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Mental illness can destroy what should be a time for joy

December 17, 2005|By M. Douglas Becker

It's the holiday season. Everything should be fun - happiness, joy and love. But that's hardly the case. From my perspective, much of the holiday extravaganza is simply window-dressing, cheesy wallpaper put up to hide the distress of everyday life. Fake smiles everywhere. If you interview real people with real problems, as I do, it's hard not to be depressed and even more so during December.

The missing ingredient is mental health. Those lacking it cast shadows on everyone else in their lives. From the youngest disruptive toddler to the oldest Alzheimer's sufferer, affected individuals stress their families into a melancholy holiday.

Chances are you have a psychologically ill dear one. You know the emotional toll as well as the financial cost. This time of year we count the totals in both dollars and emotional scars.

Society struggles to recognize what constitutes mental illness or its opposite state, mental health. The major psychiatric diagnoses are relatively easy. But add Alzheimer's, other dementias, alcohol and substance addiction and abusive relationships. Throw in criminal (antisocial) behavior and homelessness. And any emotional condition that upsets relationships within a family or impairs the capacity of an individual must be included.

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The number approximates 25 percent of the population and encompasses the entire age spectrum. We invent terms to describe the way those persons make us feel, but rarely force them to establish a working relationship with a therapist and stick to it until they give up their destructive habits or reach a healing balance on a medication. We enable the affected to contaminate everyone's lives by our lack of both understanding and will.

Numbers of mental health providers are insufficient to serve our collective needs. The reimbursement they receive is shameful and the health insurance industry treats this problem with neglect. Patients can hardly access the system because of impediments placed in their path by their own health plans. Private and public mental health services share in the inadequacies.

Suffering families try to piece together some type of safety net. This group of consumers includes many emotionally impaired souls, children and the elderly. Most cannot maintain employment due to their disability or age. Rarely is an individual from this collection affluent enough to pay out-of-pocket for providers and expensive drugs. Mental health financing is broken worse than that of the health care industry.

There are three solutions. The first requires a national attitude adjustment. Mental illness is not a matter of poor personal choices. These conditions are inherited and are some of the most strongly heritable disorders studied.

They are lifelong but may be intermittently symptomatic. Learn all you can about the specific diagnosis and what it can mean to your family. Know what drugs help and how they work. Every member of the family unit must participate in the therapy. Relatives: Stop being enablers.

Secondly, we need to fully fund psychiatric and substance abuse clinics and make universal access a mandate. A majority of these patients are marginal in the work force. Dare we request more appropriations from the health insurance industry? We need to invest in preventative and early intervention services. These measures are not just costly, but require political will.

Since Ronald Reagan began deinstitutionalization of state psychiatric care in California in the 1960s, public funds have lagged further and further behind communal needs. We all pay one way or another and it is not intelligent for this nation to look to private and non-profit institutions to close the gap. This is not a topic for weak-willed politicians. Mentally ill homeless persons wander the streets of our nation as a constant reminder of our failures.

Thirdly, a new personal approach to care for those effected individuals and their families is in order. Long-term care - grip on to that idea and don't let go. Stop looking for quick fixes. Treatments are measured in years and decades, not weeks or months. Select psychiatrists, counselors, social workers and psychologists who meet your special needs and personality type.

Then cultivate a relationship. Keep appointments. Be faithful to your medications. Don't run out of pills and don't stop them just to see what will happen without telling your providers. I am not a psychiatrist, but a pediatrician, an experienced deputy mental health provider, if you will. But I have spent more 30 years following behaviorally disturbed children and their families. I've seen them grow into adults with psychiatric diagnoses that were suspected but undefined years ago.

This isn't the Dr. Phil show where a benevolent, bald-headed godfather magically pumps money into a dysfunctional family to provide a happy ending to an entertaining one-hour pop-psych performance. It's more real than a reality show and certainly lasts longer. It's life in our times and it's endlessly painful.

During this season of emotional wintertime, let us indulge ourselves with a lasting gift. Why not survey our mental health needs and erect a more comprehensive and successful mental wellness program. The current victims are our families and friends, our loved ones. Their hurt touches us. Our New Year's resolution should work toward ending this suffering.

M. Douglas Becker is a Hagerstown physician.

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