Laura Zera

Stories to Connect Cultures

A Phone Call to an Old Friend (of My Mom) – Part Two

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Back in August, I published a post about a very special phone call. When cleaning out the condo of my schizophrenia- and dementia-addled Mum last summer, I found a letter from her old friend, Bunty. The letter was from 2001; the two of them met in 1953 at nursing school (psychiatric nursing, to be exact.)

I called Bunty in August to let her know that Mum had gone into a care home and had little memory of anything or anyone. What transpired was a warm conversation with a delightful and caring woman and I hung up the phone feeling exponentially better than I did before the call—better about my mum’s health, better because I knew more about her younger years, and better because I felt like I might have made a new friend of my own, the friendship even more meaningful given her connection to my mum.Continue Reading

Psychiatry’s Narrow View on Mental Illness Treatment

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I came across a very interesting two-part review on several books about mental illness and psychiatry in the New York Review of Books today.

The first part is here:  http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/. The reason that the reviews came to my attention is because the reviewer, Marcia Angell, is garnering a fair amount of backlash from the psychiatric community. It may be that she hit a little too close for their comfort.

Angell’s round-up includes three authors who cover a variety of important and thought-provoking issues and problems within the realm of mental illness treatment in their books, and who share similar views on the direction that treatment has taken. (I’ve read the Whitaker book, and found it fascinating).

Since the advent of the psychoactive drug revolution – starting with Thorazine in the 1950s, but really ramping up with Prozac in the 1980s – the people of America are being diagnosed will mental illnesses and treated with medications at a staggering rate. About 10 percent of Americans over age six now take antidepressants, and the new generation of antipsychotics, such as Risperdal, Zyprexa, and Seroquel, has replaced cholesterol-lowering agents as the top-selling class of drugs in the US, according to Angell.

While the review highlights many linkages throughout each of the books in the evolution of mental illness treatment in this country, the bottom line is this: psychiatrists are prescribing drugs instead of employing talk therapy (or other therapies) because they get more money that way, both from insurance companies, and from the pharmaceutical companies with whom they’ve developed some ridiculously close, and to me, patently unethical relationships.

The psychiatric community, of course, is screaming mad. Some of the letters to the editors were published last week: http://www.nybooks.com/articles/archives/2011/aug/18/illusions-psychiatry-exchange/.

Nothing is black and white, both sides have strong points, and, as is often the case with discussions about clinical study findings, different stakeholders will place emphasis on different findings, so it’s hard to know which outcome to believe. If we can just pull our focus away from the finger pointing in this argument for a moment, however, there is another basic point that needs to be considered, and it is found in the last paragraph of the second part of Angell’s review: “Our reliance on psychoactive drugs, seemingly for all of life’s discontents, tends to close off other options. In view of the risks and questionable long-term effectiveness of drugs, we need to do better.”

I am not saying that we shouldn’t utilize medication. What I am saying is that we shouldn’t stop there, and be content with that modality of treatment. We must acknowledge that there are huge risks with these drugs. There is research that points to evidence of cognitive impairment after years of taking anti-psychotic and bi-polar medication. Some of the risk is in the unknown. These medications are new enough that we haven’t seen all of the long-term effects play out.

There are also some heavy side effects. My mom has been taking Zyprexa (Olanzapine) for just over two years now. Within six months of starting the drug, she had significant tremors in her hands and legs, and they’ve never gone away. She isn’t able to stand still anymore, and constantly shifts her weight from one foot to the other, like a small child that has to go to the bathroom. In fact, she now says that she “needs to pee” about every fifteen minutes, and I’m wondering if that is due to the anti-psychotic medication, too.

Have her primary symptoms of paranoia and delusions improved? Most definitely. Would other therapies work as well on these symptoms? I don’t know. But her case, and those of many others whom I’ve read about in my research, leads me to believe that we are doing ourselves a very great disservice by relying so heavily on drugs, to the detriment of the development or continued use of other treatment options.

As we’re hearing from Angell and others, the system doesn’t support other options. Prescription coverage is standard with most medical insurance plans, long-term outpatient mental health services are not. Not only are psychiatrists and doctors defaulting to medication instead of talk therapies, it is also less costly for the patient. As we know, though, you get what you pay for. For a country like America, that prides itself on its ability to innovate, it is shameful to settle for such a one-dimensional approach when it comes to the well-being of its citizenry. I echo Angell. We need to do better.


