The American Public Gets It: Stigma Is Real, and We Need To Do More

CBS News ran this fascinating poll on mental illness. I’d argue that there aren’t many surprises in the poll, but I got two key takeaways.

First, to summarize the findings:

  • 51% of Americans say that people living with a mental illness face “a lot” of stigma and discrimination – 31% say “some.”
  • 38% of people say that mental illness stigma has gotten better, 22% say worse, and the rest say that it hasn’t changed.
  • 66% of people say that mental illness is a very serious public health problem – 28% say somewhat serious.
  • People do believe that mental illness is a real medical condition (79%). Roughly 2/3 of those polled also said that virtually anyone can get a mental illness and most people who are treated right can lead productive lives.
  • A mere 12% of people say that services for the mentally ill are adequate – but 49% said they are not.
  • A whopping 77% of people say that celebrities speaking about mental illness are doing a good thing – only 18% said no.
  • 73% of Americans know someone diagnosed with a mental health disorder (I guarantee that number is higher and people just hid their own mental illnesses), while 58% said that they had a family member who sought care for mental health (again, I’m sure that number is higher).

So, here’s what I got out of this. First, those support numbers are just overwhelming. 66% of people think mental illness is a “very serious” public health problem. 28% say it is at least “somewhat serious.” That’s 95% of the American public who think that mental illness is at least somewhat serious. That is not a small number! The key question is this: What does that translate to? Are people willing to dedicate more time and money to mental health care? Or is this simply a, “Gee, that sucks…moving right along” sort of things?

At the bare minimum, it is good to know that people understand just what a major problem mental illness is.

Second, the stigma questions got me thinking: What if the stigma is all self imposed? I mean, take a look again at that top finding. 51% of people think individuals with mental illness face “a lot” of stigma, while 35% say they face “some” stigma. That is not a small number. But if that many people think stigma is so real, what’s really the problem here? People who acknowledge stigma is real must also have stigma-inducing thoughts, right? Or, what if the stigma is just the fear of being stigmatized? Or self-stigma? I’ve always thought that self-stigma is a bigger problem then actual stigma.

The findings, in my mind, mean that we have to rethink our traditional definition of mental health stigma, because I don’t think that a traditional understanding of, “People with mental illness sure do face a lot of stigma” is enough.

But, as always, I ask: What do you think? What are your thoughts on this poll? Let us know in the comments!

Medication is Not Addiction: A response to a misinformed column

I spent way too much time on Sunday on Twitter, joining a chorus of voices who were yelling at David Lazarus, a columnist or the Los Angeles times. Lazarus wrote a column in which he discusses his own experience at trying to withdraw from anti-depressants. The title of the column? “Hi, I’m David. I’m a drug addict.”

Yep. Only went downhill from there.

Ironically, Lazarus discussed important issues like the over prescribing of medication, failure to adequately warn patients about side effects and discontinuation syndrome. These are real, important issues. They merit serious, thoughtful consideration. Instead, Lazarus decided to call millions of Americans (like me) drug addicts. He esoterically wondered “Who am I, really?” about taking anti-depressants. It’s a tragic, misguided view, one which reinforces stigma and will prevent people from getting help they need. And the language used by Lazarus is just appalling. If I’m a drug addict, so is everyone else who uses medication to survive for any other condition.

Really, this is just an ugly article.

I wrote a response which the Los Angeles Times did not accept, citing their policy to not run op-eds in response to other op-eds. Fair enough. My response, then, is below.

Don’t believe crap like what Lazarus decided to spew. Medication can be a vitally important part of any therapeutic regimen. It has saved thousands of lives.

Let’s say you are a diabetic and require insulin to live. One day, a friend tells you to quit insulin. Stunned, you ask why. Your friend responds: “Well, you can’t live without insulin. That makes you a drug addict.”

That’s absurd, right? Taking a prescribed medication in recommended doses doesn’t make you a drug addict. That makes you a responsible adult.

