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Time to Remove "Mental" from Mental Illness

Posted: 02/11/2013 5:37 pm

As someone with chronic mental illness, I want to know that should I need assistance during a mental health crisis that the health care system will be my primary care provider -- not the criminal justice system.

Mental illness, as old as time itself, is still misunderstood, poorly diagnosed and so stigmatized that far too many of our citizens are left to suffer in silence even when surrounded by those entrusted with their care. It is not as if mental illness is a new, exotic disorder.

The word "mental" carries fearful images; a man decapitating a passenger on a bus; a young man seemingly dressed as a super hero shooting randomly in a movie theatre; mothers, fathers and nannies killing children and pleading insanity. These are our referents when we think of mental illness.

Too many citizens with mental illness have died at the hands of the police who have too little training regarding the care of those in a mental health crisis.The police are not the people to engage the mentally ill. Ashley Smith died because she was treated by guards, unprepared for her needs, within the criminal justice system. Her treatment was criminal -- there was no justice.

The videos of her inhumane treatment are right out of a B-rated horror/science fiction movie. She was tied down and shackled like an alien waiting to be dissected. She was surrounded by those in authority clothed in protective coverings as if they feared contamination. She was injected, involuntarily, with anti-psychotic drugs. She was shipped all over the country, transported on a plane, manacled like Hannibal Lecter, without a thought about her needs or fears.

Adults stood by and watched a human being choke her own body and soul and did nothing. Just following orders. She was "mental" after all. Her treatment speaks to the ignorance of our understanding of mental illness, not only by lay people, but those within the medical system.

Mental illness afflicts more than 20 per cent of our population; seven million Canadians from all walks of life. About 3,600 people commit suicide in Canada each year. That's about 10 suicides per day. For every suicide death, there are an estimated 20 to 25 attempts. Suicide is the second leading cause of death for Canadians between the ages of 10 and 24.There's no excuse, today, for death from mental illness because the prognosis for mental illness is as good as if not better than those diagnosed with chronic physical diseases.

It is the stigma, the shame and prejudice attached to the phrase "mental illness" that keeps people from accessing care. They fear the diagnosis; they fear the response of others to them. They fear being considered morally weak, flawed in character. They fear it is a death sentence. Too often, it is.

Dr. Eric Kandel, the Nobel-Prize-winning neurologist and Professor of brain science at Columbia University contends that the term "mental" illness can distort public understanding of the nature of these disorders. "All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases," he says. "The brain is the organ of the mind. Where else could [mental illness] be if not in the brain?" Social and environmental factors, "do not act in a vacuum...They act in the brain." Describing mental illnesses as brain malfunctions helps minimize the shame often associated with them. "Schizophrenia is a disease like pneumonia. Seeing it as a brain disorder de-stigmatizes it immediately."

Mental illness is not in the mind; it is in the brain. This is a relatively new understanding. Depression, bipolar disorder, schizophrenia, and OCD have biological and environmental pre-disposing risk factors. Why should these illnesses still carry the stigma that it's all in your head?

Changing the name from "mental" to brain illness can be the beginning of a change in attitude towards those of us with these illnesses. A change in perspective can lead to a better understanding and acceptance. It will at the very least begin to reduce the stigma the term has carried from centuries of misconceptions and fear. Let's begin the discussion.

To learn more about mental illness, listen to my six-part radio series.

Loading Slideshow...
  • In any given year, one in five people in Canada has a mental health problem or illness.

  • Of the 6.7 million people who have a mental health problem, about one million are children and teenagers between nine and 19 years old.

  • Mental health problems cost at least $50 billion a year, or 2.8 per cent of gross domestic product, not including the costs to the criminal justice system or the child welfare system.

  • In 2011, about $42.3 billion was spent in Canada on treatment, care and support for people with mental health problems.

  • Mental health problems account for about 30 per cent of short- and long-term disability claims.

  • If just a small percentage of mental health problems in children could be prevented, the savings would be in the billions.

 
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Iris Loomknitter
Loom knitting is fun, easy, and relaxing.
08:46 PM on 03/23/2013
It is time to STOP and END the myth from Descartes, "Mind/Body Dualism" once and for all. I agree with Diane Weber Bederman, fully, above.
02:28 PM on 02/16/2013
Hmmm. I wanted to like this article, I really did. I do think language makes a difference, and shifting the focus from "mental," which does freak many people out, to "brain" may be a move in the right direction.

