The Shame of Mental Illness

Wednesday, October 7, 2009
I've been reminded by Hot Chick and thoughtful blogger Jeri that this is National Mental Illness Awareness Week. Jeri makes some very good points about how our culture addresses (or more accurately, does not address) mental illness, and how that's wrong on so many levels.

And she's right.

I want to make something perfectly clear. While I have been known to poke the whackadoos with a stick around here, I have nothing but empathy for those who struggle with mental illness, whether it's depression, OCD, substance abuse, or any of a thousand other afflictions. People with mental illness suffer in ways healthy people can't even imagine, and what makes it worse is the way that our culture sometimes looks at mental illness as shameful or as a weakness. Really? Well, guess what? People who have that attitude deserve a good whack in the noggin with the Shovel of Doom™.

There's really no end to the ways in which our society treat those who suffer from mental illness badly. We suck - let us count the ways:
  • Most health insurance plans don't cover mental health services, which leaves those who struggle with it to either go without treatment or pay out of pocket for the services they need in order to remain contributing members of society.
  • Those whose mental illness lead to criminal acts are given treatment in prison, but are essentially dropped like hot rocks when their sentence ends, leading to additional criminal acts, for which they're sent to prison...where they receive treatment. Really? This is the most cost effective model we could think of?
  • The science is immature. The brain is an incredibly complicated organ, influenced by a wide variety of factors such as chemistry, environmental issues, emotional history, etc., etc., etc. Identifying that there's something "wrong" with someone is the easy part - finding effective treatments is what's hard.
  • And even those who make their living treating mental illness sometimes can't be bothered to keep abreast of the actual SCIENCE associated with their vocation. According to a study by Psychological Science in the Public Interest scheduled to be released in November, clinicians are "failing to 'use the interventions for which there is the strongest evidence of efficacy' and 'give more weight to their personal experiences than to science.'" Yikes. Because evidently the scientific method is for those elitest scientists, not for us clinicians.
Seriously, America? Seriously? Can't we drag our sorry asses out of the 19th century when it comes to mental disease and the treatment of those who suffer from it? Can't we pull our heads out of our asses and realize that keeping people mentally healthy is to EVERYONE's benefit?

Any health care reform those self-serving twits in Washington come up with should include some protections for those who suffer from mental illness. Because the shameful part of this isn't that people suffer from mental disease, it's in how we, as a culture, treat them. Now that's some shameful shit.

7 comments:

Dr. Phil (Physics) said...

Though all are relevant, it's your first two bullet points that really fry my goat. Untreated, undertreated or Treat-and-Release mental illness spawns both more mental problems and societal problems. Needless suffering of the inflicted and their unfortunate victims is SO UNNECESSARY. Corporations and politicians who don't get this need to be put out to pasture.

(/rant)

Dr. Phil

Janiece said...

Dr. Phil, me too. And those assheads who say, "snap out of it!" to those who are ill just put me into a slow burn.

What, do they think these folks want to be miserable? Would they say something similar to someone who had been diagnosed with cancer, or a spinal cord injury?

"Snap out of it, you paraplegic! It's just a matter of will!"

gnash, gnash, gnash

WendyB_09 said...

One of my hot buttons.

And a very personal one at that. So much so that I can't really respond without frothing at the mouth and screaming at the heavens.

Short version is the stigma needs to come off mental illness and the people that desperately need to seek treatment for it. A person should not have to sneak treatment or avoid treatment for fear of losing their job if someone finds out about their illness or treatment.

Janiece said...

Damn straight, Wendy.

Being a vet, I have particularly strong feelings about that, as well.

John the Scientist said...

Of course I have to be a bit contrarian. :D

Not following scientific, evidence-based medicine is the prerogative of every licensed medical professional. That option is appropriate because a lot of studies, even good, well controlled studies, are not applicable to a given patient. Those studies have tight entry criteria, as I alluded to in my post on the alt-med stuff, and those entry criteria might have significant effects on outcomes.

Those entry criteria are in large part instituted to isolate variables (i.e. good scientific practice, not a means to make the treatment look good), so that one study can be compared to another.

However, the clinical trial population may have differences with the patient population-at-large, or with any specific patient (in the opinion of the medical practitioner) that make the trial results irrelevant, or at least less relevant, when treating in the real world. In this way, it may look as if evidence-based medicine is being cast by the wayside, when in fact, the clinician's experience is the most important factor in deciding what to do for the patient.

That being said, in mental health, there are a lot of competing factors. Some mental health physicians certainly are poorly trained, scientifically, and this is a problem.

An equal part of the problem, from what I've seen, is that the talk therapies that might be more effective are expensive. Mental health professionals are reimbursed at specific rate. They do a cost-benefit analysis in their head: I can get most of my patients at least half-way functioning with drugs, or I can get a few patients all they way to goal by talking to them - a lot, and lose money in the process because I only see one patient a day. Now which do you think they'll choose? People behave generally in a manner consistent with the way they are incented.

Finally, something I think the article completely glossed over in falling head-over heels for evidence-based medicine, is that entry criteria issue. Even beyond that, of all those who might be eligible, think about the kind of people who actually do volunteer for a clinical trial. They are motivated. They comply with treatment, they come to every appointment - and all the medical care they receive is free. The average patient, who is not quite so motivated, or hasn't been suffering as long (clinical trial participants are often long-time sufferers who enroll in the trial because they are tired of feeling bad) may not benefit from the expensive, time-consuming talk therapies so much.

I'm not arguing against evidence-based medicine - far from it (and you know why). But a clinician needs to be able to look at the patient population in a trial and say "this trial is not so relevant to my particular patient". Now, if the clinician is doing that for every patient, as some ascientific clinicians do, then there is a problem. But some clinicians practice in areas, poor inner cities, for example, where the relevance of many clinical trials is a bit questionable.

fireflame said...

I reaaly appreciate when someone with out a mental illness really shows empathy as you have so clearly in this post. Alot of people look at me and think wow you look fine why aren't you being more productive? Well lets see if I am over stressed I become symptomatic. Could you imagine saying to a cripple just get up and walk WOW how dare would anybody say that. Mental illness is debilitating in itself

Janiece said...

Welcome, fireflame.

I'm glad you're receiving the health treatment you need, and know the limitations of your disease.