Psychiatry

I feel like this is one of the most stigmatized and truly misunderstood areas when it comes to disorders of the brain is psychiatry. It's sad really....better yet, it's really sad. People get judged for their conditions, and are ashamed and embarrassed about them. Many try to keep it a secret, and hate that they control their lives. Saying "I have schizophrenia" evokes fear from some people, and no matter how you cut it, it's not the same as saying "I have Kidney Failure."

  

 Schizophrenia, Bipolar disease, and many other mental illnesses can scare people 

They scare them because many don't understand what they are. Some think of what they see in the movies - people who kill, or are emotionally unstable, and are ranting crazy thoughts at all hours of the day. At times, this is reality. But with proper treatment, you may never know that those afflicted even have a disease. Even with proper treatment though, the medications that treat these disorders can cause so many other problems (more psychiatric disorders, movement disorders, weight gain, even lactation, grogginess, nausea, diarrhea...the list goes on), that it's no wonder there's such a high incidence of non-compliance. This is often why so many people relapse and end up hospitalized for their conditions.

When I did my psych rotation in medical school, it was inpatient, and my fellow students and I would just spend our days hanging out with patients; we played scrabble, ping pong, pictionary, did art therapy, 'movement class', group therapy sessions, and we would spend time just sitting and chatting with people. When you look at it, it's kinda like kindergarten, which I think is a little demeaning, but for so many people it works (others felt babied, and I don't blame them - everything is not for everyone.) I had some of the most incredible conversations with people, and and it was really a great way to humanize the taboo that is psychiatry. When you have an hour-long conversation with someone about their time as a spy for the US, getting chased by the KGB, who implanted their brain with a chip, and they have been 'tracked' and 'monitored' ever since, you get a sense that for these people, this is their life; these things actually happened. They have memories about these events that are as real to them as your 10th birthday is to you, and I find that truly fascinating....and truly sad. They may believe that their family members are strangers, and I remember a man who's wife had relapsed, flown from South Carolina to NYC, and she refused to talk to him on the phone: 

"I'm not talking to that a**hole," she said.  

"We divorced years ago and I want nothing to do with him. I'm with Anderson (Cooper) now, and he's going to have to deal with it!" 

And when I told him she wasn't up for talking, he said he was going to bring pictures to try and jog her memory. 

"I feel like I'm grasping at straws at this point," he said with such sadness in his voice. 

It was absolutely heartbreaking. 

Because they feel these things are real, and everyone around them feels these things are crazy, it's no wonder they often keep their thoughts to themselves. The voices in their head are like your conscience, but they can terrorize them....tell them to hurt themselves or other people. I met a 6-year-old once who was being told by her voices to throw her baby brother out the window. How does a 6-year-old have any insight to the fact that this isn't normal to hear voices? Or that they shouldn't listen? Note - this little girl was smart enough to tell her parents that she was hearing these voices and that they scared her, which brought her to the emergency room where I met her. She was the sweetest little thing with the most evil thoughts going through her head....it was hard to see when she was drawing me pictures of princesses and rainbows. It hurt to know what was in store for her future; medications, hospitalizations, likely institutionalization, and ultimately a life where she would feel different, misunderstood, and alone.

The neurotransmitters responsible to psychaitric conditions are all ones that need to be in a pretty perfect balance with each other in order to keep you 'level,' so to speak. Dopamine, GABA, Acetylcholine, Serotonin, Endorphins, Norephinephrine and Epinephrine are the big players, and if they are not in their proper proportions, then you can develop depression, anxiety, bipolar disorder, addictions, schizophrenia, dementias, OCD, not to mention the movement disorders that can occur as well (Parkinson's, Huntington's, Choreas, etc.) The basis of psychiatric medications is to add, subtract, or block these substances, but again, they do so much more than regulate mood that the side effects can be almost crippling. New drugs are coming out, and being researched every day, but since psychiatric disorders are like the 'red-headed step-child' of diseases, there's so much less money going into this research, cause there's little money to be made in psychiatry (no offense to red-heads - I've got nothing but love for my ginger peeps, but we know that saying!!) 

Again, sad. 

Around the country, state psychiatric facilities are being shut down because of a loss of funding, but the number of people who need these facilities is just increasing, since many are hereditary, so as the population increases, so do the number of people with mental illness. With no where to go, many end up on the streets if they aren't lucky, and essentially they get swept under the rug by society....if we can't see them, they don't exist. But we do see them. And people judge.... "they got themselves into that situation...." or "get a job like the rest of us." Sadly, it's just not that easy for many of them with severe diseases, and so many are unable to get out of that situation without medical help which is becoming less and less available to them. Psychiatrists are becoming over-worked, underpaid, and they are being stretched to their limits all over the country.  I don't know how they do it. 

This week, I saw an attending punched in the face by a gentleman who got very agitated without warning, and the attending just brushed it off....

"He can't help it," he said.  

"It's not him, it's the disease."