But... this point of view is also permeated by the kind of scientific reductionism that I don't believe serves us well, as beautifully complex human beings. Sure, there is a physiological/neurological component to many types of "mental illness." But it is not devoid of other components, including emotional and relational. And how to account for other kinds of 'mental illness' that do not have such a clear or direct source in the 'brain'? Some kinds of depression may be well treated with medications, others are of a more situational nature and are best addressed with good therapy and strong community.

And I think the bigger question is what is the source of that stigma? How can we, as a community and a society, begin to see that people who have different ways of being in the world don't have to be a threat?
08:03 PM on 02/16/2013
The source of the stigma is an "us" and "them" mentality which is indicated by the need to differentiate between mental illness and physical illness. Both are illnesses, both occur in the body, but for some reason, someone found it necessary to separate the two implying they are "not equal". As society changes, so does the English language. We don't speak the same English spoken during Elizabethan times, society is different, different living and working conditions, different values, and an exponentially increased knowledge base. The stigma will not reattach itself to whatever new words or phrases are chosen because the awareness that comes with that change is exactly what will help reduce the stigma. It's not violating free speech, it's linguistics, it's what's been happening to our language long before someone coined "political correctness". We need to be mindful of language and the power it carries. All due respect, Ms. Duerr, you referred to those who are different as "threats". People who are different aren't threats, they're just different, but that idea has now been put into many minds. Another source of the stigma is ignorance. Myths about mental illness are circulated by people who really don't know which again perpetuates the stigma; if you don't know then please don't talk about it. Instead of speculating, hypothesizing, fearing, and even judging people with mental illness, why not ask your family member or friend or colleague who has mental illness, ask a person who knows.... a person like me.
10:39 PM on 02/16/2013
Sanghawellbeing, I think you misunderstood what I was trying to say. I am not calling people with 'mental illness' a threat, I am saying that they are largely perceived that way by many folks, and that is certainly the presentation they are given in mainstream media.

I'm on your side, believe me. I worked in the mental health system for 10 years, so I know what it's like.
12:27 PM on 02/14/2013
hmmmmm, "It is the stigma, the shame and prejudice attached to the phrase "mental illness" that keeps people from accessing care." From my own experience as one who has suffered brain/mental 'anguish' since childhood, I don't think I can say I felt shame attached to the phrase "Mental illness". What I felt was hoplessness and despair at not knowing where to turn. That was when I was a young child back in the 70s. Can't say that much has changed in the subsequent 40 years. Shameful isn't it!
01:43 PM on 02/12/2013
I am soooo looking forward to the day when we can't use any words at all to describe anything at all.
Total, complete, and ever enduring political correctness.
We will just use eye movements, that is until our brains adapt and evolve to "politicaly correct telekinesis", with Government oversight, of course.
03:31 PM on 02/17/2013
"Urg. All good or bad. Can't see in-between"
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King Stevie Harper
09:34 AM on 02/12/2013
Do you know who I am. Cause I don't.
I keep hearing about these B.S. campaigns to De-stigmatize Mental Illness, like changing the name will make any difference and its the people who don't have the illness that are the problem, not the illness itself. It is the usual PC drivel, changing the name is baloney. The real problem is since Ronald Reagan Federal Governments have washed their hands of any responsibility for the state of it's citizens mental health, downloading the problem onto state and provincial health ministries, who in turn have downloaded them on municipal welfare agencies and the police, to make the books look good to tax accountants. "One Flew Over the Cuckoo's Nest" while a great movie, gave a bad reputation to psychiatric hospitals and gave the government an excuse to close them all and dump the patients onto the streets, jails and boarding houses with a welfare cheque instead of improving health care OK Lobotomies and Shock Therapy were awful but they threw the baby out with the bath water. I and many people I know have gone to doctors to try to get help, were not afraid to ask for help but all we are given is a quick prescription for mind-numbing drugs like Pro-sac etc which just mask the problems temporarily and make the drug companies happy. I know. Lets change the name of Mental Illness to Government and Corporate Criminal Negligence and see how that works!
08:39 AM on 02/12/2013
it seems to me the biggest impediment to treatment is the requirement for the ill person to seek it out ---
friends and relaitves are powerless in getting a person the help they need if the ill person does not want it --you cannot force them

and how do you expect an ill person to make the correct rational decision --when rationality is the problem
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Diane Weber Bederman
03:19 PM on 02/12/2013
Thank you for this comment. In Ontario there is "age of majority" laws. You need permission from the one who is ill to speak to their doctor. People in the middle of a mental health crisis are really not able to make decisions. We need new laws that make it possible for the care-givers-parents, children, spouses, friends who are like family, to participate in the care and in talking with all the healthcare people about the person who is ill.Now, if one fears for the safety of a loved-one, it requires a Form 1- the court system. Something is wrong when we need the justice system involved in a health care matter. DWB
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08:38 AM on 02/12/2013
A rose by any other name...

