by Anna Berry
How else do I stay well? It’s a combination of things, really. The
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*Thank you, Google.
main reason I’ve been able to avoid the repeating patterns of dysfunction that plague my mother and brother is because I’ve mostly removed myself from their entrenched way of life. I moved far away from the small town where they live—and away from the gossip, the prying eyes, the constant bullying and teasing that are so commonplace in my extended family’s culture. Unlike many of my relatives, I don’t drink excessively, overeat, smoke, or engage in compulsive shopping or videogame-playing, nor do I associate with people who do. That decision alone means I cannot fraternize with large swaths of my extended family—but that’s not such a loss. They don’t miss me, and the feeling is mutual.
I exercise regularly and eat a healthy diet—which might sound trite or even self-important, but multiple studies have shown that making healthy physical choices also boosts your mental health and can even directly combat mental illnesses ranging from depression to schizophrenia.[1]
But that’s not all I do. Mental health is an ongoing process that requires constant work. Meditation and mindfulness have played a tremendous role in giving me the insight to change the self-destructive behavior patterns I developed growing up, along with giving me the assertiveness required to stand up to anyone who attempts to bully me back into my old patterns—whether it’s enabling other peoples’ dysfunction, accepting cruel treatment that I do not deserve, or surrendering to simple peer pressure.
I meditate in all sorts of ways—and not just by sitting on a cushion and chanting, though that’s one of my favorites. A true Zen life allows you to find meditative benefit in almost any activity, whether it’s cleaning the bathroom, taking a walk, or deciding which box of cereal to buy at the grocery store. By living in the present and studying its every glorious detail, past failures and future worries slip away, and the world just is. Dwelling in the present moment without judgment or fear is the key to springing the trap of negative emotions that can feed so many destructive behavior patterns, I’ve found.
If there’s one thing that mindfulness has taught me, it’s that I am not my parents. I am not my brother, and I am not doomed to a life of misery just because of my DNA. I have the ability to take control of my own behavior, as well as the consequences of that behavior. Furthermore, cognitive behavioral therapy has a strong mindfulness component that meditation only enhances.[2] My therapists over the years have always encouraged me to continue doing meditation while developing my mindfulness skills. Thanks to these skills, I’ve been able to avoid the need for antianxiety medications and antidepressants—though I also recognize that medication can be the right choice for some people.
Over a period of years, I’ve also trained myself not to get trapped by negative self-talk that both my mother and brother are masters at. Instead of saying, “I can’t do x because . . .” and just giving up, I go out and do x anyway, without worrying about what others might think. Not only that, I pat myself on the back for my professional accomplishments instead of constantly second-guessing myself, as I often did when I worked in the corporate world. That take-charge confidence has served me well in self-employment as well as in my personal life.
I’ve also learned when and how to lean on others, like my husband and some of my friends, like Jacey and Sharon, who have also had their own struggles with mental illness. I reach out to those friends of mine who understand what these kinds of struggles entail, and we cheer one another on, swap war stories, and keep each other up to date on how we’re learning to cope. On the flip side, I’ve also learned the hard way that there are some people you just can’t trust when it comes to your mental health, and it’s especially important not to overshare in today’s social-media-driven world. There’s still a lot of hostility and stigma out there, and anyone with a history of mental illness must accept that reality if they’re going to succeed, either personally or professionally.
Most of all, I’ve grown more humble. I know that I’m not infallible, and I’m also not afraid to ask for help when I need it. And asking for help is the most important—and often, most difficult—step for anyone with mental illness to take.
Here’s a summary of how the other major players in this book are doing.
Mom recently had another relapse of her mental illness and after a long downward spiral, found herself divorced, penniless, and suicidal. Her now ex-husband Bob had a psychotic break of his own that involved, among other things, him taking up with a convicted felon who, along with Bob, threatened to kill my mother. I was forced to drop everything, drive to Indiana, and remove Mom from Bob’s house for her own safety; she then spent several months in a series of psychiatric institutions. Mom was later declared mentally incompetent by a court of law, and I was appointed her permanent legal guardian. The whole saga is another story for another book—likely my next one. She now lives in an Indiana assisted-living facility for elderly people with mental disorders, and as her guardian, I manage her affairs from afar with the help of local relatives.
Dad married his third wife, Tracy, in 1990, and they are together to this day. However, they lead a polyamorous lifestyle, with an open marriage that is no secret to anyone who knows them well. Dad also currently lives and works in another state from his wife and current set of children, traveling back to see them occasionally on weekends. I don’t know if he has an outside girlfriend right now, but he usually does—and it’s just something I’ve grown to accept. He even jokes about it sometimes. Despite all that’s happened over the years, Dad and I get along quite well now and see each other frequently, though we never discuss anything even remotely related to mental illness or our family’s checkered past. Dad lives in quiet, happy denial where that topic is concerned, and I don’t begrudge him that if it’s the choice that works for him. Our relationship is very much in the present, and nonjudgmental.
