A little about my research...

You would rather kill yourself than seek mental health treatment?

Taking calls on the Suicide Prevention Hotline I asked myself this question dozens of times. What's going on here?

Stigma. Stigma against mental illness and psychological help-seeking. 

And I'm going to fight it. 

The stigma of mental illness is one of the most powerful and pervasive stigmas that exists today (Bathje & Pryor, 2011). I once stood at a bus station when a man with schizophrenia hobbled up. People backed away in open fear and disgust. Against what other group of people do you see such blatant discrimination?

The same stigma that literally keeps people from seeking treatment that could drastically improve or, in some cases save lives. 

I will be going to Israel this summer to work with working mental illness stigma researchers and advocates. My research is focusing in on the way this stigma shows up in religious communities - an area that has had exceptionally little research. The researchers in Israel have already made progress in this and other areas of mental health stigma. I will be able to work with them to learn what they know and to collaborate in future research to uncover and combat this stigma.   

My long term goal is to apply my research to systematically combat stigma in communities and help them understand what they can do to help, instead of hurt, those with mental illness.


To check out what's going on with my trip to Israel, check out my new blog: www.lilysisrael.blogspot.com

Who cares about mental illness? Well, maybe we should...

Are our attitudes so important they should keep individuals from getting the help they desperately need?

Right now, negative attitudes about mental illness, stigma, are doing just that. According to a recent survey by the American Psychiatric Association, one in three Americans believe that a major cause of mental illness is emotional or personal weakness is a major cause. Let’s be honest, why would we treat weakness? 

Well, let’s look at the impact mental illness. According to the 2009 National Survey of Drug Use and Mental Health (NSDUH), one in five adult Americans suffered from a diagnosable mental illness. With that in mind, consider that one in two prison or jail inmates have one. In fact, largest psychiatric hospital in the United States is Twin Towers Correctional Facility - the Los Angeles County jail. Deaths from suicide, which are inextricably linked to mental illness, are twice as common as those from homicide. In fact, while the percentage of deaths from homicide, traffic accidents, coronary disease, and cancer have all decreased in past decades, suicide has not. But let’s consider those who may not be committing crimes or attempting suicide. What is the leading cause of disability in the US and Canada? Not back pain, not diabetes, not heart disease, it’s mental illness.

We still talking about emotional or personal weakness here?

And yet that very attitude, that mental illness is just weakness, perpetuates all these problems. The NSDUH also found that whose functioning was seriously impacted by mental illness, less than sixty percent received mental health treatment. It is staggering how many people needlessly suffer from mental illness when there is effective treatment.

This is my research - addressing mental health stigma through intervention. In fact, you are taking part in it right now. This is an intervention. The stigma has been named, its effect described, the assumption challenged. My next step is to measure the impact of my intervention.

So here’s the question, what are you going to do next? 

Sources:

APA Survey/NAMI

https://www.nami.org/Template.cfm?Section=top_story&template=/contentmanagement/contentdisplay.cfm&ContentID=33805&title=Public+Still+Lacks+Mental+Health+Knowledge

Suicide/NIMH

http://www.nimh.nih.gov/about/director/2014/a-new-research-agenda-for-suicide-prevention.shtml

Serious Mental Illness/NIMH

http://www.nimh.nih.gov/statistics/SMI_AASR.shtml

http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml

MH Prevalence Rates/SAMHSA - National Survey on Drug Use and Health 2009

http://www.oas.samhsa.gov/NSDUH/2k9NSDUH/MH/tabs/TOC.htm

http://www.oas.samhsa.gov/NSDUH/2k9NSDUH/MH/tabs/Sect1peMHtabs.htm#Tab1.1A

Bureau of Justice Statistics

www.bjs.gov/content/pub/pdf/mhppji.pdf‎

LA County Jails & Mental Illness

http://www.lasdhq.org/divisions/correctional/mh/

Efficacy of Stigma Interventions

http://bjp.rcpsych.org/content/182/4/342.full

Bet My Suffering is Worse than Yours...Or is it?

It's striking how many people don't feel like they aren't allowed to be hurting.

I take 3-6 crisis calls and chats every week at the Suicide Prevention Center in Los Angeles, CA and every week, sometimes multiple times a week, individuals tell me that they don't want to burden me with their problems - even when it's literally my job to listen when I'm on the lines. I hear friends tell me the same thing over and over.

How often I hear people tell me that other people have been through worse - they don't want to complain.

What they mean is they don't feel like they have the right to complain. They don't have the right to feel as if they are suffering.

We see images of emaciated children in Africa and we think, "What right to I have to call anything I experience suffering when I have clothes on my back and some extra belly fat?"

We see images of Jews in concentration camps and we think, "What right to I have to call this suffering if I haven't experienced that level of persecution?"

It's as if suffering were some kind of competition.

As one person who called the Suicide Prevention Center eloquently put it this way, "If someone is happier than I am, does that mean I'm not happy?"

So often people tell a person in very real suffering that their suffering is nothing. That they shouldn't complain. Sometimes even that they are going through nothing compared with themselves. Too often when we try to share the difficulties we are going through who isn't weary of that one person who's just waiting to one up us.

But this kind of thinking simply doesn't make sense.

So what happens when we act like suffering is a competition? Then only one person can win. Only one person - or group of people in the case of the Holocaust - are allowed to win. The rest of the world isn't allowed to suffer.

We belittle the pain of the person trusting us with something very personal and fragile. By belittling their pain instead of trying to understand it, we push them further away, putting them in even more pain.

