Fear of People with Mental Illness Fades When We Know How to Help

Trends in the public marketplace of ideas:

• There are more houseless people around us
• Many churches, congregations, and volunteers of all sorts are trying to help
• Some local governments are trying to restrict these efforts
• Claims are made in support of these restrictions that people with mental illness are dangerous

The following post is a repeat from a few years ago. It seems time to repeat it. It does not address the mistaken notion about mental illness and violence, nor the scapegoating of people who are in need. It does address the issue of fear. I hope to provide resources for people who are exercising their constitutionally protected right to the free practice of their religion.

Mental Illness First Aid

We know how to do this. A car hits a light pole -- somebody, maybe you will call 911. Somebody is choking in a restaurant -- somebody else, maybe I will leap up to do the Heimlich Maneuver.

It doesn't have to be an emergency. If a friend has a persistent cough, or mentions a bruise that won't go away, or complains about chest pains, we urge them to see a doctor. We have learned to recognize signs of cancer, heart disease, stroke. We get involved, we even get on their case when the people we care about need help.

Most of the time we do. Sometimes we turn away. Last week I kept having the same two conversations over and over. The first was about a man who dangled by a chain from the end of a crane. He reached out to catch a woman caught in the boil of a dam, to rescue her from drowning. The second was with friends who just didn't know what to do -- about a cousin who is irrational, a daughter who doesn't get out of bed, a godson who can't keep a job, each of them diagnosable with a serious mental illness, none of them getting treatment.

What To Do When A Friend Has A Mental Illness

Bad Mental Health Take on Autism - One More from Allen Frances

Before Mental Health Awareness Month draws to its nonconsequential end -- 

Allen Frances

New York Post has published a new interview with Allen Frances about how bad it is to receive a diagnosis, or as he puts it, become a mental patient.

Become a mental patient?

Some background: Allen Frances is a professor emeritus of psychiatry and behavioral sciences at Duke University. His fields of research were wide ranging, including personality disorders, chronic depression, anxiety disorders, schizophrenia, AIDS, and psychotherapy. [Note: not autism]. He served as the chair for the DSM (Diagnostic and Statistical Manual of Mental Disorders) task force, which published the DSM IV in 1994. He later became the chief critic of the DSM 5, which is a modest revision of his work.

In a nutshell--he didn't like any of the revisions.

As part of Frances's critique of the DSM 5, he wrote Saving Normal, subtitled An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. His book was published one week before the DSM-5. Since then he has continued the themes of the subtitle.

In addition to my review of his book linked above, I have commented a few times on Frances's statements. I appreciate his concerns about Big Pharma's influence in the treatment of mental illness and inappropriate use of medication, especially in the case of mild depression. His periodic attempts to save normal, not so much.

A couple quotes from his New York Post interview:

Dr. Allen Frances told The Post that he is “very sorry for helping to lower the diagnosis bar.”

Now, Frances said, he fears his work “contributed to the creation of diagnostic fads that resulted in the massive over-diagnosis of autistic disorders in children and adults.”

Stigma Against Mental Illness

One of the themes of Saving Normal is that diagnosis exposes people to stigma. So it would be worrisome to him that so many people are now mental patients, newly exposed to stigma.

I'll grant Francis this point. Prejudice against mental illness is alive and well - and particularly dangerous when it is expressed in the medical field.

There is scant evidence that Stamp Out Stigma campaigns have moved the needle, except on the issue of depression. Judging by news reports, prejudice against people with mental illness has been growing. 

• Police killings of people with mental illness are routinely excused.

• Recently, an ex-Marine is lauded as a hero after putting Jordan Neely, a disturbed man on a New York subway, into a choke hold for fifteen minutes. In two days Daniel Penny raised over $1.5 million for his defense against a charge of second degree manslaughter.

• As politicians regularly blame mass shootings on mental illness, they also routinely reduce funding to address it.

The thing is, prejudice against difference does not stem from diagnosis. It stems simply from difference itself.

A Diagnosis of Autism

In the case of autism, let me suggest an alternative to Francis's view.

From the anecdotal evidence of many people finally diagnosed in adulthood, the diagnosis brings not stigma but relief. They had already been stigmatized throughout childhood. Not by a psychiatric diagnosis, but by the schoolyard diagnosis weird and the classroom diagnosis behavior problem. They grew up being bullied and punished because they were not normal - to use Dr. Francis's favorite word.

