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Posts tagged ‘mental illness in the news’

Does It Help When Celebrities Talk About Mental Illness?

It usually doesn’t hurt.

But how much does it help?

That depends on who is talking about mental illness and what they say.

Celebrity Activists

We need more mental health advocates like actors Carrie Fisher and Glenn Close. Both of them have spent years talking about their own and their loved ones’ experiences with bipolar disorder and schizophrenia. Neither one is a one-benefit-and-they’re-gone supporter. They repeat their vital messages again and again, in different ways, in different venues, in different words. Carrie Fisher, in particular, used her mega-star power and witty personality to keep the discussion alive and spread it to millions of people.

Active Celebrities

While not devoting as much time and attention to mental health activism as Fisher and Close, other well-known entertainers including Demi Lovato and Lady Gaga have made contributions to the public discussion on various mental illnesses. Because of their large number of fans, these messages reach millions of people. And their music reaches people at an emotional level that PSAs just can’t. If even a small percentage of their audiences pays attention to the messages, that’s a lot.

And we can’t forget Prince Harry. Positive messages about mental health coming from royalty are ones that people will listen to. (You know how we Americans love royals.)

Celebrities

Other celebrities mention their mental health diagnoses in public, but do little more to campaign for mental health causes. Catherine Zeta-Jones spoke of her bipolar II diagnosis when she was hospitalized for five days, saying that it was brought on by stress. And renowned glass artist Dale Chihuly admitted his bipolar disorder when he was more or less forced to by a lawsuit.

Staying quiet certainly is their right. Mental illness is a deeply personal and to many, a private thing. And celebrities as much as any of us must struggle with when and how and to whom to reveal their struggles. Perhaps in the future they may become more comfortable talking about their problems and contributing to mental health causes and organizations.

Suicides

Unfortunately, suicides speak loudly. Robin Williams’s death by suicide made a big impression. It got people talking – if only to ask “why?” Though a lot of the conversation revolved around “Even funny people can have suicidal depression,” that’s a start on the message that you can’t tell who’s suffering inside just by looking at them. It’s just too bad that the death of a beloved entertainer is needed to start that discussion.

Media

Are the media “celebrities”? A few individuals truly are, But as a group, the media have the largest platform of all. And what do they say about mental health? I think you know the answer. Mental health gets discussed in the news media in cases of terror and tragedy, and when no other explanation comes readily to mind.

The media bear a huge responsibility when it comes to stigmatizing mental illness. Theirs are the only messages that many people hear – and believe. The news media have (or at least used to have) a reputation for spreading the truth. Nowadays we can’t even count on that. The splintering of the news media into “sides” to promote opposing ideologies – combined with shrinking budgets that have nearly eliminated informed science reporting – make it difficult for the average news consumer to know who and what to believe.

Who does that leave to spread the message? Us. Those of us who live with mental illness or have loved ones who do. And sometimes I worry that we are talking mostly to ourselves – to each other. Don’t get me wrong. Those conversations are vital in helping one another deal with our difficulties and sharing messages of support and understanding.

But maybe we can do more – even if it’s educating a family member about depression or wearing a semicolon tattoo to promote suicide prevention or posting/commenting on social media when a news outlet has gotten its coverage of mental illness all wrong.

Among my fondest hopes is that one or more of my blog posts will be passed along to someone who needs to hear the word. “Here – read this,” is a message I would be proud to spread, even though I’m no Carrie Fisher.

The Latest Headlines on Mental Illness

There’s a wonderful article, originally in The Telegraph, with the title “Can Depression Be Treated With Anti-Inflammatory Drugs?” Snopes.com, the preeminent debunker of all things dubious, proceeded to do what they do best – debunk. In their analysis, they find several factors common to many widely reported studies that illustrate why we shouldn’t take these announcements of causes or cures at face value or at least without a grain of salt.

They break down their reasons for not jumping on the study’s bandwagon into three major categories.

