Posts tagged ‘Media’

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.

March 4, 2010 at 10:24 am 3 comments

Diagnosed by the Press

Apparently in the eyes of Dario McDarby of the Examiner, if you live strangely, have a troubled life and don’t step up to claim your diagnosis, you are  not only one of the great number of undiagnosed mentally ill but doing a great disservice to others suffering from mental illness by contributing to its stigma — at least if you’re a celebrity. In his gossipy, agenda laden ramblings, he refers to the late Casey Johnson as “obviously disturbed but possibly undiagnosed” and showing “the negative behaviors of a troubled person suffering from untreated neuroeccentricities.” His explanation for the connection between strange behavior and stigma to strangers:

The impact that this kind of notoriety of obviously disturbed celebrities causes trouble for people struggling to reclaim their mental well-being. It perpetuates the stigma of “mental illness” because of the obscene, grotesque, and ugly behavior of celebrities and others who can afford treatment but resist it because it somehow affects their notoriety. Most people do not have adequate access to services that can help them develop the tremendous talents that may lie undiscovered in their “disorders.”

I’ll never understand how people make the leap  from access to care or a right to care to the duty to receive care but it seems to be increasingly adopted by pro-diagnosis circles pretty consistently. Maybe it’s not one person’s “obscene, grotesque, and ugly behavior” that contributes to other people’s stigma around mental health. If anything, it’s armchair psychiatrists like McDarby trying to diagnose famous strangers through the microscope of gossip press, forcing a connection between serious mental illness and exploitable and tabloid-worthy acting out. One has little to do with the other  outside of the connection we create between them with articles like this. Psych diagnoses are stigmatizing because we try to put every socially unpopular or unacceptable behavior under the umbrella of a mental health label.

Though not diagnosed with any “mental illness,” at least to the public’s knowledge, Ms Johnson showed the negative behaviors of a troubled person suffering from untreated neuroeccentricities. In fact, she used them for notoriety in her alleged love tryst with Tila Tequila, possibly another troubled woman with undiagnosed mental health issues.

Instead, society becomes harsher toward neuroeccentrics because characters, who have the resources to reclaim their mental well-being, become pathetic actors in a tragedy written by scheming journalists and choreographed by dull-witted paparazzi. The blowback from this disgusting show greatly affects those with few resources, but who may possess even greater talents than the dead heiress and her grotesque Internet diva.

I’m not sure why any one person’s diagnosis is supposed to be the “public’s knowledge” and While McDarby appears to have some level of respect for people with mental health diagnoses, I’m puzzled by why he would write them into the stories of tabloid characters. To me, it seems a great disservice to link wild behaviors born out of celebrity to the people in this country with perceived mental illness that are leading (or trying to lead) “normal” lives, whatever that means. We are all too willing to throw life changing and stigmatizing diagnoses at people and now, having become quite comfortable trying people in the press, we are moving on to diagnosing people in the press which adds a lot to the notion that mental health is a matter of public opinion. I have to wonder how far McDarby is from the types of journalists and paparazzi he calls into question when he’s using a “dead heiress and her grotesque internet diva” to frame his argument that every one with troubles should get in line for a diagnosis.

February 6, 2010 at 10:19 am

Are You S.I.C.K.?

I sometimes tune in to different television shows that touch on mental health issues — some that are intended to be informative and, less often, the more sensational offerings — just to see how the issue is approached. A&E’s Hoarders is easily the most successful and most talked about show to cash in on the social sideshow that is televised “mental illness.” Having watched just a couple of episodes, maybe I’ll share my opinion of the show some other time. For the moment, I’ll concern myself with one thing that jumped out at me from one exchange.

On a recent episode, a therapist referred to one person as fitting the “S.I.C.K.” model —  a clever little acronym for “Sensitive, Intellectual, Creative and Kind.” She lost me. I cannot understand why someone would choose to attach the word sick to positive traits. I don’t know whether that little gem is in common use in her professional arena or if that’s just something she thinks is clever — a brilliantly reductionist little acronym to keep in her back pocket, just itching to use it on the next guy. Either way, nothing good can come of throwing a word as stigmatizing as sick around so liberally in regard to emotional distress, much less, positive attributes and in general we need fewer labels — not more.

For anyone who thinks I may be taking things too seriously, let’s remember it only took Prozac Nation to make the phrase “chemical imbalance” a household name and an accepted truth, despite its standing squarely in the realm of theory. These are two different things, to be sure, but we must be careful with our words. Simply put, words mean things and when you have a viewing audience of 2.5 million, words mean plenty.

January 29, 2010 at 3:44 pm 9 comments

Seroquel XR’s New Ad

You may have seen the relatively new direct-to-consumer ad from Astra Zeneca for its long acting atypical antipsychotic, Seroquel XR. Creepy and pandering to say the least. I’ve heard a few people say that if you’re not depressed before watching it, you will be after — and isn’t that the point?  Like a carefully and corporately crafted emo/indie/whatever hit song, it’s made to strike a chord and sometimes it takes a panel of well payed analysts and some market research to find out how best to strike that chord in a way that shows that the company truly understands how you feel. Look at any one of the current pharmaceutical ads. The focus isn’t so much on selling you the drug as the disease. Once you’ve bought the idea of the disease, you’ll find the drug.