In other words the stigma exists in the brain of the sufferer. You can call it what you want but the stigma will still be there. Society doesn't know how to handle mental illness and changing the name won't help or hurt. It would be one of those PC moves you make when you're out of ideas. Ashley Smith wouldn't have been treated any differently if the words "brain disorder" were on her chart, only if we knew how to handle her.

I doubt very much that people walking into a doctor's office and saying they don't feel mentally correct are treated with much haste, referred correctly, or diagnosed quickly. I doubt the treatments are effective, and for bipolar as it is termed today, I doubt most sufferers choose to give up the highs that meds preclude unless the case was mild.

Citizens and the state are in the same boat here. We are compelled by law to treat mentally ill people as if they were not mentally ill. Then when something goes off the rails everyone screams that the mentally ill protocol should have been used. Except no one has come up with a protocol that doesn't involve two caretakers 24 hours a day.

I, like most Canadians, have no solution. I know that allowing the people with brain disorders to choose their treatment paths fails any of our logical tests. What is left? PC games with names?
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Diane Weber Bederman
03:33 PM on 02/12/2013
This is a link to Kay Redfield Jamison and her book, An Unquiet Mind about her mental illness and medication. She is a professor of Psychiatry at Johns Hopkins.
http://www.dianebederman.com/the-many-voices-of-mental-illness-podcasts/share-your-story/156-take-your-meds-kay-redfield-jamison
The stigma is not in the brain of the one with the illness. The stigma comes from those who still believe that mental illness is a moral weakness, a character flaw, rather than an illness with a physiological component.
Language does make a difference. Words carry baggage. It is not Political Correctness to change the name. It is research that teaches us that the illness is brain-based. Many therapies help-talk, cognitive, spiritual care, and meds. People with heart problems often take meds and are told to monitor their food and exercise more. Most still need their meds. Many people with a mental illness may take meds for a short time and never need them again. DWB
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05:09 PM on 02/13/2013
Thanks for the link.
12:41 PM on 02/14/2013
As a person with a brain disorder that chose and manages my own treatment--I have Seasonal Affective Disorder, and my SAD Light works extremely well to reduce my symptoms--I don't think you can, logically, generalize that there is no person with a mental illness that can choose and manage their treatment. I do not require 24 hour care from 2 other people. I do require 30 minutes a day of bright-light treatment in the winter months. Like most other disorders, brain disorders are on a spectrum. For some, part of the nature of their symptoms makes them unable to identify that they are ill and seek treatment. For others, like myself, their symptoms do not prevent them from identifying the fact they have an illness. The problem with stigma is that it prevents those that would otherwise be able to manage their treatment from seeking treatment in the first place. Worse, it prevents some from seeking treatment before their symptoms get so extreme they can no longer identify they are ill--therefore creating the kind of situation you describe: a need for 24 hour care that could have been prevented. Frankly, without the stigma of "mental illness" I likely would have sought treatment many, many years before I did.
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DJ Jaffe
Founder, Mental Illness Policy Org.
08:06 AM on 02/12/2013
Amen
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05:59 AM on 02/12/2013
It is the illness model that produces stigma: http://www.guardian.co.uk/commentisfree/2010/oct/09/ben-goldacre-bad-science-adhd-stigma
02:12 AM on 02/12/2013
I think that the fact that the brain, the mind is seen as the heart of the individual itself,  that any disorder of that mind is a fundamental disorder of the individual, that the individual is somehow lacking and wrong and that the individual is at fault for BEING "wrong"... some really sound like they want to be even harder on insane people who kill than on sane people, they prefer a sane person who kills for money than someone who kills in a fit of insanity.
09:48 PM on 02/11/2013
A thorn by any other name. The word mental does not attach negative things to mental illness. The illness and it's repercussions do that. Brain illness? That is better? Changes things? We have relabeled things that have negative consequences. The new label is quick to take on those negative connotations.
01:43 PM on 02/12/2013
Yes it would still have negative connotations but right now many people still don't seem to realize that "mental" illness indicates a physical brain disorder. That isn't the only language that needs to change. Clinical depression should be referred to as "serotonin deficiency' or something similar because calling it depression confuses it with non-medical mood fluctuations.
09:53 PM on 02/12/2013
I would agree with the serotonin deficiency label. I am not sure what range of other symptoms besides depression it might present. But that is a more specific problem. I still feel that mental illness is a good term to encompass the broad range of problems that can be brain centered. Though when I hear that term, I do think of things that show symptoms of mental impairment, not physical impairment that some brain disorders / diseases cause. Maybe brain illness or mental illness depending on the effects.
07:46 AM on 02/19/2013
Thank you, this is a very astute suggestion.

