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Is It Criminal To Be Mentally Ill?

Mental illness is becoming increasingly criminalized by the system. Jail is often where a lot of people with mental illness end up, simply because there is no system designed to help them. This was the story of Jermelle Madison Jr., a schizophrenic who committed suicide behind bars, in the Clackamas County jail in Oregon City. Jermelle was a kind, caring person. When he developed schizophrenia, he became scared and confused about what was going on in his head, especially since he wasn’t receiving the help he needed. The police knew for a long time about Jermelle’s suicidal intentions: during his arrest, he had repeatedly told them that he wanted to hurt himself, and the jail had even played a part in getting him diagnosed with schizophrenia in the first place. And yet, they did not place him on suicide watch. This is a more widespread issue than just Clackamas County: a study conducted in December 2021 found that of the 10 Oregon jail deaths that year, nine of them were people with disabilities or mental illnesses. Oregon does have a system that is aimed at providing help to people unable to aid in their defense at a trial. However, this system, Aid and Assist, is becoming increasingly saturated by patients, and some people have to wait in jail, the longest wait time being a staggering 38 days. This is precisely the opposite of what these people should be experiencing, and yet it is reality. The shocking death of Jermelle has sparked protests in Oregon City and his family is filing a lawsuit against the jail.

How the Federal Bureau of Prisons Slashed Care for the Mentally Ill | The  Marshall Project

The way we think about mental illness is not the only thing that is broken: our systems for dealing with it also are. Historically, jail is the place where people who have not conformed societally are deposited. The most prominent example is the mass incarceration of African-Americans over the years and the tragic deaths of George Floyd and Trayvon Martin, for example. Whereas the criminal justice system is designed to target African-Americans, the issue with mental health is that it simply goes ignored. Mental illness is seen as something that happens to people: once they have it, it’s unfortunate, but off to jail they go. What people don’t realize is that mental illness is perfectly normal. Nearly one in five U.S. adults have a mental illness, yet the news constantly draw a connection between mental illness and criminality, either implicitly or explicitly. If mental illness is such a large part of our lives, why don’t we have a framework to support people living with it? When you think about it, it is outrageous that in some places the people who need help the most are being systematically denied that help. I don’t think it’s a coincidence, either, that Jermelle was African-American. If he was white, would he have at least received more attention before it was too late? However, I doubt that it would have drastically altered his fate. The system is broken in so many ways, and we need to start changing the ways we think and the ways we think about thinking. We need to start sharing the stories of these people. The first step is to realize that something is wrong; then we can start enacting change.

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We Are Not Crying Wolf; We Are Crying For Help

All of us have been deeply affected by COVID-19, through bereavement and/or the chaos that the virus has brought, but perhaps those who have felt the greatest negative effect are this nation’s teenagers, according to a recent Teen Vogue article. One teenager, Elias, lost both his grandfathers to the virus on the same day. The trauma has stayed with him ever since, with the terrifying image of his dying grandfather burned into his mind and giving him constant COVID anxiety. In addition, the inability to go back to a normal routine and the renewed isolation and panic after the advent of omicron have only contributed to the distortion of childhood years crucial to one’s development. Another teenager, Zandy, is disabled and suffers especially from society’s neglect of people like her. The CDC director, Rochelle Walensky, recently told the public that it was promising that so many COVID deaths were centered around disabled or chronically ill people, rather than healthy people – an explicit statement that disabled people are considered less than human. Zandy has heard from other people that it’s “just a cold” and it’s “not a big deal,” but the truth is she lives in constant fear of the virus and its threat to her. What is frustrating is that this suffering could have at the very least been reduced if society had only been less cruel. More generally, teenagers are suffering from the lack of social interaction, a crucial aspect of childhood, and the constant anxiety and uncertainty. Schools oscillate between online and in-person learning, every day we break a record number of cases, social isolation turns into social anxiety, and the hell that we are in extends indefinitely into the future. We need to do something, as soon as possible.

