Our minds do funny things with information, especially when it comes from experts and it’s personalized. For that reason, some doctors have stepped back from giving a black-and-white prognosis to their patients. When my dad was treated for high-grade prostate cancer in the 1990s, his oncologist waited until he was sprinting toward his seventh year of remission to exclaim, “We’ve never seen anyone with such a high PSA level survive past five years!” Nobody had said anything of the sort to him when he was initially being treated, thankfully. (He lived 18 years past his initial diagnosis).
I recently read Swing Low by Miriam Toews. A beautiful book, Swing Low is written as a memoir in the voice of Toews’ father, who had bipolar disorder.
The book recounts the day when Mel Toews shared his plans to marry with his psychiatrist. The doctor “expressed no small amount of shock and dismay.” When Mel told him that he was also planning on becoming a schoolteacher, “he almost hit the roof.” Mel Toews went on to earn a master’s degree in education and was a beloved husband and teacher for many years in Steinbach, Manitoba. Granted, Mr. Toews hit adulthood in the 1950s, a time when many who were diagnosed as mentally ill were also institutionalized. It made me wonder, though: how do psychiatrists and therapists handle the touchy issue of ‘prognosis’ today?
In other words, do mental health professionals ever tend toward “Tame it down a bit, partner—your vision’s a bit grand! How about just aiming for basic employment and a roof over your head? Don’t want to upset the apple cart!” Then again, how about employers? Or admissions directors at post-secondary institutions? Or me and you?
Human beings have a wide range of strengths and abilities in general, and so it stands to reason that individuals with mental illness also range in their ‘ability to achieve.’ My hunch is that due to stigma, our expectations of someone with mental illness are lower than of someone who does not have a mental illness. People, being the amazing creatures they are, continue to surprise and astound with the things that they accomplish, however. I truly hope that we aren’t imposing artificial limits on people with mental illness due to a tendency to supply a prognosis (or judgment, or opinion—they fit here, too).
Elyn Saks is Associate Dean and Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at the University of Southern California Gould Law School. She also has schizophrenia. Is she the highly-successful exception? There are certainly many people with mental illness who are struggling to keep a job and a roof over their head. I recognize this. I also recognize that each individual’s situation must be assessed on a case-by-case basis. One size—or sweeping sentiment—does not fit all.
I would like to feel assured, though, that the professionals from whom mental health consumers seek support are leaving all options open to their patients, encouraging them to claim their place in the world with all of their gifts and talents. Letting them envision their highest path, whatever that may be.
Way back in the 90s, if my dad’s doctors had told him that his cancer was so advanced he wouldn’t live past five years, would it have changed the outcome? I doubt it. My dad was irrepressibly defiant and more determined than a Finn in the Winter War against the Soviets (his favorite story). Not everybody is like that in the face of an illness, though. Some people need pure faith and support. In the realm of mental illness, I hope that Mel Toews’ experience isn’t being repeated through the ages.
If you have stories to share around this topic, I would love to hear from you.