Every Sunday I read Randy Cohen’s column, The Ethicist, in the New York Times. Cohen settles moral dilemmas with humor and common sense. This week’s ethical conundrum: A mentally ill neighbor.

The writer moved into an apartment in a small town. A woman with schizophrenia lives across the street: “She regularly accosts me, shouting insults with apparent lucidity…Other locals treat her as a harmless nuisance, speaking to her as if she were a child, but I’d feel awkward doing that since she is twice my age. How should I respond to her?”

Cohen’s response began: “Assuming your amateur diagnosis is correct, you should respond courteously and briefly. As you know, you should not chide someone mentally ill for her rudeness.” (I added the bold.)

God bless you Randy Cohen. Just for emphasis, let’s allow Randy say it again: “As you know, you should not chide someone mentally ill for her rudeness.” And one more time, Randy, because you make it sound so common sensical: ”As you know, you should not chide someone mentally ill for her rudeness.”

Nor should we ridicule, berate, deride, ignore or shame someone mentally ill for his/her rudeness. However, it seems like we have a caste system for mental illness and our etiquette depends upon the position a specific a mental illness holds within that system. Often it is easier to pardon rudeness when the person is clearly psychotic and delusional. But how do we treat – how should we treat – the obnoxious alcoholic, the panhandling addict, the “lazy” person with depression or the boiling diatribes and vengeful behavior of those in the throes of their mania?

Good question. Hey, I am as guilty as anyone. I cannot tell you how many times I have “chided” an obnoxious drunk – even though I am an alcoholic. Until I experienced, and was finally diagnosed, with depression I berated others – especially those with dysthymia – as weak and lazy. And apparently I – little Ms. Bipolar – must have  missed – or wasn’t paying attention – during the Sunday school lesson on “Judge Not Lest Ye Shall Be Judged.” But the delusional rages or mutterings of someone with schizophrenia …

What is up with Dr. Thomas Szasz?

I know Szasz is the name to drop when I want to rile up a debate about the state of psychiatry in America. As a proponent of the Anti-Psychiatry movement in the 60′s, Szasz ticked off – and continues to tick off – mainstream psychiatry with his belief that mental illness is a metaphor for bad and bizarre behavior and that the pharmaceutical industry and mainstream medical community have perverted treatment for these problems.

But Szasz went way over the top with an article in the Wall Street Journal on July 15. I have a problem Szasz’ comparison of car repairs to health “repairs.” Bizarre.  Big difference between a humane society’s responsibility to pay for my car repairs versus my body “repairs.”

“The concept of reimbursable health-care service rests on the premise that the medical problem in need of servicing is the result of involuntary, unwanted happening, not the result of voluntary, goal-directed behavior. Leukemia, lupus, prostate cancer, and many infectious diseased are unwanted happenings. Are we going to county obesity, smoking, depression and schizophrenia as the same kinds of diseases?”

I don’t know where he gets that idea. I have never categorized medical problems “in need of servicing” under reimbursable health care as either voluntary or involuntary maladies. Carry Szasz’ logic a few steps further and you have to ask – who gets to decide whether a medical problem is voluntary or involuntary? I hope it is not Szasz.

Why wouldn’t we lump depression and schizophrenia in with “involuntary, unwanted happenings” such as leukemia and lupus? It has been nearly 50 years since Szasz began making his argument that mental illness should not be classified as a disease. Maybe back then, before the invention of CAT, PET and other technologies used in neuroimaging, Szasz’ theory kinda made sense.  But come on. In 1961, the year Szasz published his controversial book, The Myth of Mental Illness, IBM introduced the Selectric typewriter. That is how advanced technology was.

How much science do we need before we stop classifying mental illnesses as character defects or bad behavior? And let’s not use the argument that if …

Welcome to Rant-O-Rama, an occasional blog about stuff that really ticks me off in the mental health world. Please feel free to share your own rants. Believe me, it feels really good.

I was watching the nightly news on Saturday and, once again, I heard some talking head use the phrase “schizophrenic” to describe a situation as though it had multiple personalities. First, I do not like the colloquial use of a horrible disease as a metaphor. Second, I do not like the colloquial use of a horrible disease as a metaphor when it totally misrepresents the horrible disease!

Schizophrenia and dissociative identity disorder (aka multiple personality disorder) ARE NOT THE SAME! DID is a condition in which at least two distinct identities routinely take over a person’s behavior and interact with the environment in their own distinct way. (I wont’ even touch the debate as to whether DID should be a valid medical diagnosis.) When you think DID, think Sybil, Dr. Jekyl and Mr. Hyde, or the movies Fight Club or Bourne Identity or the series Captain Underpants.

Schizophrenia, on the other hand, IS a psychiatric diagnosis characterized by psychosis, in which sufferers ( and I do mean SUFFER) experience hallucinations or delusional beliefs. Although schizophrenia literally means “split mind” it is not DID. This is the illness that afflicted the Nobel Prize winning mathematician John Nash. 

This may sound petty. But to me it represents the ignorance that surrounds mental illness. I do not believe – nor do I want to believe – that people would do this deliberately. I do know that when I point this out to people who misuse “schizophrenic” that they don’t seem too upset about it. Maybe that is why it grinds me to much.

What do you think?