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My View: Mental illness is a medical issue

December 23, 2014
by Kevin Turner
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Also see the opposing view presented by Robert Boraks
Kevin Turner

There are over 100 million people in the world with some type of neurological disorder including psychosis, dementia and brain trauma. Last year, as every year, over 30,000 people in this country became the victims of suicide. Mental Illness is an epidemic. It is the deadliest disease in America. Unlike AIDS, cancer, heart disease and other chronic illnesses for which we have dramatically reduced the mortality rate, we don’t need to spend billions of dollars on research to find a cure for mental illness. We know how to treat it.

The lack of progress comes from two issues. First the business side of the healthcare system is not designed to solve this problem. People are taking notice of that issue, and I hope we will solve it. However, the more important issue is that nobody wants to believe or admit that they have mental illness.

Stigma

The biggest obstacle to the treatment of mental illness is the stigma. Talk to people who are in recovery with mental illness and ask them why their recovery is so hard. They will tell you it is because they waited too long to seek help. Why? They were ashamed.

If we want to reduce the suicide rate and improve outcomes, we have to change the way that society thinks about mental illness. In my mind this is the most important issue. It is why I wear a silver ribbon every day. It is why I prefer to work in this industry. It is why I am writing this article.

Winning the hearts and minds of the American people is no easy task. The issue has to be framed in a way that is clear and understandable. We need to dispel the idea of mental illness as an excuse and get people to think of it as a disease. The medical community needs to help the country frame mental illness as a medical issue, because it is. The focus should be single minded and unrelenting.

We should use the words “illness,” “disease” and “treatment” when we talk about mental illness. We should teach people about good mental hygiene and the importance of support networks. We should portray those in recovery as the heroic figures that they are, no less than those that win the fight with cancer.

My alma mater, The University of Miami, has featured the struggle of legendary quarterback Jim Kelly as he fights cancer. Their motto is “Kelly Strong.” No less a legend, Herschel Walker openly talks about his long journey through mental illness. Nobody has shown themselves to be tougher than Herschel. Where are the “Herschel Strong” t-shirts?

Jim Kelly is described as strong in his fight against cancer and Herschel Walker is described as brave in confronting his “weakness.” We have to flip the paradigm. Let’s be Herschel Strong and start to portray those who have emerged from the shadows of mental illness as the fighters that they are.

This brings me to the subject of prisons. I understand that our prisons are full of inmates who suffer from mental illness, diagnosed and undiagnosed. I sympathize with the plight of people who should be in the hospital and not in prison. I get the magnitude of the issue and agree that it should be addressed. But in my view, this issue is a symptom of the larger problem. Most of those folks could have received treatment if they had been diagnosed before they got on the wrong side of the law. If we want to eliminate the problem of mental illness in prison, we have to first solve the problem of mental illness in society, which is where every one of the inmates were before they were incarcerated.

This is simple marketing. Prisoners don’t make good role models. They don’t make sympathetic figures. Nobody wants to wear an “Inmate #21276 Strong” t-shirt. The lack of proper treatment for the mentally ill in our jails is a travesty, and it must be addressed. But as a society, when we focus on mental illness in prison, we focus on mental illness as an excuse rather than mental illness as a disease. And we can’t afford that.

Please see the counterpoint by Robert Boraks here.

Kevin Turner, AIA, LEED, is principal, Perkins+Will, and has been responsible for the design of more than 1.5 million square feet of behavioral healthcare space.

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Comments

“We don’t need to spend billions of dollars on research to find a cure for mental illness. We know how to treat it…. If we want to reduce the suicide rate and improve outcomes, we have to change the way that society thinks about mental illness.” Kevin Turner

While I would never question Mr. Turner’s benevolent attitude, I do question these two fundamental premises.

Do we indeed know how to “treat mental illness”? Yes, I know that doctors via the drug companies claim to have pharmaceuticals of a thousand different sorts for many conditions. But if we look closer, and read into the research results more deeply the answers to the question become somewhat concerning, or should be. For example, even Thomas Insel, the director of the NIMH, on his blog last year, suggested that the continuous medication of schizophrenia, which has been pro forma by most psychiatrists for many decades in the US, might not have been the best policy to promote long-lasting recovery after all, not for many with a schizophrenia diagnosis. And ditto for the cant promoted shamelessly to the public, also for decades, that mental illness is caused by a “chemical imbalance” in their brain when in fact no such thing has ever been proven only surmised…(if you disagree, tell me, just precisely which neurotransmitter is out of whack in which condition, and what are the normal levels? Who has proven this definitively to be so? Because as of today, no one, I repeat, no one can say this is so…)

One study from the Mayo clinic stated that 13% of the overall US population is on so-called anti-depressants. If these drugs really worked, the suicide rate should have gone down. Otherwise, what good are they? So why has the suicide rate in the US not meaningfully decreased since they were developed? In fact, the US suicide rate in the 1950s was 13.6 per 100,000, while in 2013 it was 12.6, which is not a huge drop; moreover the suicide rate changes every year in ways that suggest that the rate is dependent on factors other than anti-depressant treatment, which by right ought to stabilize it.

I agree that we need to reduce stigma and change feelings and attitudes towards mental suffering. But whether we do it by medicalizing these conditions further is another question. Studies have shown that stigma may actually have been increased by the use of the medical model in so-called mental illness, that the more a mental illness is portrayed as completely genetic, bio-neuro-chemical, and out of a person’s control, the less likely the person is to be treated with compassion and humanity or to be granted agency or decision-making capacity in his or her treatment, which is absolutely crucial in recovery.

One last thing, the notion that doctors treat so many people with anti-depressants is not a minor matter, considering that bipolar “cases” appear to be springing out of the woodwork. It is well-known that bipolarity can be induced from the use of anti-depressants. But if 13% of the 300+ million people in the US population take these drugs, clearly we are either an incredibly sad people, which I doubt, or else too many doctors are wrongly prescribing them, and putting a lot of their patients in harm’s way.

Fantastic comments. Thanks P Wagner. You are right to call me out on that. I definitely did not mean to imply that research isn't needed. I am very hopeful that we will soon learn what exactly is happening in the brain that is the root cause of these illnesses, which will lead to vastly better treatments. 100% agree.

My underlying concern is that even the treatments we have are not reaching a large portion of the population. IF we can reduce the stigma; IF we can improve access to care; IF we can increase the prevalence of early intervention; IF we can get people help, we can get a lot more folks in recovery and see a significant reduction in the suicide rate.

More research is definitely needed, I am just saing we don't need to wait for it. We can take action now.