THE TRAGEDY OF MENTAL ILLNESS: Not So Uncommon

INTRODUCTION

Mental Illness is a difficult condition to manage.  However, despite many obstacles, a mentally ill person and their family can learn about the condition, the problems related to it, and find practical solutions that that can result in a full and productive life.  The purpose of the following discussion is to help eliminate ignorance about mental illness and suggest possible solutions to problems experienced by a group of people who suffer tremendously.  To this end, information is provided that gives hope and help to a mentally ill person and unites and heals wounds among family members, friends, colleagues and others.  Obstacles and solutions are presented here to address a situation that still causes havoc for many and has a negative impact on society.

MENTAL ILLNESS: PERPLEXING PROBLEM IN THE UNITED STATES

Unfortunately, mental illness is not well understood by most Americans.  This lack of understanding can have tragic consequences for both the mentally ill and their families.  A child can grow up with a mentally ill parent and be confused or angry by behavior that is inappropriate and frightening.  A spouse of a mentally ill person can become angry, burn out, and behave in a way that exacerbates the illness of their loved one.  Other family members can become angry with the mentally ill person and end up ostracizing them, urging the spouse to divorce the person, and convey to the children their disdain for one of their parents.  Such misconceptions about mental illness disrupt family life, cause  hurtful disputes among family members,  and can be harmful to the mentally ill person, contributing to a worsening of symptoms and relapse.

As adults, children of mentally ill people can have different perceptions about the cause for the aberrant behavior of their parent(s).  Even siblings, cousins and other family members  who have had close relationships with one another can be affected.  While some children have deep seeded anger for their mentally ill parent/relative or view them as weak, cruel, or immoral; others will investigate the matter, and learn that their parent/relative has/had an illness that can affect behavior and be controlled with proper treatment and medication. Such differences can lead to rifts between siblings or close relatives that can be permanent and devastating.

It is clearly known that governmental resources to help the mentally ill (at state, county and local levels) have been largely dismantled.  This has led to more cases of untreated mental illness that contribute to homelessness, increased drug abuse, fractured families, and the list goes on.  According to US Today ( http://www.usatoday.com/story/news/nation/2014/05/12/mental-health-system-crisis/7746535/ ) in an article entitled “Cost of Not Caring: Nowhere to Go,” There is a “…financial and human toll for neglecting the mentally ill.” They go on to state that:

“The mentally ill who have nowhere to go and find little sympathy from those around them often land hard in emergency rooms, county jails and city streets. The lucky ones find homes with family. The unlucky ones show up in the morgue.”

“We have replaced the hospital bed with the jail cell, the homeless shelter and the coffin,” says Rep. Tim Murphy, R-Pa., a child psychologist leading an effort to remodel the mental health system. “How is that compassionate?”

The article goes on to talk about how “States looking to save money have pared away both the community mental health services designed to keep people healthy, as well as the hospital care needed to help them heal after a crisis.”  Furthermore, in article that appeared in the New York Times ( http://www.nytimes.com/1984/10/30/science/how-release-of-mental-patients-began.html?pagewanted=all ) “[“HOW RELEASE OF MENTAL PATIENTS BEGAN,” By RICHARD D. LYONS; Published: October 30, 1984], “The policy that led to the release of most of the nation’s mentally ill patients from the hospital to the community is now widely regarded as a major failure.”  Furthermore, the article describes “…Sweeping critiques of the policy, notably the recent report of the American Psychiatric Association…”

In order to prevent the sorts of tragic situations that have been described above, some measures can be and have been taken to educate children and adults about mental illness, and its causes and treatments. Furthermore, some successful initiatives have been taken by the Federal Government, despite many obstacles and the fact that more needs to be done. Such measures include:

  • Education in the classroom (including elementary and secondary schools; community colleges and private or public universities)
  • Internet postings (blogs, social media, web pages)
  • Governmental leadership in promoting mental health awareness and creating better programs to care for the mentally ill
  • Available governmental resources and educational materials
  • Word of mouth
  • Information tables, displays, and written materials in such venues as fairs, community events, libraries, and shopping malls
  • Advertisements in the press, and on radio, or television announcing community meetings about mental illness
  • Celebrities advocating for the mentally ill on television, radio, in the press and in public appearances
  • Movies and television programs which realistically depict the lives of the mentally ill and their families; and the causes and mechanisms of mental illness

An example of how the leadership of prominent public figures, in concert with governmental leadership, can play a role in improving services for the mentally ill has been described in a post by THE CARTER CENTER Waging Peace. Fighting Disease. Building Hope, “Mental Health Program”  ( http://www.cartercenter.org/health/mental_health/index.html ): “Mrs. Carter played a key role in the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which ensures that mental illnesses are covered by insurance at parity with other illnesses.”

