Saturday, April 19, 2014

This Is Serious

Image from http://agathoi.wordpress.com/2012/12/02/stoic-week-and-a-trip-to-the-er/ambulance/
Why HR 3717 “Helping Families in Mental Health Crisis Act” is so critical to care

It’s 3:00 in the morning. I’m sitting in a brightly lit waiting room at the ER, cuddling my then-three year old son, who can’t stop screaming and tugging at his ears. His cheeks are bright red; his duck-fuzz white hair stands up in all directions. I rub his green crocheted blankie—he calls it “Biss” for reasons still unknown—against his forehead, trying to sooth him.

I’m exhausted. The whole night has been like this. But it looks like we’re next in line for treatment.

Then my son's cries are drowned out by wailing sirens. An ambulance pulls up to the bay; we hear (but cannot see) a flurry of activity, intercoms buzzing. It’s a car accident, severe trauma. We wait, but without resentment. The Emergency Room is not like a grocery store checkout line, with first come, first served. It’s constant triage, assessing the most urgent needs first.

Ten years later, it’s my son, now 13, in the ambulance, held in restraints to keep him from bolting or striking people. Ten years later, it’s my son at the front of the line for treatment when we reach the emergency room. But once he’s calm and rational again, they send us home with five days’ worth of Zyprexa. There are no beds in the psychiatric hospital.

My emergency room story ended better than Virginia State Senator Creigh Deeds’s, whose beloved son Gus stabbed his father and shot himself.  My story ended better than Jared Loughner’s, who fired on Congresswoman Gabby Giffords. My story ended better than Eric Belluci’s,who (despite the existence of Kendra’s Law) killed both his parents with a hunting knife. My story ended better than Kelli Stapleton’s, who became so frustrated with the lack of support that she took her daughter to the woods without planning to return.

I still fear, as every parent of a child with a serious mental illness fears, that my son’s story my end like Kelly Thomas’s—that he will be beaten or shot by law enforcement officers who lack training in dealing with people who have mental illness.

These stories—my own and millions of others—are why I strongly support Representative Tim Murphy’s proposed comprehensive legislation to overhaul a broken mental health system. I was one of the parents who testified in an initial fact-finding forum, where Rep. Murphy and his colleagues asked what families need to help our children. You can read my op-eds in the Idaho Statesman and  Hartford Courant, both of which outline briefly why this legislation is so important for families like mine.

But the critics of HR 3717 are out in full force. Their position is pretty well summarized on psychcentral.com author Jon Grohol’s blog post, “The Lie of Focusing onThose with Serious Mental Illness,” written in response to mental health advocate DJ Jaffe, who dared to address the opposition’s elephant in the room: funding. Representative Murphy’s bill would restructure SAMHSA and require accountability through evidence-based outcomes. And some people are afraid of that.

I actually agree with Grohol about a few things. There’s no question that ADHD or anxiety or OCDs can make life difficult for those who have these conditions. And he’s right about arbitrary lines drawn in the mental health community—I cannot tell you how often I have heard the phrase, “Well, my son has autism. That’s just a developmental disability, not a mental illness like what your son has.”

But Grohol is incorrect in stating that supporters of Murphy’s legislation don’t think everyone with any kind of mental illness—not just serious mental illness—deserves treatment. As for the “lie” of serious mental illness? Here’s the thing. People with serious mental illness are NOT treated better or with different resources, as Grohol contends. Too often, they are not treated at all—at great cost to individuals, families, and communities. There are ten times as many people with mental illness in jails as in hospitals—read author Pete Earley’s excellent response, calling this fact “a national scandal.”

My biggest problem with Grohol’s argument is this statement: “What’s not needed is cramming forced treatment laws down state’s throats — even if their own citizens don’t want them.

Forced Treatment. Wow, that sounds horrible! Kind of like the Death Tax—remember how the Republicans so brilliantly re-branded the estate tax, which affects a very small percentage of Americans, and made us all afraid that we would have to pay it?