But the above scenario would never really happen, right? No one would ever claim that taking medication to treat diabetes, Parkinson’s or Alzheimer’s would make you a drug addict.

But, apparently, such an understanding does not apply to the millions of Americans who take medication to manage mental illnesses. To Americans like me.

For eighteen years, I’ve been diagnosed with a major depressive and generalized anxiety disorder. I’ve been suicidal. The medication which I take, in conjunction with therapy and lifestyle changes, has saved my life.

About five years ago, I made the decision, as a Pennsylvania State Representative, to start discussing my battles with depression, anxiety and suicidal ideation. I did so in response to the stigma which surrounds mental illness. Depression isn’t a weakness. It can’t be willed away. Taking medication doesn’t say anything about one’s character any more than having heart disease indicates a moral failure.

That’s why I was so disheartened to read Mr. Lazarus’ column: It took serious issues like over-prescribing  and discontinuation syndrome – issues which deserve thoughtful, reflective discussion – and conflated them with drug addiction. To be sure, medication is not a panacea. It often takes months, if not years, to find appropriate medication and dosage. Prescribers sometimes fail to appropriately monitor their patients. Side effects are real and dangerous. All of these issues demand thoughtful consideration and conversation.

However, such problems exist in virtually all areas of medicine, and no one would reasonably or seriously suggest that we should stop prescribing scientifically proven medication to people in need. Yet, that is exactly what some suggest when it comes to mental health.

Mr. Lazarus refers to himself as a “drug addict” for taking anti-depressants. Yet, he also discusses being a diabetic who takes medication for chronic Type 1 diabetes. Strangely, he declines to refer to himself as a “drug addict” for requiring insulin to manage his blood sugar levels. I wonder why.

We should never, ever be so foolish as to conflate appropriate use of anti-depressants with drug addiction. To do so makes people who take anti-depressants to live sound like sound like a caricature of a drug addict, desperate for their next hit of smack…or, as I like to call it, the pills which help me not want to kill myself every morning.

Contrary to what some believe, anti-depressants are not happy pills which whisk you away on a cotton-candy cloud, carrying you to Lollipop Island to float with gumdrops all day long. What they do is help you control symptoms, improve your mood and make other forms of change – like psychological therapy and lifestyle changes – easier to obtain.

Taking medication for mental illness doesn’t change who you are. It allows you to be who you are.

Far too many Americans have ignored their own minds and medical advice, choosing to try and “tough out” spells of depression, to “man up” or ignore these painful and rehabilitating symptoms. Too many Americans have powerful fears that taking anti-depressants makes you weak. This stigma must be crushed and rebutted in the same way intelligent society has pushed back on those who attack vaccines.

Anti-vaxxers and those who deny the positive impact of anti-depressants are flip sides of the same coin: They seek to use pseudoscience and stigma. Science has given us incredible tools which can be used to our great physical and emotional benefit. To ignore those tools, or to somehow wrap their use in shame, serves only to pull us into a darkness which we should have left behind decades ago.

The nearly 1 in 5 Americans who suffer from mental illness – including me – deserve to have our challenges discussed with respect and a comprehensive understanding of mental health treatment options. This discussion is simply incomplete without discussing the importance, effectiveness and risks of medication. No one who takes an anti-depressant is a drug addict, any more than a person who takes Prilosec for heartburn is addicted to not having their chest feel like is on fire.

The facts are stark. Depression rates are skyrocketing, rising sharpest among today’s youth, who have seen nearly 50% increases in rates of depression. 47,000 Americans – and 2,000 in my home state of Pennsylvania – died by suicide last year, an increase of 34% since 1999.

We need serious, sober conversations about mental illness and how to treat it. There are many concerns with anti-depressants. These are valid, serious concerns which must be addressed. But these conversations must occur using words and arguments which shatter stigma and support science. To do otherwise does an incredible disservice to those of us who suffer.

