CHOICE? MAYBE?

According to the medical dictionary, mental illness is defined as:

 
Any of various psychiatric conditions, usually characterized by impairment of an individual’s normal cognitive, emotional, or behavioral functioning, and caused by physiological or psychosocial factors. Also called mental disease, mental disorder.

This could mean that anyone struggling with abnormal thoughts, emotions, or behavior could be seen to have a mental disorder.  At the end of the day I say “Why put a label or title on the disorder”.  Why can’t we as individuals be looked at as a person and accept each other as being different.  In my opinion, this is what makes the world evolve because we are all different and bring something different to the world. But if I had to choose one proposed changed in the DSM-V that I would be against; it would be substance abuse. I feel as though the use of substances is a choice.  An individual has a choice on whether or not to take drugs or drink.  Although many abusers have become addicted because of other mental disorders; but in my opinion the use of substances is a side-effect from something much deeper.  To be classified as an impairment of functioning shouldn’t it be based on factors that an individual can’t control such as bi-polar disorder or schizophrenia? To me an individual shouldn’t be able to make decisions about what they want to do and be characterized as having a mental disorder.  Although I don’t take from the fact that it is an everyday struggle for an individual struggling with substance abuse to stay away from it; at the end of the day it all depends on choice.  Many of Americans deal with tragedies and pain, but they don’t turn to substance abuse.  It’s the stability of an individual thinking and emotions that give them leverage to resist substances. If you can’t control that and make a choice then let’s look deeper.  IS IT A CHOICE? Maybe or maybe not, in the end these individuals still need treatment, just don’t know if they should be seen as having a mental disorder.

Addiction for the Modern Age: Internet Addiction

The creation of the internet is arguably the greatest invention of human kind. It has linked the four corners of the Earth together, and enabled the expansion and availability of knowledge to anyone with a connection to it. However, with the internet came a slew of unforeseen issues like concerns over privacy, identity theft, and more recently, addiction.

Internet addiction is defined by Dr. Kimberly Young as "any online-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one's work environment."

Over the past few years mental health practitioners have been diagnosing individuals with Internet Addiction Disorder (IAD), although this condition has never been fully accepted by the American Medical Association or the American Psychiatric Association. According to a 2011 Huffington Post article, internet addition will also not be included the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), but it could be referred to in the appendix which may lead to its inclusion in a future version of the manual.

What IS currently included in the DSM is the diagnostic criteria for abuse which is as follows:

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: 

(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)
(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights) 

Using this criteria, one could easily be diagnosed with an internet ABUSE problem. At this point you may be asking yourself if internet addiction can fall under the realm of abuse, then why is the need for IAD to be included in the DSM so important?

The answer is simple: TREATMENT.  Internet Addiction Disorder's inclusion in the DSM would inevitably lead to more research on the disorder, which would lead to more practitioners focusing on treatment. Some reputable treatment centers are available like the  Center for Internet Addiction, but the disorder is becoming so rampant that IAD "camps" are being emerge where "treatment" includes mental abuse and physical torture. If more mental health practitioners are focused on the quality treatment of the disorder, then a scientifically researched, evidence based standard of care of will emerge.        

The “R” word…

STOP THE STIGMA

Online templates

I strongly support the change of “mental retardation” to “intellectual disability”. “Mental retardation” is a name that has grown to have entirely too much stigma surrounding it. I still, to this day, hear people jokingly say, “Man you’re retarded” or “that’s retarded”. The stigma of the phrase has to stop! The Howard Stern show even has a guy that they call “Gary the Retard” that they use for entertainment because of his “intellectual disability”. Even a MLB pitcher, John Lackey for the Boston Red Sox, was being interviewed and said “This is retarded ...” (he later on apologized).

The problem is that a lot of people just use the word and don’t really even realize what they are saying or that they are offending people that are “intellectually disabled”. Click here for a great article on why one person stopped using the word “retarded”

Bottom line…the word is used to often and it needs to be changed.

Fortunately there has been some good initiative into changing this phrase. “In October 2010, President Obama signed Rosa's Law, which removes the terms "mental retardation" and "mentally retarded" from federal health, education and labor policy, and replaces them with "intellectual disability." (REILLY , 2011) This law that President Obama signed and a change in the DSM-V are a great start to eliminating the word from legal/medical documentation, but unfortunately, in my opinion, the word will never be eradicated from the mouths of society.

