The Chicago News Cooperative takes up the problem of Mayor Rahm Emanuel’s decision to cut six of Chicago’s 12 mental health centers. In Philly, that would be devastating, so I can’t imagine it’s any different there. Of course the government is saying that people will be taken care of somehow, but that’s the kind of thing they always say, right? They say they patients from the other centers can just go to the ones that will stay open. But, um, that would mean a 71 percent increase in patients for the remaining clinics and a 0 percent increase in resources. Sounds like a plan.
Go here to read the stories of the people whose lives will be impacted by the cuts. Interestingly, though you’d imagine they’re depressing, they’re actually stories of hope. People with these illnesses are so strong, they are such survivors. They’re remarkable, and they deserve better.
UPDATE: I go into this a bit further over at the Philly Post. Check it out, and thanks for your comments.
In today’s Daily Beast, Gail Sheehy writes about the exhaustive interviews she did with Newt Gingrich and his family members some years ago in preparation for a Vanity Fair article. Newt’s mother was living in Dauphin, Pa., at the time, and confessed to Sheehy that her son had a rough childhood—one she called “a heck of a mess.”
Newt’s was a rootless boyhood as his stepfather’s military career moved the family around the U.S. and abroad. His mother became more and more emotionally fragile. How did she survive? I asked Kit Gingrich.
“I almost didn’t,” she blurted out. “I had manic-depressive illness.”
“Oh, sure. My life was moving from one post to another and another doctor and more medicine,” she told me. “You name it,” she said, referring to all the medications she was given for bipolar disorder, “and I was on it.” When a new doctor took her off all medication, she said, “I almost fell apart.” Bob Gingrich was furious and demanded that she be medicated again. But in that brief window of clarity, she told me, she saw him with new eyes. “Bob is a tyrant,” she declared. “No question about it.”
Oddly, though Sheehy questions the impact that Bob (and Newt’s biological father) had on the politician, she goes on to say:
His mother’s legacy of manic-depression may be even more relevant. The condition is inherited in about 80 percent of cases. I asked Gingrich if he thought he had a genetic predisposition to bipolar disorder. He didn’t blink. He said he didn’t know, then applauded the special powers of leaders who are thought to have been bipolar.
“Churchill had what he called his ‘black dog,’” he said. “Lincoln had long periods of depression. You go down the list …” He speculated that leaders who are able to think on several levels at once may have a different biochemical makeup. “You have to have a genetic toughness just to take the beating,” he concluded.
Bizarrely, Sheehy spends the rest of the article essentially arguing that Newt may, in fact, have bipolar disorder. It’s pretty ridiculous and borderline offensive. She even quotes Frederick Goodwin, who should be ashamed of himself for stooping this low, as saying, “Gingrich’s quickness, his ability to pick things up quickly, is consistent with studies of first-degree relatives of manic-depressives.”
It’s veiled character assassination. I dislike Newt Gingrich very much, but political careers have been torpedoed by accusations of mental illness. Is that Sheehy’s agenda? I wonder if she’d treat a liberal politician the same way.
Health.com has come up with a list of celebrities who confessed in 2011 to having serious health issues, which is great because poring over back issues of People magazine would be enough to make me increase my meds. What strikes me is that those celebs with behavioral health issues are treated the same as those with issues like autoimmune illnesses. That’s progress. Instead of being deemed “crazy,” they’re being characterized as dealing with a health problem. So Catherine Zeta-Jones’ bipolar disorder is on the same list of health issues as Kim Kardashian’s psoriasis. The only problem with this is that Kim Kardashian exists at all. Also mentioned: Daniel Radcliffe (Harry Potter), who struggled with alcohol dependence but now seems to be doing well. He told People in July:
“I’m actually enjoying the fact that I can have a relationship with my girlfriend [Olive Uniacke] where I’m really pleasant and not fucked up totally all the time … As much as I would love to be the person that goes to parties and has a couple of drinks and has a nice time, that doesn’t work for me. I’d rather just sit at home and read, or go out to dinner with someone, or talk to someone I love, or talk to somebody that makes me laugh.”
As for Zeta-Jones, she wasn’t planning to discuss her bipolar disorder openly, but was forced to when the tabloids would did the job for her. Pretty despicable. When Michael Douglas appeared on Oprah, he blasted to tabs for “outing” her. Not all celebs want to serve as poster children for their conditions—nor should they have to. It was probably the last thing she needed after a psychiatric hospitalization.
Bipolar Burble blogger Natasha Tracy has a post up today about Laura’s Law (California), which mandates mental health treatment for people who are considered both severely ill and dangerously violent as a court-ordered condition of their living in the community. Unlike forced electroshock, mandated Assisted Outpatient Treatment (AOT) (which doesn’t include forced medication) is showing positive results. Tracy cites results from other states, which show that AOT “helps the seriously mentally ill by reducing homelessness (74%), suicide attempts (55%) and substance abuse (48%).” She also cites gains of the implementation of Laura’s Law, including reduced hospitalization and reduced incarceration.
