Saving Normal?

A recent opinion piece by Allen Frances for the LA Times is plainly pointing out the dangers of the new DSM’s broad strokes and the potential to paint too many “normal” people as mentally ill. It’s notable enough that mainstream press is presenting any criticism at all about psychiatry in general and the DSM in particular but Allen Frances was one of their own and no silent partner or low level underling either. He was the chairman of the committee that created the DSM-IV.

Our panel tried hard to be conservative and careful but inadvertently contributed to three false “epidemics” — attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many “patients” who might have been far better off never entering the mental health system.

The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day — despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.

Where the DSM-versus-normality boundary is drawn also influences insurance coverage, eligibility for disability and services, and legal status — to say nothing of stigma and the individual’s sense of personal control and responsibility.

It’s interesting to see someone in psychiatry addressing the notion of false epidemics of mental disorder when a committee decision and ever changing public opinion are all that separate a “real” epidemic from a false one. That said, committee decisions and public opinion have proven quite powerful and if you look back, the release of each DSM has brought on a rash of newly mentally ill. If history proves a good indicator, there will be millions of people who are normal today and mentally ill in 2013 — all thanks to a book with the power to categorize and medicalize the human condition. How much sorrow is too much? How excited can you be about everyday things before you are manic? And now with the proposed introduction of psychotic risk syndrome, anyone who isn’t deemed mentally ill can be subject to the book’s reach simply out of fear that they may be in time.

What are some of the most egregious invasions of normality suggested for DSM-V? “Binge eating disorder” is defined as one eating binge per week for three months. (Full disclosure: I, along with more than 6% of the population, would qualify.) “Minor neurocognitive disorder” would capture many people with no more than the expected memory problems of aging. Grieving after the loss of a loved one could frequently be misread as “major depression.” “Mixed anxiety depression” is defined by commonplace symptoms difficult to distinguish from the emotional pains of everyday life.

The media seldom addresses views critical of psychiatry but for psychiatrists to come out against the new proposals in such a public way is truly indicative of what’s at stake with the new DSM. You can bet that if psychiatrists are picking sides on this, it carries huge implications worth looking at. It doesn’t take much to see the power inherent in handing over our culture’s ability to define “normal” to a small committee comprised exclusively of people with something to gain and Frances is not exaggerating when he calls it “wholesale medical imperialization.” How much control are we willing to hand over? How far are we willing to let anyone go in defining us? How widely cast will the net be before it captures you? This is not an issue of special interest only to those marked as seriously mentally ill. Every label of mental illness is serious and with an ever broadening range of perceived illness encroaching upon a shrinking concept of normal, you may not be off the hook. Frances’ article says that it may not be too late to save ‘normal’ but I question whether ‘normal’ is worth saving.

See also: Allen Frances’ Opening Pandora’s Box: The 19 Worst suggestions for DSM5 in Psychiatric Times.

Temple Grandin Speaks at TED

I watched this on Beyond Meds, a great blog and the product of a very valuable mind. Go there, catch up on the archives and check back often. It is a video of a speaking engagement at TED by Temple Grandin on valuing the diversity of minds and the real-world  usefulness of different types of thinkers. Grandin, diagnosed as autistic, has used her fixations and visual thinking in a great number of ways and her approach has lead to many children’s gifts being fostered instead of shrugged off as deviations. I had seen her on television years ago and not  heard anything since. It appears she’s been quite busy. Thank you, Gianna for posting this.

While I don’t think most would place me on the autism spectrum, I can relate to certain traits and perhaps more importantly to learning and thinking in a way that was not valued in my school years (for what it’s worth, I was labeled an ADD kid later into my schooling). There will always be a larger spectrum of human thought and experience and I will always wonder what things might have been like if there were a way for me to learn with my natural tendencies instead of in opposition to them. I am blessed to have found a career and a small group of peers that find value in the very traits that made me the subject of ridicule, separation and even physical restraint (another story for another time) in a broken school system.

If there are to be labels for children and the way they think, let them be used to offer more and better options and a greater understanding of their gifts, not to measure their distance from an imaginary center held as the ideal approach to learning and socializing. As it stands, normalcy is defined by a child’s adherence to a broken, outdated and narrowly focused system and virtually everything short of that is a disorder at worst and disruptive at best. If we begin to change our views and our establishments to suit the endless resource of young minds, everyone wins. If we stifle them to suit an old educational and social framework, everyone loses — everyone.