Click here for a great site about stopping the use of the “R” word.

Resources:

Opinion-awareness-effort-help-end-stigma-of-mental-illness. (2012, March 29). Retrieved from http://www.enterprisenews.com/topstories/x777658869/OPINION-Awareness-effort-help-end-stigma-of-mental-illness

REILLY , P. J. (2011, July 13). Proposed name shift would battle stigma. Retrieved from http://lancasteronline.com/article/local/420983_Proposed-name-shift-would-battle-stigma.html

The Doctor

Initially, after examining the 8 proposed changes highlighted in the Huffington Post article, I wasn't passionate, pro or con, about any of the changes. 

I did more research and discovered the Huffington Post article only “skimmed the surface” in regards to the changes that are being proposed.  To see a list of all the proposed changes see  http://www.dsm5.org/Pages/Default.aspx  .   I found a couple of articles that outline the major problems that people are having with DSM 5.  See an article at “Psych Central’s” website http://psychcentral.com/news/2012/02/16/possible-dsm-changes-spark-controversy/34909.html )  and http://www.ipetitions.com/petition/dsm5/

The ipetitions website details the “sticking points” that people are having with the proposed modifications.  There is one new diagnosis being proposed which, I believe, warrants further consideration before inclusion.  It is “Disruptive Mood Dysregulation Disorder.”  I oppose it because it will enable the use of powerful medications in young children for whom the drugs were not designed.

Disruptive Mood Dysregulation is a disorder that is characterized by severe and recurrent outbursts of temper in response to everyday stressors.  The outbursts can either be verbal or behavioral and are considered out of proportion to the current situation.  These responses are also considered to be inconsistent with the developmental age of the client.

According to the ipetitions website children will be more “susceptible to receiving a diagnosis” once an illness is defined.  Diagnosing, in and of itself, is not necessarily a problem.  After all it’s typically the first step that is made in order to get someone the help they need.   But the inclusion of Disruptive Mood Dysregulation will allow doctors to prescribe neuroleptics to children for which the drugs were never tested.  They will merely get a smaller dose of what is prescribed for an adult.  Ask yourself "What are the long term affects of neuroleptics to the growing bodies and minds of children"

A brief search of Wikipedia came up with this information.

“A number of harmful and undesired (adverse) effects have been observed, including lowered life expectancy, extrapyramidal effects on motor control – including akathisia (an inability to sit still), trembling, and muscle weakness – weight gain, decrease in brain volume, enlarged breasts (gynecomastia) in men and milk discharge in men and women (galactorrhea due to hyperprolactinaemia), lowered white blood cell count (agranulocytosis), involuntary repetitive body movements (tardive dyskinesia), diabetes, sexual dysfunction, a return of psychosis requiring increasing the dosage due to cells producing more neurochemicals to compensate for the drugs (tardive psychosis), and a potential for permanent chemical dependence leading to psychosis worse than before treatment began, if the drug dosage is ever lowered or stopped (tardive dysphrenia).^[2 “

I know that not everything that you read in Wikipedia is true, but even if only half of the neuroleptic side effects were valid, should we prescribe them to children?  Couldn't Cognitive Behavioral Therapy be used instead?  See http://en.wikipedia.org/wiki/Antipsychotic to read the full entry on neuroleptics.

Christopher Lane has written a book called “Shyness: How Normal Behavior Became a Sickness.”   








See http://www.amazon.com/Shyness-Normal-Behavior-Became-Sickness/dp/0300143176%3FSubscriptionId%3DAKIAIRKJRCRZW3TANMSA%26tag%3Dpsychologytod-20%26linkCode%3Dxm2%26camp%3D2025%26creative%3D165953%26creativeASIN%3D0300143176 