People diagnosed with autism in adulthood often already have other diagnoses, most commonly depression and anxiety. They sometimes have experienced suicidal thoughts or attempts. These are the consequences not of their undisclosed diagnosis of autism, but of the way they have been treated by others - on the basis of their difference which it does not take a psychiatrist to notice. It only takes a psychiatrist to explain.

Hence their relief - finally to have an explanation.

The NYP quotes the statistic that rates of autism in the US have soared 500% over the last sixteen years. This is a bait and switch statistic. The DSM 5 changed the definition of autism, combining profound autism, childhood disintegrative disorder, pervasive developmental disorder, and what was once called Asperger syndrome under one umbrella diagnosis, autism spectrum.

Whether or not combining these conditions with different treatment needs under one label was a good idea is a separate discussion. But the change in rates was not as drastic as the statistic suggests. The numbers for three separate diagnoses have been added to the first.

But it is not the first time Dr. Francis has played fast and loose with statistics to claim over-diagnosis. The statistic does not support his thesis of over-diagnosis because the sample population has changed.

Underserved Children with Autism

The article misses the most significant part of the story, reported in the journal Pediatrics. There are significant disparities in rates of diagnosis between white and black children and between affluent and poor children:

Black children were 30% less likely to be identified with ASD-N compared with white children. Children residing in affluent areas were 80% more likely to be identified with ASD-N compared with children in underserved areas.

The consequence of under-diagnosis is that, while rich white kids get services, poor black kids get placed in the school to prison pipeline.

There are real life consequences to under-diagnosis. Poor black kids should not have to pay the cost for Allen Frances's hobby horse.

More Next Week

So clearly, I have thoughts. Lots of thoughts. It's time to sign off for this week and promise more to come. But you are welcome to join the conversation by commenting below!

Why Am I Still Sick? Mental Illness, Faith, and the Love of God

Rumor has it, I'm going to start preaching again. My brain functions a lot better than it used to. But it still functions slowly. So to give myself plenty of time, I have been looking ahead to the scriptures that are coming up in the lectionary.

[In the Episcopal Church, among others, we preachers don't pick and choose our favorite bits of the Bible. We get confronted by and have to deal with what is assigned.]

That's how I came across Matthew 9:18-26, one of the texts for early June. Jesus is on his way to heal a young girl when a woman with an issue of blood reaches out surreptitiously to touch him. He feels the power go out of him and turns to confront her. Then he says:

Take heart, daughter; your faith has made you well.

Ah, here it comes -- the faith question of every person with a chronic or fatal illness, every person who prays and has people praying for us.

Don't I have faith? Don't I have enough faith to get my healing?

Many years ago in one of my darkest times, I met a young woman. She was part of a mission group who had come from Mexico to Costa Rica. On behalf of a local church, she and others would be going door to door, sharing their witness.

She asked me what I was doing in Costa Rica. So I told her that I had depression and was writing a book about it.

Without missing a beat, she answered, If you give your life to Jesus, he will heal you, and you won't have depression anymore.

She described her life in her teens, a life of indulgence, as she put it. She was a smoker. But then she gave her life to Jesus and he turned her around. He took away her addiction to cigarettes

Oh, honey.

She and I had met at the church that was sponsoring the mission. The worship service had gone long. I was tired. And I didn't have enough Spanish to get into it with her.

So I didn't tell her that 

• I fell in love with Jesus when I was eight and was baptized
• I took Jesus as my Lord and Savior when I was eighteen at college
• I gave my life to Jesus when I entered seminary at twenty-five
• I vowed to . . . pattern my life in accordance with the teachings of Christ, so that I may be a wholesome example to my people when I was ordained a priest at twenty-nine
• I . . . well, you get the idea.

The thing is, I have a brain that works differently, and sometimes not very well. Living a life in Christ has not protected me from the symptoms of bipolar disorder, nor even from feeling suicidal at its worst.

Bipolar disorder has been around for millennia. People had it before the coming of Christ. And people have had it since. Faith in Jesus really has nothing to do with it.

I am glad that Jesus took away her addiction to cigarettes. I am glad that Jesus healed the woman with an issue of blood, that he freed the Gerasene man who had been possessed, that he raised Lazarus from the dead.