            This isn’t the first post I have made about the mental health of teenagers during the pandemic. To me, though, it demonstrates through example the effects of the pandemic. Personally, I haven’t been affected mentally that much by the pandemic. This is due to three reasons: first, I am a privileged, sheltered child who is free of socioeconomic troubles thanks to my parents. For this I am indescribably grateful. Second, I was never very social to begin with. I prefer to spend my time alone, and the daily social interaction that I do want is satisfied by the fact that the school I go to is consistently in-person – another result of the fact that I am extremely privileged and fortunate. Thirdly, nobody I am very close to is susceptible to COVID. My living grandparents both live far away, and my parents are both healthy enough that COVID is not a threat to them. Many millions of other children are not only not fortunate enough to have these supports, but also are more social than me. It was hard for me to imagine exactly how much the pandemic was hurting them, until I read this article. One teenager, Bella, developed social anxiety as a result of being isolated for so long. I cannot imagine the fear and sadness that Elias experienced as a result of losing two loved ones at the same time. What was most shocking to me, however, was Zandy’s story. I had no idea there was such blatant disregard for the lives of disabled people like her, and to hear that explicitly spoken on national television must have been not only horrifying but also terrifying, terrifying that the nation doesn’t care if she gets sick. The stories of these teenagers and the way that COVID is affecting them is just yet another reason to emphasize mental health.

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Are Politics Literally Killing Us?

Politics is ugly. This has always been true, but if you ask anyone who has lived in the United States for the past five years, they will tell you that it has become a major source of stress for the American population. At least, this is what a new study from the University of Nebraska, Lincoln, indicates. The study, discussed in a New York Times article, shows that around 40% of Americans consistently feel that politics is a major source of stress for them. The study even suggests that 5% considered suicide due to political stressors. Although this statistic is dubious, so far it has remained consistent across three surveys. In a 2017 survey, 20-25% percent reported loss of sleep, depression, and self-destructive or compulsive behaviors. Surveys conducted in 2020 found similar results.           

 So should politics be blamed for the nation’s stress? Chronic stress is unhealthy, and at this rate, politics is literally killing us. This isn’t a question of partisanship; everybody is feeling the burden of constant political stress. Mental health is an issue that spans humanity. It is a biological aspect of a person, and yet it is also intrinsically, irrevocably, and inextricably tied to our society and institutions. Political orientation has nothing to do with a person’s right to be happy and mentally healthy, and although the inferno of politics will continue existing, we should at least agree on keeping this country as close to the definition of sane as possible. Towards this end, if you are feeling stressed, you should try meditation: https://www.mindful.org/how-to-meditate/. It really helps!

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The Meaning of Addiction (Hint: It’s Probably Not What You Think)

Recently, the annual U.S. overdose deaths exceeded 100,000, a record high. This is in no way a good milestone, as it demonstrates that we are doing something wrong with respect to addiction treatment. Part of the issue is the terminology used to describe addiction, as Dr. Carl Fisher asserts in a recent New York Times article. People are taught in medical school that addiction is a disease – a biological imbalance in the brain which leads to binging. While not technically incorrect, using this definition of addiction is extremely problematic. Classifying addiction as a disease implies that medicine is the solution and reduces the complex mechanisms of addiction down to a matter of medical science. Addiction, in this way, is defined by society as an individual issue, not a matter of the structure of our society and communities. 

Redefining “addiction” for political gains

Dr. Fisher, seeking to understand the etiology of addiction that lay beyond the poorly understood biological mechanisms, examined the history and sociology behind the term “addiction.” In the 16th and 17th centuries, writers used the word “addict” as a verb rather than an adjective, indicating that it was something that people did, rather than something that happened to them. This understanding of addiction is closer to how it actually works, for addiction is a condition that impairs one’s ability to make rational decisions about the addictive substance. Benjamin Rush, a founding father of the United States and an important figure in the history of psychology, recognized that addiction was a condition with social roots, not just biological ones. In the later temperance movements of the 1820s and ‘30s, however, people leaned on the terminology of addiction as a “disease” in order to blame addiction wholly on alcohol and promote legislation banning it. In more modern times, people have imposed unfair crackdowns and criminal penalties on drug users, which were predicated on the idea that the drugs were at fault, so by reducing drug use it would be possible to eradicate addiction. In reality, though, unemployment, health inequities, socioeconomic status inequalities, or explicit oppression are often drivers of addiction, and the current definition of addiction simply ignores these factors and only promotes counterproductive practices. Disadvantaged and marginalized communities often found themselves riven with drugs because of the egregious conditions there, and then were ravaged by crackdowns aimed specifically at them not just because of the narrow definition of addiction, but also because of the resulting stereotype connecting race and drugs. Terming addiction as a “disease” dehumanizes addicts and takes away all their agency and hope, which is precisely the opposite of what should be done.

