Racism is not a Mental Illness; Racism is a Sin

• Racism is not a mental illness; racism is a sin.
• White nationalism is not a mental illness; white nationalism is a sin.
• Violence is not a mental illness; violence is a sin.
• Hatred is not a mental illness; hatred is a sin.

Okay, the Christian in me is coming out here when I say sin. And even some Christians have trouble using that word these days. Which is fine. Don't use it if you can't sort out sin from all the baggage it carries.

But for the love of God and your neighbor, don't substitute mental illness to explain the appalling image of the latest white guy with his racist manifesto and his swastika painted on his semiautomatic weapon shooting up the Dollar General, or the supermarket, or the bible study.

Use the word wrong if you can't bring yourself to say sin. Wrong doesn't seem strong enough, I understand that. But explaining these events as mental illness is REALLY wrong on two levels.

Ignoring the Evidence about Mental Illness

First, mental illness does not correlate with violence.

Let me say it again for the people in the back of the room.

Mental illness does not correlate with violence.

Sure, journalists will go digging into the background of the latest shooter. And journalists will find that the shooter had some previous contact with mental health services. The American Journal of Public Health article by Sherry Glied and Richard G. Frank explains this phenomenon:

The journalist’s search for a mental illness explanation of aberrant acts will almost always succeed. Epidemiological research suggests that nearly half the population—whether or not involved in crime—experience some symptoms of mental illness over the course of their lifetimes. The most recent population estimate of the lifetime prevalence of major mental illnesses meeting diagnostic criteria among US adults is 46%, and 9% meet criteria for a personality disorder.1,2 Seeking mental health treatment is hardly less common: the literature suggests that about one fifth of the US population report seeking professional care for a mental health problem in a year and nearly one third do so over their lifetimes.3 

The very high lifetime prevalence of illness and treatment seeking helps explain why virtually every story of a violent act can be linked to some clues of psychological abnormality or mental health treatment—even though the rate of violent behavior of any type among people who meet diagnostic criteria for mental illnesses is estimated to be only about twice as high as the rate among those who never experience a mental illness.3–5 Mental illness is simply not a very specific predictor of violence.

People with serious mental illness are only twice as likely to commit violence than the general population. Which means that they commit 4% of violent crime. 4%.

It is wrong, it is incorrect to explain violence by mental illness.

Why does the myth persist, contrary to the evidence? Because having rejected the concept of sin, we can't figure out why these things happen, unless something is wrong with their heads. But that explanation is wrong, as in incorrect.

Indeed, there is something wrong in their heads. But it is not mental illness.

• Racism is not a mental illness.
• White nationalism is not a mental illness.
• Violence is not a mental illness.
• Hatred is not a mental illness.

Which is why, when these guys are taken in for evaluation, they are released. Because they are not mentally ill.

Making Mental Illness Illegal

Blaming mental illness for violence is wrong in a second way. It is harmful, hateful, and dangerous.

Harmful, hateful, and dangerous.

Liberals repeat the myth of violence caused by mental illness to support funding for more services for the mentally ill (which never are forthcoming). Conservatives repeat the myth to push back against gun control (without allowing any restrictions, even for those they claim to be violent). Both liberals and conservatives, both liberals and conservatives create scapegoats of vulnerable people.

Here is what a candidate for president of the United States tweeted, repeating his answer to the violence question in the recent GOP debate:

Don’t remove guns from law-abiding citizens. Remove violent, psychiatrically deranged people from their communities and be willing to involuntarily commit them. Revive mental health institutions: less reliance on pharmaceuticals, more reliance on faith-based approaches that restore purpose to people’s lives. We know from the 1990s how to stop violent crime. The real question is if we have the spine to do it.

That this candidate has low polling numbers does not undo the damage he does by calling us violent and deranged. He makes such discourse seem reasonable.

On the other end of the political spectrum, both California and New York City politicians are endorsing forced institutionalization and treatment of people with serious mental illness, even for those who do not pose an immanent threat to themselves or others.

Forced institutionalization may look like compassion. It is a violation of civil liberties. It makes mental illness illegal.

Where will these forcibly institutionalized people be housed? The latest figures for all types of psychiatric inpatient settings are from 2014, when there were 170,000 beds available. However, that figure includes VA and private hospitals. State capacity, where those who are hospitalized by the state go, is 35,000 beds.

Where are the mentally ill really housed? According to a recently released federal Bureau of Justice Statistics (BJS) report, 1.25 million of them are in prison, where they do not fare well. According to this report:

Prisoners with mental illness find it more difficult to adhere to prison rules and to cope with the stresses of confinement, as evidenced by the new BJS statistics that 58 percent of state prisoners with mental problems have been charged with violating prison rules, compared to 43 percent without mental problems. An estimated 24 percent with a mental health problem have been charged with a physical or verbal assault on prison staff, compared to 14 percent of those without. One in five state prisoners with mental health problems has been injured in a fight in prison, compared to one in 10 of those without.

Prison staff often punish mentally ill offenders for symptoms of their illness, such as being noisy, refusing orders, self mutilating or even attempting suicide. Mentally ill prisoners are thus more likely than others to end up housed in especially harsh conditions, including isolation, that can push them over the edge into acute psychosis.

