Globe and Mail's Margaret Wente, one of Canada's leading columnists, in a May 5 article
— “Is anybody normal any more?”— reminded me of reading articles written by the late Charles K. Johnson, who up until his death in 2001 insisted that the earth is flat.
"Wherever you find people with a great reservoir of common sense," The late president of the International Flat Earth Research Society, whom he lead for thirty years said
in 1980, "they don't believe idiotic things such as the earth spinning around the sun. Reasonable, intelligent people have always recognized that the earth is flat."
In other words, for over 30 years he remained unwilling to acknowledge the reality despite the evidence around him. This meant that to cling to his reality, he made reality wrong.
When asked about the picture taken of the earth from the 1969 moon landing he had this to say: That, according to Johnson, is nonsense, "because the moon landings were faked by Hollywood studios."
It is true that Wente and the psychiatrist she quotes for support don't make any flat earth predictions. But they cling to their own perception of reality in the same way despite the evidence around them.
As a pharmacist with a Doctorate in Pharmacy, who has worked for a top pharmaceutical company in the mental health division, and most important: as a person with a beautiful God daughter who is autistic, I think that Wente offers an disturbing example of the prejudice that leads to the stigma that one in five people with a mental illness have to endure.
Psychiatrists' Prejudice can hinder their ability to help the mentally ill
In it, she quotes psychiatrist Allen Frances M.D., professor emeritus at Duke University who, well, appears to hate psychiatric medications, psychiatric conditions, and psychiatric patients. His prejudice, like flat earth Johnson, causes him to cling to his reality which blinds him from accurately seeing reality and thus the patients who need his care.
He has come to the conclusion that “We’re being overdosed and overmedicated.”
One reason this happens, she writes, has to do with family physicians. "Eighty per cent of all psychiatric medication is prescribed by family doctors, who may spend only a few minutes with the patient and have little or no expertise in psychiatry."
As a result, Wente quotes Frances saying that the people who really do need treatment fall through the cracks because the system "misdiagnoses people who are essentially normal. Only half of people with severe depression get treatment, he says."
It is true that up to 2/3 of people who need treatment for a mental illness, like depression don't seek treatment.
But misdiagnosing the normal doesn't appear as one of them, In fact, the National Alliance on Mental Illness (NAMI
) says: Mistrust of mental health services is an important reason for deterring people from seeking treatment. Their concerns are reinforced by evidence (both direct and indirect) of clinician bias and stereotyping. Enter Exhibit A: Dr. Frances.
The demonization of the mentally ill among mental health professionals is not without precedent. Its roots go back to historic times, when the mentally ill were viewed as evil and different from everyone else to justify their inhumane treatment against them.
Speaking about psychiatrists who testify in court as expert witnesses, Michael L. Perlin told forensic experts at the annual meeting of the American College of Forensic Psychiatry that Mental health experts are not immune to having a "pervasive prejudice against the mentally ill."
"Psychiatrists are not immune from the same prejudice that affects lawyers and judges and jurors and cops and newspaper headline writers," said
Perlin, a professor of law who serves as director of the International Mental Disability Law Reform Project and the Online Mental Disability Law Program at New York Law School, New York City.
Child Bipolar Disorder and Autism just another fad
For example, a person with autism or Child Bipolar Disorder just may fall through the cracks if the psychiatrist diagnosing them believes like Frances that Child Bipolar Disorder and autism are just the latest fads.
Wente writes that: The autism rate grew more than 20-fold, as severely autistic kids were lumped in with "kids who were just peculiar, difficult or eccentric.." And that children need a diagnosis in order to get access to special school services. Anxious parents with "difficult-to-manage children" are desperate for a ray of hope.
To Wente, autism boils down to difficult to manage children needing an excuse in school and parents unwilling to parent. What makes it worse, is that Frances agrees and provides myths of his own as evidence showing readers that physicians, who specialize in mental illness can be prejudiced against the people they are supposed to care for, too.
“Drug companies will do everything possible to exploit the child market,” Dr. Frances says. The newest fad, he says, is Child Bipolar Disorder, which he describes as the product of an unholy alliance between the drug companies and fancy psychiatrists at Harvard. This condition used to be vanishingly rare. Now it is 40 times more common.
“The causes behind the surge in childhood bipolar disorder are no mystery,” he wrote recently. “[They are] a combustible combination of overly influential thought leaders, aggressive drug company marketing, desperate parents and gullible doctors.”
Really? Why is it that the top selling drug in the world was a cholesterol drug and not a drug for mental health?
I remember having view similar to these before I worked for a pharmaceutical company. But that was because I didn't research information for myself, I instead just repeated the party line. I didn't know it took as long as 8 years for a drug to be formulated. And then, there is no guarantee that it will pass the FDA standards. I'm not saying that the industry has a past that is white as the driven snow. But I know one thing, offices and the patients appreciate samples to try medications that their physicians may put them on before having to spend money on a copay.
Are family doctors just duped when it comes to mental health? So to him, Child Bipolar Disorder is not a real mental illness. Might Frances be speaking of himself when speaking of patients falling through the cracks?
Now, compare his answer with the National Alliance on Mental Illness (NAMI):
Can children and adolescents get bipolar disorder?
Bipolar disorder can occur in children and adolescents and has been investigated by federally funded teams in children as young as age six.
How common is it in children and adolescents?