As long as the idea being proposed here is to shift terminology, it seems to me the most impactful way to go is to get as precise as possible. Lumping everything currently called 'mental illness' into another huge, amorphous category called 'brain illness' is just like moving the deck chairs on the Titanic. If one is going to make a change, might as well get much more specific about the actual brain functions that are being impacted, in this case your suggestion for 'serotonin deficiency.'
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08:16 PM on 02/11/2013
There's no running away from the stigma of certain conditions. You can change the words all you wish, but the stigma will eventually just attach itself to the new terms.

The term "mentally retarded" now has negative connotations, but it was originally coined to avoid this. So now people call the afflicted "special". And what has happened? "Special" is now an insult.

You can't change the world simply by changing the words. It's not that easy.
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Diane Weber Bederman
10:56 PM on 02/11/2013
"Mental" still conjures the idea that the person with the illness can fix it by pulling herself up-as if by magic. Mental illness is in the brain. Why should new research not affect the name of the illness?
No one said this would be easy. DWB
12:32 PM on 02/14/2013
Disagree! In my opinion the term 'mental' does not imply healing oneself no more than diabetes does. Regardless of the word, the name, the label, there will still be negative consequences attached to the whole spectrum. We are still in the dark ages with respect to treatment and understanding but the good news is things can only improve. (I would find it impossible for the situation to get any worse).
08:16 PM on 02/11/2013
To me, the term "brain illness" conjures images of cancer or Parkinsons.
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Diane Weber Bederman
10:54 PM on 02/11/2013
That's right. They are brain illnesses. Mental illness causes changes in the brain chemistry-hence a brain illness as Dr.Kandel said. There is no stigma to Parkinson's. DWB
08:57 PM on 02/12/2013
I familiar with depression and sadly, Parkinson's. I think they require very different conversations, I do not consider them similar just because they involve the brain.
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Creox
Life is too important to take seriously.
08:04 PM on 02/11/2013
The only problem with this article is that saying schizophrenia or depression is a brain disease is that we have no way of finding out what causes it or cures it. You can't get a blood test to verify it. You can't get an mri to test for it. Most changes seen in these cases from an mri are due to the drugs people take to help them. I don't think the mind and brain are separate but I do know that drugs and current treatments are not the answer in many cases. bio psycho social approaches are good alternatives with drugs being a help early and temporarily. Time to change the paradigm.
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Diane Weber Bederman
11:03 PM on 02/11/2013
Like many illnesses, there is more than one protocol for mental illness. I would like to see your citations for your assertion that drugs and current treatments are not the answer in MANYcases.

There is no question that talk therapies as well as exercise and art therapy are beneficial. New research suggests that talk therapy changes the brain chemicals, too. For some people, it works, others need drugs as well. Just as diabetics can often get well by changing a diet, others need diet and medication.

What paradigm would you suggest we follow? DWB
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Creox
Life is too important to take seriously.
05:23 PM on 02/15/2013
I think you are certainly on the right track but this idea that medications for mental illness is like insulin for diabetes is just wrong. The treatments I was alluding to being harmful or at least unhelpful in many cases were mostly pharmaceutical. Ask yourself why, if these meds are supposedly effective, do our numbers for anxiety disorders, depression, ADHD etc continually increase? Why do we have revolving door syndrome, more so now than ever? For some info please look for Robert Whitaker's "Anatomy of an Epidemic". Highly recommended. Blog of "Mad in America" is also full of different pov on this topic. 
02:40 PM on 02/16/2013
Here's a 'paradigm' to check into.... the innovative approach to 'mental illlness' taken by Windhorse Integrative mental health services, based in Western Massachusetts as well as in central California: http://www.windhorseimh.org/OurApproach-id-9.html