The Bigger Picture - Making Homelessness Illegal

“The man standing all day on the street across from the building he was evicted from 25 years ago waiting to be let in; the shadow boxer on the street corner in Midtown, mumbling to himself as he jabs at an invisible adversary; the unresponsive man unable to get off the train at the end of the line without assistance from our mobile crisis team: These New Yorkers and hundreds of others like them are in urgent need of treatment and often refuse it when offered,” the mayor said.

...Mr. Adams has received criticism from some progressive members of his party for clearing homeless encampments and for continuing to push for changes to bail reform that would make it easier to keep people in jail. The mayor has defended his focus on public safety and has argued that many New Yorkers do not feel safe, particularly in Black and Latino neighborhoods.

Connect the dots. From homeless to mentally ill to dangerous to better off incarcerated, one way or the other.

The Myth Will Not Make You Safe

My friends, you can put another 1.25 million of us loonies in jail. That young man will still be stalking the streets who lives with his white middle class parents in their suburban home with an arsenal in the basement. You will have done nothing to protect our schools, our shopping centers, and our bible studies.

So stop it.

Racism is not a mental illness; racism is a sin.

Doctors as Priests, Providers and Protectors - Part 4

In Priests, Providers, and Protectors: The Three Faces of  the Physician, Ron Pies proposes a third way to view physicians, not exalting them to the grandiose position of Priest nor demoting them to mere Provider. In the role I call the Protector, the physician's chief obligation is that of  the safeguarding of the patient's physical, emotional, and spiritual well being.

This is a role that acknowledges the patient's autonomy, while recognizing the physician's expertise and the ethical imperative to use that expertise to express foundational principles of the medical field: beneficence, nonmaleficense, and justice. Do good, don't do harm, and I'm not sure what he means by justice, though I have some ideas. The examples below are mine, not his.

Saving Normal - At What Cost?

Rest In Peace, John Ferguson

John Ferguson was executed by the State of Florida on Monday, August 5 at 6:17 p.m. ET.  He killed eight people thirty years ago, and many people can't get too excited about his own death.  I understand that.  As a Christian, I am grieved that my nation kills people to show that killing people is wrong.  But I get it.

The civilized world does not get it.  The United States of America is a member of an elite club, forty-three nations that have executed people in the last ten years (brown in the map below, along with China, Syria, Libya, North Korea -- our good buddies, all of them).  We bear the distinction of being the only member from among the developed nations.

We do place limitations on the death penalty.  Our constitution, since its first passage, prohibits cruel and unusual punishment, the eighth amendment.  Over the years, the Supreme Court has ruled that all forms execution are cruel and unusual, except for lethal injection, the method that Florida used to kill John.

American Medical Association on the Death Penalty

Silence Kills - The Stigma of Mental Illness

I don't use the s-word.  I hate this title.  I use it only because people who need this post will use it when they google.

I don't use the s-word.  But here it is.

First from Google:

Definition of STIGMA

Noun A mark of disgrace associated with a particular circumstance, quality, or person: <the stigma of mental disorder>.

The Power of Apology

First, a nod to our excrutiatingly polite neighbors to the north, on the Power of Apology from Scott Stratton:

Next, inspired by Scott and in honor of Magna Carta Day - a rerun of last year's Entitled to an Apology?

Perhaps because a central feature of both hypomania and depression is irritability, and because a characteristic of the "bipolar temperament" is a certain tendency toward an attitude of entitlement, interpersonal disputes tend to be common in this patient population. -- Ellen Frank, Treating Bipolar Disorder

Those Who Have Eyes, Let Them See

Yes, I said I was on sabbatical.  But I do have to write.  Like, I do have to breathe.  My facebook page this morning, somebody posted an Ernest Hemingway quote, There is nothing to writing.  All you do is sit down at a typewriter and bleed.  I have learned there is more than one way to bleed.  Teresa of Avila's stigmata, by the way, were interior.  Mine (writing) seems better than other alternatives.

So yes, I am on sabbatical.  That means I don't have to post.  I might anyway.  Oh well.

NAMI National Convention 2012

It started with Shepherd.  He stood straight tall.  Life has taken a lot out of him, including a lot of teeth.  But he stood straight tall.  I remember him as a black man, with piercing light blue eyes.  I know that's possible, a black man with blue eyes.  Maybe it isn't true in this case.  My brain really isn't that dependable anymore.  But the piercing part is the most important.  I am so glad I wasn't afraid to look in his eyes.

Entitled to an Apology?

Perhaps because a central feature of both hypomania and depression is irritability, and because a characteristic of the "bipolar temperament" is a certain tendency toward an attitude of entitlement, interpersonal disputes tend to be common in this patient population. -- Ellen Frank, Treating Bipolar Disorder

Frank goes on to explain how this attitude of entitlement plays out in the clinical setting.  Unlike the usually self-effacing patient with Major Depressive Disorder, grateful for any scrap of attention, people with bipolar get irritated at imagined slights, such as when the therapist cancels an appointment, or is late.  Sometimes, the only way the therapist can maintain the therapeutic relationship is to go ahead and apologize for these imagined slights.