Moving toward a holistic understanding 

            This article is an eloquent argument for intersectionality. Intersectionality is the idea that all the aspects of one’s identity are interconnected and inform each other. For example, matters of gender are not separate from matters of race, and it is incorrect to assume that they are. In this case, it is being argued that medicine should be viewed with a lens that considers the diverse social factors, which may be social, economic, political, etc., which may affect addiction (a medical condition). In other words, it is an argument for interdisciplinarity as well as intersectionality. In fact, I believe that the current treatment of addiction by the public is a continuation of a larger, more underlying pattern. Oftentimes, when tackling societal issues, institutions and activist groups focus on addressing the most superficial problems. In the case of the war on drugs, the administration penalized drug abuse, which was the problem they were trying to fix, but ignored the underlying root causes of drug abuse. Over time, not only has such policy harmed the people it is designed to help, but it has also done nothing to remedy the situation it was designed to fix. Activists groups seeking social justice often also focus their efforts on the surface-level problems, but do not address the source of those problems, such as systemic discrimination or stereotyping. Naturally, that is much easier said than done, and what these activist groups are doing is commendable. Even so, our mindset needs to shift towards a more inclusive and nuanced worldview to impose long-lasting, overarching change. In the case of addiction, this could mean changing the word for “addiction” and, at the same time, changing the way we teach the public about addiction and drugs, to ensure that the new word does not go down the same path as the one we have now. We need to consider that everything we do has an impact – even the words we use to describe a condition can be just as harmful as the actual symptoms themselves.

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Stigma and the Media

Stigma doesn’t just disappear – it only gradually fades, or, God forbid, gets worse. A recent U.S. News article presents research that suggests that both are happening in the U.S. right now. The study examines various representative samples of over 1,000 U.S. adults and their perceptions of depression, alcohol dependence, and schizophrenia in 1996, 2006, and 2018. Over the years, it appears that Americans’ “mental health literacy,” or understanding that mental illnesses are medical conditions, has improved. In addition, Americans in 2018 were less likely to avoid people with depression, which is a good sign. On the other hand, though, attitudes towards alcohol dependence and schizophrenia are worsening, with around 60% of the 2018 sample viewing the former as a character flaw and around another 60% viewing the latter as an indication of being “dangerous.” These changes could be attributed to the increase in high-profile figures and celebrities openly talking about their struggles with depression, or the prevalence of antidepressant ads, both of which could help “normalize” depression. Conversely, however, the media portrayal of alcohol dependence and schizophrenia helped perpetrate negative stereotypes. For example, the recent spike in gun violence has prompted people to erroneously fabricate a relationship between mental illness and violence.

This article demonstrates just how much of an impact media can have on people’s stigma. Media is also a double-edged sword – while it has the power to reduce people’s stigma, it is equally disposed to increase it. It all comes down to how we use it. Given media’s important role in public opinion, it is the responsibility of the distributors to be mindful of potential impacts. I’m definitely not arguing for restricting free speech in the media; that would obviously be unconstitutional. What I’m saying is that media producers should watch out for the effects of their media outside of the intended effect. For example, media coverage of gun violence is not intended to stigmatize mental illness (though if it is, that is a different issue). Thus, news organizations should make sure that the way they portray violence accounts for the potential stigmatizing effects. That said, doing so is much easier said than done. A more immediate solution would probably be to counter the negative effects of the media with mental health advocacy – something that is already being done, by people like Michelle. As history has shown us, though, advocacy by itself only gets us so far and it is necessary for our institutions and the government to expend effort towards the goal of reducing stigma.

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Forced Treatment and the Law

Anosognosia (uh-noh-suh-noh-zha), or a person’s inability to recognize that they have a mental illness, affects an estimated 30% of people with schizophrenia and 20% of people with bipolar disorder. It is not denial; rather, it is hypothesized to be a condition caused by disorder in or damage to the frontal lobes. People with traumatic brain injuries, for example, sometimes have anosognosia. Anosognosia is very problematic, as it emotionally harms loved ones who want the person with anosognosia to get treatment, and it also harms the person with mental illness, who feels frustrated and alienated by the people around them trying to convince them that they are sick. The typical solution for this problem is forced treatment. A recent Seattle Times article dives into the policy of mental health care and anosognosia. Washington State has had a very tenuous relationship with mental health care, at one point forcing patients into overcrowded hospitals. Thus, to avoid another such fiasco, policy has reversed and Washington is now one of the hardest places to get forced treatment, and the only way to get someone with anosognosia treatment is to prove that they are a danger to themself or others. The article argues that the system’s libertarian focus is blind to the needs of people who literally are incapable of making informed decisions about their mental health, and change is necessary. 