If you have objections to AOT, check out Tracy’s post. You may find she engages your arguments—and dismantles them.
To be honest, I don’t really know who Amber Portwood is because I never watch that show Teen Mom. But the reality show star is coming out about her diagnoses: bipolar disorder and dissociative disorder. From E! News:
“I was diagnosed with bipolar disorder three years ago. I struggle with it. I hate it. I grieve over it,” the Teen Mom star told E! News exclusively. “When I went to rehab for two months, they diagnosed me with disassociative disorder too, which makes me black out. People don’t understand what it’s like.”
Apparently, Portwood has been a bit scandalous on the show for beating up her baby’s father (she was charged with domestic battery). She was admitted to a “rehab” facility for anger management and depression in August after a suicide attempt. In October she said she was still suicidal. And now comes the confession of the illness in the wake of an episode in a restaurant in which she lashed out at fellow customers. It’s all quite sad, though it seems like viewers of the show really hate her (the comments on the article are vicious).
It’s odd that E! News’ headline is “Teen Mom’s Amber Portwood: ‘I’ve Been Diagnosed With Extreme Bipolar and Disassociative Disorder‘”. I don’t see her using the word “extreme” in the article, nor can I imagine anyone saying that since its not exactly DSM-friendly. But I guess E! liked the sound of it.
You know what I like about New Zealand (aside from the fact that the Lord of the Rings trilogy was filmed there)? I like that their courts prosecute “dishonesty.” In the States, we have all kinds of legal jargon. New Zealand doesn’t go in for that.
Take the case of Andrea Phipps, who just got home arrest instead of jail time because she blamed her actions on her bipolar disorder. Here’s what the Press of New Zealand had to say about her case:
Phipps, who has 72 previous convictions for dishonesty and has served a series of jail terms, including a term for attempted murder, had committed a further 20 offences over a four-year period.
She had previously pleaded guilty to ripping off two finance companies, filling out false loan applications in the name of her mother-in-law to get money for a boat and a car, which were later sold. She repeatedly bought time by issuing bad cheques including one to a solicitor.
She then faxed the solicitor’s receipt for that cheque to a finance company as proof that payment was on its way, which caused further losses when the car involved was released for sale before the cheque was dishonoured.
Phipps befriended a neighbour and found out her PIN when they went shopping. Then she took the woman’s bankcard and withdrew thousands of dollars.
She took cheques from her employers and used them pay a phone bill and a motel bill.
She paid a friend for a cheque for $28.18 and then altered it to $2801.18 and used it for a payment on a tenancy.
She used false documents to apply for jobs – two of them involving airport security clearance, which resulted in more charges today.
Her lawyer suggested that her feelings of grandeur from her “genuine illness” caused the latest bout of “dishonesty” and that she’s actually quite honest when she’s taking medication.
According to the Canterbury Star, the judge told her:
“This was a gross breach of trust in relation to friends, employers and authorities. The level of premeditation and deception was very high.
“You claim to have little memory of your offending, which I find hard to believe. You say that when you’re stressed, you turn to crime. I know a number of people who suffer from the same illness and they certainly don’t turn to crime as you do.
“You have 72 previous convictions for dishonesty. It is thought your mental state was a factor in some of your offending, and I agree.
“But for your mental health issues, a full-time custodial sentence would have been appropriate.”
Cases like this present a difficult challenge for mental health advocates. On the one hand, it’s frustrating to hear about people like this and have their illness associated with bad deeds. There are plenty of us with bipolar disorder who are not fraudsters, and it just sullies the image of people with mental health when stories like this are published.
On the other hand, what if she is being (uncharacteristically) honest about her diagnosis and really was impelled to do these things as a result of her symptoms? In that case, we’d certainly want her to be treated with sensitivity and not just consigned to a criminal justice system if that’s not what’s best for her.
An incredibly eloquent submission by Joe Gutstein.
Let’s imagine for a moment that you are long into the public mental health system. You have been in the hospital multiple times, in a couple of partial hospitalization programs, and have spent years in sheltered workshops and day programs. You’ve received the Prophecy of Doom, “Too sick for too long to get any better.” You’ve heard plenty of statements beginning with “You can’t, You won’t, and You will never.” You’ve been told endlessly that something is intrinsically (genetically) wrong with you and the only thing that will truly save you is a medication yet to be discovered. You’ve also been told that the most important thing you can do is get on SSI or SSDI in light of the prolonged and persistent nature of your illness. You’ve been told to engage in meaningful activities generally limited to walking, listening to music, and reading. You’ve been told countless times to avoid any stressors which might be associated with more rewarding activities and these stressors will doubtless lead to yet another hospitalization. You’ve been told so many things.