Yup, stick that fork in the 220 volt socket again.

Real Mental Health Advocacy - We Have Begun

Okay, so I just blew away this week's post.  Sigh.

Instead, I will honor the people in Chicago, who have tried every form of education, conversation and persuasion they could devise to convince Mayor Rahm Emanuel not to close six of the city's twelve mental health centers.  Finally, they staged an occupation.  For seven hours, they held the Woodlawn Mental Health Center, while Occupy Chicago gave support from outside the clinic.

They are my heroes.

Read the remarkable details here.  The videos seem to be missing from the text.  Here is the link to the story as recorded in stages on youtube.

Mental Health Day -- The Funner Version of Advocacy

Last week it was Mental Illness Awareness Week, according to NAMI.  So today it's World Mental Health Day, according to WHO.  The World Health Organization, that's WHO.

That's a week for mental illness, a day for mental health.  Whoever organizes these things must be reading my mood chart.

I cycle within cycles.  In the larger circle, I have been able to maintain a stable state for a while now -- the state of jaded, that is.  So I take up this week where I left off last week, continuing the repost of a series on the sorry state of mental health advocacy.  This second post takes a glass-half-full approach.

Not exactly mental health, but at least the upside of mentally interesting.  I mean, we got these diseases for life.  We might as well learn to make them work for us.

Mental Illness Awareness Week - Because We Are Really Good at Delusional

Imagine this -- Somebody from NAMI attends one of those campaign events and gets to the microphone.  Intending to ask about the candidate's views on funding for community mental health, this poor parent begins with a statement: 

People with severe mental illness die on average twenty-five years before everybody else.  They have the expected lifespan of Somalia. 

Nowadays the crowd will cheer.  But that particular youtube wouldn't go viral.

I am jaded about this Mental Illness Awareness thing.  It will not be subjected to any Best Practices evaluation.  NAMI and the pharmaceutical industry have been making us more aware of mental illness for decades now.  The numbers on prejudice have not budged.  They have not budged.

That negativity -- does it mean I am currently displaying symptoms or that I have done my research?  Both, actually.

I'll cop to the irony here.  I myself was a speaker at one of those Mental Illness Awareness Week events once, held on a Sunday night in a not-much-traveled portion of a university campus.

It was very moving, the candles and all that.  And it did raise awareness, in the sense that it made those of us who were there, people with mental illness and those who love us aware that we are not alone.  But did it increase funding for research and treatment?  Did it reduce prejudice?  I don't think so.

Let me answer that another way.  Did it increase funding for research and treatment?  Did it reduce prejudice?

Nope.

So symptoms, research, irony and all, my contribution to Mental Illness Awareness Week is a repost of what I think we ought to be doing this week.  And next.  And next. 

From Friday, March 11, 2011:

Ignore/Laugh/Fight/ -- Mental Health Advocacy That Wins

If they don't want to employ you, if they are afraid of you, if there are four times as many of you in jail as in the hospital, then it's not just stigma.  It is prejudice and it is oppression.

The twentieth century offered a whole degree program in prejudice and oppression.  Others have made progress against what beat them down.  Though we are now stalled and falling behind, we can move forward when we adopt their methods.

The Map to Liberation

Mahatma Gandhi was not the first freedom fighter.  But he is the great theoretician.  He gave us the map.

First they ignore you.
Then they laugh at you.
Then they fight you. 
Then you win. 

Four simple steps.  The good news -- we have already taken the first.  Got that one down pat.

Liberation 101: 

We are in charge of the map.  The oppressor doesn't decide that oppression will end.  It endures until the oppressed decide that it will end.

What we have to do is provoke the next step.

Then they laugh at you.

Well, that's where we are stuck, because we are unwilling to be laughed at.  Last month's NAMI meeting was about Iowa's upcoming budget cuts.  Somebody said, When we complain, they say we are crazy.  I think she is a therapist.  She has that therapist look, if you know what I mean.

Therapists say the funniest things.  When we complain about how we are treated, they say we are crazy.

But we are crazy!  We start off ahead of all the other liberation movements that had to get crazy to take it to Gandhi's next step.

Think Martin Luther King.  Think Nelson Mandela.  Freedom?  People called them communists.  Either that or just plain nuts. 

Like these other movements, we have to find a spiritual taproot deep enough that we can endure being laughed at.  Just like the tree, standing by the water... 

The spiritual work will be impossible if we expect our care providers to lead.  They get twitchy if we talk spirituality.  I will address that work another time.  Right now I will sketch out how we break beyond First they ignore you, and move to Then they laugh at you.

What that means more precisely is, we have to do things to make people think we are nuts.  Like, DEMAND that we receive funding for research and treatment, DEMAND that we have the same access to health care as anybody else, DEMAND that we receive our health care in health care facilities, not in jails.

It's all about budget cuts right now.  Corporate tax cuts -- that's a given.  Corporations spent good money for our current crop of legislators, and they expect a return on investment.

So who will pay for these tax cuts, the people with mental retardation or the people with mental illness?  The Iowa State legislature has a committee that has asked us to decide.  Well, isn't that special.

