0 The Power of Words: Addressing the Stigma of Mental Illness

Jenna Bowen, medical student, University of Wisconsin

Reviewed by Claudia Reardon, MD

Crazy.  Insane.  Deranged. Mad.  Lunatic. —Misused as nouns, adjectives and
lay-diagnoses, their use perpetuates stereotypes of the wide variety of people
who experience mental illness.

Maybe you know someone or, more likely, a number of people who
experience depression, anxiety, bipolar disorder or other brain disorders.  According to the National Institute of Mental
Health, 1 in 4 American adults and 1 in 5 American youth experience a form of
mental illness every year. People with mental illness are teachers, accountants,
neighbors, sisters, fathers and friends. Anyone you know could be experiencing
mental illness, but afraid to come forward and be treated. Maybe that person is
you.

People living with mental illness continue to have an identity
that is beyond a diagnosis, similar to other medical conditions. While managing
mental illness may be challenging at times—similar to challenges faced by
people with diabetes, high blood pressure, or other medical illness— there is
greater difficulty in getting the treatment needed because of feelings of shame
and stigma surrounding mental illness. However, treatment for mental illness
works. Research shows the majority (65 percent to 80 percent) of individuals
with mental disorders will improve with appropriate treatment and ongoing
monitoring. People with mental illness need to know that they will continue
to be seen as people – your brother, best friend, daughter —and not “crazed” or
“insane” if they appropriately seek help for a treatable medical condition that
they happen to be experiencing.

Bring Change 2 Mind, an organization aimed to end stigma and
discrimination surrounding mental illness, offers recommendations to reduce
your impact on the stigma surrounding those with mental illness.

• Use "person first" vocabulary. When we say a person is
  schizophrenic, we make their mental illness fully define their identity.
  Instead, be clear that this is a disease that individuals manage and live with—
  "He is living with schizophrenia."


• Avoid the verb "suffers" when discussing mental illness.
  Instead, choose, "lives with mental illness" or "is affected by
  mental illness."


• There are many phrases and terms; "crazy,"
  "nuts", "psycho", "schizo", "retard"
  and "lunatic" that may seem insignificant, but really aren't.

Be an advocate for those that you know, and the many that you
don’t know, who are living with some form of mental illness by breaking down stigma,
and being conscious of language surrounding brain disorders. To learn more check
out:

·        
Bring
Change 2 Mind

·        
NAMI
– Stigma Busters

·        
Resource Center to Promote Acceptance, Dignity and
 Social Inclusion Associated with Mental Health (SAMHSA)

·        
Mental
Health Terminology:  Words Matter

Detail: The Power of Words: Addressing the Stigma of Mental Illness

0 When recovery from depression seems hopeless, are there other options? A patient's perspective

By Andy Behrman, Guest Blogger

My experience with electroconvulsive therapy (ECT) began in 1995, when I opted for ECT as a last resort for treating my bipolar disorder. For so many people who were termed medication resistant and suffering with depression or bipolar disorder, ECT was the “last stop” when it came to treatment. But the variety of medications and other treatments now available to patients suffering from depression has expanded dramatically over the last 17 years.

I recently became extremely curious about a treatment for depression called TMS (transcranial magnetic stimulation). I was surprised to discover that even though TMS is a non-invasive outpatient procedure with few side effects, does not require anesthesia, and was approved by the FDA as far back as 2008, it is still very much “under the radar” and is a treatment which many patients are not very familiar.

According to Kira Stein, M.D., psychiatrist and medical director of Los Angeles-based West Coast TMS Institute, “In a recently published multicenter naturalistic study, 58% of patients significantly responded to TMS treatment, with 37% undergoing complete remission."

Today, TMS is primarily being used to treat those of us suffering with depression. The statistics for depression are alarming: 1 in 6 people experience it in their lifetime, which means that more than 50 million Americans are likely to struggle with clinical depression. Unfortunately, of this population, only 1 in 4 people get adequate treatment. One of the biggest concerns is the risk of suicide, as more than 36,000 people in the United States take their lives every year. Untreated depression, which causes disability at work and disrupted family and interpersonal relationships, can also lead to self-medication with drugs and alcohol. Depression has reached epidemic proportions and has become a silent killer.

When I speak to audiences about mental illness, I always encourage people who suffer from depression to seek advice from a mental health professional. Sometimes, getting people to overcome the stigma of suffering from depression is one of the hardest jobs I have to do. It is often the patient who resists seeking help, often because of the stigma, who really ends up at risk. But today, there are more treatment options than when I was ill. Technology is giving doctors more tools, and patients much more hope, for recovery.

