The first week of October is Mental Illness Awareness week in Canada and the organizers, the Canadian Alliance on Mental Illness and Mental Health, are to be congratulated for talking about mental illness rather than mental health problems and mental health issues. These are illnesses and we should recognize them as such rather than watering them down by suggesting they are merely problems and issues. They are problems and issues for those who suffer and their families but they are problems and issues because of the illness.
The five faces of mental illness who have been chosen to represent all who suffer are also to be commended for coming forth.
For mental illness week, I would like to dispel two of the myths of mental illness that are frequently mentioned -- that schizophrenia is not a disease and that medications make schizophrenia worse and/or are not needed.
There are some who say that as there is no simple test for schizophrenia, it is not a disease. However, many illnesses that no one disputes exist do not have simple tests for diagnosis. Diagnoses are based on clinical patterns exhibited by the patient. The diagnostic criteria for differentiating schizophrenia from other conditions is complex. Only after eliminating other causes, observing the patient and ensuring that the symptoms have lasted for at least 30 days and up to six months, is a diagnosis made.
The same procedure applies to fibromyalgia, Parkinson's, Alzheimer's Disease, MS, ALS and others. For none of these diseases is there a definitive test but rather the diagnosis is based upon a careful workup, a battery of tests and a process of elimination. And doctors do sometimes make mistakes but that does not mean that these are not real illnesses. Medicine is still an unsure science practised by a variety of people with different competencies. There is the old joke that is quite true that the student who graduated last from the worst medical school is still called doctor.
One sceptic commented that in the other diseases mentioned, autopsies will reveal the presence of disease but not in schizophrenia as there are no physical markers. Actually, scientists have discovered 51 blood biomarkers of schizophrenia and the Scientific American outlines changes in brain grey matter linked to schizophrenia. And this compilation of studies outlines the differences between those with schizophrenia never treated with medication and those who do not have schizophrenia.
The second myth is that there is no need for or little need for medication. Unfortunately, many forget history. The first antipychotic drug was introduced to the world in the early 1950s. At that time, the vast majority of those with schizophrenia spent their lives in asylums. The psychiatrist who was among the first to test chlorpromazine, the very first antipsychotic, was Dr. Heinz E. Lehmann in Montreal.
"For more than 10 years in my psychiatric work, I had been challenged and frustrated by hundreds of mentally ill patients for whom there were only shock treatments, that were sometimes dangerous and had only limited, temporary effects when they worked. Most mentally ill patients, once hospitalized, would remain confined for the rest of their lives."
As the result of his clinical trials, he was able to state:
"Our clinical results were so unique and surprising that they were almost incredible at that time. For the first time in history, there was now a drug that could suppress hallucinations -- frightening, morbid voices and visions that did not exist in the outside world but were very real to the patients -- and paranoid delusions of persecution."
Another pioneer in the 1950s was Dr. Ruth Kajander in London Ontario. She described treatments that involved immersing people in warm baths and holding them under canvas covers in the belief this would be relaxing for them. Patients were also drugged with morphine and opium and were left so sedated they couldn't eat or drink and in many cases they died.
For the first time, patients could be discharged from hospitals thanks to what some have described as the penicillin of psychiatry. Regrettably, more than the drug is required. While pharmaceutical intervention is the cornerstone of treatment, patients also require community support, cognitive remediation and other forms of psychosocial rehabilitation and that many do not get.
Unfortunately, many doctors are influenced in their prescribing by big pharma and some prescribe drugs inappropriately. Advertising costs for antipsychotics grew from $1.3 billion in 2007 to $2.4 billion in 2010 according to theNew York Times even though the number of people with serious mental illnesses for whom these drugs are intended is stable. They are now being given to people with insomnia and anxiety.
As the author, Dr. Richard A. Friedman said in the above article, "antipsychotics can be lifesaving for people who have schizophrenia, bipolar disorder or severe depression. But patients should think twice -- and then some -- before using these drugs to deal with the low-grade unhappiness, anxiety and insomnia that comes with modern life."
Proper treatment for people with serious mental illnesses can do wonders and it is cruel to deny that these illnesses exist. Mental Illness Awareness Week is important to help spread that message.