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?
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.