[Note: please feel free to send this to anybody you think might benefit by it.]
Society hates people like me.
Or, more accurately, a sizable minority is afraid of people like me.
Last week, USA Today ran a series about the state of mental health treatment. It drew a horrific picture of the state of mental health treatment, and of attitudes of society and medical practitioners toward the mentally ill.
Some of the lowlights concerning government programs:
Mentally ill people generally suffer for a decade between onset of symptoms and getting needed treatment. (I knew that the ten year figure applied to bipolar disorder, with a ten-year lapse between onset and diagnosis, but it appears from this article that that applies to other conditions, as well.)
Medicare treats mental illness differently than physical illness, instituting a 190-day lifetime cap on inpatient services.
Medicaid is even worse: the federal government does not pay for inpatient hospitalization, unlike with physical illness.
States and private hospitals have been closing psychiatric wards because, even when the government covers inpatient services, they do so at lower reimbursement levels than for physical illness.
Private insurance is better: California has for several years required parity in treating mental illness, and the Affordable Care Act requires insurers to cover mental health and substance abuse services at the same level that they do physical illness.
Some of the horrors of societal stigma:
Studies done in 1996 and 2006* show exactly how bad that stigma can be: 32% of Americans thought that depression was a sign of bad character; 31% thought the same of schizophrenia. While depression was viewed badly (in 2006 46% of respondents would not want to work closely with someone with depression, 20% would not want them as a neighbor, 35% will not socialize with them, 21% will not make friends with them, 53% would not want them to marry into their family, 70% thought they were a danger to themselves, and 32% thought they were a danger to others) the most stigma attaches to schizophrenia. (I am assuming the numbers for bipolar people are between the two groups.) In 2006, 62% percent of respondents would not want to work closely with a person with schizophrenia, 45% would not want them as neighbors, 52% would not socialize with them, 35% will not make friends with them, 69% would not want them to marry into their family, 84% thought that schizophrenics were a danger to themselves, and 60% — well over half the respondents! — thought schizophrenics were a danger to other people.
The most appalling statistic was that every one of these measures of the stigma against schizophrenics was higher in 2006 than in 1996. The stigma is getting worse, not better. (A Science Daily item in 2010 stated that the discrimination faced by the mentally ill was not getting any better, even in the face of increasing belief in neurological sources for mental problems.) The numbers of people who believe that the mentally ill are a danger to others poses special problems: what business owner or hiring manager who believes that a schizophrenic or a person with major depression or bipolar disorder is a danger to other employees will risk hiring them, the Americans with Disabilities Act be damned? It is to my most recent boss’s credit that, with full knowledge of my condition, he rehired me when new opportunities became available. (I had not told him I was bipolar until I felt it necessary, and by then I had worked two campaigns with him.)
Perhaps most heartbreaking of all, even the medical profession, people who should know better, treats the mentally ill differently: according to the USA Today article, a 2012 study found doctors less willing to prescribe medications or surgery for some serious physical ailments if the patient also suffered from a mental illness. (I am never one for urging people to sue, but it seems to me that withholding necessary medication is almost definitionally malpractice.) Just go ahead and die, already.
We live in a media age: an age of 24/7 coverage of the latest tragedy. The more extreme the horror, the more amped-up the coverage. What would have once been in our living rooms for half an hour (an hour at most) for a few days is relentlessly played and discussed over and over. How many places do you go that have CNN, or worse, Fox News blaring in the background? These networks (and I’m looking at you, too, msnbc, although I am willing to exempt Rachel Maddow from condemnation ) need material to feed the giant news grinder which they have created, and tragedy, the more sensational the better, fills the bill nicely. How many hours do you think the cable news networks spent on analyzing Adam Lanza, the Newtown shooter? Or Elliot Rogers, the misogynistic spree killer in Santa Barbara?
And, funny, most of the Rogers television coverage — at least that I saw — analyzed what his mental illness may have been, and pretty much ignored the absolute hatred of women and sense of entitlement that underlay his murderous anger. That discussion raged on the Internet, where the Twitter war between #NotAllMen and #YesAllWomen exploded. That Rogers acted out in an extreme way attitudes that women (especially attractive women) face all too many times seemed to fly under the cable news radar.