No Credible Scientists Have Argued that All Depression is Caused by Inflammation. The article in The Telegraph was talking about patients with Major Depressive Disorder (MDD) who were not responding to current medication, or who also had other inflammatory-related conditions such as rheumatoid arthritis (RA). And the information came from just one talk by just one scientist,

Association is Not Evidence of Causation. I’ve written on the subject before (http://wp.me/p4e9Hv-7Z, http://wp.me/p4e9Hv-9L), and included a link to a short video that explains the scientific process, from original study up to the time when a new drug or treatment hits the market (http://www.vocativ.com/culture/junk-science/). Briefly, it means that just because two things are correlated (or happened one after the other) does not prove that one caused the other. Inflammation may have caused depression, or depression may have caused inflammation, or other factors may have influenced one or the other, or both, or neither.

The Anti-Inflammatories Discussed Are Specific, Powerful Drugs with Side Effects. You can’t just go down to the corner drugstore and pick up a bottle of ibuprofen and think you’ve solved your depression problem. And it turns out that the anti-inflammatories they’re talking about increase the risk of infections and cancers, and are wildly expensive.

Snopes concludes:

While the science discussed by the Telegraph in this article is real, it omits seriously important context and misrepresents decades-old research as a breaking development in a way that could provide false hope to those suffering from depression. The interplay between the immune system and the mind is increasingly well established, but that doesn’t mean that science has established anything close to a new treatment for depression as a result of this understanding.

“False hope.” That’s what a lot of these headlines regarding causes and treatments for depression offer. Shall we look at another recent example?

This one, I’m sorry to say, comes from bp magazine (bphope.com). The headline is “Underlying Molecular Mechanism of Bipolar Disorder Revealed.” The tagline reads, “Findings inform development of potential diagnostic test and improved therapies.”

But that’s not exactly true. The first paragraph says nothing about the underlying mechanism of bipolar disorder. Instead, it talks about the mechanism “behind lithium’s effectiveness in treating bipolar disorder patients,” something very different. But that doesn’t make as snazzy a headline. The article also says the results “may support the development of a diagnostic test” and “may also provide the basis to discover new drugs that are safer and more effective than lithium.” May. Might. Or might not. Too soon to get your hopes up.

The conclusion? [T]he study demonstrated that bipolar disorder can be rooted in physiological—not necessarily genetic—mechanisms.” Well, I’m a word nerd, not a science geek, but “can be” is a far cry from “is.”

Now for my favorite, reported by the BBC: “Magic mushrooms can ‘reset’ depressed brain.” Again, the tagline says “raising hopes of a future treatment,” which is a pretty far stretch. The study was performed on 19 subjects, each given one dose of psilocybin. The article reports that “Half of patients ceased to be depressed and experienced changes in their brain activity that lasted about five weeks.”

So. Tiny sample. No control group. And flip a coin on the results. Personally, I don’t see that raising much hope.

Bottom line for this one: junk science. Eye-catching headline. They won’t be handing out magic mushrooms at the local mental health clinic anytime soon. (The article does warn not to self-medicate.)

We’ve been hearing for years about tests to diagnose depression and bipolar, and stunning new treatments. Well, the studies take years to do properly; the tests need to be proved accurate and better than current psychological testing; and the treatments must go through years and years of studies, animal testing, and human testing, complete with control groups and sufficient numbers of subjects to make them scientifically significant.

I just wish these people would quit reporting “results” until they have some to show.

 

Resources

http://www.snopes.com/2017/09/19/can-depression-treated-anti-inflammatory-drugs/

https://www.bphope.com/underlying-molecular-mechanism-of-bipolar-disorder-revealed/

http://www.bbc.com/news/health-41608984?utm_source=dlvr.it&utm_medium=facebook

Andrew Tate Doesn’t Get to Define Depression

“Depression isn’t real. You feel sad, you move on. You will always be depressed if your life is depressing. Change it.”

