Living with mental illness is hard. Not impossible, but hard. One reason is the judgments people place on individuals with mental illness. These judgments have consequences for everyone, not just people with mental illness.
If you're in doubt, Dr. Denny Morrison proves it over and over — starting with his own assumptions (0:16), the audience's sentiments (1:58), major studies on the cost to society (3:09), failures of the entire health care system (5:55), and lastly, with all of us (8:43).
People are scared to talk about mental health. That's where the stigma comes from: fear. Be part of the solution. Share this.
Denny Morrison: Wasn't that a powerful speech? In 1969, I was a college sophomore looking for a job at Ball State University. I got a job working as an orderly on a psychiatric unit at a local hospital. Now I had no interest in mental illness or psychology. I was chemistry major, and, I have to tell you, I was a little bit concerned about working on a locked unit with people that I would designate, at the time, as crazy. I was so concerned about this that I asked my roommates, at the time, to let me know if they saw my personality changing or my behaviors changing as a result of working on this unit.
I apparently thought mental illness was contagious. [whispers: It's not.] [audience laughs] I have to tell you, that was a life changing experience. I saw things that i just couldn't believe, and the result of it was I gained a passion to find out why it is that these things happen to people. How is it that people that people can see things that aren't there and hear voices that none of us can hear? And most importantly, what is it about these problems that makes taking your own life by your own hand the preferred way to handle it rather than living with it?
I changed my major to psychology. I ultimately got a doctorate, and ever since then, that has been the kind of thing that I have been most interested in. But the other thing I learned on that unit is that there are huge misconceptions out there about mental health and addictions.I was full of them, and I thing they still persist today; and that's what I want to talk to you today about, about three irrational beliefs that we have about mental illness and addiction.
But before we do that, I'm curious to know how many people in the audience have been treated for heart disease or cancer? [audience participates] Thank you, and we're very glad you're still here. How many of you have been treated for a mental illness or addiction? [audience participates] Thank you. How many of you think I got a more honest answer to the first question that the second? [audience participates] [audience chuckles] You may be right, and if you are right, it's because of the stigma that's associated with mental illness and addiction, and that's the first thing I want to talk to you about.
I don't know what it is about stigma about these illnesses, but we tend to believe that some illnesses are better than others. And the people that have them are better that have them are better than others, and I don't really understand why; but I suspect it has something to do with that we've all had various experiences in our lives. And it's through those experiences that we can understand what others go through. We've all been happy and sad. We've all been anxious and depressed, and so when we hear someone talk about major depression, it's easy to say,"well, you know, I've had a bad day. I know what that's like. How bad is it?" And I can tell you to compare having a bad day to major depression is a bit like comparing a paper cut to an amputation.
The World Health Organization had determined that major depression is the leading cause of disability in developed countries. It is ahead of heart disease. It is ahead of stroke and related illnesses. It is ahead of traffic accidents, and number five on the list in the most advanced countries is alcohol abuse. So two of the biggest causes of disability in the world are mental illness and addiction. We look at the whole business of stigma, and it's one thing to look at it for a mental illness. You know, one of the things that the World Health Organization has also determined is that the cost to society for major depression is roughly equal to that of blindness and paraplegia, and if you have an active psychosis, the cost to society for that is roughly equal to quadriplegia. That is not having a bad day.
The second big challenge I think we have in terms of the assumptions about these areas is that we tend to think about the body and the mind being two different things. Now why that is, I don't know, but we tend the think that mental stuff is over here and physical stuff is over here. And the reality is that's just obviously not the case. We have a lot of research that addresses these issues, and one of the things that we want to speak to is how it is that we can bridge that gap between mental illness and physical illness. If you have a serious mental illness, like schizophrenia, you are going to die, on average, twenty-five years younger than your non-mentally ill counter parts, and it has nothing to do with your mental illness. It has nothing to do with suicide. It has everything to do with your physical healthcare.
People who have schizophrenia are four to six times more likely to have diabetes. They're five to seven times more likely to pulmonary problems like pneumonia, and the thing that we have to remember about mental illness and addiction is that these things are ubiquitous. When we think about the future of behavioral healthcare, which is the generic term that we use, we know that we have to address that bringing together. You know, we tend to think that it's not just that people with mental illnesses don't get good physical healthcare.
The truth is that the reverse is also true. Fifty percent of all mental healthcare in the United States is delivered by primary care physicians, and they write more prescriptions for psychotropic then do psychiatrists in the United States. It's not because they want to. It's because that's where you go when you don't feel good. So when you look at the primary care side of this, well they have kind of a perfect storm going on. They know that they have about seven minutes to treat you. They also know that if they make a referral to a mental health professional, only twenty-five percent of those referrals will follow through.
And finally, and most importantly, in today's society, when you look at the way in which people address their primary care docs, they come into the office allegedly knowing what the best treatments are and what the problem is, sometimes by the internet and sometimes, often times, from direct to consumer marketing by pharmaceutical companies. So if you believed that the best treatment for mild to moderate depression or mild to moderate anxiety was medication, you can be forgiven for that because of what we see in the media, but you'd be wrong. The truth is, that a specific form of talk therapy, called cognitive behavioral therapy, is superior to medications alone. Now there are times when the two of those together are superior, but if you had to pick one, you want to pick the talk therapy over the medication.
The third big area that we see as challenging in this industry is that a lot of people believe that if you a mental health or an addiction diagnosis, it is a living death sentence, and nothing could be further from the truth. The reality is these are chronic diseases that have to be managed just like diabetes, asthma, and hypertension. The is no cure for these things. We know that, but you can live a full and successful life by taking care of yourself and taking responsibility for your own healthcare. People with serious mental illnesses, these days, have said, "Now, I do not want my treatment to be the focus of my life. I want my life to be the focus of my life. I want my healthcare provider to be an expert consultant to me to help me make decisions about where I want to go, not a surrogate parent."
We know that people want to move away from disease and disability to recovery and hope. And we can do that, but this is not a clinical ability problem. This is a personal attitude problem that starts here. We need people to believe that these are illnesses, nothing more, nothing less. We have to stop judging people because they have a particular illness, and we have to bring back together the mind and the body and treat the person as one person. And we need to move from this position of disease and disability to hope and recovery, and that requires a different way of thinking. I'm reminded as we talk about these things,
I forgot to advance my slide, so you're going to have to excuse me. I got so excited about talking to you.
I'm reminded about what John Kennedy several years ago," Too often, we hold fast to the cliches of our forbears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought." My challenge to you is to jump into the discomfort of thought. Challenge the assumptions that you have about mental illness and addictions, and lets bring rationality back to this segment of healthcare. Thank you.