Andy Behrman is the author of “Electroboy: A Memoir of Mania,” a personal story about his bipolar disorder, his experience electroconvulsive therapy (ECT), and his recovery from drug and alcohol addiction. Behrman advocates for mental health awareness and suicide prevention. He speaks to college audiences, health care professionals, and local and national mental health support groups working to stop stigma surrounding mental illness.

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Detail: When recovery from depression seems hopeless, are there other options? A patient's perspective

0 Mental Illness or Muse? Amy Winehouse and Historic Artists with Bipolar Disorder

By Mohammad Alsuwaidan, MD 



We have no doubt lost a profound musical talent in the tragic death of Amy Winehouse this week.  Her public struggle with substance abuse and bipolar disorder (commonly known as manic depression) has reignited curiosity about possible links between creativity and mental illness. In such unfortunate circumstances, it serves well to draw upon the lessons of history in making meaning out of sorrow.



A little more than 120 years ago, a misfortune befell another budding talent. A young painter entered a psychiatric hospital in Saint-Rémy-de-Provence, Southern France. Known by his neighbors in town as “fou roux" (the crazy redhead), he had been troubled with mental illness throughout his life. A few months prior, he had reached a crisis point and during his breakdown, he rushed to a brothel to see his friend - a prostitute named Rachel. He handed her a small wrapping of newspaper - telling her to “keep this object carefully” and ran off. Unwrapping it, she was shocked to find the freshly cut and still bloody lower portion of his left ear!

Vincent van Gogh holds legendary status in Art and his influence has crossed cultures and eras. To gaze onto the vivid colors and hypnotic swirls in his work is to be transported into another world - a morphed view of reality that can only be seen through his eyes. There is a tendency to romanticize van Gogh’s mental illness – which most respected psycho-biographers believe to have been bipolar disorder.



The notion that there is a fine line between creative genius and “craziness” is not new and has existed since ancient times. Most of this interest has focused on bipolar disorder; many famous figures have been speculated to have suffered from this mental illness: Beethoven, Edgar Allan Poe, Emily Dickinson, Victor Hugo, Charles Dickens, Edvard Munch, and many more. We continue to see this pattern in the modern day among celebrated actors, poets, painters, and musicians like Ms. Winehouse. Yet, despite our modern methods, illuminating the “line” or “link” between mental illness and creativity remains elusive.  Studies show that a certain level of melancholy or mixed emotions may be needed to access the creative spring. Unfortunately this negative emotion may also underlie some of the symptoms seen in bipolar disorder. 



Herein lies the eternal dilemma in the field of medicine – balancing benefits of treatments against their risks. Could some bipolar treatments dampen the creative drive? The evidence, both anecdotal and empirical, says yes.



Yet research also reveals that when individuals with bipolar disorder receive treatment, their overall productivity, focus, and organization improve. We know that the poet Robert Lowell produced the largest portion of his work after receiving lithium treatment for his bipolar disorder. And though some critics argue that his “pre-lithium” work is more striking in its poetic beauty, they admit that had it not been for the stabilizing effects of his treatment leading to many more – still beautiful – poems, we may have never known Lowell and his artistic mastery at all.



The message to mental health professionals is clear in my mind; we should attempt to treat highly-creative individuals with mood disorders with all the latest advancements including medications. BUT we should listen carefully and work with our patients to understand what effect treatment is having on their creative drive. Perhaps some individuals need some degree of discontent to “kindle the creative fire,” and we should step up to the challenge of helping them achieve a tolerable and productive balance.



At the young age of 37, after a manic episode of creating many paintings, Vincent van Gogh walked into an empty field outside his home, aimed a loaded revolver into his chest, and pulled the trigger. His famous last words, as he lay dying in his brother Theo’s arms, were "La tristesse durera toujours" (the sadness will last forever).



Perhaps had he not suffered some degree of sadness, you and I would have never heard of van Gogh. Perhaps had he lived longer, his influence would have been even greater. Perhaps the next van Gogh or Poe or Winehouse will walk into a mental health clinic next week suffocated by their sadness, yet possessed by creative inspiration. The questions are complex scientifically, ethically, and philosophically. But I believe that a balance can and should be reached (or at least approached) and that tragic endings can be re-written. 



Dr. Mohammad Alsuwaidan is a psychiatrist with expertise in Mood Disorders at the University of Toronto and a Master of Public Health candidate at Johns Hopkins University. Learn more: http://www.mohammadalsuwaidan.com/





References:

KR Jamison, Touched with Fire: Manic Depressive Illness and the Artistic Temparment, Free Press Paperbacks (New York 1993). p.85

AW Flaherty, Frontotemporal and Dopaminergic Control of Idea Generation and Creative Drive. Journal of Comp. Neurology 493:147-153 (2005).