Dad’s ex-wife Martha still lives in Indiana and runs a successful mail-order company; I have no direct contact with her, and haven’t for over twenty years.
Mark is still married to Stephanie. He recently got a heavy adjustment to his antipsychotic meds that slurs his speech, with extreme weight gain as a side effect. We speak only a few times a year and seldom visit one another. Under the constant care and supervision of VA psychiatrists, Mark remains unemployed, though he has proven to be somewhat helpful when it comes to dealing with Mom’s immediate needs—like chauffeuring her back and forth to doctor appointments, which I cannot do from my home in the Chicago suburbs.
Dieter Franzl became CEO of a large Austrian mobile telecommunications company. As CEO, he apparently enjoyed doing outrageous publicity stunts to advertise his company’s services—including racing Formula One cars emblazoned with the company logo. When the recession hit in 2008, Dieter lost his CEO position when his employer got bought out, and he remained unemployed for a couple of years. He recently became a high-ranking executive with a German telecommunications company. As far as I know, he’s still single.
Todd Naismith became a high-school history teacher, and he’s now launching a political career of sorts. He also finally married his on-again/off-again girlfriend Marcia after almost fifteen years of dating. Marcia now works in arts administration. They live in the Northeast, and they even have a baby now.
Dean still lives in Chicago and works mostly as a freelance theater actor and Japanese language interpreter. Following our breakup, he spent several years living with his parents. I hear he’s married to a professional Hawaiian hula dancer.
I currently live in the Chicago suburbs with my husband George and our two children. My career as a freelance writer and playwright has taken off in the past few years, with my plays receiving productions around the country and internationally. I make a good living as a journalist, and I’ve sold several novels under a pen name. A good life, all in all.
1. Rick Nauert, PhD, “Healthy Food Can Improve Mental Health,” Psych Central, J
uly 10, 2008, http://psychcentral.com/news/2008/07/10/healthy-food-can-improve-mental-health/2587.html; Deborah Kotz and Angela Haupt, “7 Mind-Blowing Effects of Exercise,” US News & World Report, http://health.usnews.com/health-news/diet-fitness/slideshows/7-mind-blowing-benefits-of-exercise.
2. James D. Herbert and Evan M. Forman, Acceptance and Mindfulness in Cognitive Behavior Therapy: Understanding and Applying the New Therapies (New York: John Wiley & Sons, 2011).
Epilogue: The State of Family Mental Illness in America
Mental illness is the single-greatest cause of disability and premature death in the world, according to the World Health Organization (WHO).[1] The Global Burden of Disease study copublished by the WHO and the Harvard School of Public Health in 2010 estimates that mental illness in all its forms, including suicide, will account for 15 percent of the overall socioeconomic disease burden in established market economies like the United States by the year 2020—more than the disease burden of all cancers combined.
This study also found that major depression ranks second only to ischemic heart disease in terms of overall disease burden to established market economies (disease burden is calculated in terms of lost years of healthy, productive life due to either premature death or prolonged disability). Statistically speaking, disability and premature death caused by major depression cost society just as much—if not more—than blindness and paraplegia combined. Schizophrenic psychosis produces economic disability equal to that of quadriplegia.
According to the WHO, major depression is the single leading cause of disability worldwide among all persons five years and older. (Major depression can also occur in conjunction with other mental illnesses, including borderline personality disorder.) Mental illness is particularly lethal among people in the prime of life; it is the cause of more than 40 percent of disability impairment and premature deaths among persons aged fifteen to forty-four, and it accounts for more than 90 percent of suicides.[2]
Mental illness makes an even more significant impact on the lives of women worldwide; major depression is the single leading cause of disability and premature death of women worldwide, in both established market economies and developing ones, according to the WHO study. Schizophrenia and bipolar disorder also consistently rank among the top ten disease-burden conditions affecting women in established market economies.
Despite this tremendous cost burden, and despite the fact that mental illness costs society far more than all forms of cancer combined, in 2005 the National Institutes of Health (NIH) spent four times more U.S. tax dollars on cancer research than on mental illness/mental health research ($4.5 billion versus $1.5 billion, respectively). This funding discrepancy—fully approved and mandated by Congress—is representative of the severe stigma mental illness still holds in our society.
In developing countries, persons with severe mental illnesses like schizophrenia, bipolar disorder, or advanced clinical depression are often isolated from mainstream society without any real treatment, locked in asylums that are little more than prisons, and sometimes even killed. This might seem barbaric to us in the developed world, but the fact is, if we evaluate the quality of our own mental healthcare system based on the disease burden statistics listed above, the United States and other countries with developed market economies are not much better at preventing, treating, and managing mental illness than developing countries that simply warehouse the afflicted in prisons or abandon them to the streets. One can argue that despite all the lauded advances in recognizing and treating mental illness in this country, we do the very same thing here. Indeed, substantial proportions of the long-term homeless and incarcerated in the United States are the chronic mentally ill.