 

Oregon students can now take mental health days

So, in my political world, I’m a pretty progressive guy. One of the states which I have always watched closely has been Oregon. Oregon has been a progressive success story of epic proportions: From the environment to minimum wage increases to abortion rights to gun control to expanding economic opportunity to all residents, Oregon has led the way. 1

And then, I came across this story: Teens in Oregon can now take mental health days as an excused absence from school. It was done largely to address the stigma which surrounds mental health. According to Debbie Plotnik of Mental Health America:

“The first step to confront this crisis is to reduce the stigma around it. We need to say it’s just as OK to take care for mental health reasons as it is to care for a broken bone or a physical illness.”

The law specifically states that students can have up to five absences in a three month period – and anything more requires a written excuse to the principal.

In response to concerns that the law would make it easier for students to get out of school, Haily Hardcastle, one of the teenagers involved with the lobbying for the law, said, that students would take time off with or without the law – but the new law may encourage students to take their own mental heath more seriously, and would require schools to recognize mental health in their attendance policies.

Oregon’s rate of suicide is 40% higher than the rest of the nation.

I’m…I’m really intrigued by this. It does seem like a lot of days. And I wonder how this effort would interact with other attempts to remedy chronic absences – something that we really struggle with in my home school district of Allentown. But, I believe that Mrs. Hardcastle’s comments are correct – a kid is gonna take a day off if they want to, and if we can encourage them to discuss why, maybe we can help save their life.

Regardless, I’m extremely intrigued, and I’m hoping to pursue this one more. And if you have any feedback, I’d love to hear it!

 

Yes, people really are this stupid about mental illness and suicide

Sometimes, I find myself falling victim to the availability heuristic, and if you read this blog on a regular basis, I bet you do too.

For those of you unaware, the availability heuristic is defined as: “A mental shortcut that relies on immediate examples that come to a given person’s mind when evaluating a specific topic, concept, method or decision. The availability heuristic operates on the notion that if something can be recalled, it must be important, or at least more important than alternative solutions which are not as readily recalled.”

Why am I mentioning this now? Well, if you read this blog, I’m guessing you have an interest in mental health and mental illness. It’s probably a subject you follow closely and in which you are are well educated. I bet you have more evolved views on the causes and symptoms of mental illness and understand it’s complexities. And, I’d bet that the vast majority of people you interact with feel the same way.

Ahhhh, dear reader, allow me to share portions of an Email I just received. Among it’s gems:

  • “People commit suicide because they lack hope. True hope comes from putting your trust in the Lord Jesus Christ.”
  • “A troubled person who believes in evolution and does not know anything about the Bible, may turn to suicide as an escape.”
  • “If you want to reduce suicide, introduce the Bible back into school and stop teaching the fairy tale of evolution.”

First, a disclaimer, and let me make it crystal clear: The purpose of this entry is not to mock anyone’s faith or sincerely held beliefs. Rather, it’s to point out an absolutely ridiculous example of thinking. Faith absolutely assists some in the fight against depression and hopelessness. That’s wonderful. If that’s something which may work for an individual, I highly, highly encourage them to find a method of counseling which fits their views on religion, God and spirituality.

But the notion that prayer, Jesus or teaching creationism will cure depression and suicide for everyone is absurd.

Mental illness is highly complex. It often requires time, resources and multiple, simultaneous methods of treatment and lifestyle changes in order to fully address and treat. There is no one size fits all bullet. But what absolutely will not help is judgmental statements like the above, or the adherence to a one-sized fits all approach.

I’d also challenge anyone who makes a statement about reducing depression, mental illness and suicide to make sure that their comments are backed up by research. As I’ve noted in previous entries, there is a complex relationship between religion and mental illness, but as best I could find, there is ZERO relationship between teaching evolution and mental illness. Someone correct me if I’m wrong.

We’ve made great strides in the area of mental illness of late, but we still have a long long way to go. And absolute statements like the ones made above will do nothing but drive people further into the shadows.

There are people this uneducated out there, and I hope this is something we can all remember.