The Stigmatizing Term: Mentally Ill

Stigmatizing Term: Mentally Ill

I used to think I was an expert in this stuff.  The stigma of it all.  Mental illness. 

Man, I hate that phrase.  I don’t hate many things, but I hate that phrase. Always hated that phrase. Truly,  I think I hate every awful syllable of that phrase.  I never utter it.

People who know me know this is true. 

But most people–probably most of the patients that I treat–don’t know this about me.  It’s not something I share, and it’s never been something I broadcast.  I think most people assume that psychiatrists are experts in mental illness.

Mental illness sounds like such a dirty word.

Here’s what we psychiatrists are: experts in disorders of the brain… and the mind… and the spirit… and the body—disorders that go on to affect the brain… and the mind… and the spirit… and the body.  360 degrees. Experts in treating people who are full of shame.  Who are isolated, distanced from their families, cut off from their friends.  Cut off from their insurance, denied life insurance, denied disability insurance.  Experts in helping people who are stigmatized every day for what they have.  As though what they have reduces them to the thing itself.   

Experts in the diagnosis and treatment of psychiatric disorders.

Depression.  Bipolar Disorder.  Anxiety.  Panic. Obsessions.  Addictions.  Bulimia.  Trauma.

There are illnesses, disorders, and diseases that affect your ability to walk, to digest food, or ability to function in the presence of others.  Sciatica, ulcerative colitis, panic disorder. But specifying an illness that affects your brain, your mind and spirit as separate or somehow different from all of the other problems we treat in medicine delegitimizes that illness.

So let’s start there.

We psychiatrists are not only experts in diagnosis and treatment, we are the stewards of our knowledge, and it behooves us to guide society’s perceptions about our field and the people we care for. To help our culture catch up to our science.

You’ve heard someone say, “…it made me physically ill…” and it left a specific impression, right?  Spoken in those words, we assume she felt nauseous, and that because she felt “physically” ill, it was all the more intense, believable, legitimate.

Our society struggles to find ways to legitimize illness, disease, or disorders caused by brain anomalies. People can handle discussing a brain tumor, a stroke, or multiple sclerosis, but when the symptoms affecting behavior, or moods, or thought processes don’t have a clear lesion that explains them, it seems to hit a proverbial nerve.

The Dark Ages of the Brain Finally Ends

It wasn’t until the last ten or fifteen years that researchers began finding out why those behaviors existed. And so, because of that absence of information, throughout the history of mankind, people who suffered with these disorders were ostracized, isolated, imprisoned, and dehumanized…or dismissed as “weak,” or “undisciplined.”

But that was then.

This is now.

Introducing: DNA, fMRI, BDNF, Amygdala, Hippocampus, et al…

Now we know more in neuroscience than we’ve ever known before. We have functional MRIs, that show unmistakable changes in brain activity in those with specific disorders compared to those who don’t have them.

We have 108 genetic DNA markers that are linked to schizophrenia and other illnesses.

Certain brain structures differ in people with depression, bipolar disorder, and schizophrenia.

We’ve found reduced levels of BDNF (brain derived neurotrophic factor), different genetic polymorphisms of key enzymes in the brain that affect how neurotransmitters are metabolized, and higher blood levels of certain inflammatory markers in different psychiatric illnesses.

Now, in the 21st century, we have facts.

Neuroscience is quickly becoming more and more proficient at understanding, describing, and measuring emotional shifts, behaviors, cognition, and emotion, through brain activity. No longer are behaviors and symptoms that weren’t understood by mankind in the past given fictitious explanations.

When have you heard someone say, Joe is physically ill. . . when describing his cardiovascular disease?

We might tell someone Joe had a massive MI because of blockages in 3 major vessels to his heart.

Sound legitimate? 

Of course.

We describe illness and health events specifically and in some detail.

Sarah was diagnosed with Type 2 diabetes.  She’s trying to lose weight, and feels nauseous when her blood sugar gets too low.

Or…

Jim was just diagnosed with Parkinson’s disease. No wonder he’s been shaking so much.

Again, legitimate, right?

What’s more, Parkinson’s is a neurological disorder…so we’re crossing the threshold into neuroscience and its disorders and illnesses.

Call ‘Em Like We See ‘Em

Let’s take it another step.

My sister-in-law saw a doctor last week to understand her mood swings and extravagant spending the last few months. She was diagnosed with bipolar disorder. I think she and her husband are beginning to understand a lot of things she’s been doing that seemed out of character for her.

Legitimate?  Absolutely.

It’s as natural and valid to describe what a loved one is experiencing in their health as it is to describe their move to a new house, or the addition of a new baby.

All of these scenarios speak of a health condition that brings challenge and impact to this person’s life, as well as his or her family.

To isolate health issues sourced in the brain as ‘different’ is to alter the listener’s perception of their validity. Health is health. The well-being and function of the entire human body is a vital part of living well for every person.

When any part of your health is compromised or impaired, your entire life can be affected.

There is no difference in validity or impact in the case of illness in the gut, the kidneys, the liver, the heart, or the brain.

And in each case, the physician is focused on finding treatment that improves the health and wellbeing of her patient.

We’re at the end of the darkness related to psychiatric disorders.

Stigma No More

There’s no place for stigma.

Brain tumors are not caused by guilt or bitterness, neurofibromatosis is not caused by criminal intentions, and bipolar disorder and PTSD are not caused by poor parental discipline or weakness.

People get sick.

And medical science and neuroscience want them to get better.  We want them to get better.

Let’s leave stigmatizing talk and stigmatizing terms like “mentally ill” behind and move forward into greater understanding, support, and treatment to help each person in our world discover his or her best self.

Call us to discuss your health and areas of unrest, and let’s explore how we can help with depression, PTSD, bipolar disorder, and anxiety. We can offer innovative treatment options like IV ketamine treatment and TMS  to improve your life, and help you feel much better.

To the discovery of your best self,

Lori Calabrese, MD