This article confronts (and also explicitly acknowledges) a very salient topic in the world of mental health. What are the rights of people with mental illnesses? Michelle, for example, has had very unpleasant experiences with forced treatment, having been strapped down and forcibly injected with sedative at a psych ward. On the other hand, it is true that for some people the only way to get them treated is forcibly. Where do we draw the line? Washington state drew that line towards the free choice end of the spectrum, though the article is arguing for a relaxation of laws restricting forced treatment. I believe, however, that the answer lies in neither. The solution is greater individual attention towards people with mental illnesses. Nobody tried to explain anything to Michelle when she was in the psych ward, which greatly frustrated her. I can’t speak for Michelle, but I think it would have been less unpleasant if someone had sat down with her and asked her what she thought. From there, they could have decided whether she needed further treatment or not. 

The key word here is equity – it is an inherent flaw of policy that every person is different, and so has different needs. This is no less true for mental health care, and yet this topic has not received the attention and funding that it warrants. People with mental illnesses need treatment that is just right for them, which for some people is forced treatment, and for others is not. We need to stop thinking of mental illness as a monolith, and start viewing it as no different from the other topics that dominate policy. Ideally, every person with a mental illness should be able to talk with an expert and have a say in their treatment (or no say, if their anosognosia is too complete). Of course, nothing in this world is ideal, as policies are fundamentally limited by reality and are merely approximations of the ideologies behind them. Still, simply talking more about mental health is a step in the right direction. If we can put ourselves on the right path and keep walking forward, that is enough.

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The Name Game

Will changing the name of a mental illness help de-stigmatize it? A recently published New York Times article describes a survey designed to build momentum for the name change. 

The name “schizophrenia,” meaning “split mind” and coined in 1908 by Dr. Eugen Bleuler, was not intended to have negative connotations. However, it has taken on a stereotype of “dangerous” or “amoral.” Schizophrenia has been misunderstood and appropriated as an insult. Doctors are reluctant to diagnose people with schizophrenia because it is such a loaded word, and people who do have it are reluctant to seek treatment because of the stigma. Now there is an organization trying to reduce these associations by changing the name of the disorder. 

There is undoubtedly harmful and unreasonable stigma surrounding the term. However, I don’t think that changing the term will achieve anything. It is comparable to changing a filter: it is shiny, new, and relatively problem-free soon after it is installed, but it does not withstand the test of time. The original term “schizophrenia” was coined on a scientific basis, and yet it has still been muddied by the public consciousness. Why wouldn’t the same happen for a new term for schizophrenia, especially since public stigma is just as bad, or even worse than it was soon after it was coined? The negative perception of schizophrenia attaches itself not just to the name of the disorder, but also to the people living with it. Even discounting the logistical difficulties of changing the name of a disorder, the change is not worth it. It only treats the symptoms of the problem, not the cause. The best route to destigmatizing mental illnesses is to create content, just as Michelle is doing, to demonstrate that schizophrenics are just as human as a “normal” person. Through first-hand experience (albeit through a screen), the true nature of schizophrenia overrides the stigmatized perception drawn from popular culture and the tabloids.

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Stress and Mental Health

Too much stress is bad for you. This fact may seem obvious, but it isn’t as obvious as you may think. A recent NYT article examines research which demonstrates the risk that stress presents to heart health. The recent studies demonstrate that psychological stress may play just an important part – possibly an even greater part – in heart health than physical stress. This is true not just for people with underlying heart conditions, but also for people with completely healthy hearts. Stress triggers the release of hormones which, over time, increase blood pressure and promote atherosclerosis, a condition that commonly underlies heart disease. The article also suggests ways of reducing stress, such as exercising, activities such as yoga or mindfulness, and some medications.

            As a student, I have often felt guilt for taking breaks or procrastinating. I felt that feeling stress was equivalent to productivity – which was in some situations true, but for the most part constituted for me a huge source of undue stress. For me, part of this subconscious belief comes from popular culture and portrayals of irresponsible, tomboy students shirking work in order to go and fool around with their friends. In order to be praised as diligent, I would actively try to defy these stereotypes, which is to say I would try to avoid having fun. I know someone whose father told them that they were not allowed to have fun until they got into college. The other half of this problem is the stressful modern environment, which emphasizes success and unrelenting hard work as a sort of gospel. We’re always told to do our best, but what is “our best?” Is it working until we don’t feel like it anymore, or is it working until we literally drop? We aren’t really given a choice in this matter. Nobody is telling us that we are not allowed to take breaks, but the modern culture is implicitly telling us so. That is why I hate the word “hedonistic:” it is a disparaging word which could easily be applied to people who simply value their mental health, which to me is a fundamental right. This is just the stress from my privileged standpoint, where all I have to worry about is succeeding academically. There are millions of others who have to deal with all of that on top of other stressors, such as financial insecurity. 

