Prescription for a Perspective: Approaching Mental Health as Health
August 19, 2016
Flashback to a “Normal” Childhood
There are no two ways around it. No matter who you are or where you are doing it, growing up is awkward. It’s a constant game of catch-up with your own body and your own brain. Yesterday, you woke up taller. Today, there was hair on your legs. WAIT – WHAT? Seriously?! No sooner has the word, “Seriously?!” come out of your mouth than you notice something else. Your voice cracked! You don’t even sound like you anymore. If you’re in the other half of humanity, rather than your voice swinging out of control, your lower body knocks you for a loop. Suddenly, you are navigating monthly cycles, complete with tampons, panty liners, pills for menstrual pain, and the inevitable embarrassment when one or more of those fail. They always do at some point, right? It’s just one of those things. As if all the voice-cracking and panty-lining weren’t enough, my brother and I had to reckon with an additional potential weirdness: our father was a psychiatrist. Not only that, but he saw patients at home.
Dad took care of people with depression, who felt sad, even though they didn’t want to. He tried to help people with anxiety, who were scared – even though there wasn’t a reason to be scared. Their brains would tell them to run away, but there was nothing to run away from and nowhere to go. The same people would come by the house every week, but they wouldn’t always act the same way. I remember a woman with blond hair who would show up one week grinning and talking a mile a minute. The next Saturday, she would arrive crying uncontrollably. Mascara running down her face, her husband would half-carry her through our front door down the hall to my father’s home office, which was to one side of the kitchen, in a converted porch.
The weird part about all this was that none of it seemed weird at all to us. It was no more strange than my brother’s cracking voice or the hair that now grew on my legs; it was a pain, but I learned to shave. He was kind of quiet for a few years, but eventually, Ben’s voice evened out. People of all colors and ages became sad or scared, and they dealt with it. Dad helped them deal with it. It was just one of those things.
The really weird part about growing up as the child of a psychiatrist was that the world totally accepted my awkwardness at the same time that it totally rejected the sadness and fear of these other people. I was encouraged to embrace the training bras. I was given sympathy when I spent the day curled up in a ball because of cramps. I was told that it was okay to take pills for the pain. At the same time, I knew from my father’s patients’ frightened faces, by the way they would gaze over their shoulders as they came in the door, that they were not granted any sympathy for being sick. Instead, they were on the run. They hid their pills and their problems the way a bank robber hides stolen money.
As if some sort of crime had been committed.
At the age of 15, it struck me that I had the complete liberty to say, “I think my uterus is trying to kill me,” but that no one in our entire society has the freedom to say, “I have a voice in my head telling me to kill myself.” Now that right there is the weirdest thing of all. These humans – who looked no different than the doctors my parents worked with during the day and had dinner with at night – knew they needed help and were doing their utmost to get it. Getting help meant sneaking out to the suburbs to “hang out with Dr. B.” He could have seen them in his medical office in the tall glass building downtown, but then people would ask them uncomfortable questions: Why are you going in there? Do you hear voices? What do they say? Do you want to hurt yourself? For undergoing undesired and undeserved physical and mental difficulties, these poor people became objects of (at best) fascinated scorn. I, on the other hand, got a lollipop.
Physical and mental illness arise from the same place: inside our own bodies. Neither asks permission to be present. Both tend to improve with treatment, compassion, and time. Yet our culture doesn’t treat them equally at all. Here’s the question that has haunted me since I was a kid: Why not?
Present Tense: On Being a Doctor Who Continues to Ask, Why?
Today, I’m a doctor in my own right and my question stands. For the last 38 years, I’ve watched how the physically ill are treated as unjustly afflicted, while the mentally ill are seen as somehow cursed. The looks that the mentally ill get on the streets of big cities and in the subways makes me understand why people used to come to our house on the weekends. The way that the mentally ill are instantly blamed for terror attacks – when no other convenient target is available – makes it clear why people are reluctant to seek help. I’ve seen what sometimes happens in hospitals when they do seek help. During a night shift in an emergency room, I was working in the psychiatric section when a patient started panting and screaming that he had “a terrible pain” in his chest. As I stepped towards him, the man’s face turned bright red and he fell into my arms.
