I have had mental health issues for most of my life and have been “in therapy” for 30 years. I checked myself into three different mental institutions between 2000 and 2010. In those 30 years, I heard a lot of things that sounded like answers—“you suffer from depression,” “you suffer from anxiety,” “you suffer from mood swings,” and “you suffer from fragile self-esteem.” I was also advised that I was a traveler through the “Dark Night of the Soul.” That at least sounded dramatic.
On the technical side, the confusion was equally great. In 2008, when I was an inpatient at an institution in Baltimore, the experts diagnosed me with non-specific bipolar disorder, complex post-traumatic stress disorder, panic disorder and binge eating disorder. One and a half years later, at an institution here in Atlanta, my attending physician diagnosed me with bipolar II disorder, not to be confused with non-specific bipolar. To round things out, two months later I was accepted into a clinical trial for people with treatment resistant depression.
I didn’t care what the label was, I just wanted the pain to stop. The worst was when I got to the point in 2008 that I used to have to lie down on the floor of my office just to try to breathe. Then I would get up and close another deal. I am not kidding, I was a health care transactional lawyer and I closed two deals on December 31, 2007, when I could barely eat, sleep or breathe. At that time I was struggling with extreme anxiety, not just depression. I checked myself into the institution in Baltimore for 10 weeks the following summer and again in Atlanta for a week in the winter of 2010. In the Atlanta institution I saw an elderly woman try to stab a 25 year old guy with a fork for messing with her lunch tray, the idea of somebody being on “suicide watch” became commonplace, and as for me, I was told by the medical director that I would never work again and to go ahead and apply for social security disability. I did, but I didn’t like the idea, so I kept looking for a job. By August of 2010 I had a job as a contract lawyer and by June 2011 I got my current job as a lawyer in the health care team at a large Atlanta law firm. So I guess the doctor was wrong.
The other side of my treatment over the past 30 years is the medication side. I have been on 28 different psych meds, alone and in combinations of up to 4 at a time, over the past 30 years. Now I am on none.
Well, what about you? Why should you care? When I hear that 20% of the US population will suffer from depression in a given year, it makes me think that you ought to care. Because if is not you, it is your mother, your father, your brother, your sister, your child, your friend. And that’s just depression. Throw in anxiety, bipolar, ADHD, OCD and the rest of the spectrum and it’s hard to imagine that anyone is untouched by mental health issues.
So given that a huge percentage of us are affected, the question is, what are we as a society doing about it? The answer, not just in my opinion but more importantly, in my experience, is almost nothing. The perceptions about and reactions to mental health issues are off base in so many ways that it is hard to know where to start. Let’s start with the three biggest issues I see:
The first two will go away when we deal with the last one, so I’ll just mention them briefly.
On the topic of silence, I have been looking for the conversation about mental health every day since Newtown. It’s not there. Even the couple of initiatives that are out there, like the bill for the Mental Health First Aid Act of 2013 and the proposal in the recent federal budget to allocate $235,000,000 to mental health have received almost no attention. Who in here has heard anything about either one of them? The silence is deafening.
I have experienced silence on a personal level. My issues of depression go as far back as 16 years old and my eating disorder goes back to at least 7 years old, probably younger. When I asked to see a psychiatrist as a teenager, I was told that we didn’t air our dirty laundry in public. After college, my father quietly slipped me a piece of paper with a psychiatrist’s name on it. We never talked about it again. I spent 30 years largely dealing with my problems by myself, which is the main reason that I am so open about it now. The secrecy nearly killed me, and it has got to stop.
Another thing that has got to stop is ignorance. There is plenty of information out there about mental health. I recommend the website for NAMI, the National Alliance on Mental Illness. I will tell you flat out, if anyone is not educated about mental health in this day and age, it is not because they can’t find out, it is because they don’t want to know. The reason for that, by and large, is that if they don’t learn about it, then they can usually do a pretty good job at pretending that it doesn’t exist. The question is, “What is so bad about having a mental disorder that the people closest to you need to pretend that it doesn’t exist?”
So we get to the topic of stigma. Mental health issues are stigmatized for the same reason that anything is stigmatized: because people are afraid of the unknown, they are attracted to the norm and there is a cost and a burden to it, both financial and emotional.
I have been giving thought to the idea that part of the reason we carry around so much prejudice against mental health issues is buried in the language that we use. Let me give you an example:
My daughter Jean is living in South Korea. With everything going on with North Korea, I have been worried about her, and so have a lot of my friends. They have called me to ask what I think, whether she should leave, and how I am dealing with this. My instinctive, off the cuff, roll of the tongue without thinking, answer has been:
It’s driving me crazy
I’m going insane
It’s making me nuts and
I am losing my mind
At a certain point, I stepped back and listened to myself, and I thought Wow, that’s pretty amazing if you think about it. Me, using all those pejorative terms about myself. Me, of all people, the person who has fought so hard to get stable, to balance out her mind, to get back to a more rational place. How could these things possibly come out of my mouth, and so casually? Of course it’s habit, it’s unthinking, and almost any of you would have said the same things. The point is, I don’t really mean it, right? Of course not. So does it really matter? The answer is I am not 100% sure, but I have a sneaking hunch that it does. It’s easier to see when you look at how those phrases are routinely applied to somebody else, not yourself. What do we tend to say if we disagree strongly with someone’s politics? Let’s take the current debate on gun control, either side. How many times have you said or thought any of the following about the other side: “That’s crazy, he’s a raving lunatic, she is seriously disturbed, they need to be institutionalized, that’s insane, they are all total maniacs,” “they need to have their heads examined.”
