On a New Reader's fascinating question. Part One.

A New Reader posed a fascinating question, based on yesterday’s post.

“I guess I would like to ask you (and I am highly interested in your answer as someone with so much experience), what other term would you use instead (of 'mental')? Madness doesn't apply to all mental disorders, e.g. anxiety, depression. And yes there are grey areas and people diagnose everything under the sun now as mental disorders, but how about the real, palpable issue of mental health in Canada or world for that matter?

“I just think we can make the word ‘mental’ become a neutral word, like sinusitis, or myocardial infarction, etc., so that when someone says I have a mental disorder, we can understand that they are not to be discriminated against or treated as 'abnormal' just by the virtue of having a disease.

“Or if they are to be treated as ‘abnormal,’ it should be a part of a treatment protocol so this becomes routine and we recognize that we are treating them differently, and not ignoring the elephant in the room.”

Great question. I’m glad you asked it and I hope you don’t mind if I share it here.

I‘ll do my best to live up to your expectations and share some thoughts with you, but I don’t think there is any ONE answer. This is really a book!

It’s going to be in two parts. And if you don’t mind, I’m going to consult two far more experienced people than I, Tufts University psychiatrist and professor Dr. Ronald Pies and Harold A. Maio, another one of my sages.

In the meantime, here goes:

If you believe "mental illnesses" are diseases, you could use the word "psychiatric," instead of "mental."

But that’s not a very good solution because “psychiatry” is not seen in the world of medical science as real “science” since so much of psychiatry, like diagnostics, is very subjective.

No blood tests, X-rays, scans, urinalyses, or other concrete tests can yet definitively confirm a psychiatric diagnosis.

Many psychiatric patients, myself included, have had several different diagnoses, depending on who makes the diagnosis, when it was made and what the so-called “condition” is.

This can be true in physical medicine, too, but not to the same degree.

And that’s the point.

It’s “mental” versus “physical” medicine.

I do not believe that "mental illnesses" are caused only by "malfunctions of the brain structures/molecules."

What about emotional trauma? Childhood sexual, emotional and physical abuse? They can cause what look like “mental illnesses,” too. Can’t they?

What about genetics? What about other environmental issues? And personal experiences?

Cannot they also cause mental distress?

Also, I don't see mental illnesses as "diseases."

Are disorders and illnesses the same as diseases? Are they interchangeable? If so, then why aren't Bipolar Disorders — and there are several types — called Bipolar Disease? Or even Bipolar Disorders?

Cancer is Cancer, but any doctor will tell you that Cancer is 20,000 different diseases.

It's just not that simple.

Our minds are not organs, like hearts or kidneys. If they were, I'd ask for a transplant! Just kidding. I’ve grown accustomed to my mind. I rather like it, despite its “issues.” It’s mine and there’s no other quite like it. And isn’t that the point?

Is a broken leg like a broken mind?

Is a mental illness a brain disease? That’s an ongoing debate.

My psychiatrist, Dr. Bob, says neuropsychiatry may be making a comeback. It existed until 1948, when it was split into two different specialties —neurology and psychiatry. Organic and inorganic or ... ethereal?

Medicine and Psychoanalysis.

And where does Psychology fit into all this?

Some might say we’ve come a long way, but I’m not so sure.

I think this is not only a philosophical question but also a political one. The American Psychiatric Association, which is currently revising the Diagnostic and Statistical Manual of Mental Disorders, is a highly political organization.

Disorders and Diseases are not exactly the same. Would you say you have a "diseased mind?" I don’t think so.

Mental isn't really a noun. It just feels that way when someone says, "You're mental." Like you're a "Diabetic."

And that’s the classic comparison. But it doesn’t hold because the mind is a different paradigm than the physical body.

Like Mac computers that are on a different platform than PC's and rarely if ever catch “viruses.”

I believe this. And I don’t know if anyone can prove me wrong.