We’re not talking about “forced treatment” here. We are talking about saving lives of people who, as a symptom of their illness, may not be aware of their condition. And the correct term is Assisted Outpatient Treatment or AOT. Already in the U.S., 45 of 50 states have AOT laws on their books, because they recognize that these laws help people with serious mental illness, save money, and improve communities. The fact is that AOT laws work. They improve the lives of people with mental illness and help their families. They reduce recidivism. Most important, they keep people with mental illness out of prison.

Let’s go back to my first night in the emergency room with my son. He had a double ear infection. The doctor was able to soothe his pain with a topical solution and sent us home with a prescription for antibiotics. The next day, he was a (mostly) cheerful preschooler again.

But the person who was in the car accident likely faced many months of recovery. I see mental illness in the same way—no “arbitrary lines,” no “Balkanization,” just sound, medical treatment decisions about urgency of care. I’m not saying my son’s bipolar disorder is somehow “better” or “more important” than your child’s ADHD. But the reality is that your child’s ADHD probably won’t land him or her in jail.


That’s not my reality. 

Sunday, March 16, 2014

A Time to Mourn, a Time to Dance

I’m going to miss Trey McIntyre’s ballets, but I’m excited about what’s next
My little dancer

On Mother’s Day in 2013, my children and sweetheart took me out for brunch at the Griddle. My youngest daughter, then seven, became restless as we waited for our pancakes. She stood up suddenly and launched herself across the room in a series of tilted pirouettes, to the delight of a group seated in a booth across the way who happened to be Trey McIntyre Project’s elite dancers. They laughed and smiled at her, then came over to tell her what a fun little dancer she was as she beamed at them.

In my family, it’s always time to dance, so it goes without saying that we are big Trey McIntyre fans. With some excitement but mostly sadness, I hopped on my bike and headed down the Greenbelt to see the company’s final dance performance on Saturday, March 15, the Ides of March (aside: is it permissible for a Boisean to travel to a Trey McIntyre program any other way except by bicycle?). I was excited to see how Trey would translate Edward Gorey’s delightfully macabre illustrations into movement. The Vinegar Works: Four Dances of Moral Instruction, perfectly accompanied by a discordant Shostakovich piano trio, did not disappoint: the dancers captured the dark whimsy that makes Edward Gorey’s work so “road accident” gripping.

I was sad because it was the last dance.

McIntyre uses the language of classical ballet and makes it relevant. I know that language because like many 40-something middle class white women, I spent several girlhood years at the barre, hair pulled in a tight bun, pink tights, black leotard, head erect, hips square as headlamps, moving to the mechanical time of a piano: “Plie, releve, plie, releve.” The year I started ninth grade, I had to make a choice: piano, or ballet. It was not an easy one, because I loved both. But at that level, the practice time required would not allow me to excel in both, and I wanted to excel.

So I went to the experts. I asked my ballet teacher, Gilbert Rome, whether I had a chance at being a prima ballerina. He looked at me critically, sizing me up. “Look, you’re a good, solid dancer,” he said. “You practice hard, you learn the steps quickly. I can always count on you to lead the line. But your body’s not built for what the big companies are looking for. You’d have a shot as a corps dancer, but nothing more.”

Fair enough. Then I asked my piano teacher, Linda Anthony. “Sky’s the limit,” she said. “You’re a natural. You play with a musicality that can’t be taught.”

Sold.

Note: I’ve never performed as a pianist with a symphony orchestra. But I have played professionally for years, and piano continues to be one of the great joys of my life. I compose a Christmas carol every year and have even started a musical, based on the fairy tale “East of the Sun, West of the Moon.”

Now I’m no Trey McIntyre. He is one of those rare artistic geniuses that pop up, seemingly out of nowhere, every generation or so. Boise has been lucky to have him and his world-class troupe. But I’m definitely a creative type. So I get his creative itch, that fear of complacency leading to mediocrity, the need for the next big artistic challenge. Sometimes it means sacrificing everything you have and starting over. Been there.

The Trey McIntyre project has meant so many things to so many people in Boise. For me, the work that stands out most is “Bad Winter,” the painful pas de deux danced by Lauren Edson and Travis Walker, which pretty much summed up my failed marriage, right there on the stage. Watching it the first time, I escaped the auditorium to collapse in a thunderstorm of tears. The second time, oddly, was soothing and cathartic.