What a friggen champ. How many people can have something like that happen and not hold a grudge? You know those people you see on the streets, or in the subway who get up in people's faces, cursing and talking about the end of the world, and how we're all going to hell in a hand-basket? You see how people look at them with disgust because of not only what they say, but because most likely they are homeless, dirty, and they smell bad? Well I'm willing to bet that most, if not all of these people have some psychiatric disorder or another, and that look of disgust is misunderstanding. It's a lack of knowledge to why these people are the way they are and do the things they do. You can't argue with them, as I've seen many try.....it's harsh to say, and I mean no offense in saying this, but you cannot argue with crazy. There's no logic in their thinking, and they do not compute things the way you do....their brain chemistry is often too out of balance for that. I look at many of these people with sheer pity (as if that is much better), trying to imagine how they got to this point - I imagine them as a kid, growing up with (commonly) psychiatric disorders in their families. Many faced physical, emotional and sexual abuse. They likely had their mental illness rear it's ugly head in their teen years, or early 20s. They were in and out of hospitals, and were thus dependent on the system and those people around them. After a while those people around them got sick of dealing with them, and turned their backs, so when these people got subsequently hospitalized, they needed to be released to group homes, or even homeless shelters. They couldn't hold a job, so they couldn't afford their meds, and voila! There you have the agitated homeless man standing in your face shouting at you. It's like they never had a chance. 

Now this obviously isn't everyone's story, but it's a lot of the stories I've seen in my short time in medicine, and it kills me that people turn their backs like this, but I get it. I have met people with supportive families, but mental illness doesn't just affect the patients it afflicts, it affects everyone in their lives. They can turn into mean, abusive people who are trying on your nerves, and even if you are aware it's a disease, it's hard not to harbor ill-feelings towards them after years of dealing with it. Again, sad. The real people that are letting down these patients are not their families though (this is an important point), but they are the people shutting down the facilities that they need. Or cutting the funding to the hospitals so that they can accept less patients, and hire less staff. Hard to swallow in a country that's so obsessed with what's going on on other planets, that it puts these priorities above those in their own country.....just saying. If you ask anyone anywhere, I'm willing to bet that they think that human life and well-being is important, and a priority, which makes me wonder - do they consider these people humans? True, they may not be able to contribute to society at the same level as everyone else (although many can), and they may be a 'burden' on the system, but how are they contributing any less, or being any more of a burden than the person with diabetes, hypertension, morbid obesity and heart disease that sits at home collecting disability while smoking a pack a day and stuffing their face with McDonalds? The latter are doing it to themselves, while those with mental illness were (for the most part) born with their diseases.  

It's pitiful that no matter how you got there, your medical disease will usually gain sympathy over a mental disease in this country. 

Absolutely pitiful.

I know this is turning into a rant, and I didn't mean for it, but I just find the whole situation ridiculous, and heartbreaking. So many people with mental illness are lucky that they have loved ones to support them, and the financial means to keep things in order (Charlie Sheen, who also has the celebrity to avoid a psychiatric diagnosis as of yet, which I'm SURE he deserves). And many are lucky enough to have a mild enough disease that it doesn't interfere with their lives as much as those I've mentioned above. But what about those people who are alone, and who can't afford their meds, and because they can't afford their meds, they can't hold a job, so they can't afford their meds....one of the many vicious circles in medicine. The lack of foresight is one of the things I despise about this medical system, in that if a little more money went into the system to help these people stay out of the hospital, then they'd possibly have fewer relapses, and therefore need fewer hospitalizations. I met people in med school who had been in the hospital for six months or more. SIX MONTHS!! Do you know how much money that costs? I'm willing to bet it's gotta be at least the salary of a few more healthcare professionals, or at least a few residency positions. And that's just a couple people in one hospital! A little more money now could save a lot of money later....again, lack of foresight.

So the moral here - don't judge unless you know someone's whole story....which a lot of times you never will, cause sometimes even they may not be able to recall or understand it. Don't be rude to the crazy person on the train, or the homeless guy sitting on the corner....you have no idea why they're there or how they got there, so who are you to say that "they put themselves there."  

View mental illness as a disease, 

cause it is one

It is not a choice, and people cannot just turn it off as they please. If you have a mental illness (which aside from those mentioned, include anxiety, depression, mood disorders which are common), don't be ashamed or feel too embarrassed to seek treatment. You can try to run from these diseases, but unless dealt with properly, they can turn up when you least expect it and cause more trouble. If you want to keep it from your friends and family even, that's okay (although having people who understand and support you would be more helpful), but talk to your doctor about it. You can get treatment that will help you and make you feel better. And when you do seek treatment, please make sure it's not just medications - it's like putting a band-aid on a broken bone. Therapy and medication go hand in hand, and for many disorders, therapy alone is helpful, but I'm really not a fan of just medicating someone (especially in the oh-so-common anxiety and depression where you need to get to the root of WHY someone is feeling this way in order to truly deal with the disorder.) 

Note that I've only mentioned a couple of the disease that exist, but be it known that there are 331 psychiatric diagnoses on the icd-9  (coding) system, which all fall into many different categories, have different ranges of severity, and interfere with aspects of one's life in many different ways.  Because of this huge range, and the fact that many aren't as 'affected' as others, there are hundreds of people out there who may fit a one, but they haven't even been diagnosed yet (ahem, Sheen). Maybe you're one of them.....