Antipsychotics as a Deadly Weapon

While the use of antipsychotics as chemical restraints is nothing new, charging health care professionals with assault with a deadly weapon for their misuse is. From the LA Times:

In an elder abuse case described by one investigator as the most outrageous he has ever seen, three former top managers at a Kern County nursing home have been arrested in the deaths of three residents who allegedly were given needless doses of psychotropic medications.

The state attorney general’s office contended in a criminal complaint that more than 20 residents at a skilled nursing center run by the Kern Valley Healthcare District were drugged “for staff convenience.” Many of them experienced side effects that included dramatic weight loss, slurred speech, tremors, loss of cognition and even psychosis, according to the complaint.

Arraignment is scheduled this morning for the center’s one-time medical director, Dr. Hoshang M. Pormir, former nursing director Gwen D. Hughes and former chief pharmacist Debbi C. Hayes. They were jailed in Bakersfield on Wednesday.

“These people maliciously violated the trust of their patients by holding them down and forcibly administering psychotropic medications if they dared to question their care,” state Atty. Gen. Jerry Brown said.

All three have been charged with elder abuse. Hughes and Hayes, who are accused of administering shots by force and without consent, also face charges of assault with a deadly weapon.

Three residents died and many more were drugged into a stupor in the interest of “staff convenience, ” truly being treated as members of a disposable class. I think you trade in convenience when you take on the task of caring for the elderly. When being vocal is read as being disruptive and being in disagreement is being combative and your rights have faded away over time, you don’t stand a chance. Questioning care is the cardinal sin of forced treatment but no one admits it — and it is force regardless of the age or state of mind of the patient/victim. Never mind the inherent danger and barbarism of forced drugging or that people have every right and reason to be unhappy separate from the lives and people they’ve known. It doesn’t matter that the drugs don’t make you happy, only quiet. The end result is the same — compliance. While this type of “care” is not universal, it is rampant and often with a kinder, gentler face making it harder to see. Hopefully, with cases like this coming to light and to trial people start to wake up to the scale of such abuses.

The complaint paints a bleak picture of a facility dominated by nursing director Hughes, 55, who is accused of seeking to drug all but the most docile residents. Medical director Pormir, 48, allegedly rubber-stamped Hughes’ orders for medication, failed to examine patients and was “either willfully or naively ignorant” of his proper role, according to the complaint. Pharmacist Hayes, 51, told investigators that she went along because Hughes had wide experience in psychiatric hospitals, the complaint says.

Hughes had been fired from a convalescent home in Fresno in 1999 for allegedly overmedicating patients there, according to state officials.

If Hughes was fired for overmedicating what may be the most overmedicated group of people in the US, she had to be doing the same thing then as now and should have been stripped of her license ten years ago. Clearly ten years and a dismissal have had little effect on her. While the other two might claim to be ignorant and deferential at best, any human being half paying attention can see when drugs are being administered carelessly, let alone aggressively and punitively — and when lives depend on what you do, you don’t get to plead ignorance.

At the Kern Valley facility in Lake Isabella, she ordered medications when the elderly residents — most of whom had dementia or Alzheimer’s — glared at her or spoke disrespectfully, according to Samuel Obair, a pharmacist who helped in the state’s investigation.

“It is beyond appalling to me,” he told state officials. “I have never gone into a facility and seen psychotropic medications and mood stabilizers . . . being used on so many patients, and so blatantly” without a legitimate diagnosis or careful documentation.

God help the generation that made us when they spend their last days being drugged — some of them to death — for not bowing and scraping when a self exalted staffer, just a kid in their eyes, barks orders, or if they don’t like the food, their roommate or knowing that they are at the last long portion of their lives. At what point in one’s life does it become mandatory to be compliant without exception? I hope for the sake of all who counted on these three for care, that they are held accountable. Also, I can’t help but think that if people can see drugs as weapons, there is a potential for greater implications in the future. If forced drugging is an assault to one body or twenty, it is an assault to millions.