Now, before you jump all over me, let me say that I never said that. It’s a tweet from Andrew Tate, kickboxing champion and former star of “Big Brother UK.” It caused quite a stir in the Twitterverse and was immediately challenged by, among others, J.K. Rowling and Patton Oswalt.

Obviously, there are a few things wrong with Tate’s opinions. First, the notion that depression isn’t real. To quote Hemingway, “Isn’t it pretty to think so?”

The millions of us with major depressive disorder and bipolar depression would love it if our disorder weren’t real; if we could just move on. If we could only change our lives. Kick depression out of our heads, as we should be able to, according to the kickboxer.

And Tate threw more fuel on the fire. He tweeted “MY DEPRESSION INBOX. Is hilarious. Full of crybabys. . . .”

Admittedly, many depressed people cry. But that doesn’t make us crybabies. Babies stop crying when their needs are met. People in the throes of depression don’t really know if their need for it to stop – their need for, if not happiness, at least not-despair – ever will.

When I first became clinically depressed I was a child and knew nothing about clinical depression. But I knew I was profoundly depressed. And I knew that if I waited long enough, that depression would lift. Being undiagnosed and unmedicated, I had no idea when I would come out of depression. All I could do was wait for it to happen.

Now older and wiser (and diagnosed and medicated), I know some things I can do to shorten that time until the depression lifts. I can practice self-care. I can call my therapist. I can turn to my husband. Now I know – really know and understand – that my depression isn’t forever, even if my disorder is.

And I know that, if I have to, I can push through depression instead of waiting for it to ease up on its own. Meeting my self-imposed blogging deadlines is one way I do that. Paying the mortgage and power bill is another. In some way those are both life-affirming activities, or at least statements that I am still connected to the world – however fragilely – and that I want and need to come out of the depression and get on with my real life.

It’s ridiculous to say “move on” or “change it.” Depression comes and goes when it wills. All we can do is endure it and keep pushing back until it gives the tiniest toehold. Then take that tiny purchase and push some more. It’s the hardest thing in the world when depression has sapped your energy, but believe me, there is more inside you somewhere. It may just take a long while to find it and to recognize it. We can no more change our depression than we can our souls. We can push back against it.

So screw you, Andrew Tate.

And screw you, depression.

 

 

Are Political Extremists Mentally Ill?

Yes.

Well, some of them are. Given that one in four of Americans experiences a mental or emotional disorder at some time during their lives, 25% of any given group either are, have been, or will be affected by mental problems. Politicians. Girl Scout leaders. Chefs. Whoever.

Of late, though, it seems that political extremists – and politicians, of course – are being singled out for accusations of mental illness. And as for terrorists, they are in common understanding all mentally ill, so anyone you label as a terrorist is automatically insane. But we’re far from agreeing who is and is not a terrorist. (Antifa? Greenpeace? The NRA? The DAR?)

Admittedly, some of the extremists’ actions and statements seem “crazy,” but let’s stick to the more technically correct “mentally ill.”

Except it isn’t technically correct in most cases.

A lot of people seem paranoid these days. Everyone on the “other” side is out to get them, destroy America, or at least scare the pants off us. Conspiracy theories abound. And nearly all of them are crazy. (I wrote about this a short while ago: http://wp.me/p4e9wS-AH).

But “paranoid” is a clinical term in psychology, and it has a specific meaning: Paranoid Personality Disorder is a psychiatric condition, manifested by, among other things, “generally unfounded beliefs, as well as … habits of blame and distrust, [which] might interfere with their ability to form close relationships,” as WebMD says.

Those traits your political or social opponents may have, but most of them don’t also:

  • Read hidden meanings in the innocent remarks or casual looks of others
  • Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate
  • Have recurrent suspicions, without reason, that their spouses or lovers are being unfaithful

Diagnosis at a distance is dangerous, as well as bogus. The fact is that none of us (except perhaps psychiatrists) can diagnose a person as paranoid or any other variety of mentally ill without having met the person and performing detailed interviews and tests (I’ve written about this too: http://wp.me/p4e9Hv-6F).