We have to DEMAND that they change the rules of this game.  We have to REFUSE to play Survivor.  We have to refuse LOUDLY.

How?  African Americans sat down.  That is when they moved off Step One, when they REFUSED to be ignored any more.

So how about we lie down?


Lie In/Die In

Picture this.  The next Loonie Lobby Day at the state legislature, we don't get all showered and neatly normaled up and go have sincere conversations with our legislators who are really sympathetic (their brother has depression, so they know what we are up against, but their hands are tied by that pesky deficit...)

Instead, we stand in the rotunda and read off the names of their constituents who have committed suicide.  Each time a name is read, somebody falls down.  They have to step over our bodies to get out of the building.

Mental Health "Parity"
 
The Mental Health Parity and Addiction Equity Act would be better called the Swiss Cheese Mental Health Act.

1) Only large employers are affected.

2) If they can demonstrate it causes them financial hardship, they can get an exemption.

3) Parity is a laugh anyhow, if reimbursement rates are so low you can't find a provider who accepts your insurance.

4) The provisions of even this piss poor legislation that address reimbursement rates are now the top of the list on Congress's chopping block.

So off we head to Washington.  There are 13,000,000 million of us with serious mental illnesses in the US, including 5.7 million with bipolar, 2.4 million with schizophrenia and 7.7 million with PTSD.  The numbers add up to more than 13,000,000, because some of us get to double dip.  Piece of cake to pull together 34,000 to do a die-in around the steps of Congress, representing one year's worth of the deaths by suicide in the US.  We will drape American flags over the bodies of the vets.

Yes, we are dying out here.  Let them step over us.

How nuts are we to think we can turn around this systemic discrimination?  In this political climate?

Progress Report

Remember, When we complain about how we are treated, they say we are crazy?  By now some of my readers seriously want me to reconsider Seroquel.  Others -- if you are still reading, your doc wants you to up your dose.  This means we are making progress.

At some point, laughter becomes a cover for scared.  Then it's time for the next step.

Then they fight you.

Remember, this is our map.  We are the ones who push it forward.  Nobody else will.  And if I am scaring you, look at it this way.  If we aren't scared already, we'd have to be crazy.

Until we change our advocacy, we will continue to lose psychiatrists.  We currently have less than half the psychiatrists we need to provide a even a shoddy level of token med checks.  In Iowa, we have one fourth.  While demand is going up (think Iraq, think Afghanistan), supply is going down, as retiring psychiatrists are not replaced by new doctors.  Why go that far in debt to get through med school and then choose a specialty with the lowest pay scale on the block?

Until we change our advocacy, we will continue to lose community mental health centers.  Remember community mental health centers?  The places we were supposed to go when they kicked us out of the hospital?  They are disappearing already.  Here are the Kansas numbers.  You can find the same story for any state you google.

Until we change our advocacy, we will lose what parity was promised.  Again, all employers have to do to avoid it is demonstrate that it costs them money to provide it.

Until we change our advocacy, we will lose even the programs that jails now provide.  Why should criminals be coddled?

Desperate Times Call For Futile Gestures

What were we thinking?  That public demonstrations would make a difference to cold hard facts?  Were we nuts?  (By the way, what have we been thinking, that talking would make a difference?)

After the strategies designed for Then they laugh at you prove futile, we up the ante.  In place of our bodies, we substitute urns full of ashes and dump them on the floor of the assembly halls.

In 1987 AIDS activists entered the New York Stock Exchange.  Seven people unobtrusively chained themselves and a banner to the rail overlooking the trading floor.  At the opening bell they unfurled their banner and blew fog horns.  They drowned out the opening bell, and prevented traders from trading, while they brought national attention to their demand that pharmaceutical companies stop profiteering at the cost of their lives.

Wall Street is our audience, too -- all the businesses that insure some of their employees but not us, all the health care companies that pay reasonable reimbursement to some doctors but not ours.  How about we bring ambulance sirens? 

A Day Without Mental Health Care 

Next we head to Main Street.

The 2004 film A Day Without A Mexican imagined what would happen if one day everybody in the US from Mexico, Guatemala, Honduras, Nicaragua, et al disappeared.  Economic havoc, that's what.  A few years later, the movie inspired a political demonstration.  Workers stayed home for a day.  In some places, restaurants simply closed for the day, unable to serve their customers.

So last week the Wall Street Journal reported a survey by Workplace Options.  The survey discovered that 41% of workers polled had taken 4-9 days off work in the previous year to care for their own, their friends', their coworkers' or family members' mental health issue.  Half work in offices with no benefits, support or services to deal with mental health issues.

They think they can't afford to provide services?  They haven't a clue how much it already costs them not to. 

There you have it, a National Day Without Mental Health Care.  Everybody who has a mental illness or loves somebody who does -- stay home.  I'm thinking Monday -- to make that moon connection, and maybe even disrupt Monday Night Football?

Going To Jail

At this point, we are littering, destroying property and generally disturbing the peace.  We are going to jail.