Although once thought rare, caseloads of patients examined for federally funded studies have shown that approximately 7 percent of children seen at psychiatric facilities fit the research standards for bipolar disorder.
"Be sure to ask your clinician about a comprehensive treatment approach. For an example of how expert clinicians conceptualize approaches to treatment for this condition, please review the Treatment Guidelines by the American Academy of Child and Adolescent Psychiatry from March 2005."
Not one word mentions the gullibility of physicians, the desperation of parents, or the aggressive marketing of drug companies.
ADHD market a billion-dollar jackpot
Wente argues that the nearly 1 in 10 school-aged children in the United States (5.4 million kids) that the CDC estimates have been diagnosed with attention-deficit/hyperactivity disorder (ADHD) is due to big bad pharma finding the right combination to sell to doctors.
Until recently, the drugs used to treat attention-deficit hyperactivity disorder weren’t very profitable. They’d been around for 40 years. Now, the pharmaceutical industry has developed a new generation of highly profitable patented drugs, which are marketed aggressively to doctors and – in the United States – consumers. The ADHD market has become a billion-dollar jackpot.
If Wente had checked out the Web site ADHDCanada.com she would have found that the increase in use and diagnosis of the condition follows the history of awareness of ADHD. According to the site
, Attention Deficient disorder wasn't born as a term until the 1970's. Increasing research into the disorder and the beginnings of serious efforts to treating the disorder began in the 1980s.
Wente is partially correct to say that the child with an mental illness such as ADHD displays characteristics that are normal for all children at some time or another. But it is the "frequency and severity of these symptoms that leads to a diagnosis of ADHD. Symptoms are evident in most situations (school, home, neighborhood etc,), and they have a negative impact on the individual. This negative impact affects academic progress, social skills development and later on the job performance," ADHDCanada.com reports.
Mental Health Canada
would have informed Wente that a child with ADHD faces a difficult but not insurmountable task ahead. In order to achieve his or her full potential, he or she should receive help, guidance, and understanding from parents, guidance counselors, and the public education system.
ADHD is the most common neurobiological disorder of children/adolescents, says Medscape.com. And if left untreated ADHD can have farreaching and serious consequences on their health and well-being. Fortunately, effective treatments are available and behavioral therapies can result in important improvements in a child's ability to function in school, at home, and with their friends.
So contrary to Wente's belief, the symptoms came before the pharmaceutical companies -- and their profits. And aren't we happy they did. I don't suspect the individuals with ADHD are worrying about the pharmaceutical companies because now they have more confidence in themselves in school and around their peers.
It's predictable that after diminishing the impact of mental illness that she would write: “None of this is meant to diminish the devastating impact of serious mental illness, or the relief that treatment can bring,” she writes.
That disclaimer rang hollow as soon as the word “serious” made its way front of the words “mental illness.” Perhaps I'm wrong. But I can't imagine Wente writing the same thing if the topic were on heart disease or cancer.
Imagine reading this: “None of this is meant to diminish the devastating impact of serious cancer,” or “None of this is meant to diminish the devastating impact of serious heart disease.”
Serious cancer? Serious heart disease?
You'd say, cancer and heart disease are both serious, period.
People who don't diminish the impact of mental illness sound like Canada's former mental health commissioner Michael Kirby, who said that mental health needs a social movement as powerful as the breast-cancer movement.
“Look where we are - we're at the point where my grandkids all know what the pink ribbon stands for,” Kirby, co-author of the senate report on mental health, told Postmedia
News. Money has poured into breast cancer research and services, he said, “Because there were a whole pile of Canadians who got together and organized under the social movement of the breast cancer societies to say, 'we've really got to do something.'
The strategy from the Mental Health Commission of Canada also knows what it looks like to take mental illness seriously. "People living with mental-health problems and illnesses - whatever their age and however severe their mental-health problems or illness - and their families should be able to count on timely access to the full range of options for mental-health services, treatments and supports, just as they would expect if they were confronting heart disease or cancer.''
On May 7, Postmedia
News reported that Canada's "first mental-health strategy is calling for an overhaul of a system it calls so fractured and under-funded that it's leading many community service groups to drop waiting lists to avoid giving people false hope that "eventually their turn will come.''
Are we still overmedicated and overdosed, when those who need treatment can't get any?
This only increases the shame and suffering of those who suffer with mental illness. They rather suffer alone than to suffer with a mental illness and risk shunning the ones that they so desperately want to accept them, even if they disbelieve them.
Working in retail pharmacy, I have had patients tell me that they just wait until they are by themselves to cry because those around them refuse to understand their disorder. I have had patients confide in me that they paste a smile on their face around loved ones who are Christian because anything other than how wonderfully happy they are, is seen as a sin and lack of faith, in which they think God is dissatisfied with them, too. And I have had a patient come back to the pharmacy letting me know that she was on the brink of committing suicide because her family felt she "had to be the strong one" when what she really needed was someone to for once be strong for her. She thanked me for helping her feel as though she was worth listening to.
What all of us ought to be concerned about, especially medical professionals, is making sure that we stay awake to how our own prejudices can cause those around us who are mentally ill to feel invisible and unworthy of respect or care -- less than human.
My hope for Wente and Frances and others like them is for them to understand why the reality of mental illness is so threatening that they have to distort reality to feel safe from it, even if it hurts others. But in the end, the person they really hurt, is themselves.