Mental Illnesses are not the same as Physical Illnesses.

I am not my mental illness. I do not believe that "mental illnesses" will be seen as neutral as long as universities teach doctors that there is a "stigma" around them that we have to get rid of because no one will ever take responsibility for any “stigma.”

The word "stigma" is a problem. It reinforces "stigma" and it's a linguistic problem.

Language is very powerful in creating and perpetuating our beliefs.

If people would erase the word "stigma" from our lexicon and instead talk about ignorance, fear, prejudice and discrimination, then society might take responsibility for its systemic ignorance, fears, prejudices and discrimination.

And do something about it. Using education. But first, people must be aware of their own fear and ignorance, discrimination and prejudice.

The answer is in education.

But the same old problem arises. People don’t know what they don’t know. So they blindly accept what they think is true.

And there are no absolute truths. Except that one!

I’ll stop here and continue next week!

Comments

[ladyb1polarbear]

Unfortunately still, in this day and age, where 'most' people are aware that there is at least one person in their life that is affected by mental illness, it is still stigmatized. I have personally met doctors, especially triage nurses, who should know better that as soon as I am asked for a medical history and tell them that I am on medication for bipolar disorder, I am given the bum's rush. I have been left waiting in ER's for literally HOURS, in extreme pain (I have a history of herniated discs at L4 & L5) and had a doctor write me off as someone who was merely drug-seeking. In another instance, I was left unattended for 7 hours, again in extreme pain (for what I was another hour after that, rushed in to surgery from a torsioned fallopian tube that had begun to necrotize) and told that it was "all in my head". That since I was able to fall briefly in and out of sleep, that I must be lying. I know for a fact that there are doctors; supposedly professional people; who have looked at me as though I were a "nothing". I went 9 months in pain from a large cyst on my right ovary (which was later finally removed with surgery) because my family doctor didn't believe that I was in that much pain. He wouldn't prescribe anything for the pain. I was finally sent, after many, many visits to that same family doctor to a very caring, compassionate OBGYN who found the cyst quite quickly, ordered pain meds and scheduled surgery. I was recently diagnosed with fibromyalgia, after almost 20 years in pain in my joints and muscles, and told by several rhuematologists that I didn't have arthritis. This diagnosis was made after spending a mere hour and a half with a pain specialist!
My point in this rant, is that in my experience, because I have a mental illness, I don't matter. Who in this world can deal with that without having fear and bitterness towards the medical profession? Certainly not me!
I am lucky that I finally was referred to a caring, empathetic and extremely professional psychiatrist who listens when I'm having side-effects and want to tweak my meds. I also managed to find a wonderful family doctor who works in tandem with my psychiatrist to provide me the best care possible.
Had I not found these two men, I would probably have ended my life long ago. I am truly grateful for them.
And to those doctors and nurses who treated me like dog-dirt, SHAME ON YOU! And shame on ANYONE who treats anyone with a mental illness as less than a person. We are all people who deserve respect, compassion, understanding; whether we struggle with a mental illness, physical disability, or are completely healthy mentally and physically. I wish for the day when everyone is equal.
Thank you Sandy, for your work, for your advocacy and for your blogs. Maybe in my grand-daughter's age, that day will come!

[Tara]

The mind/body dichotomy is a problem that started (I think) with the rise of modern scientific thought... Cartesian duality being the clearest, and most familiar example of a concept that our brains are very different organisms than our bodies. (Cogito ergo sum... I think therefore I am, was Descartes' motto.)

Surprisingly, these thoughts are considered "modern," as ancient philosophers, Aristotle being one of them, did not conceive of the mind and body as different organs existing within the same organism. Aristotle saw that humans were whole organisms, and that experience affected the whole organism; it was just that experience would manifest itself in different areas of the body. And even though one part of the body was sick, Aristotle thought that it was necessary to restore balance to the *entire* person, not just to the part of the person that was unwell.