But he hasn't healed me. At least, he hasn't taken away my bipolar.

Why not?

No, don't answer that question. I don't want an explanation. I especially don't want God to explain to me how He -- and I use that pronoun on purpose -- how He is using my suffering to some greater end. To help you, I suppose.

I don't want a God who manipulates people who are suffering, moves us around on some chessboard as part of His grand design.

For God's sake, don't tell me to have faith.

What a cruel notion that if you just believe hard enough you will be healed.

The first preaching I will do after an absence of a few years will be for a man who was one of the most faith-filled people I know. He died after waiting for years for a lung transplant, while people around the world prayed for him. As people have prayed for me.

Why am I still sick? I think that's the wrong question to address to God. I think that question posits the existence of the kind of God that we want, a God who will answer our questions and give us certainty and make us feel good.

A God that exists only in our desires and our imaginations.

Whoa! Did the preacher say that God doesn't exist? No, the preacher said that the God that does exist is not small enough to fit inside the box of our desires.

Who is the God who does exist? I am a very smart person. Nevertheless, that question is beyond my bandwidth. I have my own desires about God. But I no longer expect that God will satisfy them.

However, reading all those stories of healings year after year, over forty years of preaching on them, there is something that I have noticed. In almost every one of them, part of the healing is a return to community.

The woman who had had an issue of blood for fifteen years (endometriosis?) would have been unclean on that account. Nobody would have touched her. For fifteen years. Now she could take a neighbor's hand.

The Gerasene man who was possessed (schizophrenia?) lived in chains outside the city of Gerasa. When he was restored to his right mind, Jesus sent him home.

Lazarus -- dead and in the tomb. Jesus returned him to his sisters.

And me with my bipolar -- that is the kind of healing I have experienced. When I was newly disabled and not leaving my second floor condo except to go to the doctor, I joined NAMI -- National Alliance on Mental Illness. I went a Peer to Peer class, where people with mental illness teach other people with mental illness how to navigate our lives.

I discovered people who didn't care whether I had faith or not. They didn't need for me to be healed to confirm their own faith. They expected I wouldn't be. And they loved me. They invited me in. They were my new community.

Romans 8 -- that's what I believe. When I don't believe in God -- I really don't believe in the God who withholds healing based on my puny wounded capacity for faith -- I do believe this:

I am sure that neither death, nor life, [nor feeling suicidal], nor angels, nor principalities, [nor health insurance companies], nor height, nor depth, [nor the personal hell of side effects], nor anything else in all creation will be able to separate us from the love of God in Christ Jesus our Lord.

I am not healed. But I am loved.

That's a kind of healing. And it is enough.

photo by Nevit Dilman, used under the creative commons license.

This is an experiment

Oops. I didn't realize this was published. I'm trying to figure out how to get it into a powerpoint, with the byline - this is NOT what I mean by self care. Silly. But oh well, I'll leave it up for now.

But as long as you're here, check out the labels in the column to the right. Explore some topics of past posts.

World Bipolar Day: What the Heck Happened to my Brain?

Prozac Monologues is a book within a book. Its original form was a series of monologues written in an unrecognized hypomanic state. The rest of the story is what I learned about bipolar disorder after I learned that I have it.

In Balancing Act -- The Science Chapter, I answer the question, How did I get into this mess anyway? I compare it to another question, Why did the roof collapse? Both answers are to be found in a process that begins with something a little wonky and develops into a systemic mess.

The following excerpt skips the charming roof collapse explanation (inspired by true events during one Central Oregon snowmaggedon in 2017). Buy the book for that story! It goes straight to the science part. Let me know in the comments what you think.

A Book Review: Loving Someone with Suicidal Thoughts

• I just don't want to live anymore
• If only I could fall asleep and never wake up
• One well-placed bullet would solve all my problems
• You'd be better off if I were dead

Oh my gosh, words you don't want to hear from somebody you love. It is tempting, so very tempting to say something that will get your loved one to take it back.

Anxiety My Old Friend - Will I Let It Kill Me?

Anxiety and stress are not the same thing.