Whatever he does next, I’m confident in Trey McIntyre’s ability to tell stories that have meaning. So I mourn the last dance with a tear in my eye but a lilt in my step, a shuffle off to Buffalo, and excitement for the next Big Thing.

Tuesday, March 11, 2014

The Answer

What do you get when you multiply six times nine?
May 11, 2001, the day Douglas Adams died

When I was 12 years old, a Mormon missionary gave me a book that would change my life forever. No, I’m not talking about The Book of Mormon; I’m talking about Douglas Adams’s Hitchhiker’s Guide to the Galaxy. Thanks to this book, I always travel with a towel. I generally don’t panic. And I know that it’s okay that I can never quite get the hang of Thursdays (I really can’t).

I just turned 42 (thank you for asking!), and already I have a feeling it’s going to be a bang-up year. For those of you who haven’t read Adams’s four-book trilogy, 42 is The Answer to the Ultimate Question, the question of Life, the Universe, and Everything. This is my year to be the Answer.

Only it turns out that no one really knows what that pesky question is.

And that’s okay. I don’t know what the question is either, and I don’t want to know. Who am I, why am I here, and where am I going? Not particularly interesting to me anymore. More interesting: where shall we hike? What shall we drink? And where shall we go for lunch?

The day after my birthday, The New Yorker published Andrew Solomon’s intense, compassionate interview with Peter Lanza, Adam Lanza’s father. In light of my viral December 14, 2012 blog post, Time.com asked me to write a response. It seemed like all the major news outlets focused on a few sensational quotes (shocking!), which I feel were taken out of context. Take Yahoo News, for example: "Conn. shooter's dad: 'You can't get any more evil." 

I focused instead on Peter Lanza’s inability to find answers, on how a “normal weird kid” who was loved by both parents became a killer. Because that’s what life is like when you have a child with mental illness. There are no easy answers.

This is the year I’m finally starting to feel comfortable with my ambiguities, in my 15-pounds-too-heavy body. My children aren’t little anymore. We’ve left Thomas the Tank Engine and Dora the Explorer behind, trading them for Sherlock, Dr. Who, and Battlestar Galactica. We still like the Lego movie, but in that “ironic/cool we are way too old for it” sort of way.

This is the year I’m finally not afraid to say what I think. Guns on Idaho college campuses? It’s an expensive, moronic example of unwarranted government intrusion. Gay marriage? Though I pride myself on trying to see all sides of an issue, I really cannot understand a single argument against it. Mental illness? Sometimes we have to talk about violence, even when we don’t want to.

Douglas Adams died in 2001 at the age of 49 while working out in a Santa Barbara gym. The day he died, I took my two boys, then ages two and four, to the Santa Barbara zoo where I took the picture above.  That picture, my boy and a gorilla, still brings me to tears. I don’t know what it means, or what questions it answers. But I do know that I never want to feel like Peter Lanza did. I never want to wish my children had never been born. I never want these pictures to disappear, or this narrative we've shared so far to lose its meaning.

For a writer, 42 is young. When I was 22, I thought I was a great writer, but what can a 22 year old know? The truth is that I know so much less now, but I am so much more compassionate and accepting. So if you need a towel, let me know. Mine’s big enough for two.

Wednesday, March 5, 2014

Lent by Proxy

What if I want to give up everybody else’s annoying habits for Lent?

‘Tis the season when I start thinking about what Father Len likes to call “weeding the garden.” Yes, it’s officially the Lenten Season, and as a relatively new Catholic, I still look forward to these 40 days of fish on Fridays, culminating in a glorious celebration of renewal and rebirth that is Easter. Like a lot of my Facebook friends, I’ve spent the past few weeks thinking about what to give up for Lent, with the full knowledge that whatever I choose may end up leaving my life permanently, and that might be a good thing.

Some of my friends are giving up Facebook. Not me. I don’t need that kind of personal growth (though I think I should negotiate full credit with God for all 40 days if I agree to give up my smartphone for a weekend).  