A Phone Call to an Old Friend (of My Mom)

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It has been two years since my mom, Ellen, went into a care home, addled by dementia on top of her 50-year affliction with paranoid schizophrenia. I am happy to report that she is doing amazingly well. Her memory is gone, but her spirit is strong and she can be damn funny at times. Now that she is under a doctor’s care and is taking an anti-psychotic medication, she is thriving, considering the circumstances. Last month, she had her 76th birthday.

It has also been two years since a benevolent social worker gracefully reunited me and my sister with our mom, after a 17-year estrangement. Giving up on having a mom in their life is not something that any child would wish for themselves, I don’t think. I certainly did not. I am so grateful that I have her back, even though she doesn’t remember who I am. I work around that, though, and sometimes I am tempted to tell her that I married Wayne Gretzky, as that is what she wished for me when I was twelve.Continue Reading

What are the Mental Illness Stereotypes?

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Adjectives and classifiers. We use them constantly and sometimes unconsciously throughout our day to make sense of all the different stimuli and organisms that cross our paths and make up our world. Often, the descriptors that we attach to an object or event are benign, without subtext or additional meaning. For example, “He is bald.” You can say that without intending to imply anything else beyond that observation. His hair fell out and then did not grow back. And…? That’s it, right?

Then there are stereotypes. These are also used with frequency, sometimes frustratingly so (I’m thinking of my father, who used to start sentences with “(S)he’s a typical…” and then go from there). That’s not to say that I don’t use them myself. I do, and regularly. Having been so far unsuccessful in banishing them from my lexicon, I try to check in with myself on the judgment that I am attaching to the stereotype, and at least be cognizant and questioning with regards to its use. Perhaps, though, I should stop telling people that I am of hardy Eastern European peasant stock for starters. I will at least refrain from purchasing The Onion’s t-shirt that says “Stereotypes are a Real Time-Saver” (I got their “Che Wearing Che” t-shirt, instead).

At any rate, stereotypes are there, in front of us all the time. In the western hemisphere of the 21st century, there are some categories for which we will likely get called out on the carpet if we use them: racial, ethnic, religious, sexual, and gender, to name a few. There have been many decades of challenges and discussion around these, dare I say it, ‘popular’ stereotypes.

What about mental illness stereotypes? They may be less verbal than the other categories, but they certainly exist. People often talk about the stigma attached to having a mental illness, but what is the judgment that is going on behind the stigma? How does that judgment present itself? What are the barriers that are springing up between us and a person with a mental illness (because that what is often happening) when we attach a quick summary to their condition?

I’ll list the ones that come to my mind, and I hope that others will add to the list through blog comments. I’m sincere in saying that I am interested in hearing what others feel the mental illness stereotypes are, in the name of both research for my book about schizophrenia, and to drive further discussion in future blog posts.

Let’s dive in. Stereotypes about people with mental illness include:
– they are unpredictable – they may suddenly yell, or throw a punch, start crying, or start dancing, badly
– they are violent
– they are unreliable (and/or too unreliable to have a job)
– they have poor judgment
– they have limitations
– they are weak
– they are unable to be stewards of their own lives

Phew. That’s some pretty heavy stuff, and I am sure there is more. There may also be some positive stereotypes that will emerge. Now what do we do with it? Is acknowledgment of their existence enough? Do we need to set out to prove the stereotypes wrong? Why do these particular stereotypes exist? As you may have guessed, I have some thoughts and opinions on it all, and some facts and data that I may be able to incorporate as well. That will be in a future blog post. Today, I just want to get the wheels turning.

I am going to end this post with a statement that will probably be at the end of almost every other post that I write about mental illness: as I explore issues around mental illness, I aim to do so with curiosity, integrity and balance. I have my beliefs and leanings, you might say, and as this journey unfolds for me, I am sure that my convictions will grow stronger, one way or another. In recognition of the many faces, stories, and circumstances that make up the community of people with mental illness, I understand that there is deep diversity within this community and will always endeavor to write with this in mind.