Here, they are positioning their Seroquel XR as a fix for “bipolar depression.” They show scene after dreary scene of miserable looking people who have half faded into the grays and browns of their equally dreary  environments, all while an instrumental from Badly Drawn Boy plays in the background. Oddly, one thing that separates this ad from a lot of the others is that it doesn’t switch to bright scenes of people laughing with friends at parties or rolling around in green, sun bathed fields. It stays pretty gray, though one woman does find the strength to get up off the couch. At least in that respect it’s a little closer to reality, considering a lot of people’s experience with this drug and others like it.

Another thing you can’t miss is that the health risk disclaimers take twice as much time as the first part of the ad telling you how great the drug is for treating “bipolar depression.” I’ll be the first to admit that a risk vs benefit scenario can’t be weighed out in seconds of air time but with such a vague diagnosis, based not on objective medical evidence but a nebulous cluster of feelings and behaviors laid out in a questionnaire, one has to wonder when the perceived benefits justify the very real risks. The question may now be more important than ever as we see these drugs being used in increasingly mild situations and in an ever broadening range of indications and demographics. Even with twice the time dedicated to the risks, the likelihood of those risks hasn’t fully been put forth and while they touch on metabolic symptoms and state the need for cholesterol and triglycerides to be checked, the reality is that only about ten percent of doctors prescribing these drugs are looking into metabolic responses by running those tests. With these companies downplaying, often even lying outright about the risks of these drugs to the FDA, prescribing doctors and now — via direct-to-consumer ads — the public, even with their FDA mandated obligations fulfilled, truth in advertising remains questionable at best.

Just as with the ad marketing Abilify as an add-on for “treatment resistent depression,” a viewer who sees this ad would have no reason to see Seroquel as anything but an antidepressant. It’s not an antidepressant though — far from it. It’s an antipsychotic designed to combat the cluster of “symptoms” associated with a diagnosis of schizophrenia — but then, when your product was designed for a perceived illness that affects only 1.1 percent of the population, you have to expand your market somehow.

January 28, 2010 at 10:40 am 2 comments

Oprah Ignores Abuses Against Jani Schofield

Anyone who’s read this weblog for any period of time is likely to have heard of January Schofield. She and her family were on Oprah recently on a story about their struggle with her “mental illness.” I find it appalling that Oprah, much like Shari Roan, covered the story without even mentioning the fact that Jani’s parents have admitted to beating and starving her. Michael, Jani’s father even wrote about it on his blog though after some readers’ responses he removed the part where he admits to starving her.

Maybe next time Oprah can have the parents of Rebecca Riley on. She can do a whole show about the topic of “pediatric bipolar disorder” in toddlers and the struggles they’ve faced without having to drag down the tone of the show with the fact that her mother kiled her with an overdose of clonidine. Perhaps she can do a show with the mother of Iman Morales, discussing his views on the gentrification of Brooklyn and leave out the part where the police kill him.

Let’s be honest, no one turns to daytime television for credible journalism but if someone is going to tackle a story like this, they owe it to the victim and the viewing public to tell the whole story. Oprah’s omitting the abuse of this girl amounts to endorsement of it just as Shari Roan’s original coverage of it for the LA Times did. It’s bad enough to turn a blind eye to stories like this entirely but to dig into a story and go through he trouble of leaving out the abuse and strange defenses of it is unconscionable.

It’s just one more case of the media looking the other way when those diagnosed as mentally ill are abused and when you dig a little deeper and find out how much it’s happening it is truly frightening. The refusal to address these things is a ringing endorsement of it and it’s happened throughout our history with regard to different groups of people on the basis of class, race, gender — you name it. The difference is that we now look back on it with shame and, however delayed, some amount of outrage. I wonder how long it is going to be until you can no longer beat and starve another human being and — as long as they are deemed mentally ill — be regarded as a struggling hero.

October 8, 2009 at 9:16 am 2 comments

ABC Primetime: The Outsiders

Last night, ABC aired Primetime: The Outsiders which was supposed to highlight the Mad Pride movement. Oddly, it opened with a story on mustangs running wild on “government land” and being captured and broken at the hands of maximum security prisoners. While they briefly mentioned that the prisoners could relate to the captivity of the horses, they didn’t say what the horses might have done to be separated from their freedom. I’m pretty sure it wasn’t cocaine and robbing safes though. It seemed like such an obvious parallel to the many people confined in the psychiatric system that I honestly thought at one point that was going to be their angle, but no. Apparently the similarities were lost on them.

The show was predictably topical and seemed to reduce the movement to a group of weirdos who don’t know what’s good for them, however inadvertently. With few exceptions, when they mentioned someone going off meds, they were quick to follow with people’s fears about what that might lead to. When they showed people insisting on choice and rights in mental health they followed it up with an advocate of forced psychiatry who used the phrase, “rotting with their rights on” to describe those that don’t know what’s best for them. Of course, they couldn’t be bothered to show any real information to support these fears — but fear sells when facts fail.