This is also true of public figures. We can say that Donald Trump, to choose an example not entirely at random, has narcissistic traits; or is a narcissist in the garden-variety, non-technical meaning of the word; but we cannot say that he has Narcissistic Personality Disorder, an actual clinical diagnosis. We may think he’s crazy, but we can’t say whether he’s mentally ill.

Public readiness to label people, both acquaintances and public figures, with loose pseudo-psychiatric terms raises a number of problems, particularly stigma.

Labeling is a convenient way to dismiss a person who disagrees with you without listening to what he or she has to say, or considering the possible validity of an argument or even a statement of fact. If we apply a label, we make an assumption about a person that may or may not be true.

Stigma comes with the label mentally ill. People with diagnosed mental disorders are too often assumed to be violent, out-of-control, homicidal (or suicidal) maniacs – and therefore not worth listening to. In fact, many people with mental illnesses have no impairment in their cognitive function. It profoundly devalues them to dismiss them from political and social topics of conversation.

So, bottom line. “Those” people may be crazies, may act crazy, talk crazy, believe crazy things, but it is not accurate or helpful to call them crazies. Neither is it helpful to label someone who has never been diagnosed or has never been open about a diagnosis as mentally ill.

I just think that how we talk about people affects how we treat them. And that matters.

I Don’t Care If They Discover the Cause of Bipolar

Recently there have been several so-called “breakthroughs” in discovering the cause of bipolar disorder.

And I really don’t care.

Whatever they decide the cause is, I still have bipolar disorder. No matter if it’s toxoplasmosis, gut bacteria, or faulty synapses that are behind it, I still get to experience the lows and (sometimes) highs, the apathy and psychological pain, the weeping and despair, the irritability and touchiness, the anxiety and the gloom.

Knowing the cause will not alleviate my symptoms one bit.

I know that people believe that discovering the cause will bring us that much closer to a cure.

But will it really?

If the cause is genetic, how am I supposed to go back and change my genes? Or does anyone really believe that gene therapy will be available to the mentally ill when even hospital beds are denied them?

If the cause is viral, does that mean that a cure is right around the corner? We now know what virus causes AIDS – HIV was discovered in 1983 – but nearly 35 years later, a cure is still far away. Yes, there are treatments that improve health and extend life, but there are also treatments that alleviate some of the symptoms of bipolar disorder. Will any advances be orders of magnitude greater, or merely incremental? And how much money will be devoted to finding those treatments when Huntington’s disease, multiple sclerosis, and a host of other conditions are still without a cause, a cure, or sometimes even minimal treatments?

With most bipolar sufferers being treated (if at all) in community mental health centers, via EAPs, or through six-weeks-and-out insurance programs, what are the odds that any new breakthroughs and any new treatments that result will be available to the bipolar-on-the-street (or in the group home or even at home or at work)? Will someone really arrange MRIs or TMS or brain implants for the homeless?

With bipolar disorder once again considered a pre-existing condition and not given parity with physical ailments for insurance purposes, will any advances trickle down to us at all?

What do you want to bet that any breakthroughs regarding the causes of bipolar disorder will lead to more pharmaceutical research and yet another pill that costs more than the average person can pay or the average insurance will reimburse? And how long will that treatment take to get through the FDA pipeline to reach the people who need it?

Nor is knowing the cause of a disorder necessary to cure it. Isaac Semmelweis didn’t need to know the cause of childbed fever, a disease that killed thousands – perhaps millions – of new mothers. Germ theory wasn’t even developed until decades later by Lister and Pasteur. But Semmelweis knew that if only doctors washed their hands between conducting autopsies and putting their hands in pregnant women’s vaginas, the death rate would decrease.

So when I hear that there’s a new theory on the cause of bipolar disorder – and they seem to be coming with increasing frequency – I say, “Where’s the treatment? Where’s the cure? Who will be able to access it? Who will be able to afford it? When will it produce positive results for me and those like me?”