Stress is a physiological experience in the face of a change in the internal or external system. It has its plusses and minuses. A little bit of stress over something you can do something about [I need to make that doctor's appointment] provides motivation to get it done and satisfaction (a nice hit of dopamine) once you do it.

via GIPHY

On the other hand, chronic stress that cannot be resolved [I never knew when he would explode] exhausts every resource the body has to maintain homeostasis/balance. And that's not good.

Anxiety describes the negative thoughts and feelings that accompany stress.

via GIPHY

It's not the only feeling that could accompany stress. When faced with changes like a new job, a challenging ski slope, or a date with the person of your dreams, you might also feel excitement.

via GIPHY

Or maybe not. "Good" change and "bad" change are labels we apply from our own perspective. As far as the body goes, they don't really figure in. The physiological response is the same.

Consider a winding mountain road in a snowstorm. Some people default to excitement. [That would be Colorado-raised me.] Some people default to anxiety. [That would be my California-born wife.] The people who can't help but default to it have an anxiety disorder. These are my people.

Anxiety Defined

Anxiety is the intense, excessive, persistent worry, fear, or dread about everyday situations, present, future, and imagined future. It's a normal enough experience. It becomes a disorder when "intense" tilts over into "excessive" to the point of interfering with daily activities.

Insert side comment here: People who have a mental illness, whether social anxiety disorder, depression, or schizophrenia, are not a different kind of people. Almost every symptom of a mental illness is a "normal" experience - shared by people who do not have a mental illness. These experiences do not need to be diagnosed or treated, until they pile up and become so intrusive that they become unmanageable, until they interfere with daily activities.

The physical manifestations of anxiety include fast heart rate, heavy breathing, sweating, and fatigue. How do we get from a thought to a heart rate? The brain - that's how.

Anxiety in the brain

Anxiety involves an interaction of three different parts of the brain in particular.

It begins when the amygdala senses a threat. The job of the amygdala is to leap into action at the sign of a threat. The amygdala initiates a sequence that releases adrenaline and cortisol to gear the body up to address the threat. As with the body's response to other stress, these hormones cause the faster heart rate and heavy breathing. Blood flow increases to the limbs to prepare it for action, and away from the digestive system - when your life is in danger, lunch can wait.

The prefrontal cortex, the "thinking" part of the brain, provides information and interpretation that mitigate or support the threat. [That's a garter snake, not a rattler. It's harmless.]

The anterior cingulate cortex sorts through the sense of threat and the additional information to find patterns and determine whether the current situation is a big deal or not. It tells the amygdala whether to calm down or GET MORE EXCITED!

The difference between anxiety and anxiety disorder

When there is a threat, the amygdala goes into action. When the threat goes away, what is supposed to happen is that the amygdala and all its downstream partners stand down. The body returns to its pre-threat state.

When the threat is chronic or, even worse, unpredictable, then these systems do not stand down. They just keep pumping out that cortisol.

In the brain, the amygdala increases in size.

Under constant assault from cortisol, the hippocampus (memory and emotion) and prefrontal cortex shrink. The hippocampus gets stuck on negative memories and emotions. [I call this the little time machine inside my brain. It plays the worst of my past on an unending loop.]

The connection between the amygdala and the prefrontal cortex that could moderate the fear goes down.

In other words, the brain changes. It changes in a way that reinforces the the problematic pattern, raising the risk for depression and dementia. Yuk!

Everybody gets anxious is not a helpful thing to say to a person with Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Post-Traumatic Stress Disorder, or Social Anxiety Disorder. These are real things. They have tipped past the experiences of everybody. And a warm bath or deep breathing do not fix them.

Healing the problematic pattern may take many forms: distancing from the chronic stressors, medication, a variety of modalities in psychotherapy, even therapy dogs.

At ProzacMonologues.com I like to focus on what is happening inside the brain, to help me remember that my issues are not mere thoughts. They are experienced in my body. Here's an article with much more detail about the sympathetic and parasympathetic nerve systems and how they function.

A physical therapist friend, encouraging me to take a leave of absence to deal with my tattered brain, once told me, It's just like a broken bone. It takes time to heal.

I do wish it healed as easily as that broken foot is healing. But these issues do respond to treatment. If your anxiety interferes with your life, you don't have to suffer alone!

brain graphic from www.xcode.life/genes-and-health/how-anxiety-affects-brain/

photo by author

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