There’s the obvious stuff: sugar/wine/coffee/refined carbohydrates or whatever else is keeping a few extra pounds on my waistline while also greasing the wheels of my incredibly “intense” (my fiance’s carefully thought out word choice, not mine) lifestyle.  If I take the results of this Buzzfeed quiz as valid, I should give up caffeine. Really? I’m a mother of four children, in graduate school, working full time, and on the planning committee for Idaho’s Children’s Mental Health Week in May. I think there’s a scripture somewhere, probably the Book of Esther, that says, “Thou shalt not give up caffeine for Lent, lest thou drive thy coworkers crazy.”

In fact, I’m going with Father Len on this one. In one of my favorite homilies of all time, he said not to give up chocolate or wine or things that make you happy, because that’s not what Lent is about. Lent is actually a celebration. We are celebrating the death of our sins, the weeding of the soul’s garden, a new simplicity in our relationship with ourselves and with God.

When my kids asked me about what I planned to give up for Lent, I said, “I’m giving up your Xbox. I’ve decided on Lent by proxy.” Hey, I was raised as a Mormon, and we used to baptize people who were dead—why not outsource Lent?

This year, I can think of plenty of things other people ought to give up, starting with fear, hate, and bigotry that has characterized this year’s session of the Idaho Legislature.

But that’s not the point. Neither is telling everybody what you’re giving up. The point is the journey. The point is simplicity, reflexivity, self-awareness.

In that spirit, I recall some of the more meaningful Lenten journeys I have taken. One year I decided to give up dating, after a string of unhappy and unfulfilling relationships with men who could definitely be described as invasive species. Three years later, I looked at a kind, joy-filled friend and realized I was hopefully (not hopelessly) in love. And now we are planning a wedding. If by planning, you mean, which lake should we hike into?

I will freely admit that I am kind of God-challenged, meaning I just can’t quite buy in to the idea of a big man in the sky telling me what to do. But I can totally understand the statement, “God is love.” If God is love, then Lent is an act of love, of self-abnegation, not glorification. I’m not going to give up caffeine. I’m not going to give up my kids’ Xbox. I’m going to pull some weeds, to work on things I need to work on. And what those things are is none of your business. In the words of Voltaire, "Let us cultivate our gardens." 

Friday, February 21, 2014

Victims

Dylan Farrow, Woody Allen, and conflicts with no resolution

I think it’s fair to say we all read the letters. First there was daughter Dylan’s painful missive, the anguished confession of a 28-year-old young woman still dealing with unspeakable (and yet spoken) trauma she allegedly endured at the hands of a man she should have been able to trust most—her father. Who happens to be famous. Extremely famous.

And then Woody Allen’s response—a self-serving, selfish missive also filled with too much information, his active hatred of Dylan’s mother Mia Farrow still evident in every line of indignant prose (See Gawker for the most recent missile fired in this ugly skirmish).

I’m not sure why either of them decided to air this painful trauma in public. I’m even less sure why Nicholas Kristof and the New York Times decided this was news fit to print.

It sure got our attention. And plenty of people weighed in, supporting Dylan, supporting Allen, resurrecting the painful divorce that made scorching headlines so many years ago.

In the interests of full disclosure, I have been guilty of writing letters like Allen’s in the past. They have now been hidden from this blog, where some of them were originally published, because I have realized that I was wrong to write what I did and to share it in a public space, even though I thought I was doing so anonymously, and even though I felt justified at the time. My divorce six years ago was unexpected, traumatic, and continues to be high conflict, much like Mia Farrow’s and Woody Allen’s—and the people hurt the worst in those kinds of divorces are the children. That is undoubtedly true in Farrow and Allen’s case, and it is undoubtedly true in mine.

I learned over several years to disengage by honestly assessing my own behavior and realizing that I was wrong to air the gory details in public. This does not mean that I agree with my ex-husband—we disagree about everything from the reason for our divorce to what kind of socks our children should wear (I wish I was exaggerating, but I am not). But the fact that we disagree does not mean he is an evil person—far from it. We are just really, really not supposed to be together. 

I’m now taking a Conflict Management course in my Ed.D. program, and I’m finally starting to understand why conflagrations like these can continue unabated for so many years, and why they can flare up so viciously, even years after the initial event.

When everyone is still a victim, there can be no resolution.

When narratives continue to compete, there can be no happy ending.