The Carter Center also provides examples of how a prominent person can have an effect on other sectors of society to improve care for and understanding of the mentally ill which include:

  • “Since the Rosalynn Carter Fellowships for Mental Health Journalism were established in 1996, fellows have produced more than 1,400 stories, documentaries, books, and other works during and after their fellowship year. Their projects have garnered an Emmy, nominations for the Pulitzer Prize, and other awards.”
  • “Since 1985, the annual Rosalynn Carter Symposium on Mental Health Policy has brought together national leaders in mental health to focus and coordinate their efforts on issues of common concern and recommend action steps to move an agenda forward.”

It should be remembered that there are still some Federal programs that assist the mentally ill. One such agency is:

The Social Security Administration provides disability benefits for people with mental illness (  12.00-Mental Disorders-Adult – Social Security ).  The criteria given on this site for determining mental disability are strict and complex.  However, it is still possible for the mentally ill to get Social Security Disability if they supply all the information needed by Social Security to determine whether or not its criteria are met.  To help an applicant navigate the maze of information needed to apply for and obtain Social Security Disability benefits, there are web sites that provide assistance, and legal help can be obtained.

Nevertheless, it is important to note that information on available resources that assist the mentally ill is difficult to find unless one spends a great deal of time in tracking things down on the internet and by networking with other people and known agencies.

 HOW COMMON IS MENTAL ILLNESS?

According to Mental Health America ( http://www.mentalhealthamerica.net/recognizing-warning-signs ) “Most people believe that mental disorders are rare and “happen to someone else.”  In fact, mental disorders are common and widespread.  An estimated 54 million Americans suffer from some form of mental disorder in a given year.

“Most families are not prepared to cope with learning their loved one has a mental illness. It can be physically and emotionally trying, and can make us feel vulnerable to the opinions and judgments of others.

“If you think you or someone you know may have a mental or emotional problem, it is important to remember there is hope and help.”

WHAT IS MENTAL ILLNESS AND HOW DO WE RESPOND TO IT?

Mental illness is actual a group of illnesses which are caused by various abnormalities in the brain. There are many types of mental illness.  For example, one of the best descriptions of the different types of mental illness can be found on the web site of the Mental Health Association in Forsyth County, Winston Salem North Carolina, (http://www.triadmentalhealth.org/what-is-mental-illness/ ). According to this Association,“there are more than 200 classified forms of mental illness Some of the more common disorders are:  clinical depression, bipolar disorder, dementia, schizophrenia and anxiety disorders..”

Furthermore this information can be verified by other sources on the web, including:

When talking about different types of mental illness, it is important to realize that there is a difference between the “abuser” personality and that of a mentally ill person.  Due to the complexity of mental illness, it can be difficult to tell the difference between mental illness and someone who, while not meeting the generally accepted criteria for mental illness, regularly or habitually abuses others .   Every day, doctors and scientists are learning how to ascertain such differences.  Research continues, on an ongoing basis to best determine the different causes for abusive behavior and how to effectively treat the mentally ill.

New techniques are regularly being devised for managing (controlling) mental illness that prevent relapse or a worsening of the disease. Medications allow many mentally ill people to live normal or nearly-normal lives. It must be remembered that the science of treating the mentally ill is still in the infant stages of development.  However, as more is learned about mental illness, treatments will continue to improve.

TYPES OF MENTAL ILLNESS

Anxiety attacks can be devastating to the person that experiences them. They are confusing and frightening by a person who observes such attacks in a person they encounter. Anxiety attacks are generally an internal thing: the person feels like they are going to die, their chest gets tight, they sweat, feel a sense of panic but are generally not harmful to others. Such anxiety can last from an hour to being a more permanent chronic ailment, depending on the situation. Medications, education, and talk therapies can be very helpful in managing anxiety.

The effects of Schizophrenia can be confusing and devastating. Generally, schizophrenics are initially nonviolent. If a person with schizophrenia is correctly talked through a hallucination, a violent outburst can be prevented. Many schizophrenics, including those who have been violent, can live almost normal lives if properly medicated and they stay on their medications.

