Educating the Educators...

Last week, for the first time ever, I went to Kingston to speak to about 100 Queen's University first year medical students, the Class of 2012, during their Mental Health Awareness Week.

I was invited because of a question one of these students posed here about my ongoing campaign against the use of the word stigma. As I'm a Queen's alumna, Class of '74, she asked me to speak and I was happy to accept.

I was pretty nervous. I've never spoken to medical students before. I'm no scientist nor was I prepared to lecture. I wanted to initiate a dialogue. Engage these students. Challenge them. Get them asking questions.

After all, they're the next generation of doctors, perhaps psychiatrists. I was told that they hadn't heard one word in their classes about mental health/illnesses/psychiatry until the four 50-minute lunch time presentations last week. Mine was the last. 

It went very well. I had a full house and 95 per cent of them were medical students, along with a few psychology and occupational therapy students.

My introductory remarks were short – a quick overview of my mental health history, all my different diagnoses, my subsequent kidney problems caused by 16-years of badly monitored Lithium and the fact that despite "overcoming every psychiatric indignity short of a lobotomy, I'm still here."

I was hoping they'd be open to thinking about mental health outside the medical model. Consider the recovery model. I assured them that I was not anti-psychiatry but I wanted them to hear about the possibility of change. Desperately needed change in the way medical doctors are trained. So I chose to speak briefly about recovery, the power of language and mental health and why I detest the word "stigma" – and then open the floor up to them. They asked a steady stream of good, intelligent questions, especially about labelling.

"Isn't calling yourself crazy a label?"

Sure, but I asked, "What do you think crazy means?"

"Being out of control."

Don't you get out of control sometimes?

"Yes."

So, we're all capable of being crazy sometimes. That's one word I think we all use. I happen to like it. In the same way the many people who are gay, lesbian, bisexual and transgendered like to call themselves queer.

I told them that I also love the word "mad" – because madness has always been part of the human condition. Long before it was pathologized into the sphere of medical/mental illnesses. Since biblical times, people who behaved irrationally or too differently were seen to have what are today considered mental or psychiatric problems.

Invariably, though, people perceived as mad were, and still are, dismissed and disregarded. Marginalized. Perceived as less than human. With no voice. And because we have no voice, change is slow to happen. No one wants to listen to us or take us seriously.

I cannot remember many other specifics about my talk – I don't use a script – my presentations are spontaneous. The students were very attentive and according to the feedback I received they found me refreshing. They were very surprised that I was so open about my psychiatric history.

This always amazes me. I have no reason to feel anything but proud of my life. With all its ups and downs.

Before my presentation, I met with Heather Stuart, a Queen's professor of community health and epidemiology. She gave a very informative and thoughtful lecture a few days before mine on "Mental Health Stigma and Health Care Delivery."

Stuart is a world leader in the field of "stigma" as it is associated with mental illnesses. She told me that only three medical students attended her talk, which is too bad because they would have benefitted enormously from her research and experience, her empathetic approach and her wisdom. She is a scientist, yet she is as passionate as I am about changing the public perception of people with mental health difficulties, their treatment and maltreatment 

One statement shocked me. She said that people are afraid to come to seek treatment for their mental health problems, because of the negative stereotyping of and discrimination against people with mental illnesses.

"Three quarters of people in Canada and worldwide who meet criteria for mental health diagnoses do not receive care," she said.

In 1998, when I first started publicly presenting my story, putting these issues of stereotyping and discrimination out in the open, that figure was 66 per cent. Now, it's 75 per cent. What's happened?

That's the subject for another post.

Stuart was very receptive to my ideas about problematic use of the word stigma. As I see it, that word is part of the problem.

As well, she said that in terms of change, "We know contact counts. When we put people with mental health problems with those that don’t and allow positive interaction, we can see the difference that it makes. We need to do that. More contact. And we need to focus. We shouldn’t be going about spraying the public population. We need to target groups. Here are some groups that can be targeted ... worthy of targeting. Understanding what they need is the important way to proceed: School, police, health care workers."

I say, start with the health care workers, especially the doctors.

Especially the doctors who are training doctors in medical schools.

Medical school curricula must be revamped so that health is considered. Physical, mental, emotional, spiritual, social. Holistically. Surely health is more than absence of disease. Yet, healing and doctoring by today's standards are very different.

Today, we are a series of body parts and systems. Medicine is so specialized and technological that the essence of the person seems lost. That's where complementary medicine, and other schools and approaches to health have so much to share.

Not in today's medical schools, where one model is taught. The biomedical model. Not the recovery model. Doctors are scientists. Psychiatrists are neuroscientists.

What about our minds?

Nothing in medicine is purely objective – writes psychiatrist Ron Pies in his fascinating essay "Psychiatry Clearly Meets the 'Objectivity' Test." According to Dr. Emmanuel Persad, psychiatry can be an intellectually vigorous and rich specialty if talking therapies are a mainstay of its practice. If they aren't, I would think psychiatry must be boring as hell.

How can the neurosciences – biochemistry, pharmacology of the brain and nervous system – help people with issues that relate to their life experiences? Their traumas? Their minds?

Brain disease? No way.

Drugging people is a quick fix that doesn't always work well. It can help, but pharmaceuticals can also have serious side effects. Without the insight that can only come, in tandem, with psychotherapy, the neurosciences are only a partial fix. They're only one set of tools in a therapeutic tool box filled with many other potentially more effective tools. Certainly, handing out drugs without any human, therapeutic support isn't the only answer.

You need to have an open mind. That was my parting shot to these future medical doctors.

An open mind.