Get back to me when you’ve found something that will help. Until then, keep splicing your genes and culturing your bacteria and stimulating your synapses. I’m getting pretty good results with what you’ve already discovered. For now.

Don’t keep raising my hopes until you have something more than “mights” and “some days.”

 

 

Discrimination: Mental Illness and Disability

A while back I wrote a post called “Another Word for Stigma” (http://wp.me/p4e9Hv-oz), which was about the new-to-me term “sanism” and how it set up a dichotomy between the sane and the insane. While sanism may have been intended to reframe the discussion about mental health issues, I said, “We already know that stigma exists surrounding mental illness. We don’t really need the word ‘sanism’ to redefine it. Or to pit us against one another.”

When applied to mental illness, “ableism” is another word that subtly reinforces stigma. It implies that, unlike the neurotypical population, those of us with mental disorders are differently abled, mentally challenged, or – dare I say it – disabled.

Many of us – including me – have applied for disability and many – including me – have been turned down. Despite that, many of us live with varying levels of ability and disability, which are nearly impossible to see and therefore to prove.

When I applied for disability, I was in the depths of what would once have been called a nervous breakdown. I had mental deficits, emotional instability, trouble performing the skills of daily life, inability to hold a job – certainly at the level that I formerly had, or possibly not at all. My thoughts were disordered. My life was disordered. I got by only with the help of a caregiver – my husband. If that’s not at least partial disability, I don’t know what is.

By the time my claim was denied and my disability lawyer was prepping me for a hearing, however, I was, if not well, at least better. I had found part-time work that I could do at home, which provided as much income as disability would have. At his suggestion, I dropped my claim. Perhaps I shouldn’t have, because the lack of medical benefits has been a constant difficulty.

So, am I disabled? I would have to say, partly. I still cannot hold a full-time job – certainly not without accommodations – and my caregiver (still my husband) has to help me with many of the tasks of daily living.

The notion of requiring accommodations leads us to the subject of discrimination. Employers are required by federal law to provide “reasonable accommodations” to persons with disabilities, according to the Americans with Disabilities Act (ADA), for conditions including “a physical or mental impairment that substantially limits one or more major life activities,” and also to “a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. The ADA does not specifically name all of the impairments that are covered.”

“Reasonable accommodations” are not defined for mental disabilities, but examples of accommodations for other conditions include modifying work schedules, as well as leave flexibility and unpaid leave. But just try telling a prospective employer (as you are entitled to do) that you will need flexible hours to accommodate appointments, panic attacks, or other phenomena; or asking someone you work for to give you unpaid leave for a hospitalization. I think you know the result as well as I do.

One problem is that these forms of discrimination – which is what they are – are damnably hard to prove, as onerous and unlikely as being classified disabled in the first place. Yet the protections against these forms of discrimination are defined by law. But how many of us have the wherewithal to challenge them, prove our cases, and get by while waiting for the results of a lawsuit?

Even the act of asking for an accommodation opens us to yet another instance of stigma, and the outcome depends on the individual knowledge and understanding of an employer, when it should follow the law. We approach employers and prospective employers hat in hand, asking for – but not expecting – to get the treatment that is legally, rightfully ours.

In these days of rampant discrimination against people of any number of races, religions, national or ethnic origins, sexual orientations, and disabling conditions, our voices may not be the first to be heard. But we, the neurodivergent, the mentally ill, the emotionally disabled, the psychiatric patients, and our caregivers and loved ones deserve to be free from the effects of ableism, discrimination, and stigma.

Let’s speak up, keep educating about our issues, and support each other in banishing stigma, ending discrimination, and putting ableists on notice that we will not shut up until our rights are acknowledged.

 

But What Happens in January?

Health insurance is a hassle, especially when you’re talking about mental health. And it’s an even bigger hassle when the government gets involved. That’s not necessarily a bad thing, but it does add a layer of complexity to the insurance process.