Depression is increasing in frequency among Americans of all ages. It can be a debilitating illness, and can cause lost work hours and friendships.  Signs of depression can include some or all of the following: feeling hopeless; having changed or disrupted sleep; problems completing normal daily tasks; loss of energy; unexplained aches and pains; inability to enjoy life, even when doing things that were once gratifying and fun; unexplained weight loss or gain; appetite changes; low self-esteem. Depressed people can become suicidal. Furthermore, symptoms of depression can vary from person to person, making it harder to treat. Major depression is characterized by intense, relentless symptoms and can last six or more months. Episodes can recur if major depression is not treated by medical professionals with drugs and talk therapies. Recurrent or mild depression, also referred to as dysthymia, is characterized by feeling mildly or moderately depressed most of the time and can last as long as 2 years. Symptoms are harder to recognize, especially if a person is used to having a continuous “low mood.”

Bipolar Affective Disorder is an illness that can be debilitating. A person with Bipolar Disorder has episodes of depression that alternate “manic episodes” manic episodes, where a person can behave impulsively, be hyperactiive, speak rapidly and require little or no sleep. People with “Bipolar 1” have the most severe form of Bipolar Affective Disorder. During manic episodes of their illness, they can become violent if they feel backed into a corner. Their tempers can be volatile. One should avoid aggressively confronting a person with Bipolar 1 disorder because when they feel “attacked” by another person, they will strike back. They can have hallucinations, can be out of control in how they spend money, may engage in sexually promiscuous behavior, have pressured speech, have “racing thoughts” and “flight of ideas,” and leap quickly from one topic to another during a conversation. About 1/3 of these people can eventually behave normally without medications, 1/3 can behave normally with medications, and about 1/3 don’t respond to treatment well and often need hospitalization. Severe depressive episodes can be equally debilitating. It is hard for a depressed Bipolar 1 person to perform the basic functions of daily living. They may sleep all the time and have little energy to bathe, cook, visit with friends, or engage in productive activity. Severe depression can cause suicidal thinking and eventually lead to a person taking their own life.

“Bipolar 2” is a less serious form of the disorder, and these people can usually function well with proper medication and talk therapy. During a manic phase, they may experience flight of ideas and irritability, but to a far lesser degree than a person with Bipolar 1. During a depressive phase, they experience fatigue, low energy, and have a difficult time getting things done. However, many daily activities can be accomplished, but at a far slower pace than is the case for a person without the disease. An otherwise intelligent person with the illness can have difficulty concentrating on details.   This can impair the quality of their work, and lead to job loss due to poor performance.

EFFECTS OF MENTAL ILLNESS

Lower Self-Esteem and Stigmatization: Depression, Schizophrenia, Anxiety and both forms of Bipolar disorder can lead to lowered self-esteem and self-confidence. These feelings can be exacerbated by the fact that mentally ill people are stigmatized and judged harshly by a society that does not foster education about mental illness.   All too often, ignorant people (family members, employers, work colleagues, and friends, to mention a few) ostracize a mentally ill person and make it almost impossible for him/her to find gainful employment or develop a network of social contacts.  According to the web site, verywell.com,”Stigma associated with mental illness can be divided into two types: social stigma, which involves the prejudiced attitudes that others have around mental illness; and self perceived stigma, which involves an internalized stigma that the person with the mental illness suffers from.”

A Danger to Themselves or Others: Some mentally ill people (especially in severe cases of Bipolar disorder, generalized anxiety, or schizophrenia, etc.) can be a danger to themselves or others. According to more than one source quoted by Mental Health Reporting: Recovery happens. Be part of the change (http://depts.washington.edu/mhreport/index.php), there are few mentally ill people who actually become violent.  In fact they state that according to the Institute of Medicine “the contribution of people with mental illnesses to overall rates of violence is small.” To learn more about the possibility of mentally ill people becoming violent, as well as obtaining additional information about mental illness, you can download the book,  Mental Health: A Report of the Surgeon General at(https://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS).

It is possible to legally commit such a person to a mental hospital (involuntary commitment.   However, such information is difficult for the general public to obtain.  This imposes an unfair burden on families and friends of the mentally ill who often don’t know commit a person who is a danger to themselves or others.  Furthermore, each state has laws about when and how to involuntarily commit a mentally ill person.  (what few there are still left after the mental health system was gutted over the last 20 years). Additionally, it is very hard to prove that the mentally ill person can harm  themselves or others. Strict legal restrictions on how to hospitalize a person with severe mental illness can either be appropriate and necessary or lead to tragic consequences for that person, their family, friends, and other people with whom they interact. Furthermore, while a person may need to be involuntarily committed, their right to make decisions concerning their treatment is compromised.  Experienced professionals are seeking to find  a just balance between protecting the mentally ill person and society and protecting a person’s right to have a say in the care that they receive.