This man was in the hospital because he was hearing voices, not because he had chest pain. He was also overweight, in his 50’s, and the perfect candidate for a giant heart attack. In spite of that, I could not get anyone from the the medical side of the emergency room to come and help him. They wouldn’t even help me help him. In the end, I grabbed an EKG machine from “their” side of the room and wheeled it over to “our” side. I asked a passing nurse to give him some oxygen, sat the sweating, terrified man up in his bed, and took his readings myself. His blood pressure and pulse were high, but his heart wasn’t failing – just running fast. After a while, the man calmed down and began to cry. He confessed that he was sure he had caused 9-11. The voices told him so. They told him that he deserved to die.
Nobody deserves to die because they hear voices. But people do every day. People with mental illness die for the same reason that people with physical illness die: because they run out of their medication, as this man had, and are overwhelmed by the symptoms of their disease. They die because there is no one able or willing to take care of them. They die because the system, and those of us responsible for it, neglect them. That brings us to the next point. People with mental illness face an additional hurdle to survival to which people with physical illness are immune: those of us in the health care system often don’t seem to want to take care of them. As became apparent during my overnight in the Emergency Department, we would often rather treat things like high blood pressure, heart attacks, diabetes, and appendicitis. “Why is this so?” is the question that has haunted me as an adult and a doctor.
These questions are probably starting to sound familiar to you. It’s the Dr. G signature move: see something that doesn’t make sense, ask “Why?”, and don’t stop asking until you have a satisfactory answer.
Examining the Reasons: Why Getting Treatment for Mental Illness is So Difficult
This particular Why (as in Why does the system want to treat physical illness more than mental illness?) took me a while to discover. At first, I considered this answer: maybe treating the things we can fix quickly is more satisfying than treating something difficult or impossible to cure. Appendicitis is scary, but it’s fixed with a surgery. There are surgeons I know who can complete the entire appendix removal, from when the patient goes to sleep to when she or he is wheeled into the recovering room, in less than half an hour. That is very satisfying! Heart attacks are also scary. Depending on how badly clogged up the heart is, it might take us doctors days to put in devices to open the heart up again so blood can flow, and then to thin the blood so that the heart doesn’t get blocked up again. We treat the pain, help with breathing, and get the patients who had heart attacks walking again. Using these tried-and-true techniques, we’re very good at treating heart disease and getting better all the time.
However, this is true of mental illness, too. We are getting A LOT better at treating it than we used to be. When my father was in practice, all he had to work with were words and a few kinds of pills. Most of these pills either made people sleepy, overweight, zombie-like, or disinterested in sex. Today, we have many, many more choices in medications and in therapies. Rather than drugs, my brother-in-law uses magnets to dial-down depression1,2. Deep depression – the sadness that comes from the brain and won’t leave – can sometimes be cured by convincing the brain circuit that creates it to stop running. The treatment isn’t fast. It can take weeks or months to work, but in the end, people go back to living their lives the way that they did in the years before they were depressed. Even though it’s scary, electroconvulsive therapy – ECT, as we call it – works the same way; it shuts the misbehaving circuit down. Neither of these are cures, but they are effective therapies in many, many people, as are some modern medications.
So now the question is, If we have the tools to treat mental illnesses, at least some of them, why aren’t we more excited about treating them? My next thought is that maybe people are scared. Doctors are people, too. We have the right to be scared.
We are also extremely educated people and we have the duty to be honest, with ourselves and the world. We have the duty to point out that violence is a problem in physically-ill populations just as much as it is in mentally-ill populations. The psychiatric patients I’ve treated have typically been terrified, confused, or odd, but rarely violent (unless drugs were involved). In fact, the only people who ever actually tried to hurt me while I was trying to help them were “sane” at the time. They had a lot of problems, but mental illness wasn’t one of them.
