Mental illness stigma still pervasive in society

They shuffle along the aisles of local grocery stores to keep cool in the summer, dirty and smelly with nowhere else to go, raising eyebrows in some cases, compassion in others, and ire in most.

The worst among them babble incoherently to no one in particular; some are simply disruptive to our day, some are wild-eyed and a little scary; some are calm and looking to be left alone, some are combative and aggressive.

And the best among us sit at the desk next to you, cry themselves to sleep at night, miss workdays due to dark days, don’t take you up on offers to go out for a drink, not because of anti-social behavior or minor phobias, but because they are in the grips of the same types of brain imbalances that makes life for them just as difficult as that of the derelict and the delusional, or the self-medicating alcoholic and the shut-in.

The common theme is mental illness, in all its degrees and spectrum of diagnoses, and the stigma that limits access to true treatment, either through a lack of effective medical intervention and hospitalization, or the social shame of admitting help is needed and knowing where to find it.

A couple weeks ago a story made its way around social media in which the psychiatric and pharmacological history of nearly every gunman of any significant mass shooting in recent years was printed, not to draw attention to a broken mental healthcare system or even gun control, but to blame the shootings on Big Pharma, to make the culprit the psychoactive medications the shooters were being prescribed, not the serious illnesses for which they were being treated in the first place.

It was a classic example of misplaced blame and anger, in this case a microcosm of society on social media refusing to acknowledge a larger problem that speaks to the failure to help the mentally ill.

That particular story was silly, because these shooters were poised for a larger break from reality one way or another, quite possibly held in check just a month or a week longer by their meds, rather than in spite of them. If anything, the proliferation of anti-depressants, mood stabilizers and heavy-duty psychotropics is the Band-Aid and the smokescreen for a society that has abdicated its responsibility to treating the chemical imbalances of the brain the same way it would the chemical imbalances and organic failures of the body itself.

This week, USAToday published an extensive piece on the continuing stigma of mental illness in this country. It outlines a history of institutional discrimination through services the government shies away from under Medicaid, Medicare and state and county social medicine plans.

At the same time, the article partially acknowledges the positive movement made toward treatment coverage by private health insurance companies, which further sheds light on a caste system in place for the mentally ill.

The wards of the state, the poor, the elderly, anyone on government assistance and social programs gets a lesser class of treatment than the well-off or the better covered. It’s a problem we’ve long seen with conventional medical disorders, from cancer, to heart disease, to osteoarthritis, for example.

Yet the inequities over the treatment of physical ailments are subject to a more traditional and conventional social safety net, a state and federal system of healthcare that in some ways gets the treatment to the people who need it most.

Not so for the mentally ill. The inequities manifest themselves in the homeless, the poor, the wild-haired bogeymen accosting you in public places — the men and women who have fallen so far through the loose weave of that net that they now exist in a netherworld where they exist among us, but they don’t coexist.

The gainfully employed and privately insured, on the other hand, are medicated, have therapy and lead productive lives with private problems you know nothing about, that is, when the shame and social stigma isn’t still getting in the way. No one is embarrassed because they need insulin to control their diabetes, or a pacemaker to prevent arrhythmia the way people will avoid a mental health diagnosis at all costs.

Meanwhile, more psychiatric wards close every year, fewer and fewer beds become available for the sick, and less and less money is thrown toward treatment of symptoms and problems directly masking or occurring because of diagnosed illnesses. Instead, the state throws money at programs that look good on paper but never really address the more direct problems.

Mental illness and our failures toward the ill is one of America’s last ongoing dirty little secrets, the product of a society so hung up on individualism that we’re hard-wired for shame over anything that we can’t understand, fix ourselves or simply accept.

This column first appeared in the Imperial Valley Press, June 27, 2014.