Everybody on a three-month wait list for an intake interview,

Everybody on a two-year wait list for the judicial review of an SSDI application,

Everybody on a four-year wait list for sheltered housing,

Everybody who had been doing okay, but stopped taking meds when the day program closed,

Everybody who can't afford the copay for that third tier prescription anyway,

Everybody who doesn't have health insurance at all,

Everybody who is homeless,

Go downtown and set a trash can on fire.

We Need Some Coordination Here

No, not everybody.  Jail is not a good place for people with OCD, PTSD, nor Borderline.  You all, your part is to run right down to the courthouse, legal brief in hand, to make sure the police department fulfills its obligation to get the rest of us our meds.

Prejudice And Oppression -- Some Observations

This post has been about fighting oppression, the institutional arrangements that support an unjust system.  Oppression is weighty.  It is fierce.  It does not respond to reason.  Power yields only to power.  The strategies and actions I have described are the power of anger that has been organized.

Our families and our care providers are just as scared as everybody else of our anger.  So they will not help us here.  They want to address prejudice, not oppression. 

Prejudice is the irrational thoughts and feelings of individuals.  Well, prejudice also needs to be addressed.  There is work enough for everybody.  Think of differential diagnoses as differential skill sets for the differential tasks of freedom-fighting.

That's coming next week...

banner from nami.org

image of prison bars from microsoft

photo of Mahatma Gandhi in public domain 

flair from facebook

forest photo by Maylene Thyssen used under the GNU Free Documentation license

sit in at Walgreen's in Nashville, Tennesee, March 25, 1960, in public domain

photo of die in casualties by Brendan Themes and used under the Creative Commons Attribution 2.0 Generic license

fist graphic in public domain

Jared Loughner -- It Doesn't Have To Work This Way

The man who wants to put Jared Loughner to death is concerned for his health.

The United States attorney for Arizona, Dennis K. Burke, wrote to the Ninth Circuit Court of Appeals that despite being under suicide watch, Loughner’s unmedicated behavior is endangering him. 

It has been determined that Jared suffers from schizophrenia, and is unable to participate in his defense against the 49 charges stemming from the Arizona shootings that left six people dead and thirteen wounded.  Now somebody wants to get this desperately sick young man some help.  Because if he can't stand trial, then he can't be prosecuted, convicted and executed.

Jared's attorneys think it is not in his interest, under the circumstances, to take Risperidone, a standard antipsychotic medication given to people who think that somebody is trying to kill them.  It might have been in his interest earlier on.  But the community college that noticed his bizarre behavior, including the speech salad that is the dead giveaway of schizophrenia, simply expelled him.

The Ninth Circuit Court of Appeals agreed with the prosecution, and Jared is now being forcibly medicated.

I intended to return to my NAMI Convention reporting this week.  But wow.  This story lands on my laptop, the very essence of the Prozac Monologues spirit.

There are so many layers of meaning here.  I don't think I am up to the task of analysis.  Instead I will tell another story, the original sequel to last week's rerun.

This is how a Christian community responded to the violent act of a mentally ill man. -- as they understand what it means to be Christian.  From January 21, 2010 --

The Miracle of Gheel

It was seventh century Ireland.  The Queen died.  King Damon's grief was so deep that it moved into depression and then psychosis.  He thought his daughter Dymphna was his queen.  Rather than submit to his advances, Dymphna fled to Belgium, to the town of Gheel.  But her father followed.  When she again rebuffed him, he killed her, cut off her head.  Dymphna was buried in the local church.

Six centuries later, her coffin was found during renovations.  Signs on the coffin demonstrated her holiness.  She began to be venerated.  Cures of the sick were attributed to her.  She was canonized in 1247 as the patron saint of the mentally ill.

Okay, here the one last bit of unrecovered Catholic in me demands to be heard, to note Rome's fascination with girls who prefer death to rape.  Even as a nine year old, that troubled me.

Abandoning The Mentally Ill -- Or Not

Moving on.  People came to Gheel for healing.  Many brought family members who were mentally ill.  Sometimes they left them there.  The priest housed these abandoned ones next to the church.  When the job of caring for them became too much for him, townspeople started bringing in food.  They built a hospital in the 14th century.  When it was full, the real miracle of St. Dymphna occurred, or rather, began.  Townspeople took some of the patients into their own homes, reserving the hospital only for those most ill.

All across Europe, people with mental illness were thought to be possessed.  They were exorcised, tortured and burned at the stake.  But not in Gheel.

Imagine it!  A psychotic foreigner commits a terrible deed.  But the townspeople do not close the borders.  No, they open their homes.

And they still do.  Through plagues, wars, revolutions, recessions, depressions, during the Napoleonic "Reform," when all the mentally ill people in the country were ordered into one big hospital, during the Nazi occupation, with their "final solution" for mental illness, during the latest reform when the U.S. of A. was/is dumping all our mentally ill people out of the hospitals, onto our streets and into our jails, the people of Gheel developed and continue genuine community-based mental health care.