Do you get my drift? What it says to me is that the attitude of marginalizing mental health is so deeply buried in our lexicon that it’s our language of choice to express any kind of deep disagreement or personal discomfort.
Let’s assume I am right and this needs to be changed. Like I said, it’s a deeply ingrained habit to use these words, so there is going to be great resistance to change. Let me point out a very recent example of a similar change that has come off without a hitch. I have a son who is almost 25 whom I remember vividly about ten years ago using the phrase “that’s so gay” all the time. I mean all the time. Has anyone in here ever heard that phrase? Raise your hand. …. Let me ask you something. Do you hear anyone use that phrase now? Ever? Raise your hand if you do. …. I didn’t think so.
Why not? You know why not. Because everybody had a brother or a sister or a cousin or a friend or a Facebook friend of a friend who was gay, and they knew that it hurt them, that it made them feel sneered at and made fun of, and so they quit saying it. And that phrase just went away in a puff of smoke.
So think about it the next time you say “He’s driving me crazy” or “You must be out of your mind.” “You’re a jerk” works just as well, and it’s what you really mean anyway.
If we can understand this, then I think we will be on our way to making our understanding of mental health issues intrinsic and personal, and that is a big piece of the solution.
I think changing our vocabulary is a great idea, but it is subtle and will not solve the whole problem of stigma. To me, where we really need to make some progress is stigma in the workplace. Most people spend the bulk of their lives trying to get a job, get a promotion, get a client, get a patient, get a customer and, more importantly, to keep them.
How do you do that if you are struggling with depression or other problems? When I interviewed for my current job in 2011, I was scared to death. I did not remotely consider telling the attorneys I talked to that I had been in a mental institution the previous year. I got the job, and during that first year, I worked hard to do a good job and to show that I was competent and reliable. At the same time, I was finishing my book and then going through the editing process. I was ready to publish right around my one year anniversary, so I took the book and marched into the office of every person in my department, about 14 people, and told each one that I had written a book about my journey into, through and out of depression and anxiety and that the name that anybody was going to see on the front cover was going to be the same name that was on the bottom of every email that I sent out to our clients. I asked each one if they had a problem with that. To a person, they said no, and at least two-thirds of them came to my first book reading, including the head of my department.
Why did I get that kind of response? Principally because by that time they knew that I was a good lawyer, they knew I was dependable. In other words, it was personal. But it was also because I am lucky, I have generally been able to work no matter how bad my depression was. That’s not true of everyone, and we are actually losing people because of it. I was at a meeting on Tuesday about suicide prevention for lawyers. My profession has a suicide rate 6 times the national average. I think much of the reason is what I said—you are afraid you’ll be punished for coming out in the open, so you keep your problems secret and you don’t get the help you need. And there is also the idea that you should pull yourself up by your bootstraps, that if you can’t do that, you are not a deserving member of society and you should be kicked to the curb anyway. Let me tell you something about “pull yourself up by the bootstraps.” I used to have a chapter in my book called “Pull Yourself up by Your Own Damn Bootstraps.” It got combined with another chapter and I lost the title, but here’s part of what it says:
“About two weeks into the program at the institution in Atlanta, it occurred to me that it might be useful to give my psychiatrist a list of my daily physical symptoms to help with my treatment. In less than three minutes I jotted down on the back of an envelope what came immediately to mind: trouble drawing a deep breath, shoulders hunched and tight, bones popping in my neck, twitching, aching jaw from clenching my teeth, trouble falling asleep, waking up three to four times a night, hot and cold, shaking violently, particularly in the hours after waking up, blurred and grainy vision, chattering teeth, trouble writing by hand, constantly losing my balance, nearly falling asleep while driving, tightness in my chest, feeling like my blood was sizzling, sudden high blood pressure, inability to concentrate, panicked, racing thoughts from the minute I woke up until the minute I fell asleep, feelings of extreme despair, disoriented, some self-harm thoughts, severe memory loss, losing access to words and spelling, being extremely irritable, no longer driving automatically but having to think myself through it every time I turned the wheel, braked, or speeded up, and lyrics from songs looping around and around and around in my head.
These were merely the symptoms that popped into my head without having to think about it, so an end to all of that didn’t seem too unpalatable.”
So, no, pulling myself up by my bootstraps was not an option. It took me a long time and a lot of effort and a lot help to get better, but I did. And if I could do it, anybody can. Just give them a chance and give them a hand and give them comfort that they will not lose you as a parent or a child or a friend or a spouse or a partner or a client or a patient or a boss. If that seems like a lot to ask, remember one thing—the odds are pretty good that you will be on the receiving end of that goodwill at some point in your life.