“...all the most acute, most powerful, and most deadly diseases, and those which are the most difficult to be understood, fall upon the brain.” Hippocrates (c. 400 BC)
Before electronic medical records, the severity of a patient’s illness could often be gauged by the thickness of his chart. Even though “John” was only in his mid-twenties, and his chart had been thinned many times, I had to strain to lift it. When I first met John, he spoke in what psychiatrists call “word salad,” a meaningless mixture of phrases broken up only to allow time for him to attend to the voices in his head. John’s father accompanied him to his appointments. Though he was bewildered by John’s schizophrenia, he loved his seriously ill son.
Over months of follow-up visits, John was able to offer glimpses into his terrifying world. He believed that, just as the National Geographic channel predicted the ultimate fate of the solar system, Stephen King movies predicted the ultimate fate of mankind. It was only a matter of time before alien spaceships, evil clowns, or rabid dogs came for him, and for all of us. John watched The Tommyknockers and Cujo over and over, searching for clues that might offer a way out. Perhaps because John believed that I wanted to help him, and knew that his father loved him, he took his medicines and tried to listen to his therapist. In the beginning, though, he was simply too preoccupied with the imminent demise of mankind, Stephen King –style, to pay attention to anything else.
Patients with severe diabetes or lung disease often require more than one medication to control their symptoms. The treatment of John’s illness was not different. The combination of anti-psychotic medications for his false beliefs, additional medicines to address the anxiety that accompanied these beliefs, as well as talk therapy, to offer support and the option of a different reality, began to work on John. Sometimes his speech made sense. He could listen to his father and shush the voices when they came. He began to question the reality of his frightening world and felt safe enough to enroll in community college. John and his father began to have hope.
A half a year into John’s recovery, his grandmother became terminally ill. John’s father couldn’t help crying when I asked how he was at John’s next appointment. “I only have one mother,” he told me, “and John only has one grandmother.” As his father spoke, I watched John carefully, expecting him to retreat back into his familiar Stephen King world, given the increased stress in his outside one. Instead, he put his arm around his father’s shoulder and said the 2 most coherent sentences that I ever heard him utter: “It will be ok, Dad. I’m here for you.” For the first time since John became ill, he was able to put aside his concerns (which were not trivial in his mind, by any means) and reach out to someone else. Treatment had offered him not only hope, but also the dignity of being empathetic, of being able to contribute something of himself to someone else.
Doctors often speak of patients being at their “baseline,” by which we mean there is little expectation for further progress. John’s baseline was not what anyone would consider sane- he would never be without voices or doubts about a world that did not feature a Stephen King plot twist. But even John, one of the most severely ill people that I have ever met, was able to get better. Improvement was not fast or simple, but it was achievable.
Although most do not have such a dire presentation as John’s, mental illnesses, which are biologically based illnesses of the brain, are quite common. According to the National Institute of Health (NIH), an estimated 26 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. 1 in 17 Americans has a serious mental illness.
Similar to diabetes and lung disease, mental illness is treatable, though not yet curable. While most people don’t hesitate to seek treatment for illnesses like diabetes and asthma (affecting less complex organ systems), illnesses of the brain are highly undertreated. An estimated 2/3 of people with mental illness don’t get the help they need. Indirect costs of mental illness due to lost productivity represented a $79 billion loss for the U.S. economy in one year (according to the US Dept of Health). Depression is the leading cause of disability among young adults, while suicide is the third leading cause of death in this population. Sadly, young adults are far more likely to die by their own hand than by someone else’s. Mental illness also has physical consequences. For example, the American Heart Association has recently issued a recommendation that depression should be added to the list of official risk factors for heart disease.
Untreated mental illness takes a tremendous toll on patients and their families. In addition to incapacitating symptoms, those suffering from mental illness often believe that their condition is the result of weakness or personal failing; that they should somehow be able to control this illness by themselves. The belief that they can manage their illness on their own is the main reason people stop treatment according to a recent NIH study. Family members may blame themselves or their loved ones, often making well-meaning statements like: “why don’t you just think happy thoughts?’ Telling someone in the middle of an episode of major depression to think happy thoughts is about as helpful as telling someone in the middle of an asthma attack to breathe better. Believe me, if he could, he would.
Where to go for help with mental illness can be confusing and frustrating. Former president Woodrow Wilson said: “I not only use all the brains that I have, but all that I can borrow.” When confronted with questions about mental illness, EAPs (Employee Assistance Programs) are designed to work like a “borrowed brain” to provide direction and support. EAP also offers services to improve the mental wellness of employees and their families, with services such as financial counseling and childcare resources, whether or not they are affected by mental illness.
The space shuttle is the most complex flying machine ever built. In the moments before launch, the five onboard computers made 200 million decisions per second. When you woke up this morning and rolled out of bed, your brain was making over 1 billion decisions per second. Given the complexity of our brains, it is a wonder that they work as well as they do. Given this complexity, it should never be embarrassing to seek help when something seems wrong. In this monthly blog, I will talk more about mental illness: what can go wrong and what can be done. I hope that readers will believe, as did John and his father, that there is treatment; that there is hope. Also, through the blog and postings on this EAP website, I hope that readers will learn more about the care and feeding of the human brain, almost certainly the most complex, and miraculous, structure on Earth.
Dr. Bonanno is a board certified psychiatrist with nearly 20 years of patient care experience. She currently serves as a behavioral health medical director for the Anthem central region.
**Names and minor details of this story were changed to protect confidentiality
For more information:
http://www.ncbi.nlm.nih.gov/books/NBK20369/
Statistics
Mental Health Parity Fact Sheet