I tend to agree with Aristotle's concept of our body, even if his concept came before a time where we could even begin to think about the division between mind and body.

What happens to our bodies is imprinted on our minds. What happens to our minds, leaves an impression on our bodies. The two can never be divided. This statement is not new-age mumbo jumbo. Our empirical method, developed and supported by the likes of Descartes and his ilk, the empirical method that has carried us to where we are today in terms of technology and medical advances, has brought us full circle to this place we are in now where we can come to conceive of our mind and body being wholefully united as interdependent within the walking, talking, interactive system that is the human being.

All illnesses, all conditions, all diseases, all problems of the human condition therefore are "physical" in nature as opposed to "mental" versus "physical." (But post-modern medicine is still loathe to admit this.)

Supporting the dichotomy encourages post-modern medicine to treat us on the basis of an ageing, and inappropriately named, modern philosophy that has no ground in a post-modern society. Supporting the dichotomy means that we will never unify the experience of the body and the effects on the mind and, concurrently, the experience of the mind and its effects on the body. Supporting the dichotomy means that we will never come to a place where we would consider treatment approaches that work on improving the *life* of the person. (Currently our approaches work on improving the symptoms of a disease... which medicine assumes by extension will improve a person's life, but this medical "leap of faith" does not happen for every person who has been treated for a health problem.)

We need to come to terms with the fact that we are whole beings, and that experience, no matter how large or small, whether we are old or young, affects the entire being, no matter where this experience manifests in the body.

Stop with the dichotomy. Stop compartmentalization.

Treat the person.

*** Notes on Modern vs. post-modern (based on what is written above) since these words aren't used very often:

Modern is a word we used to describe things that were very new and unfamiliar to a world that was coming out of an industrial era. Modern referred to advances in technology and science that we didn't fully understand but that we believed would become useful some time in the future. In the modern age, people weren't really comfortable with these advances, and were often skeptical of the utility. (Think of 1800's manufacturing, WWII, the nuclear bomb, microwaves, and all the optimism, fears, and questions surrounding these new-fangled things.)

Post-modern refers to a time or place where people have become very familiar (and almost comfortable) with the technological and scientific advances, and where we can reflect on that time in history where we as a society were uncomfortable with those historical advances. And not only is there a level of comfortable familiarity with technology, but the extent of the utility is accepted, and the usefulness of the technology has been tested, put to use, and is now trusted as a regular tool that should be relied upon, and is expected to be relied upon in every day use. Post-modern advances help us to question our older "modern" ideas about our world, our bodies, and how these two interact.

[New Reader]

Thank you for a great post. I have been thinking for the past 2 days, and have reached the conclusion that although yes, words are powerful, I am more concerned about our approach to "wachamacallit" disease/illness/whatever. It's true that we have to use appropriate words, but I don't think the stigma (for lack of a better word) will disappear just by proposal of new terminology. I am concerned about our approach to people with these afflictions. And how we can eliminate the discrimination of the health care system against this afflicted group (again for the lack of better terms). Doctors are not well-educated when it comes to psychiatric illnesses. And indeed, education is the answer. We should lobby the ministry of health and have them implement systematic programs that deal with this problem. The department of public health is doing very little (if anything) about psychiatric health, and we easily let them get away with not doing their job. Intensive polio vaccination programs eradicated polio, and it wouldn't be wishful to think that intensive educational programs targeting these problems would do the same.

[Sandy Naiman]

Hi New Reader,

Thank you and I agree with you completely. You are very wise and you might find my next post interesting, too.

As long as "education" programs are NOT "anti-stigma" campaigns.

As long as these programs are "health education" campaigns. Mind-Body-and Soul Wellness Campaigns.

I am very grateful for your provocative input on this blog and I hope you will continue to participate in our dialogue, New Reader! You're very insightful and thoughtful. I am thrilled that you've found me and I've found you!

Cheers and be well,
Sandy