In these situations, I sometimes doubt whether the participants are looking for resolution at all. They actually seem to want the conflict—and the drama—to continue. Commentators on the Dylan Farrow/Woody Allen road accident wanted to know who was right, and what was true. I would argue that this is not a useful question. The real question to ask is, “How do we move past this?”

One thing that definitely doesn’t help is rehashing the whole painful thing in public. I’m speaking more to Allen here than to Dylan. Sharing her story may serve the greater good of helping others to confront the pain of their own childhood abuse, to speak their truth, and to move past it toward healing. But ultimately, now that Dylan is an adult, she is responsible for her own happiness, no matter how traumatic her childhood was. I know this statement seems harsh. But plenty of people move past horrific victimhood to embrace happy, productive lives as adults. I hope this becomes Dylan’s story.

And I hope we never have to read any of it in the New York Times again. 

Monday, February 17, 2014

Add the Words

Why sexual orientation and gender identity matter to me



Katie M. (not her real name) was my best friend in high school. Tall, blonde, and beautiful, she introduced her simple, unsophisticated Mormon classmate to foreign cinema and the Smiths, while I returned the cultural exchange with apricot Jello and Wednesday night Mutual activities. A gifted artist, Katie passed me notes that were illuminated manuscripts, masterpieces of satiric humor. Once a month on a Friday, we would skip school and pursue our own education at the Houston Museum of Fine Arts—my mom was more than happy to write a note stating (honestly): “Liza did not feel like coming to school on Friday.” At our Texas high school graduation ceremony, Katie was the only woman in a pants suit—in her muted yellow, wide-legged costume, she looked like a young Katherine Hepburn.

My Dad had already accepted a transfer to Bakersfield, California, and two days after I graduated, Katie and I watched as movers loaded up the contents of my parents’ two-story Tudor style home. I was sad to leave my boyfriend and Katie behind (the boyfriend and I broke up shortly afterward. Katie and I are friends to this day). Katie had already arranged to visit me in July; we had been planning a road trip to San Francisco during our senior year’s final semester.

A week later, I got her letter. Written on thick cream colored paper in her distinctive bold, backward-slanted hand, were words that would change how I felt about sexual orientation forever.

“I can’t keep this a secret from you any longer,” she wrote. “I am gay. I have always been this way. It is not a choice.”

“I know you probably will never speak to me again,” she continued. “I know how important your church is to you, and how they feel about homosexuality. But I have to tell you the truth.”

I put the letter down. And that’s when I realized that knowing what I knew now about Katie didn’t change how I felt about her. Not one bit. I loved her as one of my dearest friends before I knew she was gay, and I still loved her.

I also felt immediately ashamed as I remembered the Mutual activities she had attended with me at the LDS church. In one activity, a leader explained how AIDS (a new disease in those days) was God’s specific curse for homosexuals, a modern day scourge for our nation’s new Sodom and Gomorrah. Had Katie flinched? Had I noticed? We talked about that—and other things—on our road trip that summer. We talked about what it meant to be a gay teenager, about the prejudice and painful stigma. These were things I had never known. My worst experiences in high school had involved a toxic bout of highly visible acne in ninth grade. That was nothing compared to the anguish Katie felt as she realized how difficult her life path would be.

I still love Katie today. And I think she has just as much right to marry her life partner—a lovely, brilliant woman—as I have to marry mine (and he is all guy).

That’s why I spent my lunch hour at the Idaho State Capitol building today.

My state, along with many other states, is in the midst of a new civil rights war. State Senator Lynn Luker, a Mormon from Meridian, has proposed legislation that would allow people to deny services to other people on the basis of their religious beliefs. As Magic Valley Times reporter Kimberlee Kruesi reported:
Under the bill, doctors could deny providing medical treatment to gay people or even unmarried mothers and not lose their medical license. The same would be allowed for teachers to deny educating one of their students if they were gay.  
Meanwhile, the LDS church has joined other religious organizations in actively fighting against the legalization of gay marriage in Utah, claiming that it is not bigotry but concern for children’s welfare that drives their opposition as well as a defense of so-called "traditional marriage" between a man and a woman as the only type of marriage sanctioned by God. I’m sorry, but the whole “It’s not me; it’s my God who is a bigot” statement  just isn’t going to cut it as an argument against fairness, decency, and dare I say it, love.