You’ve lived through several successive Eras: Psychosocial Rehabilitation, Evidence Based Practices, Transformation, Recovery and now Recovery and Wellness but the only thing that actually changed was your medication. You’ve been referred to as a patient, a recipient, a client, a consumer, a prosumer, a self advocate and now a “person with ….” but everything is the same at the hospitals, the sheltered workshops, the partial hospitalization programs and the very day program you now attend. You are now told pursuant to the Recovery model that you are suddenly empowered but what evidences your empowerment? What is it in your life that is now different? When did you last hold a meaningful job, live in decent housing, go on a date, attend to a party which wasn’t held at 3 pm or have friends over to your place? Has your health improved? Has your circle of friends and acquaintances changed? Has your income increased to provide for more options? What activities do you now engage in which you wouldn’t have before you were empowered?
Are you empowered? Not really, nothing has changed in your existence. What you do have is a familiar long standing delusion in which you are empowered. You imagine, it is part of your symptomatology, that you can provide anyone anything and everything with a CGI script. This is an empowering belief within your disempowering reality and among all the other folks at the day program it gives you a unique identity, a unique story where being unique in other areas might not be highly regarded. Fortunately, there is no impact on your role as a person in the day program unless you chatter away about it. (No more so than your peer who believes he is being watched by friends on another planet. After all, he is no longer alone all the time. Someone is watching over him where no one else might otherwise care about him.)
What is going to replace this powerful delusion and that which accrues to you by virtue of it? Let’s consider your options and the system of supports and services which will assist you in replacing it. Knowing that it is best not to ask for anything specific which might fall beyond the groups found at the day program, You say, “I want to be empowered.” The reply is “Of course, we can help you with this. Did you know that the day program has an Empowerment Group?” (You knew there was an Empowerment Group.) Consequently, you are signed up for the day program’s Empowerment Group. It meets in the same room as the Socialization Group which was going to help you get a date on Saturday night and the Pre-Vocational Group which was going to help you get a meaningful job. But you know the folks in the Empowerment Group. Not a one has become empowered. (The group meets weekly and all the chairs are in a therapeutic arrangement. There are handouts and members of the group so inclined read aloud from the handouts.)
So in the final analysis, you have the delusion and the Empowerment Group. The delusion is empowering but the Empowerment Group isn’t. Sadly, no one asked you the right question in the Era of Wellness & Recovery. Now – for the first time – the very question he or she would want to be asked in the same circumstances is being asked, “What do you need to thrive?” What is it that would lead you to hope for a life where the delusion has no value and might be patently detrimental. And for once you truly know that your answer shouldn’t be limited to something that happens in another group but involves real skills, fostered and facilitated in the real world with services and supports which promote a life. And just maybe you’ll now believe in the possibility of that date on Saturday night and a meaningful job for this new reality is more satisfying and empowering then any long held delusion.
In the recovery movement, which is the zeitgeist in the delivery of mental health services at this time, we are supposed to look past someone’s diagnosis. I am not “a bipolar” or “depressive” or “schizophrenic.” I have been diagnosed with such, but the relevance of that diagnosis is highly suspect. Because aren’t I just Liz? Liz who is addicted to Dunkin Donuts hazelnut coffee, Liz who likes chihuahuas in sweaters, Liz who tries to do gluteal exercises to increase her butt’s circumference — without success. So many things make up my Liz-ness, right? So who cares what some doctor said?
Generally speaking, I agree with this approach. For many years we have been labelling people in an attempt to treat them, and the results aren’t exactly stellar. So why not change protocols, DSM by damned?
Yet as a person who works on the frontlines of mental health care, I sometimes do find myself stymied by a person’s behavior, and a diagnosis can (infrequently) help. Because there certainly are definable characteristics of certain illnesses that can help me understand where a person is coming from. It also helps in distinguishing substance abuse from simple illness.
Here’s what I mean. Say I meet a guy who talks to me about his power over floating CGI-enhanced rabbit-shaped angels — who says he can get me anything I want by talking to them and persuading them. This is not true. By any measure we use to determine reality, the CGI-enhanced rabbit-shaped angel is clearly a fiction. But what if he slurs while he tells me this? What if he leaves that day and I have to understand what’s going on so I can advocate for him? Wouldn’t many people think, “That guy is on some serious crack.”
Now, we’d like to think a mental health professional would be more sophisticated than that, but then, you’d be assuming a level of knowledge that some MHPs simply don’t have (I say that with love). So if you look at this guy’s medical records and it says he has been diagnosed 10 times by 10 different doctors in the last 10 years as a person with schizophrenia, that might be good knowledge to have. Additionally, if his records state that he has never used drugs or alcohol, that’s also good to know.