It can be difficult to understand why a child who has gone through abuse most of their life names the death of their dog is their most traumatic moment, certainly. But when one stops to consider that if their parents, their siblings, their aunts and uncles are there to be safe and welcoming form of love, then a dog becomes the only source of love they can depend on.

Take that away and what do they have?

My suffering will never look like yours and will most certainly never look like that of Elie Wiesel, the author who wrote a memoir about being a victim of the Holocaust.  And if we expect it to then we will miss the truly most important thing about another human being - what hurt them the most deeply.

Suffering is not and will never be a competition. If it were, then even Elie Wiesel could never win. Because even he could never be truly understood.

Snapshot of Mental Illness: Naïveté

Naïveté

Naïveté. Entrapment of cathartic desire
concealed beneath folds of misapprehension.
Naïveté beckons with demonic undertones
to desire the horrific. Naïveté envies
through silent anger victims of rape
and vicitms of burns and lacerations paid
by their fathers' violent anger. 
A wise, a saner voice asks 

why empathy extends only to victims of drunk 
and violent fathers, or perhaps a Munchausen mother
by proxy, poisoning her son's oatmeal. No pity

I ask, for pity may smother more. No. 
Neither squirming nor shock at my story. No. No more. 
Not your first uncomfortable visit to the world
of residual "emotional dysfunction" from 
an unprotected childhood. No more do I want to be
your token freak, your one-uppance in tales of mistfortune. 
Like a ghost of story. No. 

I beg your silence, your ears.
And perhaps if you too can sit in pieces
of broken innocence, I beg but your companionship,
your arms around my chest, my chin 
allowed on your shoulder despite
the tears soiling your shirt.

But instead I find naïveté painted
as reality. 

Naïveté: (to) consider the reactions of the sane 
to the insane as naïveté.

No empathy. Only fear, repulsion that makes pain 
keen. 

Then worse. The verdict. 
The two sentence answers to lifelong battles
fought in the demon dark corners 
of a haunted mind. I don't interrupt anymore.
Just see naïveté.

Naïveté: (to) consider the reactions of the insane 
to the sane as naïveté.

Until the "h" word broke through the stupor. 
Hospitialization.  
Wait, me? Yes. Then, oh, temptation of escape. 
Wanting nothing more than a pillow, sinking into covers
staring at a wall. With others. Like me.
So perhaps this is, as they say, a sever mental illness. No more. 
No more no more no more. Naïveté.

Unpacking the Insanity Plea: Looking at Suspected Murderer James Holmes' Not Guilty by Reason of Insanity Plea

http://www.nytimes.com/2013/06/05/us/suspect-in-colorado-movie-killings-enters-insanity-plea.html?_r=0


Not guilty by reason of insanity means you don't have to be punished for your crimes - right?

Definitely not.

Before we get to the issue of punishment though, let's make sure we have a firm grasp of what the Not Guilty by Reason of Insanity plea (NGRI) is.

The NGRI is a unique plea not only because it references mental illness, but because it is saying something seeming paradoxical - the individual has committed a guilty act without having a guilty mind.

What? We watch law and order and time and time again it's about proving that it was Joe that killed Mary. So if there's no question there, then what are they talking about? What's this "guilty mind" nonsense?

Well, lets talk about insanity. Insanity, despite the way we throw it around everyday, actually has a stringent legal definition. It is a "mental illness of such a severe nature that a person cannot distinguish fantasy from reality, cannot conduct her/his affairs due to psychosis, or is subject to uncontrollable impulsive behavior. Insanity is distinguished from low intelligence or mental deficiency due to age or injury." (http://legal-dictionary.thefreedictionary.com/insanity)

The crux of this definition is the severity of the mental illness. Even if a person is in the midst of a psychotic break it is extremely unusual for them to be so completely impaired that they they think they are holding a banana when they are actually holding a gun. Another example of a severe mental illness is if the individual was so out of touch with reality - so utterly in the throws of a delusion, for example, that they honestly believe that if they don't kill their son then he will be tortured in hell for all of eternity. So they kill their son.

The NGRI, then, is not a trial whose goal is to determine whether the individual committed a crime, rather it will be based on "the issue of the defendant's insanity (or sanity) at the time the crime was committed." (http://legal-dictionary.thefreedictionary.com/insanity)

 So let's skip to the end, let's say that an individual actually goes through a trial, and the verdict is Not Guilty by Reason of Insanity. (Which less than 10% of individuals who attempt this plea succeed in doing). Does the individual go free?

By no means. The individual goes to a state mental hospital until they can prove that they are no longer a threat to society due to their mental illness.

This means that the individual may actually spend more time locked away from society than they would have in jail.

A infamous example of this is John Hinckley, Jr. - the man that attempted to kill then-President Ronald Regan in order to win the love of teen actress Jodie Foster. His conviction was not guilty by reason of insanity.

He is still in St. Elizabeth's Hospital in Washington, DC. He has been there more than thirty years.

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.

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:  http://communities.washingtontimes.com/neighborhood/stress-and-health-dr-lind/2013/may/9/terrible-psychiatric-joke/#comments

 

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 Suicide.org.

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 drugs.com 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? 



Bibliography:
http://www.mayoclinic.com/health/mental-health/MH00076
http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-157.pdf
http://www.suicide.org/suicide-causes.html
http://www.drugs.com/prozac.html
http://articles.washingtonpost.com/2013-05-02/national/38974326_1_suicide-rate-12-suicides-prevention
http://www.cdc.gov/nchs/fastats/lcod.htm
http://www.webmd.com/depression/features/are-antidepressants-effective