Even so, the mental health crisis remains firmly in place. Three times more Americans die from suicide (42,000 in 2014, the last year with solid statistics) than from homicide. But who would know of this fact from the news, which routinely features gun violence perpetrated against others but almost never discusses the inner pain related to depression and suicidal thoughts? Around the world, suicide is the third leading cause of death for people aged 15 to 44—and the leading cause of mortality for adolescent girls. Taken together, mental illnesses account for more disability than physical illnesses. For people in their forties, mental disorders predict a greater level of disability than all physical illnesses combined.
Mental disorders don’t afflict them—a deviant group of flawed, irrational individuals—but us: our parents, sons and daughters, colleagues and associates, even ourselves. A quarter of the population will experience a significant mental disorder in a given year. Countless veterans and trauma victims suffer from post-traumatic stress disorder (PTSD). Rates of child-onset conditions like autism and ADHD are skyrocketing. Eating disorders contribute to major health risks. Substance abuse devastates lives, especially via the current epidemic of opioid-and heroin-related fatalities. Together with thought disorders, anxiety disorders, and a range of developmental conditions, mental illnesses drain hundreds of billions of dollars annually from the U.S. economy and over a trillion dollars around the globe, linked to unemployment, related physical conditions, and sheer despair. Personal and family suffering far outstrips the financial burden.
Chillingly, serious mental illness reduces life expectancy by 10 to 25 years, through risky behaviors, poor exercise and health habits, proneness to chronic physical diseases, low access to health care, and self-destruction. Yet it takes over a decade for most people experiencing symptoms to seek help, linked to the shame and denial surrounding the entire topic. What if it took people ten years or more to understand and treat symptoms of heart disease or cancer? The headlines would never stop.
The paradox—and tragedy—is that evidence-based treatments for mental disorders really work. Cures aren’t yet at hand, but interventions for mental illness are as effective, on average, as treatments for physical disorders. Yet utilization remains low. “Parity” for mental health is not living up to expectations, and the treatments most people receive are nowhere near the kinds of state-of-the-art, evidence-based interventions needed. Recovery is a definite possibility but far too often does not get realized.
In many ways, mental illness is the final frontier for human rights.
Haven’t attitudes toward mental disorder fundamentally changed? Consider the flood of stories, blogs, and magazine articles linked to the topic, many quite moving. Disclosing inner turmoil and consulting a “shrink” might be seen as a badge of honor on the coasts. Yet, as noted earlier, rates of stigma and social distance toward mental illness have hardly budged in the past sixty years, and perceived links between mental illness and violence are far more common. Even worse, in half of our nation’s states, admitting to a mental illness, or even a history of such, can result in loss of a driver’s license, inability to serve on a jury or run for office, and automatic relinquishment of child custody. My history of depressed mood disqualifies me from driving or jury service? My eating disorder, if that’s what my forced vomiting was, means I can’t run for office or be a parent? It’s a good thing such laws weren’t in place in 1860: Lincoln could never have run for president, with his history of debilitating depressions.
The view that disturbed behavior emanates from evil spirits may be long past in much of the world, but moral perspectives still predominate. Popular culture depicts people with mental illness as either demons or brilliant misfits—like John Nash of A Beautiful Mind, the mathematician with schizophrenia who won the Nobel Prize. It’s still acceptable to use abhorrent language to describe mental illness: psycho, nut-job, wacked, lunatic. National politicians, including our new president, imitate and mock people with physical and mental disabilities as if it’s perfectly OK to do so. Where are the everyday stories of struggle and triumph, loss and recovery, and family connection that must be heard? Where’s the empathy and identification, rather than fear-mongering, so urgently required?
To fight stigma, a key strategy over the past 20 years has been to convey that mental illness is a brain disorder linked to aberrant genes. As with alcoholism, the disease model should reduce guilt and blame. Indeed, psychological theory tells us that if negative behavior is thought to emerge from a cause that can’t be controlled, like an illness—particularly one linked to genetic vulnerability—the individual will be absolved and stigma will plummet.
Experimental studies show that when people believe mental illness to be a genetically triggered brain disease, they do hold the individual in question less blameworthy. At the same time, though, they believe that the individual is essentially hopeless—after all, immutable DNA is to blame—and unworthy of social contact. In other words, the biological/illness perspective often backfires, promoting pessimism and increased social distance.
