This popular T-Shirt slogan is wrong!
When my son was age 12, he had a friend who lived with his mother in low income housing. He and I picked up his friend, Michael, one day and they played in our backyard. When we took Michael home, there were police cars and police tape surrounding the apartments. The boys stayed in the car while I approached the closest officer to tell him I was bringing a child home and to ask what happened. He informed me an older woman had been shot and killed by a police officer because she had rushed him with a butcher knife. The police were originally called because she had been wandering around the complex talking to herself.
I returned to the car and asked the boys if they had seen a woman with a knife in the complex. My son replied, “Yeah Mom.” Shocked, I asked, “Why didn’t you tell me?” He answered with the nonchalance of a therapist’s son, “I didn’t see a knife. She was just talking to herself. I figured she was schizophrenic.” He understood better than the police did that she wasn’t dangerous to others if not provoked.
Police forces have gotten better at handling mental illness in most cases in recent years. Many forces employ outside mental health officers or train one within the ranks who go to any disturbance or call with a likelihood of encountering someone suffering with mental illness. Tragic mistakes are still made.
It’s not just the police. The general public is confused about mental illness. They have trouble recognizing it, defining it and understanding it.
Schizophrenia is not the same as DID, Dissociative Identity Disorder, which was formerly called MPP, or Multiple Personality Disorder. “I’m DID and so am I” would be a more accurate T-shirt slogan.
While schizophrenia primarily describes a disorder which causes people to have either auditory or visual hallucinations or both, Clinical Depression and Bipolar Disorder (of which there are 5 types) can also cause hallucinations. And delusions can be a product of any of these, as well as some types of anxiety.
The public aren’t the only ones confused by all the symptoms and labels of mental illness. Mental Health professionals have to constantly stay aware of the regular changes in the DSM (Diagnostic and Statistical Manual of Mental Disorders), of which there have been multiple revisions since its publication in 1952. The first forerunner of the DSM was the 1840 census, which labeled people as “idiots” or “insane” and sometimes counted entire populations of African-Americans as insane. Military observations by psychiatrists during World War I brought about the first real changes in classifications. In fact, all the information that can actually be considered “scientific” is based on observation. The first DSM conference had psychiatrists, therapists, psychologists and doctors arguing, sometimes aggressively, for their own observations and definitions. The final decisions were by consensus. Can you imagine oncologists coming up with diagnoses this way?
No wonder lay people are confused. And it doesn’t help that certain diagnoses become “popular” among diagnosticians and practitioners. Bipolar Disorder, which presents as mood swings, was once considered rare. Now that five types have been identified, it has become something of a catch-all. With so many types of Bipolar, it can be tempting to label people with other kinds of depression as Bipolar. Specifically, some manias present as anger and irritability, while those are also symptoms of depression.
Other catch-alls are ADD and ADHD in adults, resulting in adults taking amphetamine based medications that increase their energy rather than calming them down, as the drugs were originally used to do for children with ADHD. It might be argued that both results can help with focus, but when taken for “energy” it can increase anxiety, which does not improve focus. There are non-amphetamine based medications for ADD, but I seldom see doctors prescribing them over the amphetamine based ones. The prescriptions are so available that many college students who are not ADD or ADHD take them just to stay awake longer to study, or party.
There are so many misunderstandings of mental illness and treatment today. The public, in particular, blames “Mental Health Services” for current tragic shootings. The reality is that mental illness can be hidden by those who suffer from it. There are few definitive diagnostic tests that indicate whether someone is prone to violence. And those are expensive and can only be administered by psychologists, so getting someone tested can be arduous. In addition, treatment can seldom be involuntary, although the courts and family members can intervene. This also requires money, time and inclination on the part of the family, as they have to retain guardianship. As a therapist, If I believe someone should be hospitalized, I have to convince either the police or the family that this is necessary. Most states only allow a 48 to 72 hour hold for someone brought into the emergency room by police. And that is when the police don’t shoot, as they did in the event my son and I were privy to.
Still, diagnosis and treatment have improved dramatically since 1840. At the same time the rights of patients are being protected, which didn’t happen until many people had been held against their will, and effectively tortured by early treatments such as freezing baths and intense showers, lobotomies and electric shock treatment which broke bones and erased memory.
Today we use electric shock therapy much more effectively, at lower doses and with the patient anesthetized. There is much less short term memory loss, and it has been quite effective for hard to treat depression. However, we don’t really know why. Treatment efficacy is also determined by observation in trials, not by any real knowledge of how the treatment actually works.
So, if you have laughed at the T-shirt slogan about schizophrenia, you are not alone in your confusion. The diagnoses and treatment of mental illness is still more art than science. Research does support the treatments available today, and also supports the combination of therapy and medications or other interventions as the most successful way to treat the most recalcitrant issues. We in the profession must continue to educate, treat and advocate.