Santosa C.M. et al. Enhanced creativity in bipolar disorder patients: A controlled study. J. Affect. Disord. (2006), doi:10.1016/j.jad.2006.10.013

Flaherty, A. (2011). Brain illness and creativity: mechanisms and treatment risks. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 56(3), 132.





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Detail: Mental Illness or Muse? Amy Winehouse and Historic Artists with Bipolar Disorder

0 Can My Child Have Bipolar Disorder? Pediatric Bipolar Disorder: Fact or Fiction

By Molly McVoy, M.D.   



Can children really have bipolar disorder?  Or, is it a parenting issue?  Is this mental illness overly-diagnosed?

Many of these questions have been raised in the media with increased frequency over the last several months.  What's most concerning is, that instead of focusing on diagnosis and treatment for children with serious mental illness, the debate has focused on who is to blame: is it parents, psychiatrists, drug companies, schools?  The bottom line is that children are suffering, and parents are struggling to keep their children safe, healthy, and happy.  More attention should be paid to actually helping these children, not to pointing fingers of blame.

Pediatric bipolar disorder is a rare but very real illness.  The most recent statistics indicate the mental illness affects approximately 1.5% of children.  Contrary to popular reports, the most recent studies also indicate the rates of pediatric bipolar disorder are not increasing over time, and the rates do not vary between US and non-US populations.¹

When pediatric bipolar disorder occurs, it can be very impairing.  Affected children have extreme mood swings – not for minutes at a time but for days.  Children can become suicidal, violent, and often feel quite out of control.  When properly diagnosed and treated, the lives of these children and their families can improve dramatically.  Treatment often involves a combination of mood stabilizing medication and intensive psychotherapy.  But when missed or misdiagnosed, these children may go on to suffer for a lifetime.



Stigma continues to be associated with a mental health diagnosis, and nowhere is that truer than in pediatric mental illness.  Perhaps, in the future, efforts will focus on how to help, not who to blame.

Links:

http://www.aacap.org/

http://www.bpkids.org/

References:

1. VanMeter, AR, Moreira, AL, Youngstrom, EA. Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry. 2011, May 31.

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Detail: Can My Child Have Bipolar Disorder? Pediatric Bipolar Disorder: Fact or Fiction

0 Understanding Psychosis

By  Sara Coffey, D.O.



Often patients and family members have a hard time understanding how a person can be psychotic.  Psychosis is defined as grossly impaired reality testing. Psychosis can be present in several mental illnesses including, schizophrenia, schizoaffective disorder, bipolar disorder and even depression.

The stigma or lack of information surrounding these disorders leaves them feeling guilty or ashamed. I often explain to them that the brain is an organ just like the heart, the kidneys or the liver. And just as our heart, kidneys or liver can become diseased, so can our brain.

The brain is a complicated organ with several different functions. It helps regulate our breathing, our heart rate, and our temperature and handles more complex tasks such as vision and hearing, pain sensations as well as processing complex thoughts or emotions. It is easy for us to understand that if the heart becomes damaged it might not pump as effectively, but it is often harder for us to understand what happens if the brain becomes compromised or unwell. A brain with mental illness may start to hear things that are not there, or experience thoughts that cannot be explained and seem irrational.  A person may become excessively anxious for no reason, or depressed without warning or cause.

In the world of mental illness we use terms to describe such experiences like hallucinations and delusions.  A patient with hallucinations might experience voices talking to them when no one is present. When we recall that one function of the brain is to process and interpret sound it is easy to see how auditory hallucinations might occur if that part of the brain is compromised.

Patients can have delusions that people are out to harm them for no reason, and without proof, or delusions that they are famous powerful figures in history. And again, when we look at how the mind works, how complex processes are taking place that help us navigate who we are and what we do, it makes sense that if something wasn’t working normally in the brain that a person could have a belief that was false.

Although these symptoms might make sense when we look at the brain as an organ, or a tool performing a function, it doesn’t lessen the impact mental illness has on families. Often mental illness takes away what we consider the heart or personality of person and this can be extremely difficult to cope with. Furthermore, the simplicity of understanding is not without criticism. For instance although we are learning more and more about the brain every day, there is still no cure for mental illness, only treatment for symptoms, and often times the treatment cannot fully clear the symptoms of certain diseases.

However, it is important to know that psychosis, like other mental illness symptoms, is not the fault of the person with the illness or the family who cares for them. These symptoms are part of a complex illness that affects patients unwillingly every day.