            The point of this rant was to demonstrate that modern medicine has fixed many of humanity’s physical ailments with its wondrous vaccines and medicines, but unhealthy mental habits are not just still present, but are also getting worse. The mounting stress of the COVID-19 pandemic, for example, is literally destroying our hearts, and the stress of the modern world has been killing us for quite some time. The field of medicine is already starting to turn its attention to this topic, but when will policy finally acknowledge the gravity of this crisis? I’m not trying to suggest that there is a silver bullet to this problem, nor that is it a problem that cannot be solved. As I have repeated ad nauseam, what mental health warrants is international attention. It should not just be treated like a health problem; it has to be viewed as a fundamental human right and deserves a spot in the pantheon of social justice, alongside race, gender, socio-economic status, and religious belief, among other things. People disadvantaged by, for example, systemic racism, experience more stress than the average white person (look it up – there are so many studies done examining this relationship). Mental health is not unrelated to all of these things, and it is high time that we realize that.

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Mental Health and Social Media

At first glance, there is no obvious connection between TikTok and mental health. However, as a brief WYNT article warns, TikTok can influence teens to self-diagnose themselves with ADD/ADHD, OCD, anxiety, and depression. Therapists have seen a rise in teenagers claiming to have one of the above disorders. The issue here is that teens are using the word too lightly – feeling anxiety is not equivalent to having anxiety disorder. Of course, the article then lapsed into a discussion of TikTok and security threats, but the message is still there: what do we do about the public perception of mental health, especially when it comes to teenagers?

            Considering that today’s teenagers are experiencing a mental health crisis due to the pandemic, misinformation mishaps due to social media are the last thing we want. By so glibly throwing around words like “anxiety disorder” and “depression,” influencers undermine the actual weight that these words carry. Although it is a good thing that mental health is receiving more attention is this manner, the attention it is getting is desensitizing the teenage public to the gravity of the mental health situation in our country by reducing it to a few offhand comments about a teacher’s annoying grading policies. Depression is much graver than that. The voices of the teenagers who are actually suffering from anxiety and/or depression are being drowned out by the voices of those who don’t have it – some of these TikTok users are actually suffering from a mental health disorder or simply trying to offer their thoughts on mental health, but it is impossible to tell who it is when there are so many others crying wolf. In addition, the misinformation surrounding mental health can prevent teenagers from identifying when these mental health disorders actually appear, either in other people or themselves, because they have a skewed perception of how it manifests. It’s not that TikTok is an evil institution (which is arguable, but I will shelve that argument), it’s how people use it which can be harmful.

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Children and Mental Health

A recent opinion article in the New York Times lays bare the mental health situation in our country. The author is a child and adolescent psychiatrist experiencing unprecedented patient volume. One of his patients, who is 11 years old, has panic attacks whenever she wears a mask. Many others have expressed—or acted on—suicidal thoughts. Adolescents are suffering from overwhelming anxiety and depression. Even before the pandemic, mental health care was precarious. There was (and still is) a psychiatrist shortage, with the national average number of psychiatrists at less than 25% of the average recommended by the American Academy of Child and Adolescent Psychiatry. Many schools, especially, are shorthanded when it comes to mental health care. As a result, less than half of the children in this country receive adequate mental health treatment. The advent of the pandemic has only intensified these problems, with mental health clinics (both in person and online) saturated and overburdened.

            What will our future look like if this generation’s mental health is defined by the stress and trauma of the pandemic? The solution is simple: we must pour our resources into mental health institutions. As the author of the NYT article argues, the mental health care system should be substantially expanded, a process already begun by SAMHSA. Even so, the unending influx of public health advisories and pessimistic pandemic outlooks, whether political, economic, or medical, drown out the voices of mental health experts. There is still not enough attention towards mental health care, which was egregious even before the pandemic, when many were struggling with inadequate resources. As I have reiterated many times, the pandemic is a case study for what happens when our flawed healthcare system is put under stress, and a clarion call for the world to finally face mental health head on.