You are not alone
Compassion must keep pace with science for mental health issues
I’ve been working in pediatric mental health for 15 years. After people find out what I do for a living, it always starts the same way. A cautious glance around the room to make sure nobody is in earshot. Then an outpouring of heartache over their personal encounter with mental illness — be it in themselves, a niece or nephew, cousin, spouse or their child.
They are propelled by the need to tell somebody, to feel some empathy from that person and maybe some hope. Sadly, this is not the reaction they get very often.
When facing most chronic, dangerous illnesses, folks are greeted with sympathy and help. Tell a friend your child has cancer and they bring food over, help with a fundraiser, or offer a shoulder to cry on. Tell a friend your child has mental illness and all too often they just stop coming over. Someone fighting cancer is seen as a hero. Someone fighting depression is seen as “damaged” or “troubled.” Why this disconnect?
There are many stubborn myths and misconceptions about mental illness that are the breeding ground for stigma. In a 2008 survey by the Canadian Medical Association, it was found that half of Canadians think people use the term mental illness as an excuse for bad behaviour. One in four is scared of people with mental illness. Seven in 10 don’t feel that mental illness is hurting the economy. With half a million people off work each day for mental health issues and a cost of $51 billion, they are clearly wrong.
What can modern medicine do for mental illness? People often take their cues from television shows such as House, where the main character spews orders for dozens of (expensive!) tests and then makes treatment choices based on that, all while annoying his co-workers. But what biological tests do psychiatrists have that will tell them what the patient has and how best to treat it? None. They have only their training and clinical experience to guide them.
Imagine walking into your doctor’s office and having them diagnose you with diabetes based on behaviour alone. Psychiatry is one of the hardest jobs in medicine, requiring great skill.
Why has it been so hard to understand mental illness? When people think of the heart, most can grasp the idea of a pump. When people think brain, they think computer, but they don’t know how either works. The metaphor for most people doesn’t go much beyond “it’s complicated.”
There is a great line from Emerson Pugh, a leading computer scientist: “If the brain was simple enough to understand, we’d be too simple to understand it.”
But some of us are not so easily deterred. Indeed, for some, a limited understanding of the brain acts to bolster their excuse for ignorance. Because we can’t point to a single spot on a medical image or a single gene to explain a disorder, it can’t be real. There are many people who make a good living being naysayers when it comes to mental illness. Their time is ending, however, as neuroscience is marching forward.
Using new imaging technology, we are beginning to map these disorders in the brain, and our understanding of genetics and epigenetics — where genes meet environment — is improving every day. For young scientific minds, there is no better field to be in now, where true progress can be made.
Since we don’t fully understand the biological causes of mental illness, does that mean that they don’t exist? Hardly. At one point we didn’t understand diabetes or heart disease, either. For many years epilepsy was thought to be demonic possession.
Even today, a recent study by T.B. Kate Collins from Dalhousie University showed that a good number of people still think that people with epilepsy are more prone to violence — similar to a quarter of a century ago. So misconceptions are very persistent about many brain diseases despite scientific progress.
What is the result of this stigma about mental illness? People are slow to seek treatment for their illness and slow to seek social support, often due to fear and shame. But not seeking treatment promptly has real consequences.
For every year bipolar disorder goes without proper treatment there is a 10-per-cent less likelihood of recovery. More alarming, in a 2009 Canadian study, almost half of patients who have suicidal ideation, and one in four of those who have made a suicide attempt, report not receiving care or even perceiving the need for care.
On a larger scale, it can also lead to bad policy, such as insufficient funding for care for people with mental illness, or support in schools, etc.
Stigma says more about the person espousing it than the person with the disease. The science has come too far to allow ignorance to continue to flower. Would you joke about somebody’s child having cancer? Blame the parents? No.
What do I want people to do? Not much: just to be understanding. A little compassion goes a long way. It is time for us, as Canadians, to rethink pediatric mental health. When a friend confides in you that their child is having a difficult time, don’t recoil; reach out. Even with all the people working hard to help, these children need the support of their families and communities.
And if you’re dealing with mental illness, remember it is common. Odds are good a neighbour, office colleague, or someone in your circle of friends is dealing with it, too.
There are mental health professionals out there giving it their all to help — psychiatrists, psychologists, pediatricians, nurses, social workers, just for a start. There are researchers working to improve diagnosis and develop new treatments.
In research, words such as prevention and cure represent goals, not unrealistic dreams. Just as there are people who don’t understand, there is an army out there trying to make things better.
When faced with these troubles, remember one thing: You are not alone.