Monday, May 20, 2013

The Blessing of Mental Illness

I have come to realize that the exertion of wrestling with the monster called Mental Illness has enabled me to lead others toward life.

In the New Testament of the Bible, there is a story of a man born blind. Jesus' disciples asked him, "Who sinned, this man or his parents, that he was born blind?”
"Neither this man nor his parents sinned,” said Jesus, “but this happened so that the works of God might be displayed in him."

 I heard this story and for most of my life never understood it.

To a certain extent the disconnect is cultural. Our society sees a man or woman who is blind and we chalk it up to genetics. Blindness has nothing to do with this or that person's sin. The concept is completely foreign. (I will come back to this in a moment.)

But there is a far deeper level here as well that, frankly, repulsed me: why would God make a person suffer so that he might gain fame? Why would God give someone cancer or lupus or tuberculosis or leprosy so that He can heal them and amaze any onlookers? Isn't there a way to amaze without inflicting so much pain?

To consider the problem from a less spiritual point of view, we can return to this cultural assumption that illness or disability is caused by some sin. We may not think this true about a slipped disk or autism but this is the standard assumption, otherwise called the stigma, about mental illness.

Why does that person have major depression? Because they made terrible life choices or they are weak or their parents mistreated them when they were children. Because they didn't pray enough or try hard enough. Not because they have a illness that needs treatment just as much as diabetes.

The similarity is striking to me in particular because I have been in treatment for chronic major depression for six years and have likely had it for most of my life. In addition I was a psychology major focusing in on mental illness and have worked in clinical psychology research labs and as a mental health paraprofessional on a suicide prevention hotline.

And still I think I have this mental illness because I am doing something wrong. Because I've sinned. Because I'm weaker than other people. In many ways I believe the stigma.

And there was definitely a part of me that saw the story of the blind man and wanted to revolt against the vanity in it.

But recently I've come to understand this story from a different point of view.

I may still have some part of me that believes the stigma but I've also broken loose of its most restraining bonds. It was not without tears of shame and self-loathing that I went to therapy the first time. How worthless I felt going to a psychotherapist - I have to pay someone to talk with me.

But I went. And I over the years I came to realize that the problem I had wasn't normal. I was reading C.S. Lewis' description of his grief after his wife passed away and I shut the book thinking - what's the big deal, this is what my life looks like at least a couple months out of the year. I didn't think much of it until a good friend, who also struggles with depression, described to me her grief after her father passed away. She said that it was as though she was going through another depressive episode, only there was a reason for it.

And I realized. The depth of despair and suffering in the midst of severe depression is comparable to the grief after the death of a loved one. Only there's no understandable cause.

This is what it means when people call Major Depressive Disorder an illness.  And an illness should be treated by a healthcare practitioner.

So what does all this have to do with the concept "that the works of God might be displayed in him?" 

I, a woman who has nearly drowned in the cesspool of depression, became a suicide prevention counselor on the National Suicide Prevention Hotline. I've come to realize that because I somehow dragged myself out I've been able to guide others how to escape. 

I've literally saved lives because I, too, have suffered.

Wednesday, May 15, 2013

More Money for Drug Companies, You Say? The Disastrous Stigma Against Mental Illness

A rebuttal to Dr. Peter Lind's article in the Washington Times entitled, "More psychiatric illnesses means more money for drug companies." Link:


More Money for Drug Companies, You Say? The Disastrous Stigma Against Mental Illness

I will start by saying Prozac is not an anti-psychotic drug as Dr. Lind suggests in his article. Yes, it's psychoactive. Yes, it's an antidepressant. No it is not an anti-psychotic.

While this may seem like a captious point, it exemplifies the author's understanding of the subject area. It is clear that Dr. Lind knows a thing or two about the human body, as his suggestion that mental illness may have its roots in advanced catabolic disintegration reflects a knowledge of human physiology. In addition, his request for physiological evidence for mental illness is a valid one - the knowledge of the biological basis for mental illness has been increasingly recognized in the mental health community over the past thirty years and this recognition has benefited those with mental illness.

But it is clear that Dr. Lind's understanding of the mental health field is elementary. If this ignorance were my only concern I'd go on my merry way and think little of this article.

Unfortunately, I sense a far more sinister motive at work in this article - that of the stigma against mental illness and mental health treatment.

Dr. Lind argues that the increase in diagnoses in as reflected in the DSM-V (and seems to insinuate that most if not all diagnoses in the various DSM editions) are "bullshit." And yet in a country whose health care is almost entirely dependent on insurance a diagnosis is the difference between affordable treatment and astronomical out-of-pocket expense. 

Treatment of depression includes medication, it's true. But Dr. Lind claims that there "is no money in non-drug treatment" - is he unaware of  "counselors," "therapists," and "psychologists?" Last I checked there were no drugs administered in a session with a Marriage and Family Therapist. Were Dr. Lind's intent to encourage his readers to seek treatment using what non-drug methods are available, therapy would be an excellent suggestion.