In their role as mainstream media, ABC perpetuated the stigma that the Mad Pride and related movements fight so hard to bring to an end. They did what the media usually does, which is to lump all mental illness together with the violent schizophrenic as its flagship. Rather than allow this movement an uninterrupted voice by way of at least a full segment, they used a story of a sensational murder at the hands of a young man diagnosed as paranoid schizophrenic to punctuate virtually every sentiment from the Mad Pride crowd. (As a side note to anyone who saw the story, I can’t imagine that the kind of forceful institutional “care” offered by a public mental hospital would do much to ease a person’s fear of the CIA’s action through authority figures.) It wasn’t all bad. There was sincere talk of reducing the stigma associated with mental illness. Joe Pantoliano even said he wants the discussion of mental illness to be as “cool, sexy and trendy” as that of erectile dysfunction — whatever that means. Still, it lacked any of the impact that showing true balance would have had and even had an air of possibly using the movement as just another angle for the age old violent-mentally-ill story. I would love to have seen time given to statistics that are counter to popular notions, alternatives, people who have fully recovered, why people are leery of the system but I think that day is still pretty far off.

Imagine the impact that a story on recovery from “serious mental illness” could generate. So many people don’t even know it’s possible. With David Oaks (director of MindFreedom International) as a guest, I’d imagine that they could have had the opportunity to speak with a wealth of people who have left the psychiatric system to take care of their own emotional well being — with or without drugs. It seems like a vague half attempt to address Mad Pride and the idea of freedom of thought without showing in any depth any unquestionable success stories such as Stuart Baker-Brown or any number of others that comprise this movement. That said, David came across loud and clear and, as always, spoke well to the issue, unswayed by the many distractions thrown into the ring. If there is any good that came out of this, people watching may find that alternatives are out there. Many people don’t know their options and many more don’t know there is a movement behind them, a large and increasingly vocal group in their corner.

People that need to get violent impulses under control need to address them but no more or less whether accompanied by odd thought and behavior or not. There is a vast movement of people simply wishing to embrace their uniqueness and the highs and lows that life offers without having someone else determine to what extent they may experience them. There are people who wish to choose their own path to wellness and are willing to make some noise until that basic right is afforded them. Industries and governments shouldn’t be in a position to make these critical choices for us. Refusing drugs and confinement or demanding to take an active role in their own health regardless of their chosen path does not equal reckless abandon and opposition. Most who bear these diagnoses and resultant stigma have a lot more in common with the captured and broken mustangs in the first segment than the killer in the rest and it’s a shame that couldn’t come across.

August 26, 2009 at 5:12 pm 2 comments

Cecilia Casals

   On August 13, Cecilia Casals set herself on fire at the Mall of Americas in Miami, Florida and walked quietly and calmly among shocked onlookers for two and a half minutes. She suffered third degree burns over 75% of her body, from which she ultimately died three days later. This is a sensational enough story and it is not my intention to add to that. 

   Many of the people nearby were understandably frozen in shock. For that I can’t blame them. None, I’m sure, had ever seen anything like it before. The troubling thing (aside from the obvious) is that while three people made some attempt to help her ,even at risk of injury to themselves, many people’s first response was to reach into their pockets and pull out their cell phones and cameras to take pictures.  I must give credit to John Torres and the two others who attempted to come to her aid — for being human beings. While their actions were commendable, it’s a shame that they are the exception and not the rule.

   As it turns out, she had  a history of “mental health” issues and a criminal record for drug charges and attacking a boyfriend with a knife who, still in love with her, dropped the charges. People, as they often do, used her past to put her on trial in the press and over the internet but her past is irrelevant to the inaction of the people around her. We shouldn’t question the value of the life that was lost even at her own hand and when it happened, it wasn’t a “mentally ill” woman or a criminal that people saw. Nobody knew anything about her in that instant. She could have been anybody — you, me,  your mother or daughter — and when it mattered the most and precious seconds could have saved her, people took pictures. I can’t wrap my head around that. People are seeing the worst individual human tragedy they’re likely to see in their lives and instead of reaching for a way to help her, they reach for their phones so they can share it with friends and strangers alike.

 In a move that was both tactless and tasteless,  NBC Washington’s headline for the story read,  “Human Torch Had Issues Burning Inside.” Their website also offers a survey in the sidebar as to people’s response to the story. Unfortunately but not surprisingly, it’s 53% sad, 20% laughing, 13% bored and so on. That says a lot about us as a whole. Of the people that cared to offer a response, 33% were either laughing or bored by the story.

   This may be another instance in which the news media is not so much a window through which to see the world but a mirror. God help us if in that reflection is a mob of onlookers who have lost their last shred of regard for the life their neighbors and find humor in something so devoid of it .  I find it disgusting beyond measure that many among us would rather watch someone die than help them and miss the show.

August 22, 2009 at 9:45 pm 1 comment


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