HEALTH: July 05, AU Edition

july05healthart.jpgCRAZY ENOUGH TO WORK?
Bad movies and worse ideas contribute to our misunderstanding of mental illness
The infamous Australian stockbroker Rene Rivkin was convicted of insider trading in 2003. Now my understanding of insider trading is that you know something other people don’t and use it to make money on the stock market. Dangerous criminals such as Martha Stewart have been jailed for this heinous crime, as was Rivkin, who was given nine months periodic detention. He fell to pieces in prison and was hospitalised. There was little sympathy for him at the time, perhaps because he didn’t suffer from something nice and straightforward, like epilepsy or a stroke. Of course he did have that benign brain tumour, but since it only affected his mental health and not, say, his ability to walk, no one cared. That and bipolar disorder. ‘The big baby’, people thought, ‘trying to get out of his prison term by saying he was unbalanced. Pull your socks up Rene, you big faker. Get over it and do your time.’ Rivkin was divorced from his wife and committed suicide at his mother’s home earlier this year. He was survived by five adult children.
Great attitude towards the mentally ill, huh?
About a month ago I saw one of the local mums in the playground. New babe in arms, looking drowsy, and could this supermum be her pre-pregnancy weight? ‘You’ve got it going on’, I commented. I waited for the inevitable litany: ‘oh no, I had terrible morning sickness, I actually lost weight…” Well, I should have known her better; she has integrity. I have never known her not to be straight up and she was. ‘No, it’s crap. I’m depressed.’
Give the woman a medal: it takes a hero to stand up and shine the light on the proverbial black dog. It really stood out for me because of the rarity of both insight in a person with a mental illness, and the raw honesty she displayed.

The movie Me, Myself and Irene was about a ‘schizophrenic’ who had two personalities. More like Jekyll and Hyde, really. I asked around and apparently a lot of people believe that schizophrenia is something that gives a person a split personality where normal self is intermittently replaced with a Jim Carey character who thinks he’s Jesus. Kinda fun-sounding, almost. Another film, Girl, Interrupted, features Winona Ryder as a young woman with ‘borderline personality disorder’ (and the tagline, ‘sometimes the only way to stay sane is to go a little crazy’) who suffers psychological distress and in the end receives enlightenment. It could happen to anyone, right? Well, no. Personality disorders are pervasive, life-long, and serious. Meeting Angelina Jolie does not provide any insight for the patient, and for their poor families, it probably makes things worse.
Mental illness affects a lot of people, but the statistics are different depending whom you ask: 1 in 4, 1 in 10, 1 in 25. In the end, what difference does it make? We’re still talking about a lot of people. And yet we still can’t decide whether mental illness is a big deal or not. People seem to talk a lot more about it (Rivkin was very upfront about it), but as a community we don’t seem to do much to help. Do we even know much about mental illness? Mostly it seems to depend on which campaign the health department is running at the time.
Aside from the really esoteric out-there stuff (rare specific psychoses about shrinking genitals, Munchausen syndrome, and so forth), when people talk about mental illness they seem to mean either the psychotic illnesses where the patient sees, hears or believes things that the rest of us do not (yes, it’s complex, and there are many other symptoms) or affective disorders (disorders of mood). Aside from the obvious symptoms, mental illnesses have many other symptoms, such as disordered thinking, sleep disturbance and so forth. They are not fun, nor are they easy to deal with. They can either be managed and lived with in one way or the other (for most people), or they can spiral out of control, ruining the lives of everyone they touch. The homeless guy ranting on the street corner? How do you think his mum feels?
Maybe the term “mental illness” is too broad. It describes everyone from the person who gets mildly depressed and then mildly manic, also known as cyclothymic disorder (which can even at times be an advantage in life) to the person who is totally divorced from reality. Rivkin was desperately seeking help and understanding. The illness that gave him an energetic business edge also gave him week after week of abject misery. His family was shattered, over and over again. And Rene got the best medical care that money can buy. What do you think you get if you can’t afford private treatment?
You get a prescription. And that’s about it, unless you happen to be competent, live in an area where mental health services are accessible, and be referred by someone who knows what help is available. Private psychiatrists charge fees. Psychiatrists in public services have time to treat people in crisis, and that’s about it.
We know that early intervention works. But unless you (or a family member) have the insight and the cash to front up to the appropriate specialist(s) seeking and paying for help, you are unlikely to get help until you show up in an emergency room with a gut full of booze and grandma’s sleeping pills. People with severe mental illness don’t advocate well for themselves. The ranting homeless are sleeping under the letters to the editor, not writing them.
Perhaps part of our problem is that mental illness is a new frontier. For the longest time, we have acknowledged the existence of mental illness, but effective treatment and recovery is a new thing. The first effective treatment for a mental illness was lithium carbonate, accidently discovered by an Australian doctor in 1948, to be a highly effective treatment for mania. This was back in the days when you could just test any old theory out on your hospitalized patients. The occasional person died from lithium toxicity, of course, but suddenly we had a medication that specifically treated mania. This assisted in refining the distinction between psychotic mania and other forms of psychosis. It also allowed very sick people to quickly get better and be treated as outpatients.
Iproniazid, the first modern antidepressant, was originally developed to treat tuberculosis in the early 1950’s. In addition to treating tuberculosis, iproniazid was observed to elevate mood and in many patients. The first tricyclic antidepressant – no longer used due to toxic side effects – was likewise discovered accidentally in the search for a treatment for schizophrenia. The first modern selective serotonin reuptake inhibitor (Prozac) was released in 1987. There are now a whole new generation of treatments for depression. There are now anti-psychotic medications that do not belong to the “major tranquilizer” group, because they are not majorly tranquillizing.
Our understanding of these drugs gave us insight into how mental illnesses might work, and not the other way around. As medical treatments to treat chemical imbalances in the brain get more refined, our knowledge of mental illness increases. Go on, write me. Perhaps the odd person goes nuts and kills their family entirely due to taking Prozac. It’s very, very rare, if it happens at all. But certainly a significant number of people destroy their own lives and families (literally and figuratively) as a result of their untreated – or perhaps untreatable – mental illness.
We don’t do well at handling mental illness (in ourselves or others). Should, but don’t. The last sixty or less years have been a sharp learning curve. Sorry, Rene, you deserved better.