This is Amazon’s description of this book  “In the 1970s, a small group of leading psychiatrists met behind closed doors and literally rewrote the book on their profession. Revising and greatly expanding the Diagnostic and Statistical Manual of Mental Disorders (DSM for short), they turned what had been a thin, spiral-bound handbook into a hefty tome. Almost overnight the number of diagnoses exploded. The result was a windfall for the pharmaceutical industry and a massive conflict of interest for psychiatry at large. This spellbinding book is the first behind-the-scenes account of what really happened and why.  With unprecedented access to the American Psychiatric Association archives and previously classified memos from drug company executives, Christopher Lane unearths the disturbing truth: with little scientific justification and sometimes hilariously improbable rationales, hundreds of conditions—among them shyness—are now defined as psychiatric disorders and considered treatable with drugs. Lane shows how long-standing disagreements within the profession set the stage for these changes, and he assesses who has gained and what’s been lost in the process of medicalizing emotions. With dry wit, he demolishes the façade of objective research behind which the revolution in psychiatry has hidden. He finds a profession riddled with backbiting and jockeying, and even more troubling, a profession increasingly beholden to its corporate sponsors.”

The book does make one think about the long-reaching ramifications that the DSM task force can elicit.  The points that I'd like to make are that neuroleptics are dangerous and giving children a "pint-sized" version of an adult diagnosis is risky business.

Look for More Than What You See

Look for More Than What You See!

In reading the article this week I realized just how much discrimination people face every day; but the impact it can have on an individual suffering from mental illness can be devastating. As a child growing up in a home with someone suffering from a mental illness, I was taught that they are different but they still need to be treated the same but be careful because you never know what will happen.  And every time I seen an individual with similar characteristics as my family member I will keep as much distance as possible.  But now that I am older and beginning to understand an individual is more than just their illness it makes me thankful for policies and resources that are available to individuals suffering from mental illness. Link and Phelan describe 3 different discriminations which are direct, structural, and internalized.  Direct discrimination is defined by individuals who hold stereotypical beliefs about the mentally ill.  You see direct discrimination from individuals in the work place. Mental Health Matters states, “Stigma keeps people from getting good jobs and advancing in the workplace. Some employers are reluctant to hire people who have mental illnesses. Thanks to the Americans with Disabilities Act (ADA), such discrimination is illegal. But it still happens! Stigma keeps people from getting good jobs and advancing in the workplace. Some employers are reluctant to hire people who have mental illnesses. Thanks to the Americans with Disabilities Act (ADA), such discrimination is illegal. But it still happens!”  Although there are laws against this treatment the fear and lack of knowledge prevents jobs from giving equal opportunity.  Structural discrimination is seen a lot in jail systems.  They take individuals with mental illness and expose them to circumstances that can be very stressful and cause breakout episodes.  Even children suffering from mental illness, the environment they are placed in has a great impact on how they cope with their illness.  Mental Health matters list the do’s and dont’s regarding stigma on mental illness.

DO'S

·    Do use respectful language

·    Do emphasize abilities, not limitations.

·    Do tell someone if they express a stigmatizing attitude.

 

DONT'S

·    Don't portray successful persons with disabilities as super human.

·    Don't use generic labels such as retarded, or the mentally ill.

·    Don't use terms like crazy, lunatic, manic depressive, or slow functioning.

For other resources and stigma busters you can go to www.mentalhealthmatters.com.  This site gives information about many mental illnesses and to inform society.

INDIVIDUALS ARE MORE THAN JUST THEIR ILLNESS!

J., I understand you a little bit better

I saw an example of stigma while growing up.  My neighbor, J., was an elderly woman in her seventies when my family moved into the town she lived in.  I was 16 at the time and just learning how to drive my family’s stick shift.  (You can imagine what a joy it was to ride with me.)  

J. lived by herself in a house about a mile from my family.  She didn’t own the house she lived in.  It had belonged to her brother who sold it to a doctor before he died.  The brother had retained “living rights” for J. to live there until she died.  J. never had a job.  I don’t know what she did for money.  I guess she got a little money from the government.  She did have a telephone.

J. didn’t have a car, and we lived out in the country.  There was no public transportation.  Whenever she needed to go to the store she had to call up her neighbors to ask them to give her a ride.  People didn’t like to give J. a ride because she smelled bad, she had snuff in the corners of her mouth, and her clothes were always raggedy.  Although J. had no immediate family, she had a lot of cousins who lived nearby.  They must have helped her out some (for example she had wood for her wood stove) but I don’t remember her talking about her cousins helping out.  She talked a lot about how people didn’t like her.

