Sunday, July 28, 2013

Just no. No.

You know, there are some things in life I just really struggle with.  For example, if someone tells me they are going to do something, I expect them to follow through.  If they don't follow through, it's a waste of everyone's time.  So naturally, after a few times of poor follow through, I make sure I let those people know I'm not going to engage in wasting time with them.  I'm a fairly patient person, so it takes a while before I get to that point.  While this issue of follow through bothers me immensely, I'm actually more fired up about something else at the moment.  I've been trying to determine how my annoyance with lack of follow through is connected to my current frustration with this piece about bipolar disorder.  I think the rub is a) simple disrespect, b) maybe it is about follow through after all.

In the case of the....ahem...article, I am so angry and annoyed that I'm physically upset.  My chest feels tight, my hands are freezing cold (something that only happens as a result of excitement/anticipation, or considerable anger), and blood is pounding through my veins.  In addition to this, I am almost at a lack of words for how I feel, a rare occurrence indeed.  So why all of this vitriol and emotional taxation?  

I believe it starts with the general tone of the piece; it is sensationalist, disrespectful, and generally negative.  I think I'm also incredibly pissed off that it is clearly an opinion piece masquerading as substantiated fact regarding mental health disorders (that it was originally published in Real Simple is further evidence of this).  I find it unconscionable that it is classified under Health and not opinion, that's low even for CNN.  I will say, I empathize with the author, having grown up in a home with a father who had(has) a diagnosis of Bipolar I, and who has gone off and on medication, as well as in and out of psychiatric institutes.  Also, I support the fact that she was empowered enough to leave the situation which she found threatening, unlike my own mother.  I can appreciate her efforts to find appropriate support and care for her (ex)husband.  However, her careless, dramatized narrative is sickening, and heartbreaking.  I believe the intention of this article was to be about the author's experience, however, it fails to make that point. 

Not only does the author (technically authors) portray individuals with a mental health diagnosis as dangerous, she uses pathologizing language, and quotes others using similar disrespectful language.  For example, her husband's "mind was the problem", because as you know, people with a diagnosis of a mental illness are broken and need to be fixed so they can be, as she put it "normal".  The author makes these comments and uses such language while making paltry attempts to say, "there isn't anything wrong with being mentally ill".  She cites her desire to make her daughter feel more comfortable by expressing, " I never want her to feel mental illness is something that should be hidden" but due to her husband's "erratic behavior", a poor euphemism for mental illness, they only see him once a year, and they "don't keep in touch."  This makes sense, as long as you bring it out once a year and play with it, you aren't hiding anything!  And of course, "there is no known cause, but a family history of the disease makes a person more likely to get it."  Makes a person more likely to "get" it?  I can't even go into the data side of that statement and the genetic heritability of something like Bipolar disorder, let alone stand by the irresponsible, if unintended, presentation of the diagnosis as a contagious disease. 

One of the other large issues I have with this piece is the quotes used by the author from a psychiatrist who heads a mental health center, which is supposed to provide specialized treatment to individuals with a diagnosis of Bipolar disorder.  The seeming utter lack of respect for individuals with a diagnosis of Bipolar disorder from this psychiatrist's quotes are appalling.  His use of the phrase "bipolar people" in describing an individual with the diagnosis is obscene.  Given that the entire article is written in such a way that mental illness is classified as solely a medical issue, this type of language becomes even more ridiculous.  For example, when was the last time we spoke of people who are managing a terminal illness such as cancer, "cancer people"?  Or people with broken appendages, "broken people" or "fractured people"?  Perhaps they just all fall under the umbrella of "sick people"?  It seems unlikely that anyone would allow their doctor or medical staff to refer to them by their illness; "As a cancer person, you might experience symptoms of nausea, headache, and death."  Or, "Yeah, the cancer in bed 5 is scheduled for surgery at 9am."  Take it to the logical conclusion.  If you ever have the need to seek mental health services, it is never, ever, ever, ever, ever, appropriate for whomever you may be working with to treat you as though your diagnosis defines you as a person.  You are not "Cancer", you have cancer.  Likewise, you are not "Bipolar", you have a diagnosis of Bipolar disorder.  Also, the fact that an "accurate" diagnosis can take between 10-20 years (*Proudfoot et al. (2009)) means it (any kind of diagnosis) should be treated with a special kind of tentativeness.

With all of the talk regarding "mental illness", there is no mention of "mental health".  I firmly believe they are not dichotomous concepts.  Instead of describing what a state of mental health would be for a person experiencing symptoms of Bipolar disorder, only their "bizarre ideas" and "erratic behavior" come up.  There is no compassion in this framework, and there is very little genuine hope highlighted either.  They author's damnation with faint praise for the "treatment" of such mental health concerns is quite apparent.  But, hey, it might allow people to live an almost "normal" life.  If you told the average individual who uses a wheelchair to supplement mobility they could have an almost "normal" life because of the wheelchair, it would be considered horribly offensive.  Why not just address them as gimp, or cripple?     

The last concern to be mentioned is the statement, "If you suspect that you or a loved one may have bipolar disorder, talk to your primary-care doctor about how to proceed."  Only if there is no other alternative should you consult a primary-care doctor first regarding any kind of mental health concern.  You would not go to the Dentist to get more information about or be treated for the measles.  There are specialties in the field of psychiatry and counseling for a reason.  A primary-care doctor may be able to provide a prescription or a referral, but medications should be monitored by a psychiatrist, and the combination of medication (when needed) and counseling is considered the most effective treatment available for mental health concerns.   

People with a mental health diagnosis, or those who are working to manage a mental illness, are not dying. Therefore, they should not be treated as though they are.  I am aware that the author likely experienced her husband's mental illness as a loss, the title is pretty much a giveaway.  However, we don't need to use the hushed tones and solemn phrasing found in funeral homes.  I would imagine this situation was terrifying for the author, and I certainly can't take issue with her experience.  I personally find it difficult to blame individuals with a mental health diagnosis for their mental health concerns, which I think this article actually does.  That, perhaps, is the most upsetting part for me.  Having paranoid delusions and being placed in and out of mental health facilities is not a life I would like to live.  I find it hard to accept that someone else who does live that way is enjoying it and intentionally engaging in such destructive living.  I would not add to that psychological and emotional pain, as a matter of fact, I've dedicated a large portion of my life to to reducing the pain, or making it bearable.  I would not expect the author to stay in the situation she faced, and it is unfortunate that she felt guilty for leaving her husband as he struggled with his mental health.  That is not my issue.  Aside from what has already been mentioned, my issue is the propagation of negative and harmful stereotypes about individuals with a mental health diagnosis, and the begrudging "hope" presented regarding such individuals "leading relatively normal lives."  I find it troubling that nowhere in the article is there a call to change the system we currently operate in that does not provide adequate care for mental health concerns.  For the sake of her daughter who is worried she might "get it [bipolar disorder] I would hope this author would be a strong advocate against stigma, against the continued discrimination and disrespect of individuals with mental health concerns, and for adequate, supportive care and understanding.  This applies to not only individuals experiencing mental health concerns, but the people in their lives.  Someone living with a person who has a mental health issue could potentially use support and understanding of their own, possibly even counseling.  This narrow, limited view of what "mental illness" is, without so much as a reference to mental health or wellness is problematic.

*Proudfoot, J.,  et al. (2009).  What happens after diagnosis? Understanding the experiences of patients with newly-diagnosed bipolar disorder.  Health Expectations, 12, 120-129.

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