• • •

California Advocates for Nursing Home Reform (CANHR)

Defending a Diagnosis

When I first heard that the Asperger’s syndrome diagnosis was going to be dissolved and absorbed into the autism spectrum disorders, my first thought was that people with the Asperger’s diagnosis were not going to be pleased. As it turns out, I was right. Aspies, a name many with the diagnosis have adopted, have an identity and a community wrapped up in the diagnosis around which many rally in mutual support — a diagnosis that’s been the source of some contention as its legitimacy has been debated and now its existence as a stand-alone disorder is in question. I’m not one for labels, in large part because they tend to be divisive but I firmly believe that we should be able to define ourselves as we see fit and the Aspie community has done just that — or at least they’re trying. In a time when thousands of people are trying to shake off one label or another, Aspies are clinging to theirs. Many diagnosed with Asperger’s fear that their collective identity will suffer a hit, even be lost entirely if they are to be lumped in with the Autism spectrum.

From Lindsey Tanner for the Associated Press:

Some parents say they’d welcome the change, thinking it would eliminate confusion over autism’s variations and perhaps lead to better educational services for affected kids.

But opponents — mostly older teens and adults with Asperger’s — disagree.

Liane Holliday Willey, a Michigan author and self-described Aspie whose daughter also has Asperger’s, fears Asperger’s kids will be stigmatized by the autism label — or will go undiagnosed and get no services at all.

Grouping Aspies with people “who have language delays, need more self-care and have lower IQs, how in the world are we going to rise to what we can do?” Willey said.

With any diagnosis comes assumptions preconceptions and often stigma. You are one of these, therefore I can expect this of you and these are your limitations. That’s the power of labels and that’s why some people are fighting so hard for some measure of control over the labels attached to them. While incorporating the Asperger’s diagnosis into the autism spectrum may have some benefits that are not currently available to those with an Asperger’s label, many disagree on how to amend the situation. Do we change the label or the distribution of services?  And what, if anything, is a reasonable trade-off?

Rebecca Rubinstein, 23, a graduate student from Massapequa, N.Y., says she “vehemently” opposes the proposal and will think of herself as someone with Asperger’s no matter what.

Autism and Asperger’s “mean such different things,” she said.

Yes and no.

Both are classified as neurodevelopmental disorders. Autism has long been considered a disorder that can range from mild to severe. Asperger’s symptoms can vary, but the condition is generally thought of as a mild form and since 1994 has had a separate category in psychiatrists’ diagnostic manual. Both autism and Asperger’s involve poor social skills, repetitive behavior or interests, and problems communicating. But unlike classic autism, Asperger’s does not typically involve delays in mental development or speech.

Aperger’s revolves heavily around social differences and many who embrace the label embrace those differences not as subnormal or abnormal but as very natural and normal leanings and behaviors viewed unfavorably “neurotypicals” (those outside of the autism/Asperger’s umbrella). While some connections may be made based on the many parallels between the two diagnoses, many Aspies fear the distinction in developmental abilities will be lost in the blur created by blending the labels. The change in diagnosis may prove to be a double edged sword in some ways. We tend to see developmental delays (as with autism) as being objective, legitimate and neurologically based while the traits of Asperger’s are primarily behavioral and lend themselves to a more hazy and subjective reading. For many, there is a struggle to link Asperger’s to autism as an established diagnosis while maintaining its distinction as not meaning limited or delayed developmentally. Still for others, especially parents seeking useful services and placement in schools, the question of perception has to be weighed against very real needs which currently hinge on the little numbered code that accompanies every diagnosis in the DSM.

As I’ve said, I’m not one for labels applied by people other than the wearer and I’m inclined to think the whole situation might be better handled if we throw the book out altogether. If the DSM and it’s hairsplitting, mind measuring scales and labels didn’t exist, what choice would we have but to see people as individuals and not as representatives of their limitations — real or perceived? No one should need to take on a label to get the help they need, least of all children in schools and no one should need to cling to a diagnosis because a collective identity rests in it. Autistic people, Aspies, neurotypicals and beyond, we are who we are despite labels, not because of them.

