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Schizophrenic.nyc

The Shortcomings of Health Care Part 2

The former director of the National Institute of Mental Health (NIMH), Thomas Insel, writes in his book, “Healing,” that although during his directorship countless medical breakthroughs led to reductions in death rates from heart problems and infections, the nation’s mental health crisis ballooned out of control. Today, suicide kills three times as many people as homicide, and this figure is only growing. The reason for this, Insel asserts, is that there is a “gap between what we know and what we do.” Specifically, the healthcare system is designed to help people only when they get sick; it does not prevent them from getting sick in the first place. In other words, the system ought to provide social services, rehabilitation, and job opportunities, and treat patients holistically: that is, treating them socially as well as biologically. In the current system, patients spend their time in one of three places – the homeless shelter, the emergency room, or prison. The first results in tragedies such as the death of Michelle Go, the second drains our resources, and the third perpetuates negative stereotypes and causes unnecessary and unjust suffering. Insel estimates that the current system costs us $1 Trillion a year (a lot!). Mental healthcare that does exist is often expensive or of low quality.

There is only one word to describe how the system is now: lazy. That’s one drawback of the rapid advancement of modern technologies and science – people often don’t understand how limited it really is, and assume that medicine can fix all our problems. I, myself, am guilty of this fallacy. It’s the same with climate change: it seems so far away until it happens right in front of you. While it’s true that neuroscience is a rapidly developing field, it is important to understand that the brain is an immensely complex and enigmatic organism, such that we’re probably not even close to understanding a tiny fraction of its inner workings. But we do, more or less, know how to help people with mental illnesses, and at that task we are failing horrendously. In Insel’s words, “We know what works, we’re just not doing it.” Well, it’s time for policymakers to start doing it.

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COVID-19’s Effects on the Brain

In the largest study of COVID-19 and mental health to date, researchers from the Veterans Administration and Washington University in St. Louis found that COVID-19 survivors had a 35% higher risk of developing anxiety, 39% for depression, 41% for sleep disorders, and 80% for neurocognitive decline, or “brain fog,” in layman’s terms. Antidepressant use increased proportionally, as well as the likelihood of opioid usage (a 76% increase in risk!) and thus substance abuse. Even when compared to the typical negative mental effects of ordinary sickness or hospitalization, COVID-19 had a significantly greater impact, suggesting that the study’s results were unique to COVID. This side effect of the virus is hypothesized to be a direct result of the virus’s influence on the brain. The study examined 153,848 COVID-19 patients from March 1, 2020, to January 15, 2021, and compared the data with more than 5.6 million COVID-free people. The sample size was relatively diverse, containing a sizable number of women, African Americans, and people of different ages. Granted, this study was conducted before the large-scale introduction of the vaccine and the Delta and Omicron waves.

            Even so, this study demonstrates, with little room for doubt, just how dire this country’s situation is. The previous posts have mainly focused on the stress caused by the effects of the pandemic, but the virus itself has an incredible impact on mental health, and this discovery was made only very recently. Obviously, one way to circumvent this issue is to help prevent infections – by wearing masks and getting vaccinated. Of course, these measures cannot possibly prevent all infections, even if everyone follows them, so we must be prepared to deal with the inevitable mental health fallout from COVID-19 cases. As I have said time and time again, the mental health pandemic is possibly one of the greatest threats this country has faced, and yet it continues to worsen and languish in relative obscurity. The day that this issue is brought into the limelight will hopefully be the day that we start to fight back against the enemy right under our noses.

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Schizophrenic.nyc

Mental Illness and Racism

What we know about Times Square subway shove victim Michelle Go

In a recent Schizophrenia and the City episode, Michelle Hammer examines the death of 40-year-old Michelle Go, who was killed by a train in Times Square after being pushed into the tracks by a homeless schizophrenic man named Martial Simon. This incident was largely a product of the inadequacy of New York City’s mental illness support systems, but as a CNN article reports, many are viewing it as a manifestation of anti-Asian hate. “You can tell me all you want this is not related to me being Asian but when I look at pictures of Michelle Go and read the story I see myself in it,” asserts Sung Yeon Choimorrow, executive director of the National Asian Pacific American Women’s Forum. As an Asian-American myself, the issue of anti-Asian hate that has spiked during the COVID-19 pandemic is personal. Even so, I believe that it is misleading to label this incident as a hate crime. I cannot say whether or not Michelle Go’s death was even remotely racially motivated, but I do know that focusing in on the race aspect serves only to obscure the fact that Martial Simon had schizophrenia and that the larger issue is likelier a lack of awareness and action concerning mental illness. The less privileged mentally ill bounce back and forth between prisons and under equipped mental institutions, and when they’re not in either they are homeless. The CNN article does not mention that Simon had schizophrenia; it only mentioned that he was homeless. We should be viewing this incident through the lens of intersectionality – that is, by understanding that multiple factors are at work behind the scenes. Asian hate is not the only thing that should change – stigma towards mental health should too.

