CHRONIC TONIC posts on Thursdays at 9 p.m. EST, it is a place to share stories, advice, and information and to connect with others with chronic health conditions and those who care for them. Our diarists will report on research, alternative treatments, clinical trials, and health insurance issues through personal stories. You are invited to share in comments (and note if you'd like to be a future diarist).
Tonight's diary by: DrPlacebo
We've had a number of fights on Daily Kos lately about mental illness and psychiatry, and I thought it would be a good idea to set the record straight.
I was especially disappointed today by diaries slamming the APA over drafts of the DSM-V. It's true that the DSM can be over-expansive in places, and psychologists and psychiatrists joke all the time that you can't read the DSM without diagnosing yourself with half the stuff in it. But that whole line of argument misses an important point: the DSM doesn't support diagnosing anything - at all - unless it causes "clinically significant distress or impairment." No, the APA isn't out there trying to find something to diagnose you with. I'd suggest, in fact, that there might be a much less nefarious (if no less selfish) ulterior motive behind the relentless expansion of the DSM: subdividing pathologies into as many tiny categories as possible, in order to justify selling more copies of the new DSM to mental health professionals trying to stay up to date. Not that I don't have some disagreements with the DSM or the profession of psychiatry, but I felt that today's diaries came dangerously close to dismissing mental illness entirely.
As anyone who has lived with depression or bipolar disorder or schizophrenia can attest, mental illness is very real. It can be extremely debilitating. And it is never something that people just "snap out of" - improvement takes time and often intensive treatment. For that matter, for reasons that science has yet to discover, it often doesn't ever go away entirely. Of patients diagnosed with major depression, fully half will require antidepressants for life.
But the picture really isn't that bleak. Like many other chronic diseases, mental illness may not be curable, but it can be controlled. This is a concept that a surprising number of people don't realize. With my depression, which is usually under control to the point that the vast majority of people I meet never realize that I have it, my mother keeps asking me when I'll stop taking antidepressants, and expressed surprise when I started looking for a psychotherapist here in Sacramento. I've just had a very successful first year of law school, will be spending half of the summer writing for the law review and the other half in Austria taking a summer course taught by Justice Anthony Kennedy. The point is: nothing about mental illness prevents one from having an active and productive life.
Except for one thing, that is: other people's fear. As a society, we've mostly progressed past overt racism and sexism. For the most part, we've learned to accept people with physical disabilities in our workplaces. But stereotyping people with mental illness as "crazy" is still widely accepted, and it hasn't been helped by tragedies like the recent shooting sprees at Virginia Tech and Fort Hood and in Arizona. In fact, it was the Virginia Tech shootings that changed my life. I had been almost halfway through medical school when, literally the day after the shootings, I was suspended merely for being Asian-American with depression, and therefore "fitting the profile of" the gunman. Needless to say, that kind of thing doesn't help. I got a settlement for it eventually after finding a lawyer, but spent over a year mostly hiding in bed. I am speaking from first-hand experience when I say that mental illness is one of the last frontiers of civil rights in this country.
Which brings me to the brouhaha over last Saturday's hate mail-a-palooza. Kos's comment was inappropriate, and I'm going to leave it at that. I found the soul-searching in Daily Kos a little more fascinating, in that the characterization of the far right as "batshit crazy" was criticized by some.
As I mentioned briefly in a couple comments around that time, I'd like to suggest a different proposition. Namely, let's separate "mentally ill" and "crazy." There are people with diagnosable mental illness, and there are crazy people who believe outrageous things. There are even a few people who are both mentally ill and crazy. But people with mental illness are, for the most part, not crazy. We're not any more likely to commit acts of violence than anyone else - in fact one study found that people with schizophrenia were more likely to be victims than perpetrators of violence.
The hard part is making that distinction more widespread. What has helped other underrepresented groups gain acceptance has been being seen in public, and at work, doing the same kinds of things that everyone else does. But mental illness is usually totally invisible, and like many other invisible, chronic illnesses, it can be risky to disclose, which makes it even harder to fight the stigma surrounding it. I certainly see similar attitudes toward epilepsy and other episodic diseases.
I am hoping that the ADA Amendments Act will work some changes, at least indirectly. There are two elements of fighting discrimination: preventing the acts of discrimination themselves, and enforcing the law when discrimination happens. There are no easy answers to preventing the stigmatization of mental illness; that will take years of dialogue. But mental illness has also been a challenge in that victims of discrimination have a much more difficult time enforcing their rights than most. One major obstacle in obtaining legal remedies is the fact that, should a case go to court, the existence of a mental illness would be a major issue, and some or all of a patient's medical records could become public.
What I am hoping changes this state of affairs is the expansion of the "regarded as" clause of the ADA. With "regarded as" being changed so that a plaintiff need only prove that he/she was discriminated against on the perception of a chronic condition, it might be possible to protect plaintiffs' privacy. Ultimately, by giving the ADA some teeth, we might end up seeing a stronger incentive against discrimination on the basis of mental illness and other invisible disabilities.
Please note in comments your interest in being a diarist. (We will happily format your diary for you, including links and pix!)
May 5: Diarist needed
May 12: Diarist needed
May 19: Diarist needed
May 26: Diarist needed
June 2: Diarist needed