• • •

You may also be interested in:

Psychology Today: What does this change mean? Don’t people have the symptoms of Asperger’s syndrome any more? Of course that’s not the case. But let’s look at mental health problems as they are reflected in years of DSM editions…

NPR: Right now, the diagnosis often hinges on a person’s language skills. But that’s pretty subjective and can change as a child grows up, researchers say. “The categories are just not used by clinicians in a reliable fashion,” Lord says. A single category for autism spectrum disorder will let clinicians stop agonizing over which diagnostic category to put someone in…

The image at the top is a still from Adam Elliot’s brilliant film, Mary and Max, featuring the voices of Philip Seymour Hoffman and Toni Collette. Go watch it.

What Does Haiti Need Most?

“The most urgent need … is not food and water which is temporary. The most urgent need is for psychiatrists.” — From an AP article in the Monterey Herald

Ah yes, food and water are temporary. Psychiatry is forever. Who can forget the great Thorazine famine of Ireland or the poor little Ethiopians with no Zyprexa in their bellies?

As many as one in five Haiti earthquake victims has suffered trauma so great with the multiple shock of lost homes, jobs and loved ones that they won’t be able to cope without professional help, doctors say.

The people of Haiti are grieving. They have every reason to grieve. It’s not an illness. Who are doctors to ascertain who will cope without psychiatric intervention or even to declare that coping is mandatory? No nation that has ever rebuilt itself from ashes and rubble or the widespread damage of war and political land grabbing has psychiatry to thank for their renewal. It has never been a drug induced haze of vague acceptance that spurs people to rebuild but the knowledge that action is required and genuine help from people in a position to offer it. We should be providing the true necessities of survival and the tools necessary to rebuild as they determine the direction of their own nation, not assuming as we have here that we know someone’s needs better than they do and there is a pill for every hardship that’s been thrust upon us. By all means, let’s offer our emotional support but let’s let them determine their needs and act as friends, not crusaders. God help us if our response to grief and loss in every suffering country is the expansion of the lucrative, western and drug-centered psych industry with all of its ills — but then again maybe we can offer a little bit of the peace and happiness synonymous with being a psychiatric patient.

Martin Luther King on “Maladjustment”

The following is an excerpt from Rev. Dr. Martin Luther King Jr’s speech on the topic of social justice, delivered to an audience at Western Michigan University as part of a series called “Conscience of America.” It was apparently poorly attended. I would love to have been there. If his efforts and accomplishments were limited to black civil rights, he still would have offered us much but the principles of social justice, equality, and human rights are universal and only have as much to do with race as we allow.

Dec. 18, 1963:

There are certain technical words within every academic discipline that soon become stereotypes and cliches. Modern psychology has a word that is probably used more than any other word in modern psychology. It is the word “maladjusted.” This word is the ringing cry to modern child psychology. Certainly, we all want to avoid the maladjusted life…

But I say to you…there are certain things in our nation and in the world which I am proud to be maladjusted and which I hope all men of good-will will be maladjusted until the good societies realize. I say very honestly that I never intend to become adjusted to segregation and discrimination. I never intend to become adjusted to religious bigotry. I never intend to adjust myself to economic conditions that will take necessities from the many to give luxuries to the few. I never intend to adjust myself to the madness of militarism, to self-defeating effects of physical violence…

In other words, I’m about convinced now that there is need for a new organization in our world. The International Association for the Advancement of Creative Maladjustment — men and women who will be as maladjusted as the prophet Amos. Who in the midst of the injustices of his day could cry out in words that echo across the centuries, “Let justice roll down like waters and righteousness like a mighty stream.” As maladjusted as Abraham Lincoln who had the vision to see that this nation would not survive half-slave and half-free. As maladjusted as Thomas Jefferson who in the midst of an age amazingly adjusted to slavery would scratch across the pages of history words lifted to cosmic proportions, “We know these truths to be self-evident, that all men are created equal, that they are endowed by their creator certain unalienable rights” that among these are “life, liberty, and the pursuit of happiness.” As maladjusted as Jesus of Nazareth who could say to the men and women of his day, “Love your enemies, bless them that curse you. Pray for them that despitefully use you.” Through such maladjustment, I believe that we will be able to emerge from the bleak and desolate midnight of man’s inhumanity to man into the bright and glittering daybreak of freedom and justice. My faith is that somehow this problem will be solved.