I’m not saying that guy is only his diagnosis. I’m saying that hearing what psychiatrists have labeled him with for a decade might be useful information for me to have if I’m going to help him.
Similarly, the search for diagnosis can be a good road to travel. In today’s Washington Post, a mother asks Marguerite Kelly what her depressed daughter should do — meds or exercise? Kelly gives an answer that anyone should get in the absence of clinical assessment:
It’s time for your daughter to find an experienced board-certified internist who listens well and is curious enough to test her for viruses, low thyroid, high cortisol, candida and many other conditions that can cause depression. If she’s healthy, she then should be evaluated by a psychologist or a psychiatrist, who will ask her about any trauma or loss that she’s had, any history of depression in the family, any bad PMS occurrences or any sadness in the winter, all of which can trigger depression.
This is a good protocol in search of a diagnosis. That being said, my psychiatrist reminds me again and again he doesn’t care what my label is; he just wants to help me feel better. And it’s true that it doesn’t matter if you call it OCD or bipolar of DID or PPP (for Poo Poo Poo), if you’re counting every crack in the sidewalk, it’s probably time for some help.
These are my thoughts for today, messy though they are. I’d love to hear your thoughts.
Not because she’s a phenomenal actor, which she is, but because she’s just initiated a new project to banish stigma. The project is highly personal, as she explains on Huffington Post:
As I’ve written and spoken about before, my sister suffers from a bipolar disorder and my nephew from schizoaffective disorder. There has, in fact, been a lot of depression and alcoholism in my family and, traditionally, no one ever spoke about it. It just wasn’t done. The stigma is toxic. And, like millions of others who live with mental illness in their families, I’ve seen what they endure: the struggle of just getting through the day, and the hurt caused every time someone casually describes someone as “crazy,” “nuts,” or “psycho”.
What’s remarkable is not her frankness about this personal history, but her motivation to act, which seems almost like a wholesale rethinking of her career and what it’s meant in popular culture. In Fatal Attraction, for example, she played a woman obsessed with Michael Douglas (those were the days, right Michael?). She loses control of the obsession and becomes terrifying. As Close writes, the movie was a great success, and audiences loved to hate her character.
Alex Forrest is considered by most people to be evil incarnate. People still come up to me saying how much she terrified them. Yet in my research into her behavior, I only ended up empathizing with her. She was a human being in great psychological pain who definitely needed meds. I consulted with several psychiatrists to better understand the “whys” of what she did and learned that she was far more dangerous to herself than to others.
The original ending of Fatal Attraction actually had Alex commit suicide. But that didn’t “test” well. Alex had terrified the audiences and they wanted her punished for it. A tortured and self-destructive Alex was too upsetting. She had to be blown away.
So, we went back and shot the now famous bathroom scene. A knife was put into Alex’s hand, making her a dangerous psychopath. When the wife shot her in self-defense, the audience was given catharsis through bloodshed — Alex’s blood. And everyone felt safe again.
The ending worked. It was thrilling and the movie was a big hit. But it sent a misleading message about the reality of mental illness.
This is a bold admission from a woman who derived so much success from this role, but there’s no escaping what she says. It has long bothered me — and, I suspect, other advocates — that the message there is one of terror and fear.
Not only does Close take on her role in that film, she assesses the entertainment industry as a whole:
Whether it is Norman Bates in Psycho, Jack Torrance in The Shining, or Kathy Bates’ portrayal of Annie Wilkes in Misery, scriptwriters invariably tell us that the mentally ill are dangerous threats who must be contained, if not destroyed. It makes for thrilling entertainment.
There are some notable exceptions, of course — Dustin Hoffman in Rainman, or Russell Crowe’s portrayal of John Nash in A Beautiful Mind. But more often than not, the movie or TV version of someone suffering from a mental disorder is a sociopath who must be stopped.
I like to think that her speaking out will change this. As she so eloquently says, silence is the problem. Read more of her elegant prose here. It is well worth it. There you’ll find links to the initiative she’s promoting.
Thank you, Glenn, for speaking out against silence. You rock.
First of all:
Ted Kennedy’s Health Care Legacy
Patrick, my condolences on your father’s passing. When your dad’s brothers died, he had to get himself together and stop being an irresponsible, drunken frat boy. He had to become a leader who espoused what they did: social justice, pacifism, equal rights, etc. You have a head start: You made mental health parity happen, and you’ve been engaged in fighting the good fight since the beginning. You’re my hero.
But I also know you’re flawed and troubled, like your dad was, like we all are. The politicians who pretend to be saints tend to fail us, so you just go on being imperfect. And if you need support in your time of grief, just think of us out here, rooting for you to do well. We support you because you’re our voice now. And because we know what it’s like to live with loss. We believe in you. Carry on.