We, the providers, all know that mental illness is something that befalls to people as often and as tragically as physical illness. We know that they don’t deserve it and that we should try to take care of them – or, at least, not add to their undue burden by refusing to take care of them. And yet, we hesitate. So here’s the question now: Why do we hesitate?
The only answer that I have been able to find is this: Doctors, ordinary people, even the mentally ill themselves, look down on mental illness because it isn’t “normal.”
To this I say: mental illness is as common as can be. People have headaches, backaches, colds, and anxiety. It’s so common, it’s right up there with high blood pressure. It’s as common as diabetes. There’s not a human alive who doesn’t know what it’s like to have a cold. There’s not a human alive who doesn’t know someone who struggles with mental health issues. At least 30 percent of us know about mental illness from the inside out. What other diseases can we say that about? The two-thirds of us who haven’t had to live with depression, anxiety, and so on inside our bodies and brains are partners in living through it with the people we care about.
Given how common mental health issues are, our whole society should be on board with dealing with them. Furthermore, we should be as skilled and quick at the treatment of mental health disorders as we are in dealing with strokes, which are far less common than depression. We should be less scared of mental illness than we are of alcohol, which kills thousands of people every year. True, like non-mentally ill people, mentally ill people bring harm to others. Mostly, though, they harm themselves. Wouldn’t we lose far fewer people – friends, brothers, sisters, people who matter to someone – if we could think of mental health problems as being normal?
The Prescription: Provide the Same Level of Care – and Respect – for All Illnesses
I’m not saying for a minute that mental illness is easy to treat. Like the most common modern afflictions of the body – high blood pressure, high blood sugar, and addiction – these hundreds of diseases of the mind often defy our attempts to take care of them. I am saying that we shouldn’t look at depression, anxiety, schizophrenia, and bipolar disorder as less normal than cancer or heart disease, or any less worthy of our time and efforts to defeat them. Mental health disorders befall us the same way as many cancers. People inherit bad genes. They become unlucky. True, both mental health problems and cancers can be caused or made worse by choices people make – but that’s far more true of cancer than of mental health disorders. For that very reason, both types of sick people deserve the same level of care. They deserve the same level of sympathy. They deserve to be thought of as normal people who have been afflicted, and who, with the proper treatment and some luck, may live with and beyond what has happened to them.
My prescription for the world when it comes to mental health disorders is this: think of them as illnesses like any other, naturally occurring and worthy of treatment. If you can’t, try this: Remember the day you woke up and there was hair on your chest or between your legs? When your voice started to change or you had bled the bed sheets red? These things just happened to you, just as anxiety, depression, and schizophrenia suddenly happened to these people: people you know, people you care about, or will someday. It happened just like that. What would life have been like for you if, when your world began to change beyond your control, you were treated the way that society treats them? If you can’t think in those terms, think about the news. Remember all the things we say that “crazy” people do- mass shootings and so on. How different would the world be if the people who suffer from mental health disorders received the same level of respect as those who suffer from diabetes, heart disease, and cancer? How different would the world be if we cared for all these humans and their diseases equally? How much better off would we all be if, instead of turning away, we stepped in and caught these people when they fall?
1) Philip NS, Ridout SJ, Albright SE, Sanchez G, Carpenter LL. 5-Hz Transcranial Magnetic Stimulation for Comorbid Posttraumatic Stress Disorder and Major Depression. Journal of Traumatic Stress. 2016.
2) Philip NS, Dunner DL, Dowd SM, Aaronson ST, Brock DG, Carpenter LL, Demitrack MA, Hovav S, Janicak PG, George MS. Can Medication Free, Treatment-Resistant, Depressed Patients Who Initially Respond to TMS Be Maintained Off Medications? A Prospective, 12-Month Multisite Randomized Pilot Study. Brain Stimulation. 2016.
Dr. Sheyna Gifford