Anyway, since I was young and needed spending money, I would agree to drive J. to the store. (Looking back, she must have been pretty desperate to ask me considering my tendency to “dump the clutch.”) This was in the day before a lot of cars had air conditioning.  So trips to the store with J. automatically involved rolling down the windows no matter what the weather.  Summer time was the worst because the heat made the smell stronger.  It was kind of a mixture of B.O., tobacco, and excrement.  I don’t know whether her house had a flushable toilet.  I don’t think it did.  If she had running water, I “highly” doubt that she had a hot water heater.  That, in part, might explain the lack of bathing.

I’d drive her to the store to get some tobacco and ice cream.  She paid me $2.00.  I remember thinking that she didn’t eat very healthily.  I don’t know what she told me that she ate, but I do remember at age 16 thinking “That’s not healthy.”   She said that most food didn’t taste good to her.  “Meals on Wheels” hadn’t been invented then.  And it still doesn’t exist in my home town.  You’d have to move about 90 miles away to find the nearest “Meals on Wheels.”

Nobody called the police or the health department to get J. any help.  I guess that was an example of “Direct Discrimination.”  I don’t think we intended to “discriminate” against her.  We just knew we didn’t want to be around her.  She smelled bad, and she acted different from most people.  Okay, I’ll be truthful.  We called her “crazy.”  At the time that was acceptable. 

Thinking back on her living conditions, e.g., no inside toilet, no water heater, wood stove, no A/C, lack of accessibility to stores, etc., I think that was an example of “Structural Discrimination.”  She lived at the end of a dirt road about ½ mile long that was behind a hill.  When people drove down the road, they never saw her house, so they didn’t have the occasion to think about her. I don’t know which came first:  the isolation or her mental illness.

I don’t know what her diagnosis was.  She told me that she “changed” after a near miss accident.  She was riding down the road with her brother and a neighbor in his truck when she was in her 30’s.  She was sitting on the passenger’s side next to the door.  (Once again, this was in the “old days.”)  She wasn’t wearing a seat belt.  Somehow, her door came open, and she pitched headlong towards the road.  Her brother grabbed her by the ankle and saved her life, but only after she had “dangled” out the door for a while.  She thought she was going to die.  She said she never was the same after that incident.  (I don’t think anybody would be.)  

Lastly, I’ll talk about “Internalized Discrimination.”  Once J. and I were talking about an argument that she’d had with another one of the neighbors.  There had been some angry words between them, and J. hadn’t defended herself against the neighbor’s insults.  I remember her saying something like “Well, I guess that’s because I’m a yella-bellied coward.”  (Only she used words much worse than that.)  That phrase really disturbed me at the time.  It still disturbs me even now when I think about it.  Back then I didn’t know what self-esteem, or self-advocacy were.  I know a little bit about those terms now, but I still don’t know whether I could teach someone to have them.  How would you go about doing that?

When researching for this blog, I searched for “successful end to stigma” and “ways to end stigma.”  I thought if I could find something that worked for other illnesses, I’d recommend its use for mental illness.  I tried to think of illnesses that used to be very stigmatized but were not stigmatized as much now.  I thought of leprosy, epilepsy, and AIDS.   

A World Health Organization article has ideas for stopping leprosy stigma.  (See 
http://www.who.int/mediacentre/news/releases/2003/pr7/en/index.html   )


The Epilepsy Foundation gives approaches for stopping epilepsy stigmas. (See http://www.epilepsyfoundation.org/livingwithepilepsy/parentsandcaregivers/parents/helpingothersunderstand/fightingstigma.cfm  ) 

The International Council for Nurses recommends several ways to stop AIDS stigma.  (See http://www.icn.ch/publications/2003-nurses-fighting-aids-stigma-caring-for-all/  )

Lastly, the May Clinic recommends these approaches to stop the stigma of mental illness.  (See 

http://www.mayoclinic.com/health/mental-health/MH00076/NSECTIONGROUP=2  )

• “Get treatment.
• Don't let stigma create self-doubt and shame.
• Don't isolate yourself;
• Don't equate yourself with your illness;
• Join a support group.
• Get help at school.
• Speak out against stigma.”