The God I believe in is all about love. And love—transformational, all consuming, non-judging—is not present in Senator Luker’s bill.  In all fairness to my LDS friends, many of them disagree with Senator Luker’s hateful stance and support former Idaho State Senator Nicole LeFavour’s brave crusade to add the words—see Joanna Brooks’s Ask Mormon Girl, or pretty much the whole gang at Feminist Mormon Housewives.

But this isn’t just a religious or civil rights debate to me. Respecting and protecting people on the basis of sexual orientation and gender identity is a mental health issue. Our children are dying. Suicide is the third leading cause of death for children and young adults ages 10-24. A disproportionate number of these young people are LGBTQ
Our refusal to love and accept our children for who they are is leading to their deaths, as In theParlor blogger and youth pastor Tyler Smither noted:
"We are now faced with the reality that there are lives at stake. So whatever you believe about homosexuality, keep it to yourself. Instead, try telling a gay kid that you love him and you don’t want him to die."
What kind of God would want a young person to take his or her own life because of persecution and rejection? Not the God who said, “Love thy neighbor as thyself.”

Another Christian, Archbishop Diarmuid Martin of Dublin put it bluntly: ““Anybody who doesn’t show love towards gay and lesbian people is insulting God. They are not just homophobic if they do that–they are actually Godophobic because God loves every one of those people.”

When I was a Mormon (a phrase that increasingly feels like “once upon a time” to me), our Sunday School teachers told us that we already knew who would win the great war between good and evil. I can now extrapolate that lesson to this current fight to deny our friends and neighbors, our brothers and sisters, equal protection under the law. We already know how this fight will end; and fortunately, Senator Luker and his supporters are on the wrong side of history.

But I want to make history today. I never want any young person to feel like my friend Katie did, afraid to lose a friendship or a job or even her life, simply because of whom she loves.  Add the words, Idaho! And let there be love now, for all of us.



Monday, January 6, 2014

Next Topic: Mental Health (Again)

Since Nick Kristhof was kind enough to ask

On Sunday, January 5, 2014, a heavy hitter weighed in on the topic of mental illness. Pulitzer Prize winning columnist Nick Kristof of the New York Times published an op-ed piece that asked a provocative and welcome question to the mental health community: what’s next?
“Mental health issues pose a greater risk to our well-being than, say, the Afghan Taliban or Al Qaeda terrorists, yet in polite society there is still something of a code of silence around these topics,” Kristhof noted. “Indeed, when the news media do cover mental health, we do so mostly in extreme situations such as a mass shooting.”
Why is that, exactly?

As the mother of a son with mental illness, I have a few thoughts on this subject.

Stigma
I talked about the devastating effects of stigma for parents and children, including my own family, in my October 2013 TEDx San Antonio talk. It’s not just external; stigma is internal as well. Peer advocates metaphorically beat up parent advocates, as Marlowe Franklin, a close friend of Kelli Stapleton’s, notes in her recent blog post about peer advocate attacks. In case you don’t remember Kelli, she’s the mom who attempted to kill herself and her 12 year old daughter who has autism because she truly felt she had no other options.

Speaking of autism and internal stigma, the mental health community is not immune, with too many people acting as if bipolar disorder or schizophrenia are “bad” but a developmental disability like autism is “good.” Guess what, folks? A lot of times, developmental disabilities and mental illness are comorbid.

And you know what else? Lots of children with autism and/or mental illness beat their parents up, every single day in America. Here’s some advice about protecting yourself during an attack straight from Autism-Help.org: “When a person is attacking you, you have the right to defend yourself. This is best achieved through defensive and blocking moves. If you have not attended a non-violent self-defense or crisis intervention program, I would highly recommend it.” The same fact sheet recommends calling the police when behavior escalates to violence.

In rare but still too common instances, children with mental illness grow up to be adults who attack or kill their parents, like Adam Lanza. Nancy Lanza was his first victim. More recently, Gus Deeds was unable to get treatment for his mental illness, attacked his father Virginia State Senator Creigh Deeds, and in every parent’s worst nightmare, took his own life.