Armchair psychiatrists come out of the woodwork, making diagnoses based on hearsay and innuendo. Legal experts and media psychologists such as Drew Pinsky weighed in.
David Granirer, founder of Stand Up for Mental Illness, a program which teaches people with mental illness standup comedy to help ease the stigma they face observes “the truth is that people with mental illness commit about 5 percent of all crime. So that must mean that so-called ‘normal people’ commit the other 95 percent. Yet the media never goes out of their way to tell us that the perpetrator was considered to be sane and well-adjusted.” That would be too uninteresting, I suppose.
That’s the news. What about popular entertainment?
Silver Linings Playbook came out in 2012. At least one critic lauded it as an accurate portrayal of person struggling with bipolar disorder. Of course, all of us with the condition refuse to take our meds, throw chairs though windows, threaten our parents and scare our neighbors, and are saved through the love of a good woman and some dance lessons. I left the theater after watching it uneasy and vaguely ashamed and with the beginnings of anger. (Although I was glad to see Bradley Cooper do serious work; he and Jennifer Lawrence were much better in American Hustle.)
Even the works that I use most often to describe part of the experiences that I have gone through, especially before I found a medication regimen, A Beautiful Mind and Next To Normal, pose problems. Both of them show individuals who are much more seriously ill than most. There are few examples of mentally ill characters who are functional and whose family is not severely burdened by their very existence. (Which is not to say that I have not been a burden to my family at times; so are people with cancer.)
I love Criminal Minds. I like the characters, I like the equality between the men and women on the team. Yet, every third week, it seems, they speculate that whatever serial killer they are seeking is schizophrenic (often preceded by the word “undifferentiated”) or in the middle of a psychotic break. (They also have killers with far more obscure mental illnesses.) True, they sometimes have characters who are mentally ill who are not the killers, and the writers at least have the decency to point out that the mentally ill are more likely to be victims of violence than perpetrators, but all too often those characters are themselves barely functional. When Dr. Spencer Reid, whose mother is schizophrenic, began suffering from headaches and possible hallucinations (it was never clear), the fear he exhibited about possibly being diagnosed with the same illness as his mother rivals that a character would show when faced with the possibility of a terminal illness.
People treat you differently when they know you have a mental illness. I have had individuals try to argue with my diagnosis, and have seen people with mental illness told that there is nothing that exercise and diet can’t cure, that the medicines which keep people like me alive are nothing more than the products of Big Pharma run amok. (Usual warning, don’t read the comments. Although one of the comments led me to this gem from robot-hugs.com.) Then there is what I call the “bipolar horror story”: the people who want to tell you about their cousin who refused meds and went psychotic repeatedly; the boss whose bipolar ex-wife claimed he was an abusive alcoholic. In some cases, the horror stories have nothing to do with the mental illness, but more with someone being a horrible person, with the nastiness blamed on the bipolar disorder rather than an unpleasant personality. Few people say “I worked with someone I found out had a mental illness; I would never have known.” Like gays and lesbians a couple of decades ago, those who can “pass” do.
I have chosen not to pass, with full knowledge of what that might entail. I tell employers I have bipolar (although usually after I have been hired), I have included my piece on motherhood and mental illness on the list of publications on my resume. I’ve told all of you, in a forum easily Googleable by anybody who cares.
I’m no hero: studies show that the most effective way for people to lose stigma about mental illness is to actually know someone who is mentally ill. I believe that I live in a part of the country that is more accepting of those outside the norm, but I am not sure what the limits of that tolerance is.
I really feel I have no choice: how else can the world change for the next generations if some of us do not come down from the attic now?
I know some of you are in the same place I am — who will join me?
*The graph in the USA Today article is misleading; I have read the original article from the American Journal of Psychiatry, “’A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence” and provided the results from the article. (Am J Psychiatry 2010;167:1321-1330. doi:10.1176/appi.ajp.2010.09121743)