One of the objectives I hoped to fulfill with this book was to show that mental illness is at heart a disease of families. Although the social stigma against mental illness in our society remains profound enough that parents, children, and extended families will deny and suppress family histories and family-based sources of mental illness as much as possible—and will seek out and blame external societal forces (such as poverty, racism, sexism, war, job stress, and bad luck, ad nauseum) whenever and wherever they can—mental illness and mental health both begin at home.
A 2005 study by the National Institute of Mental Health (NIMH) found that more than half of lifetime cases of mental illness begin by age fourteen and that despite the availability of effective treatments, there can be long delays—sometimes even decades—between the first onset of symptoms and the seeking/receipt of effective treatment. The study also found that this frequent delay in treatment also facilitates the development of multiple comorbid mental illnesses, including self-medicating substance abuse. In contrast to many other chronic illnesses—e.g., diabetes, heart disease, hypertension—that often develop later in life, mental illness strikes early in life and is primarily a disease of the young, with half of all lifetime cases striking by age fourteen and three-quarters by age twenty-four. This same NIMH study found that mental illness in general is far more common than previously thought. At any given time, 26 percent of the general population displays symptoms sufficient for diagnosis of one or more mental disorders within the past twelve months—whether or not the affected have sought treatment (and more than 60 percent of the time, they haven’t).[3]
With mental illness cases so widespread, and those cases more often than not striking children and young people before they even graduate from high school or college or move out of their parents’ homes, to ignore the family component of mental illness to the extent that we have is dangerous at best, and catastrophic at worst.
Most published treatment guides currently available for addressing mental illness in the family assume that mental illness affects only one member of the family. All the published tools I’ve found (from private mental health organizations, universities, local and state mental health societies, and the federal government) are designed to advise the supposed “well” family members on how to “deal” with having an afflicted loved one in their midst. This treatment paradigm fails to address the fact that in many cases, mental illness impacts the whole family, whether from the ripple effects of stress, stigma, and guilt because one or more family members is ill, or from the fact that mental illness itself tends to run in families.[4]
My own experience and mountains of clinical research statistics both show that mental illness does not occur in isolation, and to approach the incidence of mental illness in the family environment as if it were a single, unfortunate voice in the wilderness is an institutional mistake of gargantuan proportions. Throughout the course of my research, I have found no treatment guidelines, informational brochures, self-help books, or anything else that specifically addresses mental illness from a comprehensive, multigenerational family perspective other than the broadest epidemiological studies whose purpose is solely to determine if there is a statistically significant increase in risk for developing mental illness among the offspring of mentally ill parents (there is)[5] rather than to develop comprehensive treatment paradigms for addressing the mentally ill family as a whole. And while the Affordable Care Act will likely reduce the number of uninsured somewhat, in Republican-controlled states that have refused Medicaid expansion, you will continue to see a large proportion of the population without health insurance. Meanwhile, private insurers still remain resistant to providing robust mental health benefits that are comparable to the coverage physical ailments receive.
With the health insurance plans that do exist relying increasingly on the dispensation of psychoactive drugs at the expense of cognitive behavioral therapy for both individuals and families (a huge measure of the influence Big Pharma has on current American healthcare policy)—I doubt whether a shift toward family-based cognitive behavioral treatment in American mental health treatment paradigms will occur anytime soon. Indeed, Big Pharma makes a killing on psychoactive drugs, with sales of antipsychotics and antidepressants generating $16 billion and $11 billion respectively in Big Pharma
revenues between 2001 and 2010 in the United States alone.[6] Keeping the mentally ill on expensive drugs that may or may not improve their condition in the short term (and provide little to no effect in terms of reversing the disease permanently) is very big business in this country.[7]
The fact that the American mental health system now relies almost exclusively on pharmacological therapy for treating major mental illnesses should be cause for alarm. While recent advances in drugs for treating depression, bipolar disorder, and schizophrenia are to be lauded, drugs should not be exclusively relied upon for treating the mentally ill. As I hope the anecdotes in my memoir have shown, there are still far too many opportunities for psychiatrists to improperly administer psychoactive drugs to patients who are vulnerable to addiction to these drugs or who could even use them to commit suicide. Even non-habit-forming antidepressants have been shown to increase the risk of suicide among child and adolescent depression patients, to the point that the U.S. Food and Drug Administration (FDA) recently placed its most severe “black box” warning on those drugs.
Further, though most practicing physicians will not admit to it, there is a substantial underground economy in which dispensing psychiatrists push the “latest and greatest” expensive, brand-name psychoactive drugs on their patients, regardless of whether those drugs make sense for treating those individuals. The motivations salespeople offer to doctors to engage in this unethical (and potentially lethal) practice can vary widely—from free pens and prescription pads and expensive meals and golf outings to all-out, tit-for-prescription-tat cash kickbacks. Though this practice of pharmaceutical companies “bribing” physicians to prescribe their products with free lunches, dinners, golf trips and pens is increasingly regarded as unethical, in most cases (except for direct cash kickbacks, which can be easily disguised on paper as legal “consulting fees”), it is perfectly legal.