Comments

[Wellness Writer]

Dear Sandy,
Good for you! I think it's so important for medical students to meet those of us who don't fit the stereotypes. I've often felt that aside from their training, one of the key problems with psychiatrists is that most of them probably only meet the sickest BIPS (bipolars) and DEPS (depressives) in the psych wards. And they probably rarely talk to people who are fully functional.

Susan
P.S. I'm a little stunned by how many people don't seek treatment.

[Tammy MacKenzie]

Another great article Sandy.

I am not surprised that fewer people are getting help.
Now, there are fewer resources for more people, and the cost is prohibitive for many. The only OHIP covered help is a psychiatrist, requiring a referal from your doctor - many people don't have family doctors, or the doctor would rather treat themselves and get the billing (especially as drugs are the treatment of choice, it seems).
I would bet that the much higher numbers of single parents play into it as well, for fear that children will be taken away, or that a hostile ex will use it as an excuse to have them declared unfit.

You have it right: Open minds are needed to remove the myths, stereotypes and barriers that tag along with mental/emotional health issues, and how people who are coping with them are treated.

[John McManamy]

Yes! Crazy! Not only that - crazy and proud!

Thanks for spreading enlightenment, Sandy. :)

[Fatemeh]

You definitely provided a fresh look at Mental Health, and I am so pleased with how positive all the responses were. I am sure you have left a lasting impression on many minds, and am most grateful for your candid talk.

On another note, just saw this in The Star on the potential for erasing harmful memories.

http://www.healthzone.ca/health/article/601600

It is so tempting to believe that a few cells erased will do the same work as years of psychotherapy, but so far, it seems too good to be true.. time will tell.

In the mean time, I have been converted to a proponent of the recovery movement and the need for psychotherapy as opposed to drugs solely, thanks to your teachings!

All the best,
Fateme

[Sandy Naiman]

Finally, I have a minute to respond to the comments to my most recent post. What a wild week this has been.

How lovely to take a bit of a breathe, before going to visit my oral surgeon in 20 minutes!

You are all so wonderful, Susan, Tammy, and John! Sonia, always. No one likes to talk to me about anything smacking of "mental" – whatever it is. I figured "thinking" is "mental" so they're be a lot of takers. After all, I work in post secondary education. But not when you tack on the word "illness" – it's a real conversation stopper!

Even "mental" on it's own is tainted. To bad, since without our mentality, we'd be vegetables.

And that's the point. I'm not particularly enlightened. I'm just out there and willing to share and engage and field or answer questions if I can, agree to disagree and even admit quite openly that "I don't know anything about that."

It' a real education, too. I learn so much from the the people who come to see me and engage. I'm sure of it!

One of the Queen's students asked me a question about Cognitive Behavioural Therapy which I understand can be very helpful for some people. But I've never done it, so I said that.

"I just don't know enough about it to answer your question as it deserves to be answered. It's a good question."

That's one of the greatest lessens I've learned in my years of public speaking and mental health advocacy. If you don't know the answer, say so. It's a great thing to do in the classroom, too. I also tack on, "but I'll try to find out for you!" Students love that. They expect you to know everything, but I make it clear that I not only don't, but that I learn a great deal from them and that I'm great at making mistakes. That's the best way to learn. You tend to remember mistakes, or at least I do, and then I try not to repeat them.

Kids feel encouraged when you tell them that.

Susan, you are so right. Shrinks-in-training see all the worst-case scenarios. Read old outmoded case histories. They're behind the times. Academics so often are.

Seasoned shrinks in practice see people in real time who've grown and developed and graduated into their meaningful and meaning-making lives.

But I know that 75% statistic is true. What really shocked me was that it's risen 9%, even though psychiatric "survivors" (another term I hate) are coming out increasingly.

I suspect the media is also desperately in need of education.

And government institutions.

Not to mention the entire world!

Tammy, you are so insightful. Your concerns are ones I do not address very often because I have not experienced poverty. Thank you for your candour and for you invariably intelligent, insightful comments in this ongoing dialogue.

And thank you for being my moral support at Queen's and sitting front row centre during my talk – a friendly and familiar face. And a great stand-in for my husband, who usually plays that role.

It was great to finally meet you and have lunch with you and learn more about you.

Finally, John. "Enlightenement?" Me? You're the author of a brilliant book. A must-read for anyone with a mood disorder: "Living Well with Depression and Bipolar Disorder."

You buoy my spirits.

Ooooops. Must run. Dr. Diamond, periodontist extraordinarie awaits. Hopefully with his stitch snipper!

Thank you, all!

Have a great weekend.
xox
sln

[Sandy Naiman]

I am so pleased, Fateme.

That was my goal for my Queen's keynote. To "convert" as you say, at least one person. I'm glad it was you. As for the story you post... that's a whole post in itself, but I suspect that it has limited uses. Wiping out memory wipes out identity and a lot of other good stuff, too. I wouldn't be up for it. And I have some horrifying memories, but I've learned where to stick them, what mental albums they belong to, how to keep those albums shut or when to open them.

Those skills come only, I believe, through the talking therapies. They are healing. Medical doctors deal with mental illnesses, while psychotherapists deal with healing our minds.

Two different paradigms. Recovery bridges them. Recovery is healing.

Erasing memory is a gimmick, I think. It might help with some bad traumatic, soul destroying memories – like rape – but not all of one's life is made up of one's bad memories. Often we don't remember them at all until we're ready to work on them. Our minds take the lead and readiness cannot be predicted or forced.

It's the way you interpret your memories that is helpful. Those interpretations change over time and as you mature.

It's the old "peeling the onion" metaphor I love so much. There is no quick fix. It's all about journeying. Speaking of which... I must run.

I'm late for a very important date with my periodontist.

Cheers,
sln