We’ve Come a Long Way, Baby–or Have We?

Posted on October 10, 2012 by

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I like to think that stigma surrounding mental illness has gone the way of the patents on the big blockbuster medications–it’s just expired and other views, less expensive on the psyche, have moved in to fill its place.

Celebrities and the otherwise famous ‘come out,’ shattering the illusion of the mentally ill as hapless, disenfranchised, unsuccessful. TV shows feature high-powered characters with mental illness, and portray them sympathetically and without excessive bathos.

Bipolar disorder has–and who wouldn’t need this?–a Hollywood spokeswoman.

I’ve recently been converted from PC-dom to Mac-hood, having finally seen the light. As part of my package, I have regular session at the Apple Store, which often involve manipulating my 1,253,742 bookmarks, of topics I mean to write on, any minute now. So Apple ‘geniuses’ (that’s really what they’re called. The first day I went for my appointment, a salesman said, “I’ll go get a genius,” and I actually answered, “I don’t need a genius; I just have a few questions on my Mac.” I was so naive) who work with me on bookmark organization see folders with names like, ‘Bipolar disorder and medical comorbidity,’ or ‘depression and cancer,’ or a personal favorite when others are searching my Safari–’Suicide’ (it has a capital ‘S’).

Not wanting my friendly geniuses to think they should need to call a helpline on me, I always explain that I’m a mental health blogger.  And they are so receptive about this. Three times, when we’ve been moving around my bipolar bookmarks, people have told me, ‘oh, it’s nothing, my [blank] is bipolar.’ I’ve gotten, in that blank, a cousin, a close friend, an aunt, an old college roommate. [People are rather more quiet when we deal with the suicide folder.]

See–it’s all ok, it’s all out there, there’s no fear of mental illness, and certainly no stigma. If it’s okay with Apple, the most powerful stock in the world, it must be okay with the world.

But I did notice one thing in all these interactions. Not once has someone said, ‘oh, it’s nothing, I’m bipolar/depressed/suicidal.’

Perhaps that’s because anyone who gets called a genius and is lucky enough to have early access to a new iPhone 5 just can’t possible be afflicted by mental illness.

But it makes me wonder if as a society we’re ‘okay’ with diseases of the mind–up to a point. It’s okay–for somebody else to have them.

My parents both work in the mental health field, and throughout the years and decades have come across the more than occasional resistance to taking psychiatric medication.

Now, if most people hear there’s something wrong with their hearts, and they and need to take a statin, you know what they do?

They take a statin.

Same goes if there’s something wrong with their thyroids, or their pancreas–they take the proper medications.

But when all too many people receive a diagnosis of depression, say, or bipolar disorder, just to use those as examples, a common response seems to be an entrenched belief that those are not ‘real’ illnesses. Sure, they feel unhappy, feel ‘off,’ as if something’s ‘not right’–but take a medication? That seems extreme. Certainly exercise, an improved diet, more sleep. . . .that can fix what’s wrong with them, right?

The reluctance to give in to taking medication for a mental illness is a strong force. Doctors note how many times they’re asked, ‘Will I have to take this for my whole life?’ as if the patient has been handed a death sentence.

You know what happens when you have thyroid cancer and your thyroid is removed? You take synthroid–for your whole life. People don’t ask before they’ve started when they can come off. And, for the adult diabetic, it’s metformin–if not insulin–all the way, no initiating questions about stopping after 6 months.

And once a person with a mental illness has finally been convinced to try medication, know what happens? More likely than not, they come off it, often without remembering to mention it to their doctors (must slip their minds).

John McManamy who writes the well-known and respected bipolar site http://www.mcmanweb.com tells us that, “According to an article in Medscape, as many as 70 percent of patients on antidepressants may be noncompliant, and according to another article in Medscape 50 percent of patients quit on their antidepressants before 30 days.”

The 30 day part of that impresses me–half the people on antidepressants  have quit them  before one billing cycle on their credit card is complete. Did Lipitor ever suffer such indignity?

You know why I think it is that no Apple geniuses ever say, ‘Oh, don’t worry about your wacky bookmarks, I have depression’? Or why patients being prescribed Nexium don’t ask if they can come off it after 3 months? Or why 70% of people who take Advair don’t just up and quit?

Because, in the end, we don’t really believe mental illness is a disease in the same way diabetes, or asthma, or reflux is. Somehow the brain [unless there's something physical in it--people don't ask if they have to treat a brain tumor, and for how long] and its malfunctioning still isn’t considered as real as illnesses of the body, and if it’s not really real than we don’t have to do anything about it.

We don’t have to take medicine, we certainly don’t have to stay on medicine. We can say we have no shame in others’ suffering, but we certainly don’t want to let others know that we have some phantom illness, some sickness that if you just picked yourself up by your bootstraps, everything would be fine.

You see, we’ve come a long way, baby, on the stigma front. We’re ‘cool’ if others suffer from mental illness, and seeing bookmarks on bipolar doesn’t scare us (my geniuses were notably quieter when we organized the ‘schizophrenia’ category–and no one volunteered anything about their roommates, cousins or aunts. It’s something to think about.).

But if we ask people to accept a diagnosis of mental illness in themselves? Those old walls come up, and sometimes it seems we haven’t come much farther than out the barn door, which we’ve left open, enabling chaos in the barnyard, and destroying clarity of vision.