Because there is often little or no family education regarding mental illness, spouses, parents, children, or siblings, often no not know how to effectively respond during a severe exacerbation of symptoms in their mentally ill loved one. Such a situation can make the problem worse and lead to stress or burnout for the patient’s family, their employers, and their friends.   It can also contribute to compromised mental health for family members.

Furthermore, because mental illness affects the whole family,  toxic familial relationships are not uncommon. It is important for the entire nuclear family of a mentally ill person to be educated and treated for living with such unpredictable behavior and abnormally unstable circumstances.

Mental Illness can Lead to Homelessness: Too many mentally ill people end up homeless because there is nowhere else for them to go. Of course, mentally ill people who are violent have to be in locked facilities for the protection of society and themselves. There is no getting around this. No matter what the cause, it is intolerable to have anyone exposed to unpredictably violent people.

HOPE FOR THE MENTALLY ILL

With therapy, drugs, and healthy lifestyle changes, most mentally ill people can lead normal lives, function well in society, and hold down a job. New discoveries of better drugs and treatment plans for the mentally ill occur on a continuing basis. With supportive family, friends, and employers, mentally ill people can more quickly recover from debilitating episodes and have fewer chances for relapse. More than one organization offers help and hope to mentally ill people and their families.

CONSUMER AND ADVOCACY ORGANIZATONS:

nami, National Alliance on Mental Illness

http://www.nami.org/Learn-More/Mental-Health-Conditions

It is noteworthy that National Alliance on Mental Illness (nami) is probably the most effective educational and support organization for families and their mentally ill loved ones (Consumers). This organization is administered by family members and Consumers that advocate and provide regular support for Consumers and their families. Their advocacy has stimulated ongoing research for new drugs and treatments for the mentally ill, and prompted the development of legislation that provides better access to assistance for Consumers and safeguards their rights to adequate medical care. Nami regularly has support groups for families, advertises support groups for Consumers, publishes materials on mental illness, and provides community education to help reduce the stigma that Consumers still face in the workplace and in most social situations.

Mental Health America (MHA)

http://www.mentalhealthamerica.net/recognizing-warning-signs

Mental Health America (MHA) is also a very effective organization that speaks out on behalf of the mentally ill, including advocating for legislation “to develop and pass laws, regulations, and policies to promote mental health,” provides education and outreach, and offers information and referral services. It is becoming increasingly involved in establishing innovative “social inclusion projects” that provide support and training for Consumers.

PARTIAL LIST OF WEB RESOURCES FOR CONSUMERS AND THEIR FAMILIES

HelpGuide.org: Help yourself to greater health and happiness

http://www.helpguide.org/

Mayo Clinic: Diseases and Conditions

http://www.mayoclinic.org/diseases-conditions/depression/basics/definition/con-20032977

WebMD, Mental Health Center

http://www.webmd.com/mental-health/default.htm

MedicineNet.com

http://www.medicinenet.com/mental_illness/article.htm

 verywell.com

https://www.verywell.com/search?q=mental+illness

GOVERNMENTAL AGENCIES THAT HELP CONSUMERS AND EDUCATE THE PUBLIC ABOUT MENTAL ILLNESS INCLUDE

SAMHSA (Substance Abuse and Mental Health Services Administration) is an agency of the Federal Government Department of Health and Human Services. It provides research grants and eductional materials about addiction and mental illness.

www.samhsa.gov

MentalHealth.gov ( https://www.mentalhealth.gov/talk/index.html )(HHS.gov)

The Social Security Administration provides disability benefits for people with mental illness (  12.00-Mental Disorders-Adult – Social Security ).

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About this Site

This site is dedicated to creating positive social change through the power of the word.  By highlighting issues that need to be addressed, it is hoped that others will be inspired to participate in activities that will contribute to the betterment of society.

In addition to reporting news about social conditions around the world, there are profiles of  people and groups who have created or are creating positive solutions to seemingly insurmountable problems.

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I look forward to receiving comments and feedback about different ways in which we can make a positive difference at grassroots, national, and international levels.

Inadequate Health Care, Shame of the U.S.

I recently interviewed someone (Mary; not her real name),  who was a patient, in a convalescent hospital in the United States.  Not only was her situation horrifying, but many State and Federal laws were broken in the facility where she was staying.