I know that unfortunately, for many, this is just a day that they are inconvenienced by closed banks and post offices, for some a day off but let’s pay attention. Let’s get out of adjustment for a little bit. Martin Luther King pledged his life to a movement that had a tremendous impact on our country but the work is far from done. Every time we become aware of the inequities forced upon others and the indignities and harm suffered by them, we are presented with a choice. May we always choose to become bigger than these wrongs and take them on rather than adjusting ourselves to them.

Kings County Hospital to be Monitored by Federal Judge

You offered them as martyrs but that was not your right
God’s instruments of change sometimes walk beneath our sight

Ballydowse — Open the Record

A year and a half after Esmin Green died on Kings County Hospital’s waiting room floor as a direct result of staff negligence, a settlement has been agreed upon which will allow a federal judge to monitor Kings County Hospital. Esmin’s death may have been a turning point but Kings County’s psychiatric ward had already been called a “chamber of filth, decay, indifference and danger” in legal filings which were under way well before Esmin’s involuntary commitment and death. That lawsuit was filed by Mental Hygiene Legal Service, the New York Civil Liberties Union and the law firm Kirkland & Ellis. Unfortunately, it takes more than a lawsuit for most Americans to take notice so we had to actually watch someone die before turning the spotlight onto Kings County.

From the NY Times:

In a 45-minute conference call on Thursday with Judge Kiyo A. Matsumoto of Federal District Court in Brooklyn, lawyers for the city, the federal government and the patients confirmed that they had agreed on a consent decree that would require changes at the hospital and a timeline for enacting them. The conference call was broadcast in the courtroom.

The judge indicated that she was prepared to sign the agreement, even as she expressed some reservations, saying that some parts seemed “vague” and “ill defined.”

Hopefully with this agreement, we can expect some real, immediate and measurable changes. People only seem to act when someone is watching. Still, I’m not exactly encouraged by parts of the agreement being “vague” and “ill defined.” In light of the fact that KCHC staff failed to adhere to existing policy and even falsified reports, I question their willingness and ability to truthfully and effectively report to an outside overseeing body.

Judge Matsumoto could modify the agreement before signing it, lawyers said, and indeed, during the conference call on Thursday, the judge expressed concerns about what she saw as somewhat flabby language.

She noted that the settlement called for the hospital to meet “generally accepted standards” for psychiatric diagnoses, a goal that seemed to underwhelm the judge, who said it was “obvious.”

Judge Matsumoto criticized another section that called for mental health treatment plans to be assessed and revised “when appropriate.”

“O.K.,” the judge said tartly. “How do we decide?”

She pushed the parties to submit progress reports to the court sooner and more frequently than they had envisioned.

Judge Matsumoto would function as the enforcement agent for the decree and would have the power to hold the city in contempt or impose other penalties if the decree’s provisions were violated.

Hopefully Judge Matsumoto can cut through that flab and get to the heart of the matter, making the necessary changes before signing the agreement. When systemic neglect and abuse is allowed to continue and worsen for years, only to be exposed by death on tape, we should be demanding more than vague talk about “accepted standards.” Fortunately,  Judge Matsumoto seems to be of the mind to see it through. I sincerely hope she does. I’m glad to see she’s pushing for more timely and more frequent progress reports but how gradually are we willing to allow things to change and again, how much can we trust the integrity of those reports? These are matters that need to be addressed.

In the end, it shouldn’t take paperwork, compliance and transparency policies and administrative oversight to motivate people in the field of “care” to act as though they care. If you need a court order to tell you to pick someone up when they’ve fallen face first onto cold, dirty tile, then you are not only ill qualified to work in a hospital setting but to call yourself human. We can make all the clerical and administrative changes in the world to enact outward change but we will never be able to legislate decency, respect and dignity.

The Kaufman House – Part II

Here are two short videos regarding the Kaufman house, the failures of SRS and an interview with survivor Nancy Jensen. In addition to standing around with our jaws dropped at the  severity of it all — we really need to start asking ourselves how these things can happen and why some people are not being heard, why our agencies aren’t doing what they signed on for and what we can do about it. It’s not enough to be outraged if it doesn’t lead to change.

Elyn Saks Awarded MacArthur Grant

In a society that seldom puts the spotlight on someone diagnosed with serious mental illness, other than in the light of violent crime, and much less for admirable and inspiring behavior — I found this worth sharing.

