I just watched President Obama’s “Shameful Day for Washington” speech, and I take issue with the fact that he included people with severe mental illness in a group he described as “dangerous individuals.” Here’s what he said:

“By now it’s well known that 90 percent of the American people support universal background checks that make it harder for a dangerous person to buy a gun. We’re talking about convicted felons, people convicted of domestic violence, people with a severe mental illness.”

“We have no national database of these lunatics… We have a completely cracked mentally ill system that has these monsters walking the streets.”

— Wayne LaPierre, Executive Vice President NRA

Since the tragedy at Sandy Hook Elementary School in Newtown, Connecticut there have been pages and pages written and hours of audio and video created by people from all sides of the gun control/gun safety discussion. The conversation about the need for better mental health awareness and care, especially for children, is welcome. Comments like Mr. LaPierre’s are not.

Yesterday, I served on a panel of family members who have loved ones with mental illness, where we talked to a room full of police officers (approximately 30 of them) as part of their crisis intervention team (CIT) training. NAMI-WCI (West Central Indiana) provided the training.

As I prepared my story for the presentation, I realized that I am never the one who calls 911 when my wife is experiencing a manic episode. My wife has always been the one to call, usually because she is experiencing paranoia and psychosis and feels the need to call the police for protection.

This made me wonder… why?

The Fall edition of the NAMI Advocate (2012) contains an interesting article by NAMI Communications Coordinator Brendan McLean entitled “The Hope for Mental Illness Research: Dr. Tom Insel Shares the Latest Data at NAMI Convention.” But it wasn’t the discussion about research that piqued my interest. Instead, it was what Dr. Insel said about stigma and the importance of engaging the family in the recovery process.

Stigma Versus Discrimination

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Last Thursday, my wife and I attended a viewing of Dr. Delaney Ruston’s documentary film Unlisted followed by a panel discussion. The film and panel discussion focused primarily on schizophrenia, but individuals with bipolar disorder and their families face similar struggles.

I was very impressed by the keynote speaker, Dr. Alan Breier, MD, who passionately and compassionately described the struggles of people living with schizophrenia. He called schizophrenia the “quintessential human experience,” because it affects the two qualities most responsible for making a person feel human:

• The ability to work
• The ability to love

The other day, I was looking through a very helpful publication entitled “What To Do in a Psychiatric Crisis in Indiana,” published by NAMI Indiana. I read it before and mentioned it in a previous post entitled “What To Do in a Psychiatric Crisis,” but what struck me this time was the discussion of calling 911. If you call 911 to report a psychiatric crisis, the dispatcher is most likely to send the police, and NAMI cautions:

It is important to note that depending on the police officer involved and other contingencies, s/he may take your loved one to jail instead of to the emergency room. Be clear about what you want to have happen.

That’s excellent advice, but wouldn’t it be better if you called 911 to report a psychiatric crisis, and instead of just the police an ambulance arrived, too? After all, bipolar disorder is an illness, and ambulances have medications that can calm a person down. Also, wouldn’t someone who’s experiencing a major mood episode be more inclined to voluntarily go away in an ambulance than in a squad car? Wouldn’t it be less stigmatizing?

Today’s headlines are packed with reports of a Jet Blue pilot who “flipped out” and went “berserk.” If he had had a heart attack during the flight, I’m sure he would have gotten some sympathy. Instead, reporters are talking about charges that may be filed against the pilot.

Mental illness carries a stigma, no doubt about it. Recently, however, I began to wonder just how deep this stigma really is and how much of it is self-imposed. In other words, do we feel stigmatized mostly because people stigmatize us or because we fear that they would if they knew we were living with mental illness? (And when I say “we” I mean members of the bipolar community, including people who have loved ones with mental illness.)

Two events triggered my thoughts on this.

We distinguish between mental and physical illness. Why? Many illnesses we consider physical have a mental component, including ulcers, asthma, hypertension, irritable bowel syndrome, heart disease, urticaria (hives), and sexual dysfunction. And the illnesses we consider mental all have a physical aspect to them, namely the brain. Yes, the brain is physical. It’s not just some nebulous collection of emotions, thoughts, and brain waves concentrated in a person’s head. In addition, some so-called mental illnesses – anorexia, for instance – have readily observable physical symptoms.

Whenever we use the phrase “mental illness,” regardless of whether we intend to do so, we reinforce the false dichotomy of mental vs. physical, mind vs. body. This leads many people to question whether brain dysfunctions such as depression and bipolar disorder are truly illnesses, even when they have no trouble recognizing that that certain so-called mental illnesses, such as autism, epilepsy, and Alzheimer’s are physical.

As a psychiatrist, every day I encounter families struggling with mental illness, especially in their children whose lives range from disrupted to shattered as a consequence of these challenges. In these daily battles I’m most frustrated and saddened by the jaw-dropping lack of compassion surrounding me and my patients regarding their family struggles and their child’s distress.

Unfortunately, many people still view mental illness as a moral rather than a medical or developmental issue. As a result, they readily dispense judgment when someone is struggling with emotional and behavioral symptoms – shutting down open discussion and squashing attempts to problem solve rather than blame.

Even worse, stigma and misunderstanding paralyze many people who might consider seeking help but don’t because they’re afraid of being judged or feel somehow to blame. Families are told they’re being manipulated by their loved one who’s suffering or that their parenting is impaired. Just “try harder” says the teacher, the coach, the neighbor, and the in-laws.