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Detail: Understanding Psychosis

0 Bipolar in kids? Probably not.

By Scott Benson, M.D.



The 5-year-old little girl had been referred to a therapist by her school because of her severe disruptive behavior. The almost daily tantrums had everyone concerned. She was uncooperative with the assessment and arrangements made for further evaluation. The therapist wrote a diagnosis of bipolar disorder.

The patient was certainly reactive to any limits and her tantrums seemed like they would never end. But she slept well at night; she rarely had behavior problems with her grandparents who provided afterschool care.

After a few parent training sessions with the little girl and her parents her behavior control improved. But continued treatment was threatened when her dad tried to get her on his new health insurance. The diagnosis of bipolar got the application bumped by the computer and it took a lot of calls and several letters to get her on the policy so that her treatment could continue.

At times it seems we are a little too quick to throw a label on a child’s behavior, and bipolar disorder seems to be the most popular current label.

But new research at the October meeting of the American Academy of Child and Adolescent Psychiatry found that children with some symptoms of mania probably do not have bipolar disorder.

Boris Birmaher, M.D., a child and adolescent psychiatrist at the University of Pittsburgh presented his group’s research. More than 2,000 children presenting to 10 different academic centers were included in the Longitudinal Assessment of Manic Symptoms (LAMS) study. 621 were found to have elevated symptoms of mania, but the full evaluation did not find sufficient symptoms for a diagnosis of bipolar disorder. Most had attention deficit hyperactivity disorder (ADHD), others had another disruptive behavior disorder. Children who did have bipolar disorder have poor function and are likely to require treatment in hospitals.

"Kids with manic symptoms don't necessarily have bipolar disorder," he told Reuters Health. On the other hand, "Many children with bipolar disorder are not being correctly diagnosed."

The LAMS study which will follow these children for five years should provide direction for the assessment and treatment of children with severe behavior problems. In the mean time parents should insist on an adequate evaluation for children with severe behaviors.

The Parents' Medication Guide for Bipolar Disorder in Children & Adolescents is a great source of information for understanding the evaluation process and treatment options. Or visit HealthyMinds.org for more information on bipolar disorder or mental health issues in children.

Detail: Bipolar in kids? Probably not.

0 This one is for my mother

By Gariane Phillips Gunter, M.D.

During my year as Mrs. United States and daily as a psychiatrist I am fighting to eliminate the negative stigma of mental illness. The presence of mental illness has been very real to me since I was a child. After many years or suffering without a clear cause, my mother was diagnosed with Bipolar disorder when I was in elementary school. Frequent hospitalizations, medication adjustments, ECT were part of a typical day in our household. Nevertheless, my mom is my mom, not “crazy”, “psycho” or a “freak”.



As an adult and now as a psychiatrist, the presence of stigma toward those suffering from a mental illness has become very evident to me. I believe that the source of much of this misperception is from a lack of understanding not a lack of compassion. Many people still do not know that mental illnesses are true biological illness similar to diabetes or hypertension.



They don’t understand that they are brain diseases, not character flaws. Having a mental illness does not mean that you are stupid, lazy, worthless or incompetent. You don’t develop a mental illness because you did something wrong or because you are a “bad” person. It is not your fault.



For you that are struggling with a mental illness, or have a family member who is, you are likely all too familiar with the devastating effects of stigma in your own life. Let us all work together to teach the truth about mental illnesses, as education is our most powerful weapon in the fight against stigma.



……………Be The Change You Hope To See In This World















9PAZK9VY4VER

Detail: This one is for my mother

0 Knowledge is Power

By Jeffrey Borenstein, M.D.

When it comes to mental health, knowledge is power. As host of the Healthy Minds public television series, my goal is to provide people with information about psychiatric conditions and treatment. I interview experts who provide cutting edge information and more importantly, I speak with people who have sought treatment for a mental health issue.

One of the most moving interviews was with Jennifer Crane, a veteran who served in Afghanistan. She spoke about her experiences with post-traumatic stress disorder (PTSD) and how treatment is helping her recover. She has received treatment through the Give an Hour program, which is sponsored by the American Psychiatric Foundation.



The combination of medical and scientific information with the real life experiences of individuals and their families provides our audience with new knowledge and insights about mental health. I hope the show will open up conversations in families and inspire people to seek help. In addition to PTSD, topics include autism, chemical dependency, depression, bipolar disorder, eating disorders and suicide prevention.



As we plan for future episodes of Healthy Minds, I would very much appreciate your comments, ideas and questions. And, remember, when it comes to mental health, knowledge is power.

Detail: Knowledge is Power