Elyn Saks is one of just 24 people in varied fields awarded a $500, 000 grant from the MacArthur Foundation this year. The grant is without restriction and can be used as its recipients choose but is offered in the interest and spirit of continued creative endeavors. There are some amazing individuals among the MacArthur Fellows, ranging from scientists to artists to legal advocates. From their website:

The MacArthur Fellows Program awards unrestricted fellowships to talented individuals who have shown extraordinary originality and dedication in their creative pursuits and a marked capacity for self-direction. There are three criteria for selection of Fellows: exceptional creativity, promise for important future advances based on a track record of significant accomplishment, and potential for the fellowship to facilitate subsequent creative work.

Saks, a legal scholar and mental health policy advocate has been actively questioning how we approach the idea of mental illness and more importantly the people to whom these labels are attached — both in the nature of her daily life and in her studies and works. Elyn has received a philosophy degree from Oxford and a law degree from Yale. She is on the faculty at USC and is researching societal rejection of people diagnosed as mentally ill. She hasn’t merely gotten by in her field but excelled, all the while dealing with her own serious mental illness. Saks is diagnosed with schizophrenia.

The fact that she has not just been able to live a “normal” life but one of remarkable work is a testament to the fact that people shouldn’t be defined by their perceived illnesses or the limitations we associate with them. The fact that she only went public with her diagnosed schizophrenia in 2007 but was facing it down throughout her successful studies speaks to the fact that limitations associated with perceived mental illness may not be inherent but placed upon people externally. Elyn’s work and achievements are admirable regardless of any mental health issues and backstory which is what places her among the 24. From the LA Times:

Saks said in an interview Monday that she would use at least some of the prize money to extend her memoir by interviewing other people with schizophrenia who are doing well.

“When I’m traveling, people always say, ‘You’re unique.’ Well, I’m really not,” she said. “I would just like to tell other people’s stories as well to further give people hope and understanding. . . . Some of their stories are just so inspirational.”

One has to wonder what doors would have been closed to her along the way if she had disclosed her situation — and how, if the mentally ill are so limited, the only conceivable thing that could have ve separated her from her goals is not an illness but the people around her.

He’s Amongst Us…

   A pair of short films have been released by UK based Time to Change,  a group focused on ending the stigma and discrimination surrounding perceived mental illness. The films feature Stuart Baker-Brown who is living with a diagnosis of schizophrenia. They are designed to play off of the sensational nature with which mental illness is portrayed in the media and call into question the public’s fearful notions of people diagnosed as mentally ill.

   The first begins with all of the time worn visual cues and creep-out noises of a horror movie and the title, Schizo: He’s amongst us…, then reveals the very “normal” scene of Baker-Brown making tea and discussing his condition. The second bears the tag line “Schizophrenic man terrifies kids at party” and the appearance of actual home video footage, leading the viewer to believe they are about to see a madman on the attack. 

   While they lose some of the impact if you know what they’re about (as in being directed to them by a weblog such as this) most people that see them will see them as ads, not unlike public service announcements and without the benefit of being clued in to the intentions of the film makers. While very deliberate in setting up the viewer, they should do a good job of making at least some people question what they think of mental illness and why. 

   There is no question that people tend to associate perceived mental illness with violence despite all evidence to the contrary. That’s why people are so willing to lock up and medicate their neighbors whether criminal and violent or not. It’s the fear that their “illness” rules them and violence is virtually inevitable. However, studies show that people with mental health diagnoses are no more likely to commit violent acts than those without and that there are far better indicators as to whether someone may become violent. That said, sensationalism sells. Whether it’s newspapers or movie tickets, the idea of this unpredictable and uncontrolled group of violent lunatics plays on people’s fears and fears have  never had to be rational.

   In both of the films Stuart Baker-Brown stresses the importance of the support of his family and friends in helping him live a full life — and his life seems very full. Among other things, he is a traveller and a brilliant photographer creating images that easily stand on their own without any backstory. If he can credit his friends and family for adding to the fullness of his life and playing a large role in managing his formidable problems, what damage can we attribute to the many more people who respond to “mental illness” with fear, prejudice and scorn? It must be a lonely and empty world when the people around you fear you, often before they even know you but let’s face it — fear is so easy and understanding takes effort.