On the one hand, we certainly don’t want to revert to the idea that mental illness is a character flaw or simply the product of bad parenting. Most forms of mental illness are in fact moderately heritable, meaning that genes are clearly involved in underlying risk. But all-biology views are not the full story. Experience and context mold genetic vulnerabilities, and individuals and families must still make choices to seek and stay with treatment. It’s not either-or, it’s both-and.
Remember the evolutionary model of stigma, where signs of disturbed behavior are believed to trigger, nearly automatically, fear of contagion and avoidance of threat? The third evolutionary module—keeping one’s distance from those thought to be members of a different “tribe”—was instead linked to racism but not mental illness.
Yet attributing deviant behavior exclusively to biological and genetic factors might inadvertently promote just this form of stigmatization. In other words, if unpredictable, threatening, and irrational behavior patterns are believed to result from flaws in the person’s very DNA, that person may be thought of as genetically deficient, part of a deviant tribe, perhaps even subhuman. Unexpectedly, then, the biomedical perspective may unleash a form of stigma associated with utter hatred. If history serves, resentment, subjugation, and even extermination will follow.
Reducing stigma—that other form of madness, far worse in its consequences than mental illness itself—will take coordinated strategies: enforcement of antidiscrimination policies, access to high-quality care, a far different set of media messages, personal contact that fosters more empathy, and the replacement of silence with dialogue. Above all, humanization is the goal. Getting young people engaged in the fight for human rights is central to the entire effort. Each year that we maintain our current attitudes and practices is another year of lost productivity, wasted human potential, and unspeakable tragedy.
It will require an unprecedented team effort to make a difference. The knowledge is there and the pieces are in place. Do we have what it takes to mount the fight?
Acknowledgments
I would never have completed this book without the vision, faith, and skill of Don Fehr and Karen Wolny. Working with them has been one of the great gifts of my career. Don, my agent from Trident Media Group, immediately “got it” when we first communicated about a memoir that would also address larger messages about stigma. He put me through the paces—multiple revisions of a lengthy proposal—to present this book’s essential message in the best possible light, doing so with vision and verve. In a word, Don is a force.
Karen, my editor at St. Martin’s, has perennially showed patience, support, and expert guidance in challenging me to dig deeper, to provide an integrated voice, and to keep “on message” throughout the book’s chapters. She never dictated precisely what to write. Rather, as a remarkably sensitive elicitor, she compelled me to take this work to a different level, always revealing considerable insight and co
mpassion. Her blend of ultra-competence and warmth is nothing short of remarkable.
To have gathered the support of these experts means that I’ve been amply blessed.
My ongoing team in the Bay Area includes my colleagues and friends Allison Harvey, Bennett Leventhal, Mary Main, and Rudy Mendoza-Denton. Their unflagging support and spot-on critiques have been essential. Bennett pointed me in the direction of the incredible quote from James Baldwin, an excerpt from which serves as the book’s title. Scott Lines provided a different kind of inspiration in helping me to understand so much about my past and present.
In the early stages, Betsy Rapoport masterfully showed me how to approach this kind of writing. I also received encouragement and critiques from the generous input of Katherine Ellison, Nan Weiner, and Lee Gutkind—the “godfather” of creative nonfiction. Linda Isbell played an essential role in linking me with Don Fehr and championing my efforts regarding this book. Among my enthusiastic additional supporters have been Shaikh Ahmad, Kyla Buckingham, Daphne de Marneffe, Howard Goldman, Sheri Johnson, Laura Mason, Nicole Murman, Lisa Post, and Robert Villanueva. Eric Youngstrom provided sage guidance regarding the concept of “Cade’s disease” in the context of bipolar disorder. My sister and I will always be grateful to my friend and colleague Bob Knight, who instantly understood the consequences of Mom’s odontoid flare during the last week of her life.
The support, love, and sharp editorial skills of my wife, Kelly Campbell—now Dr. Campbell—made the entire effort possible. Kel, I can’t thank you enough.
Our three boys, Jeff Hinshaw, John Neukomm, and Evan Hinshaw, have shown me, full-on, the intergenerational pull that keeps our species going forward. Their close bond to one another is wonderful to behold.
Finally, my sister, Sally Hinshaw, didn’t have the same kind of relationship with our father that I did. But as the book’s dedication reveals, our closeness as siblings and her courage are always at the front of my heart.