What Community Care Looks Like

Today, there are 700 foster homes for 1000 people with mental illness.  A person will enter the hospital for evaluation and stabilization.  S/he meets the psychiatrist, psychologist, nurse, social worker and family practitioner who staff one of the five neighborhood community mental health centers.  Each of these staff people spends half a day each week in the hospital, so everybody gets to know everybody.  The potential foster family and patient meet at the hospital, then over tea at home, then over a meal, then over a weekend before placement.  Outpatient care, medication monitoring and therapy continue at the neighborhood center.  If possible, the biological family participates in the treatment plan.

Once part of the family, the person shares in family activities, chores and church.  The church doesn't have special bible studies, services or programs for the mentally ill.  They are fully integrated, regular readers, members of the choir, ushers, etc.

But What About Relapse?

What if the person's symptoms flair?  We say s/he is having a bad day.  Because the person lives in a family, not on the streets or alone in an apartment, problems are caught and addressed early, not after getting fired or evicted or arrested or in a bloody mess.  If needed, s/he can go back to the hospital for a while.  In fact, the hospital is not the place of last resort.  When the foster family has to go out of town, say, for a funeral, the person can stay at the hospital.  There is continuity of care.  There is care.

Three years ago I wrote a chapter for Deep Calling called, If This Were Cancer.  I detailed all the ways that hospice patients receive the support of others, and that people who have suicidal depression do not.  If this were cancer, there would be casseroles...  I imagined the total collapse of care for the mentally ill, under the weight of our crazy health care system.  In fact, it's happening as I write.

I imagined that the Church would step in to meet a desperate need, to create hospice for the mentally ill, as the Church originally created hospice and hospitals.  I claimed that the Church has the resources to organize for such care on a local basis.  It has the faith to imagine such a thing, the love to cast out fear, and the values to demand it.  I will have to rewrite that chapter.  I didn't know it had already been/is already being done.

I am ever so grateful to Janet, whose last name I don't remember, who gave me Souls in the Hands of a Tender God: Stories of the Search for Healing and Home on the Streets by Craig Rennebohm, the source of this story. 

Lord God, Who has graciously chosen Saint Dymphna to be the patroness of those afflicted with mental and nervous disorders, and has caused her to be an inspiration and a symbol of charity to the thousands who invoke her intercession, grant through the prayers of this pure, youthful martyr, relief and consolation to all who suffer from these disturbances, and especially to those for whom we now pray. (Here mention those for whom you wish to pray.)

We beg You to accept and grant the prayers of Saint Dymphna on our behalf. Grant to those we have particularly recommended patience in their sufferings and resignation to Your Divine Will. Fill them with hope and, if it is according to Your Divine Plan, bestow upon them the cure they so earnestly desire. Grant this through Christ Our Lord. Amen. 

... I think maybe Jared could use our prayers, too.

photo of Risperidone by V1ND3M14TR1X and used under the terms of the GNU Free Documentation License

image of Dymphna in the public domain

A Kitchen Interior by Joachim Beuckelaer, 16th c., in the public domain

book cover from amazon.com

Mental Health Advocacy -- The Funner Version

Okay, last week was weird.  That's what you get for reading a mental health blog written by an Episcopal priest.  You never can tell when Jesus might interrupt with, No, what would I really do?






As it happens, that is where Gandhi got his program for freedom fighting, from Jesus.

First they ignore you.
Then they laugh at you.
Then they fight you.
Then you win.

There's a Lenten meditation for you.  Overlay Gandhi's road map on the birth, ministry, death and resurrection of Jesus.  Gandhi taught us to do what Jesus would do, what he really did do.

But not all of you are Christians.  Not all of you follow The Way.  Not all of you even follow my train of thought!  What does death and resurrection have to do with mental health advocacy?

Well, never mind.  The post stands on its own, as the tried and true program for addressing oppression, the institutional arrangements that support an unjust system.

This week's post turns to a different path, what we think of as stigma-busting.  But I have come to suspect that the word stigma itself conveys the stigma it is trying to bust.  It directs attention away from the stigmatizer and toward the stigmatizee.

No, what I am talking about is flat-out prejudice, the irrational thoughts and feelings of individuals.  Focus on the person who has irrational thoughts and feelings.  How can we help him/her get over these nonproductive and painful experiences?

This path parallels last week's -- we're all headed in the same direction.  But this one you can travel while wearing designer shoes.  In fact, designer shoes might just be the ticket!

Come Out, Come Out, Wherever You Are

First step, come out.

See, if all you know about African Americans are those cop shows, all you know about Islam is Osama Bin Laden, and all you know about people with mental illness is Jared Lee Loughner, then you are not going to want to live next door to a black person, let your daughter date a Muslim, or hire a person with a mental illness.

People want to stay away from people that they think are dangerous.  This is because our brains are hard-wired to help us survive.  This is a good thing.

The problem comes when people's estimation of danger is out of whack, when they think that a whole class of people is dangerous, and when those thoughts do not have a basis in reality.

People whose fears are out of proportion to real risk need our help.  They need evidence if they are going to change what they know.  You can cite statistics until you are blue in the face.  But the most persuasive evidence is personal.  They need a face.