For quite a while I was uninsurable, or functionally so. My husband and I both had decent insurance when he worked for the county, but after he left that job, it was all downhill. We muddled through without coverage, paying for our meds out of pocket and avoiding the doctor’s office unless death seemed imminent or we had to have blood work. Mammograms, flu shots, and other preventive services fell by the wayside.

Then came the Affordable Care Act, aka Obamacare. Our pre-existing conditions were no longer a factor. My mental health coverage was guaranteed without going through the county’s EAP plan (Employee Assistance Plan, a six-week, take-the-therapist-we-give-you, cure-’em-quick affair).

The only problem (well, the major problem) was that, even with the ACA subsidy, the insurance cost us $650 per month. And my doctor started prescribing Abilify (cost: $800 per month, and wouldn’t you know, it wasn’t on the insurance plan’s formulary of preferred drugs). Fortunately, the generic came out soon after. It still wasn’t cheap, but it was somewhat lower.

The next year we switched plans. Unfortunately, the new company, a co-op, went under and we were transferred to yet another plan. It was no better than the previous one. In many ways, it was worse.

Prescriptions, for example. After getting them filled at our pharmacy for a certain number of months, we were told that almost all our meds MUST be ordered for home delivery, or the insurance company would not pay for them.

Which would be fine, as they were maintenance drugs. Except that meant paying $1100 for three months of generic Abilify, in addition to the monthly premium for the insurance. I can’t scrape together a lump sum like that, so through GoodRx coupons (https://www.goodrx.com/?c=criteo_au&utm_campaign=activeuser) and the local Kroger, I managed to get my prescription for under $200 per month.

Then the real fun started. My husband’s meds and my non-psychotropics went through the mail-order system easily. The ones my psychiatrist prescribed, not so much.

I’ve just spent the time between November 19 and now trying desperately to get the mail-order place and my doctor’s office to talk to each other, fax each other, send smoke signals or carrier pigeons to each other, to get me my drugs. As I gradually ran out of meds, which I’ve written about before (http://wp.me/p4e9Hv-kO).

I finally got a little action when I went to my doctor’s office, camped out in the waiting room, talked to one mail-order person on the phone while the receptionist talked to another one on another phone, and the nurse worked the fax machine. Then I went home, called mail order again, jumped up and down, threatened to hold my breath until I turned blue, asked for the supervisor, talked to the actual pharmacist, and almost burst out sobbing. Yesterday I got my pills.

This time when I had to pick a new insurance plan or renew my old one, I found one that was almost exactly as crappy as our previous one, but at one-third the cost. And the company representative says that all generics can be bought, at either the pharmacy or via mail order, at the same low co-pay. Including generic Abilify.

We’ll see.

The next problem is, as I’m sure you’re all aware, the president-elect and Congress have sworn to repeal Obamacare as soon as they get into office, whether or not they have a plan to replace it.

What will happen then?

Will I be able to get affordable insurance?

Will I be able to get insurance at all? (Even crappy insurance is better than none.)

Will it cover mental health services? Outpatient? Inpatient? Both psychiatrists and psychotherapists?

Will it cover psychotropic drugs at the same rates as others? Or will the meds that really work for me not be in the formulary of preferred drugs?

And how long will it be before even the crappy, but lower-cost, insurance that begins on January 1st, disappears?

I’m guessing (hoping) that our insurance won’t vanish immediately, given the pace at which the government usually moves. But repealing Obamacare (though not replacing it) has been touted as one of the first things the new administration will do. And anxiety is one of my psychiatric problems. How long will I have to wait, unknowing, to learn what those answers will be?

Generally, I have anxiety when I don’t know what’s going to happen. I catastrophize, then feel at least a little better when the answer comes. (It’s usually not as bad as I had anticipated.)

But this time, when the answer comes, will it lessen or increase my anxiety?

And will I be able to afford the medicine that keeps my anxiety in check and the psychiatrist who prescribes it?

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