Index of Medical Terms
The index that appeared in the print version of this title does not match the pages in your e-book. Please use the search function on your e-reading device to search for terms of interest. For your reference, the terms that appear in the print index are listed below.
addiction. See also alcoholism; substance abuse
AIDS. See HIV/AIDS
alcohol poisoning
alcoholism
antibiotics
antidepressants
antipsychotic medications
anxiety
attention deficit hyperactivity disorder (ADHD)
autism
barbiturates
behavior therapy
bipolar disorder
Cade’s disease
depression
euthymic period
and genetics
kindling theory
and lamotrigine (Lamictal)
and lithium
and maltreatment
mania
mixed state
and neurotransmitters
and psychosis
and schizoaffective disorder
and schizophrenia
and stigma
and suicide
and therapy
See also manic-depression
cancer
depression
and bipolar disorder
and electroconvulsive therapy
postpartum
Dexedrine
Dilantin
dopamine
Doriden
Down syndrome
eating disorders. See also vomiting, self-induced
electroconvulsive therapy (ECT)
emotion dysregulation
family therapy
grand mal seizures. See also seizures
Haldol
Hansen’s disease (leprosy)
headaches. See migraine headaches
HIV/AIDS
hypomania
ideas of reference
insulin coma therapy
internalization
kidney failure
L-DOPA
lamotrigine (Lamictal)
leprosy (Hansen’s disease)
Lewy-body dementia
lithium
macular degeneration
maltreatment
mania
manic-depression. See also bipolar disorder
Mellaril
migraine headaches
Minnesota Multiphasic Personality Inventory (MMPI)
mood disorders
moral treatment
MRI
neurotransmitters
paranoia
Parkinson’s disease
placebos
postpartum depression. See also depression
post-traumatic stress disorder (PTSD)
Prader-Willi Syndrome
psychosis
delusions
hallucinations
illogical thinking
relaxation training
rheumatoid arthritis
odontoid flare
schizoaffective disorder
schizophrenia
and bipolar disorder
electroconvulsive therapy
and genetics
insulin coma therapy
See also psychosis
seizures
grand mal seizures
status epilepticus
social deviance
stigma
anticipated stigma
courtesy stigma
definition of
evolutionary model of
historical context
internalization of
objective and subjective burden
physical and psychological
self-stigma
and social distance
stigma reduction
substance abuse
suicide
talk therapy
tardive dyskinesia
Thorazine
transformations, behavioral
tuberculosis
Valium
vomiting, self-induced. See also eating disorders
About the Author
STEPHEN P. HINSHAW is a professor of psychology at UC Berkeley and the vice-chair of Psychology at UC San Francisco. Hinshaw is the author The Mark of Shame: Stigma of Mental Illness and an Agenda for Change, the first book in the United States on mental illness stigma. His research has been covered in The New York Times, The Washington Post, Time, The Economist, and The Wall Street Journal, among others. He lives in Berkeley, CA. You can sign up for email updates here.
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Contents
Title Page
Copyright Notice
Dedication
Preface
Introduction
1. Sunday Dinner at the Willard
2. Out in California
3. The Midnight Drive
4. The View from Right Field
5. Miracles of Modern Medicine
6. The CBS Evening News
7. New England
8. The Iron Suit
9. Dawn
10. The Thought Experiment
11. A Deeper Layer
12. Progressive Decline
13. The End and the Beginning
14. The Rest of My Life
Epilogue
Acknowledgments
Index of Medical Terms
About the Author
Copyright
ANOTHER KIND OF MADNESS. Copyright © 2017 by Stephen P. Hinshaw. All rights reserved. Printed in the United States of America. For information, address St. Martin’s Press, 175 Fifth Avenue, New York,
N.Y. 10010.
www.stmartins.com
Cataloging-in-Publication data is available from the Library of Congress.
ISBN 978-1-250-11336-8 (hardcover)
ISBN 978-1-25011337-5 (ebook)
e-ISBN 9781250113375
Our e-books may be purchased in bulk for promotional, educational, or business use. Please contact your local bookseller or the Macmillan Corporate and Premium Sales Department at 1-800-221-7945, extension 5442, or by e-mail at [email protected].
First Edition: June 2017
Another Kind of Madness Page 26