80s.
The 1990’s ushered in the era of ADD and ADHD children and adults. We put our kids on speed to slow down their minds and calm their thoughts. By the mid-2000s, somebody knew somebody who had something.
The Big 3
So of the mood disorders, organic, biological, but that present behaviorally and cognitively, (in other words, psychiatric illnesses without a co-morbid defect involving mental or developmental retardation), schizophrenia is conventionally, as well as acknowledged by the ICD-10, to be the most severe and disruptive of the psychiatric mental illnesses. Usually the person must be on medication in order to even have a semblance of a normal life. On the lower end of the spectrum, many people take medication and lead relatively normal, productive lives. Yet some, even medicated, are permanently disabled and in need of care, either in-home or inpatient care. Many are never able to fully integrate into society. There are many ways it presents, but I won’t go into them all here. However, schizophrenia became part of the public discourse during the 1970’s with the release of a popular book-turned-T.V. mini-series, Sybil.
So, for a while, people and the mental health profession conflated schizophrenia with MPD (Multiple Personality Disorder), but they have since been divvied up into different, separate, disorders. Of course it came out later that the subject of the book had faked her symptoms and the whole thing was a an elaborate hoax. Yeah. NOT awesome. Not MPD, but a PD for sure, somewhere, methinks.
Next, we have Bipolar Disorder, formerly known as “manic-depression,” which is also on a spectrum, ranging from cyclothymia (marked mood instability, but without serious life disruption — often people at this end of the spectrum don’t need to be medicated) to full-blown bipolar disorder I or II[1] which can include (in its most extreme form): ultra-rapid cycling, treatment-resistant depressive episodes, cognitive impairment, and sometimes, psychosis. This high-end spectrum of sufferers almost always need medication, usually a mood stabilizer, often antidepressants (although study after study has shown that antidepressants for bipolar depression have little or no positive effect on bipolar depression) to function inter-personally, socially, and professionally.
Major Clinical Depression is considered the third most severe. I don’t need to tell you anything you don’t already know on this. Right?
Public Depression, Depressed Publicly
It’s no longer shameful to admit you battle major depression. People nod their heads sympathetically; a token hand goes on a shoulder. They say, (try this with a New Jersey accent) “I had a cousin…” (friend, aunt, sister, horse, you name it.) Oh yes, they all understand what a bummer depression is.
But you don’t know…until you know.
Although the public is slowly coming around, there are still some old-school die hards who believe depression is for the weak of character and/or for those bereft of ___(insert religion, God, intestinal fortitude, spirituality, gratitude, yoga, raw food diet, etc.) or they were viewed as people needing attention. Before being diagnosed as severely clinically depressed at 17 years old, my mother used to tell me to “count my blessings” when I told her how sad I felt. While good advice, it does not completely eradicate a major depressive disorder. We are still very judgmental about who we allow to have depression — who gets a social and cultural “pass.”
I saw this picture on Facebook on a friend’s timeline. Her comment on it was, “I wish that was the hardest part of my day!” or something to that effect, and then she followed up with a hashtag: #firstworldproblems.
I responded, gently. I told her to look at Angelina’s face. This was the face of a person who knows suffering. I hashtagged my comment: #compassion.
If you are wealthy, beautiful, young, famous, thin, sexy, or in any other way considered “privileged,” you run the risk of harsh societal judgement if you admit you struggle with depression. Some people tout celebrities who come forth as “brave.” Others, like my friend, can’t possibly see how a woman who seems to “have it all” could possibly have problems with depression, given how successful and “cushy” her life must be.
Yet, I think we are all aware enough to know that there is no amount of fame, beauty, money, wealth, social standing, or even social inclusion that fends off depression. It is a biological condition. It’s as silly to say Ms. Jolie is immune to depression as it is to say she would be immune to cancer — and we all know what she did to avoid that.
Some people are genetically predisposed to depression. But it’s not that simple. Sometimes a life event, such as divorce or death of a loved one, can initiate a major depressive episode. Once you have lived with the external stressor long enough, the depression may be hard to shake. That’s because, in layman’s terms, our brains develop neural-pathways that feed into, and ultimately create, the physiological condition: the depression is no longer based solely on external circumstances, but becomes, physiologically, a part of your brain.
Many people decide to go on medication to help with their depression or anxiety that often accompanies it. While I won’t weigh in on that here and now, I will say that whether a person decides to go the pharmacological route or not, the doctor prescribing the medication is, in my opinion, derelict in his duty if he does not strongly encourage the individual to also seek a licensed therapist for “talk therapy.” And if you do decide to take medications, learn ALL YOU CAN about the side effects. Google the SHIT out of it. Read the medical journals, the studies, AND go to the message boards on mental health, boards that have people’s experiences. More on this to come in an upcoming article.
Cognitive-behavior therapy (CBT) or psychotherapy, formerly referred to as psychoanalysis, is as effective — or even more effective, than medications alone. In fact, I would posit here that medication alone will not change your brain chemistry unless it is coupled with talk therapy. CBT and psychotherapy are different approaches, and the person seeking help should understand the differences and search for a provider who will best suit his needs.
I can’t stress this enough — talk therapy is incredibly important if you suffer from a mental disorder. Study after study has shown how it not only helps people cope with the disorder or illness, it also literally changes their brains. It teaches them emotional intelligence and self-awareness. Coping mechanisms and how to mitigate the negative impact the disorder has on his or her life. Too many people are biased or outright hostile to therapy. They have seen things go wrong, have had bad experiences, have NO experience, or believe bad experiences via popular media. And of course, there’s also the always-oh-so-reliable anecdotal influence, “I had a cousin…” Trust me, there are good therapists out there, and there are bad ones, just like any profession.
Also a word of advice: you shouldn’t settle for the first person you see if it doesn't feel right. Interview therapists. Check their credentials. Check their specialties. Most importantly, if you don’t feel a rapport with them within the first 1–2 sessions, start looking for someone else. It’s delusional to think you will instantly “click” with the first person with whom you meet. Like any relationship, it takes time to develop trust. But also like any relationship, you will know in a fairly brief amount of time if you and this person are compatible — if they are a good “fit” for you.
Whew. That’s A Lot.
Yes, I’ve touched on a lot here — touched…actually glanced on it: history and historical attitudes; basic stats; the fracturing of the different sciences and the impact it had on people suffering from mental illness; some definitions and accepted terminology, and the “Big 3” of mood disorders. I spent a little time on cultural attitudes concerning depression, as well.
Just wait until we get to Personality Disorders. Gah. But for now…
Coming up next, I’ll be addressing the second major mood disorder, bipolar disorder, and how the illness has been portrayed in the media, how it’s been seen historically, culturally, as well as how the illness impacts people on a personal level.
Until next time …
Peace to you —
J.A. Carter-Winward
Coming Soon:
Chronic Illness and Us:
PART IIIB: On Mental Illness —
How Break-Ups Magically Make People into Mental Health Pros
[1] According to ICD10Data.com, there are 10 parent sub-categories of bipolar with many differentiating sub-categories within each parent. Bipolar I is considered more difficult to manage and more disruptive in the GAF (Global Assessment of Functioning Scale) Scale than bipolar II.