What does Jared Lee Loughner have to do with your child's kindergarten teacher, the kindest, gentlest person you know?  Or your Uncle Charlie, funny, generous, hard-working?  Or your roommate from college, who really struggled freshman year, and still does on occasion, yet runs a successful business anyway?  Jared is one lost soul who didn't receive the help his parents tried hard to find, and whose story could have been so different -- as demonstrated by the evidence of all these other people with mental illness whom you know.

NKM2.org

Remember these guys?  They are Joey Pants Joey (Pants) Pantaliano's bid to make mental illness as cool and as sexy as erectile dysfunction.

That's right.  Joey Pants (The Sopranos) has major depressive disorder.  And he wants the rest of us loonies to come out of the closet, too.  I described his No Kidding, Me Too campaign last October.  He represents the funner version of mental health advocacy.

Joey has a bracelet with the birds on it, a cute little way to identify yourself.  Go here to buy one.  If these bracelets catch on, then when you see somebody wearing one, you say, No Kidding?  Me, Too!  When somebody else asks you what your bracelet means and you explain, their response, one chance out of five, will be No Kidding?  Me, Too!  Or, No Kidding?  My Brother, My Boss, My Priest, My ... Too!

One brief exchange at a time, people learn that people with mental illness live and work and function and add quality to life all around them.  We are no more dangerous than anybody else.  That is not only a cold hard fact, it is also the experience of people who know people who have a mental illness.  And a number of us are rather fabulous!

Got it?  For those of you who are not ready to set a trash can on fire (last week's post on oppression), you can wear a bracelet.  You can come out and be one of many people your neighbor knows who have a mental illness and sometimes exhibit symptoms and usually get the lawn mowed anyway. 

NKM2 Needs Some Bipolar Help

It's a great idea, potentially cool and sexy.  But somewhere the program got hijacked.  Each of us has our abilities and our disabilities.  And Joey needs an assist, assigning the right task to the right section of the DSM.

That is Prozac Monologues' task for the day, to get these birds back on track.

To start: Joey's medallions come in 144 combinations of colors and finishes and a twelve page catalog from which to choose even more medallions.  My guess is he handed the bracelet job to somebody with Asperger's, who can see every potential option and wants to make each one available.

You always want to have somebody with Asperger's around to find the option outside your neurotypical box.  That person might redesign your computer platform, or notice the pothole that will break your axle if you don't swerve now, or find the resource you never dreamed existed, or restate the problem so the solution is both easy and joyous.  You always want to have an Aspie around.

My Aspie friend says, Give the Aspies the money.  Tell us the rules, and we will make sure they are followed.

But this medallion thing falls into marketing.  Go to the bipolar spectrum for marketing.

The Silver Ribbon Campaign

So maybe you have noticed there is a ribbon for every cause you can think of and many that you have never heard of.  A cloud ribbon for Congenital diaphragmatic hernia?

Nobody is in charge of this ribbon thing.  In our field we already have orange for ADHD and for self-injury, checked (they call it jigsaw) for autism, yellow for suicide, white for gay-teen suicide, green for mental health and for childhood depression, purple for dementia, silver for mental illness and for brain disorders.  A marketing nightmare.

Marketing 101: Get yourself a message.  Attach a brand to it.  Stick to it.

So we need a ribbon.  One ribbon.  One color that umbrellas all the rest.  Prozac Monologues here and now declares the color -- silver.  Just because I said so, that's why.

No, not just because I said so.  My eye is on the platform.

The Oscars.  The Emmys.  The Grammys.

We need a color that is Oscarlicious, that will stand out and look fabulous on tuxedos and those designer dresses.  We need a color that designers will design around.

AIDS awareness soared when the red ribbon became the de rigour fashion accessory at the Oscars.  The entertainment industry knew that AIDS was their issue, and they got on board.

Even more so, mental illness.  If suddenly tomorrow, the entire planet went neuro-normal, comedy would die.  Just die.  Ditto any other writing, music and set design.

So, one color for the bracelets.  One color that will take over the award shows and establish our brand.

Fire That Guy!

Next, the latest NKM2 PSA features solemn music against words on a screen about how few people with mental illness commit violent crime, alternating with video of police cars and ambulances at the sight of the shooting in a Tuscon shopping center.  WTF?!?!!  I don't know who is responsible for this marketing mess.  But fire that guy!  Or rather, channel his/her energies in a different direction.

In a nutshell: Confucius said A picture is worth a thousand words.  Maybe it was Confucius.  He usually gets the credit, sometimes Napoleon Bonaparte.  Anyway, a moving picture with *flashing police lights* is worth a whole lot more words than a mere one thousand.  It does not matter the teeniest, tiniest bit that the text says we are not violent.  The picture shows something very different.

There is nothing cool and sexy about Jared Loughner.  I don't want to live next door to him, either.

Recall NKM2 To Its Mission

Most of NKM2's videos feature depressed people ruminating about stigma.  It's what depressed people do best, ruminate.  Which is why they don't belong on camera unless they are acting.  Let's get back to cool and sexy! 

Mount Rushmore And Marilyn Monroe

So let's we put those loonie birds to work in a new PSA!

One bird says to the other, I have a mental illness.  The other: No kidding -- me, too!!