After surgery on a badly infected foot, Mary was transferred from the hospital to an extended care facility for further treatment and rehabilitation.  In fact, Mary, was not treated in a safe or professional manner.  She was medicated incorrectly and did not receive the help she needed to take care of her physical or emotional needs.    Although, by law, caretakers were supposed to assure adherence to medical orders for assistance with walking, personal hygiene and physical therapy, such help was not consistently given.  Although maintaining cleanly physical surroundings and adequate personal care was mandated by law, such was not the case.   For example, her bed linens were not changed on a daily basis, she did not get the help she needed to bathe, and her refuse was not regularly discarded.  Furthermore, Mary was expected to read and understand a complex manual regarding patient rights, legal standards of care for the hospital, and hospital rules of conduct, when she was extremely ill and had family that lived too far away to assist her.  For example, she was ignored when she expressed concerns that her medications were not given appropriately.  This put her in a life threatening situation due to other serious medical problems that she had.  For example, her medications for breathing difficulties were not administered per the schedule ordered by her physicians and which she had been following carefully up until the time of her hospitalization.  There were times when her meals were served on chipped or cracked dishes, and the kitchen did not take her dietary restrictions into account.  Her discharge home was complicated by the fact that the person who was supposed to care for her had to change her plans at the last minute, leaving Mary with no one at home to help her.   Furthermore, she was told by her insurance that they would not cover extra help and she had no family living close enough to assist her. Once home, she was not supposed to walk on her injured foot.  However, she had to take care of her daily needs and had no help in figuring out how to do this.  She was able to receive some help from her friends who brought her frozen food.  However, such food did not fully meet her dietary requirements.  In order to heat her meals, bathe, and the like, she had no way to avoid walking on her injured foot!  She was not supposed to bear any weight on her foot, but had no way of completely avoiding this.  It is not hard to understand why her wound got reopened.  When this happened, her insurance finally provided 2 nurses to come to her house to change her wound dressing. However, she still did not receive the other help that she needed.  At more than one point she was afraid that he foot would be  amputated due to skilled facility and insurance “mistakes” that created problems that wouldn’t have occurred if the she had received proper care in the first place.

This is not an atypical story for convalescent care in the United States. I plan to find a way to publish her story because the public should know what is going on in these horrible places.

Even though the U.S. is one of the “richest” countries in the world, it is well known that we have the worst health care system in the industrialized world.  I was shocked when I learned that Bangaladesh has a better health care system than the U.S. regarding number of people covered, cost of care, and kinds of care that people don’t have to pay for. Due to poor insurance coverage or lack of health insurance people in the United States have had delays in care that have caused serious problems and even death.  Lack proper medications or  management of chronic illness, have also contributed to hospitalizations and long-term problems that could have been prevented. It is strange, given our material wealth, that this sort situation even exists. One of my mottos has long been “don’t get sick in America or you will end up in the poor house!” One of the most common causes of Bankruptcy is indebtedness due to the high cost of medical care, resulting in lost wages, unemployment and disability.  Indeed, this cruel violation of human rights in the United States causes needless suffering and heartbreak.

 

Is There Hope for Homeless Addicts?

An excellent profile of what it is like to be a homeless person in the United States is presented in a book entitled  “Righteous Dopefiend.”  The authors, Philippe Bourgeois, a medical anthropologist and Jeff Schonberg, a University of California graduate student visited a group of homeless people in San Francisco on a long-term basis.  Their video gives a visual snapshot of what is detailed in their book (see link below).  In only four minutes, Bourgeois and Schonberg provide an excellent overview of how people who are addicted to heroin attempt to overcome the obstacles of living in a hostile environment.  Upon reading the book, “Righteous Dopefiend,” one gains a deeper understanding of the plight of the homeless in San Francisco.  Issues concerning the inhumane treatment and stigmatization of homeless addicts by a largely indifferent society are clearly brought out, as are the problems involved in attempting to help a group of people who are ill, impoverished and oppressed. The unique way in which Bourgeois and Schonberg combine anthropological techniques and analysis with individual assistance and community organization work on behalf of the “have nots,”  is undoubtedly a model that if widely adopted, provides hope for solving a perplexing problem that has been insurmountable until now.

Next Door But Invisible: The World of Homelessness and Drug Addiction

Penn medical anthropologist Philippe Bourgois and UC grad student Jeff Schonberg study the lives of homeless heroin addicts in San Francisco. SAS Frontiers …

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