Why can’t we all be on the same side here, the side that wants effective treatment for ourselves and our loved ones before another tragedy makes the media take notice of mental health again? And when will we agree that mental illness is a medical problem, one that requires evidence-based medical, not “feel-good,” solutions?

Language
Stigma is inextricably linked to language. I have a simple suggestion for journalists that could go a long way toward improving the lives of those suffering with mental illness. Use people-first language. We never describe a child with cancer as “that cancerous child,” or an adult with heart disease as “that diseased woman.” But we say “autistic child” and “bipolar young person” all the time. We also use phrases like “bipolar” inappropriately, as this recent HuffPost article noted.

I personally think it’s time to adopt National Institute of Mental Health Director Thomas Insel’s suggestion and start calling mental illness what it is: “brain disease.” You can watch Dr. Insel’s TEDx talk here.

Something about the word “mental” conjures up the false notion of choice in mental illness. Perhaps it’s the word’s history. Mental comes from the Latin mens, which is closer to our conception of the word “mind” than the more organic word “brain.” Think of the legal phrase compos mentis, “of sound mind.” That’s the standard for determining whether a person can be guilty of a crime.

People with serious mental illness like schizophrenia or bipolar disorder do not “choose” their mental state. They have an organic brain disease, which can be treated and managed. But one in three people with schizophrenia attempts suicide, and one in ten completes suicide. That’s another new word for journalists. When we say that someone commits suicide, we are suggesting that their act is criminal. In most cases, suicide is a tragic, fatal, preventable outcome of an organic brain disease, not a criminal act, and not a rational choice made by a sound mind.

Triage
Considering our limited resources, it just makes sense to help those who are most in need. That was the rationale behind Representative Tim Murphy’s (R. PA) proposed “Helping Families in Mental Health Crisis Act.” Murphy, who practiced for years as a psychologist, is co-chair of the Mental Health Caucus and spent 2013 talking with stakeholders, including parents like me, about what we most needed to help our seriously ill children. The answer: access to medical care for the 11 million people who suffer from schizophrenia, bipolar disorder, or major depression. The bill seeks to accomplish this goal by empowering parents, increasing acute care beds, and promoting AOT (assisted outpatient treatment) for as many as 50 percent of schizophrenia sufferers whose symptoms include anosognosia, or lack of awareness of their illness.

The bill also addresses the critical shortage of child psychiatrists (one for every 7,000 children in the U.S.) with funds for telepsychiatry and seeks to reform SAMSHA by redirecting funds for community-based care toward evidence-based programs. The Wall Street Journal praised Murphy’s efforts, noting that “SAMHSA [the government agency charged with funding community mental health treatment] has little or no focus on medically driven care, and of its 537 full-time employees only two are physicians.”

Mental illness is truly a bipartisan issue, and in fact, we already have the resources to attack this problem that harms children, families, and communities. DJ Jaffe of MentalIllnessPolicy.org, a nonpartisan resource, advocates for “spending smarter” by using funds for mental illness, not for mental health. This is an important distinction.

Deborah G., the mother of an adult son with schizophrenia, recently set off an Internet maelstrom when she criticized peer-driven care: “How confident would you be entrusting your daughter with a life threatening, cancerous brain tumor to a system of care that has developed policies and therapies influenced primarily by "peers"?” she asked. Her answer—and the answer of so many other parents in her situation—not too confident.

This is not to say that peers don’t play an important supportive role. Mom-peers like Deborah are invaluable resources for me when my son is going through a crisis. What Deborah was saying is that she wants more funding to go toward evidence-based, medical treatments for her son’s very real medical condition.

Unfortunately for so many of our most seriously ill population, lack of insight condemns them not only to the mental prison of psychosis but also to very real prisons, where we have chosen, as a society, to warehouse them. As I said in my TEDx talk, spending $80 billion on prisons and just $1.4 million on the National Institute of Mental Health is just plain wrong.

That’s my three cents’ worth, Mr. Kristhof. Thank you for bringing this issue to the forefront. As you so eloquently noted, “if we want to tackle a broad range of social pathologies and inequities, we as a society have to break taboos about mental health.” Let's go smash some statues.