Then Joey says to the camera, I have major depression.  Abraham Lincoln answers from Mount Rushmore, No kidding -- me, too!  (Monty Python can do that moving jaw bit.)  Buzz Aldrin in his space suit chimes in, No kidding -- me, too!  Next up, J.K. Rowling, Where do you think the dementors came from?

Back to Mount Rushmore.  Teddy Roosevelt says, I have bipolar, to which a flying nun Patty Duke answers, No kidding -- me, too!  Charlie Pride can sing it.

Green Bay Packer Lionel Aldridge steps up to the line and says, I have schizophrenia.  Picture of John Nash and caption, receiving his Nobel Prize in Mathematics, with voice-over, No kidding -- me, too!

Jane Pauley, I have a mental illness.  Then pile on the animations, illustrations, faces speaking to the camera, No kidding -- me, too!  Harrison Ford, Beyoncé, Patrick Kennedy, Ann Hathaway, Amy Tan.  Include an apple falling on Isaac Newton's head.

Joey's voice comes on again, on top of photo after photo of famous and not so famous people in daily life: In science, the arts, government, business, sports, people with mental illness make valuable contributions to your life every day.  Your teachers, doctors, clergy, barristas, mechanics, neighbors, coworkers, one out of every five has a mental illness.


And the closer -- surely somewhere in Marilyn Monroe's body of work, sometime that breathless voice utters those now immortal words, No kidding -- me, too!

Are we getting closer to cool and sexy now? 

Coming Out As Evidence-Based Stigma-Busting

But coming out is scary!  Bad things will happen to me if people know I have a mental illness!

I can't argue with that.  I don't know what will happen to you.  There are ways to protect yourself.  I expect that Prozac Monologues will address this topic in the future.  This post is on how to help prejudiced people become less prejudiced.  And the research supports me here.  The more experience the general public has with people who have mental illness, the less prejudice.

Notice, I said experience.  Not knowledge.  Knowledge hasn't helped.  Experience does.

Personal Experience Mitigates Prejudice

Here is a study that shows familiarity breeds respect.  208 community college students, of diverse backgrounds and ages, were asked about how familiar they were with people who have a mental illness, whether that exposure was from movies, documentaries, work with, work for, friend, family member, own life.  They answered questionnaires on their estimation of how dangerous people with mental illness are, their fears of people with mental illness and their desire for social distance (whether willing or not to work with, live near, or associate with people with mental illness).

Sure enough, the closer the contact, the less expectation of danger, less fear, less desire for social distance.  And note: when you are asked whether you work with or live next door to somebody with a mental illness, the real questions is whether you know that you work with or live next door to somebody with a mental illness.

Strategies For Reducing Prejudice

These findings are consistent with a large body of research over a long time about how people who are familiar with members of a stigmatized group have less prejudice toward that group.  The following paragraph is quoted from the report.  You can find references for each point in the original.

Social psychologists have examined several variables that are relevant to ethnic prejudice and that could be adapted for research on contact with and stigma surrounding persons who have mental illness.  One important variable that affects contact is opportunity: members of the majority must have opportunities to interact with members of minority groups if stigma is to be reduced.  Thus persons who have serious mental illnesses must have formal opportunities to contact and interact with the general public.  Other factors that augment the effects of interpersonal contact include treatment and perception of the participants as equals by members of the public, cooperative interaction, institutional support for contact, frequent contact with individuals who mildly disconfirm the stereotypes of mental illness, a high level of intimacy, and real opportunities to interact with members of minority groups.  Each of these factors suggests specific hypotheses on how contact between members of the general public and persons who have serious mental illness can be facilitated.

These citations are for ethnic prejudice.  One's ethnicity is usually more observable than one's medical status.  Gay and lesbian people have gotten the same results with the same strategies -- by bringing their membership in a stigmatized group to the awareness of their friends, family, coworkers, neighbors, fellow church members, golf buddies...

So Come Out, Come Out, Wherever You Are

All you have to do to reduce prejudice against people with mental illness is be one.  Out loud.  We need every one of you who possibly can to come out.  We need family members and coworkers and neighbors and friends to talk about you, too.  We need to start laughing at the stereotypes and at the people who hold them.  We need to be out loud proud of our recovery.

Because there is a lot at stake here.

Silence = Death

icon of Christ Pantokrator in public domain

photo of Mahatma Gandhi in public domain

photo of Dorothy's ruby red slippers by Alkivar, used under the GNU Free Documentation License.
photo of kindergarten teacher in public domain
photo of Oscar Su Sfondo Rosso by Idea go
photo of Harrison Ford as Indiana Jones by John Griffiths and used under the Creative Commons Attribution/Share-Alike License
photo of Mount Rushmore by Kimon Berlin and used under the Creative Commons Attribution/Share-Alike License
photo of Charlie Pride in public domain
portrait of Amy Tan by David Sifry and used under the Creative Commons Attribution/Share-Alike License
screen shot of Marilyn Monroe in public domain

The Road Map For Loonie Liberation

First they ignore you.
Then they laugh at you.
Then they fight you.
Then you win.

This is a preview of next week.  Me -- taking a mental health break.

photo of Mahatma Gandhi in public domain