Instead Dr. Lind argues that the increase in diagnoses in as reflected in the DSM-V (and seems to insinuate that most if not all diagnoses in the various DSM editions) are "bullshit." And yet in a country whose health care is almost entirely dependent on insurance a diagnosis is the difference between affordable treatment and astronomical out-of-pocket expense.
And why might an individual want treatment? 

Because untreated depression is the number one cause for suicide, according to

Dr. Lind seems to be suggesting that Prozac itself is dangerous. His focus on Prozac is entirely on how it causes suicidal thoughts. Well, let's take another look at that, shall we?

According to the report of the side-effects of Prozac (otherwise known as fluoxetine), "The 1991 meta-analysis of controlled trials (which was sponsored by the manufacturer of fluoxetine) reported six suicidal acts occurring in a total of 1763 patients treated with fluoxetine. The frequency of suicidal acts was 0.3% and was similar to the frequency reported for placebo (0.2%) and tricyclic antidepressant therapy (0.4%)."

For those in the world that did not love statistics class, this means that when researchers looked at several well-designed studies and averaged them out, there was 1 more case of a suicide attempt (which are far more common than completed suicides) in 1000 for those who took Prozac than for those who took no drugs at all.

(If you are thinking that the drug companies have a reason to report so low a percentage reflect that the same page reports that 12% of participants experienced diarrhea. What benefit could possibly come from that?)

Dr. Lind spends three of fifteen paragraphs in his article describing the increased risk of suicidal behavior in those taking antidepressants when the difference is 0.1%. 1 in 1000. 

My question - why are we ignoring the 999 in 1000 over that 1?

Does Prozac work for every person that tries it? No. But if an individual with diagnosable Major Depressive Disorder keeps at it and tries more than one medication, he or she is more than likely going to find one that works.

Also, the more severe the case, the more effective antidepressants are. Why is this important?

Suicide is the tenth leading cause of death among Americans in 2012 according to the Center for Disease Control and Prevention.

The treatment of depression is effective 60 to 80% of the time, according to the American Association of Suicidology. 

What this means is that, literally, by encouraging individuals not to take antidepressants when they have diagnosable depression he is encouraging them not to take actions that could save their lives.  

He may not have to deal directly with the consequences of reinforcing the stigma against seeking help for mental illness, but I do. I volunteer at the Suicide Prevention Center in Los Angeles and take calls every week from people that suffer from major depression. I can't tell you how many people I've spoken to who think antidepressants are a hoax and are at the same time taking steps toward their own suicide. I've been on the phone with individuals in the last moments before their self-delivered death and had to live with the thought that if this person had had treatment for their severe depression, they might still be here today.  

So here is the question I pose: Is Dr. Lind's quarrel with drug companies worth tens of thousands of lives? 


Sunday, May 5, 2013

Experiencing a Panic Attack: A Poem

Panic Attack

I can hear my heart pumping like a knock
on the door before someone else knocks down
the door I’m waiting to open and I cannot
open but need to open. I’m breathing steady
but only because I’m trying to breathe steady
and even though the breath is coming in it’s like
the breath isn’t coming and there’s a vacuum
building in my lungs and if I don’t breathe harder
the vacuum will build and destroy my lungs
and my lungs won’t breathe to my body and
my body will collapse and I won’t be able to open
the door that someone’s knocking at but they’re not
really knocking that’s my heart that’s knocking that
I can’t keep from knocking and

Now the world is spinning and I don’t want it to be
spinning I want it to stay still so I can keep them
from knocking trying to wake me up but I’m not
asleep I’m awake can’t you see I’m awake and I’m
trying to answer can’t you see me try to answer
but no you just see me breathing and you don’t like
my breathing and you’re trying to stop my breathing
but the vacuum is taking over and the vacuum
needs feeding and I’m feeding the vacuum can’t
you let me feed the vacuum but there is no vacuum
why do I think there’s a vacuum make the vacuum go
away and leave me be so I can answer this knocking
the real knocking the people knocking on the door
needing an answer that I need to give them now now now now now now

Snapshots of Mental Illness: An Introduction

This will begin a series on individual mental illness. This series could include what it is like to have, current research on, and reflection on common perceptions about each mental illness. These posts will be vignettes rather than comprehensive definitions. The goal will be to offer snapshots into the life of those with mental illness in order to express the various facets of these complicated disorders.  

Disclaimer: I am more familiar with some mental illnesses than others. For example I would say I know depression intimately while my knowledge of schizophrenia is theoretical at best. While I will attempt to give a voice to each mental illness there I am limited by my experience and hence coverage will reflect that. Each mental illness is equally worth understanding and I encourage those who feel like a mental illness is not being well represented to share their experiences and/or voice their desires to understand more. I would be happy to do research and share my findings.