If I had to quote the “stigma busters” for each of these 4 web-sites (Leprosy, Epilepsy, AIDS, and Mental Health,) I’d say:

• ·         “Expensive and separate programs have been shown to be the wrong approach”
• ·         “The more you and your child learn about it and help to educate others, the better you will be able to fight stigma and discrimination.”
• ·         “Stigma and discrimination block the march forward…creating a culture of secrecy, silence, ignorance, blame, shame and victimization. . To stop prejudice speak openly about the facts.”
• ·         “Speak out against stigma.”

Why treat Mental Illness differently than any other illness?  All 4 of these web-sites have 2 common threads: educate yourself and speak out.  I believe an OTA could teach someone how to do that.

Stigma, Discrimination & Mental Illness

Mental illness is not 'catching'. It is not contagious and yet it does not discriminate. Why then, is society so afraid of it? This question we can ask ourselves when discussing stigma and discrimination of the mentally ill for it is fear that lies at the root of these horrors. 'Horrors' seems a strong word but not when one considers the effect of discrimination upon the mentally ill person. This cannot be more evident than in the case of internalized discrimination when the person being discriminated against actually believes the negative stereotypes being thrust upon them. This can only lead to the worst consequence of all...isolation. (www.successfulschizophrenia.org) It is alienation that not only can prevent the mentally ill from seeking help towards recovery but it harms us as a society as well because placing each other on the outside of the 'inner circle' muddies the waters and reflects poorly on us as a group. There is nothing worse than contempt prior to investigation. Here a lot of the responsibility falls on the mentally ill though as they must work to accept themselves and not believe these negative stereotypes through such interventions as self-help group therapy and psychology.
When a person directly discriminates against a mentally ill person it is their responsibility to make changes within themselves and this could be accomplished through education if that person is willing to be open-minded. With education intervention I'm referring to institutions that effect us in our daily lives to change their negative characterization of the mentally ill such as the media and the world of advertising.
If this is not enough we are also bombarded with a type of discrimination stemming from certain societies and communities that have a structural type of negative view towards other members of other communities and societies. This type of stigma is very powerful as well for there is certainly power in numbers and power is a necessary factor in the discrimination of someone viewed as inferior. Having a mediator of sorts bring the two communities together for discussion and social activities may be a possible intervention for this sort of discrimination. Perhaps getting together and having a first hand experience with each other could squash some of the lies they believe about each other.
Although I have not experienced nor witnessed discrimination against a mentally ill person, what I can imagine it to be like seems atrocious and I'm sure what I imagine is not even half of the true experience for them. Things would be so much easier if we could all treat each other with love and tolerance, if we could put principles before personalities, and if we could break down the walls of fear that somehow reside in us all.

Stop the Stigma

Many people talk about the short bus, aka, the short school bus. There are jokes thrown around like, “Hey you must ride the short bus.” These stigmas need to stop. Historically, the short bus was made for the “developmentally disabled” children who needed a ride to school. So now there are jokes that are associated with the short bus. “You must ride the short bus”. O.k… so you are trying to say that I am developmentally disabled? Really? So what if I am. Is there something wrong with that? Should I be treated any different than you? I DON’T THINK SO! The stigma’s surrounding MI must stop! 

Click here for a blog about riding the "short bus"

According to Bruce Link and Jo Phelan there are 3 different types of discrimination that are connected to stigma: Direct discrimination, Structural discrimination, and Internalized discrimination.

Direct discrimination is described as people holding a stereotyped belief about those with mental illnesses. One way to reduce this would be to EDUCATE. People need to be educated regarding MI instead of believing what they see and hear on television.

Structural discrimination is described as a person’s social environment that can have an effect on their safety, health care options, and on the amount of funding available for research on MI. One way to reduce this problem would be to once again, EDUCATE. If people are educated regarding MI and they get a chance to see what structural discrimination is, then they are more likely to try and help make some changes. But if people don’t see it, then often they are unaware of it.  

Internalized discrimination is described as learning from a young age the negative attributes surrounding those with MI. Well, once again, EDUCATION would help these stigmas. Some of the people that do have a MI are scared to seek treatment because they don’t want to be labeled. But if the population was educated properly on MI then the mentally ill would not have to worry about being labeled and they wouldn't have to be scared.

Do you see a pattern here?

 I do…The answer to reducing stigma is to EDUCATE, EDUCATE, EDUCATE!!!

 

For information on building awareness about stigma, click here

 

For a journal dedicated to stigma research and action, click here