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Talking About Talking: The Name Game Part 2

Slowly but surely, our society’s perception of mental illness and therapy is becoming more inclusive and less stigmatized. Even so, less than half of US adults with a mental illness are receiving treatment. In addition, as a recent Daily Campus article opines, the public image of therapy is beginning to sour. Statements in popular culture, such as “[Blank] is my therapy,” while true to some extent, imply that therapy is not only just a minor, everyday thing, but also for people who are so weak as to not be able to provide their own “therapy.” Such statements, then, also imply that if one does see a therapist, it should solve all their problems.

            These statements were probably not designed with the emphasis on the “therapy” part. I would guess that they were meant for people to demonstrate to others their passion for a certain activity. Unfortunately, words can be interpreted in any manner of ways, and some of those ways can have negative impacts. I agree with the points that the author makes, and I want to add a few things. The use of the word “therapy” so glibly makes it seem like treatment for mental health is monolithic and uniform – a rigid definition, one which can lead to dangerous misconceptions. If therapy is viewed as a singular object, it becomes that much easier to attach to it certain connotations, such as the stereotype of the couch, clipboard, and “How does that make you feel?” In this way, the word “therapy” is treated like a foreign, exotic word; it is a means which is to be used only in cases of extreme mental illness, an idea which only further alienates those who do happen to have a mental illness and/or see a therapist. Caring for mental health is something everybody should do with a certain level of care and seriousness. Estranging the word “therapy” just makes help seem like it is so far away. In addition, the idea that therapy is a silver bullet for mental illness can also lead people who go into therapy expecting all their problems to be solved to walk out feeling disappointed that the therapy did not do that. It may convince some people that therapy flat-out does not work. This demonstrates a rule which one should always uphold when interacting with the world: assume complexity. Everything has an impact, often in subtle ways, and failure to see those subtleties can result in negative effects.

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The Shortcomings of Health Care

A recent Jama Network Open study examined the use of medicare benefits by people with mental illnesses. The results found that compared to 2019, in the first month of the pandemic outpatient visits and prescription refills of antipsychotics were reduced by about 20%, and ER visits and hospital admissions decreased by almost 30%. These numbers rebounded later in 2020, but still remained lower than rates in 2019, despite the transition to telemedicine. Disadvantaged groups, such as racial minorities, were particularly affected by the pandemic.

In my opinion, these findings are not simply the result of an underdeveloped health care system – they are the result of apathy towards people with mental illnesses. Hospitals were overwhelmed with patients with COVID-19, and so those deemed to be “lower priority” were pushed out. While treating those with COVID is important, it should not be used as an excuse to marginalize those with psychosis. Having a mental illness may be long-term compared with the acute short-term effects of COVID, but cutting off resources to these people by means of redirecting it towards COVID efforts is tantamount to ignoring COVID patients – severe mental illness is severe for a reason. Of course, what is needed is more attention towards healthcare, but also we need to change how we think about mental illness – as deserving constant attention. 

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Are Colleges Not What They Once Were?

 On December 15, 2021,  in the middle of finals week, a student at Northeastern University was found dead in the library, suspected to have committed suicide. The university responded by sending out an email to all the students telling them that counseling services were available. And then finals week resumed. This is a clear-cut example of the COVID-19 pandemic’s dire and disproportionate effects on the mental health of youth, and the inadequate organized response. In 2020, 40% of students reported experiencing depression and 34% reported anxiety, and to make things worse, 60% of undergrads said that they did not have access to adequate mental health resources. Northeastern isn’t completely ignoring the issue of mental health: they created “mental health days” to give students time to relax. Even so, professors still assigned work on or around those days, completely defeating their purpose. A Tufts University Junior was completely unable to access the college’s mental health resources, despite having had multiple panic attacks. Most students end up having to rely on private therapists, the use of which is both expensive and complicated. The efforts which universities do make, such as Northeastern’s “mental health days,” are usually inadequate, short-term, and fail to account for the intricacies of the student body.

The Rising Problems Of Mental Health on College Campuses | by justin doria  | Medium

The word “youth” makes one envision children of the age no later than their early teens, but without a doubt college students closer to 20 years of age fall into this definition. Even if they didn’t, the fact remains that they are just as heavily impacted by the mental health crisis that the nation’s youth are experiencing. In fact, this is simply speculation from someone who has yet to reach such a time of their life, but it might be the worst for young adults of that age, because they are independent enough to grapple with the entirety of the pandemic’s effects, but have not yet learned to navigate the world fully. The nation’s shortage of mental health experts is no less severe at universities, where they are arguably needed the most. The sad truth is that many major colleges have so far been remiss in their duties to ensure the health of students, both physically and mentally. If they do not have the resources to address mental health, they should at least cooperate with the many student-run organizations that have sprung up in the wake of the pandemic. Universities should at least expend more effort to address the crisis from which their students are silently suffering.

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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.