In 2004, Dr. Lorna Breen’s 17-year-old daughter suffered from severe panic attacks. At first, Breen dismissed the problem. “I took her to talk to a psychiatrist, who discharged her because she was asymptomatic,” Breen wrote to me in an email. “Her panic attacks didn’t affect her ability to do anything. They were just painful.”
Breen didn’t ask how her daughter’s anxiety stemmed from her wartime service, because she didn’t know. She didn’t ask if her daughter needed therapy. But as she spoke to other mothers in her daycare, she asked these women’s children “if they had any family history of stress, anxiety, depression, and general difficulty with mental and emotional health.” She asked. She found that most of the children did.
Breen wondered what to do. Not everyone, after all, has access to good mental health services. In order to benefit from a healthcare system that gives valuable mental health care, all people need to be treated equally. And yet a medical community that is likely to handle an episode of mental illness rather quickly and effectively to prevent a dire situation may well appear to many people as imposing the psychosexually normalization of mental illness. And this can be one of the worst problems medical care faces.
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Breen says: “Most people are terrified of symptoms of mental illness. They feel that they have to be perfect to not be judged, punished, or stigmatized. And while I understand and have empathy for those who may experience an episode and say: ‘That’s OK! I won’t let this bring me down!’, it may not always be true.”
Breen was first assigned a psychiatrist in 2005. And although she kept thinking about her daughter, Breen says she didn’t contact that psychiatrist for years. The first time Breen contacted her psychiatrist about her daughter was when she saw a picture of her daughter in one of the articles she read at her daycare. It was after this interaction that Breen, with the help of a therapist, worked with her on a care plan that included seeing multiple doctors, and taking medication. “I’m not making excuses for my daughter,” Breen writes to me. “This is me. I can’t change it. And I hope I have learned to better manage it now.”
This is the challenge of every treatment for mental illness. Most people are terrified of their struggles, and too many do not seek help. And yet many who do manage their own mental health and get help are stigmatized as “weak”, “crazy” or even “bad”.
While there have been changes in the medical profession to accommodate gay and transgender people – the American Medical Association, for example, declassified homosexuality as a mental illness in 1973 – there has been much resistance to addressing the mental health needs of people who aren’t gay or transgender. That includes discussing mental illness as a community-wide issue, as well as engaging in cross-cultural and other diversity education that recognizes mental illness’s impact on people of different socioeconomic status, race, or sexual orientation.
Given that nearly one in five (20%) of American adults suffered a mental health problem in the past year, surely the health care system can learn from the social and cultural models developed to treat physical health in the first place.
It is also worth noting that about 2.3% of doctors treat psychiatric patients. And that, rather than chastising parents for sending their kids to the doctor for treatment, we should be thanking them for “walking a mile in their shoes”.
• Dr. Lorna Breen is a professor of population health at the University of Michigan School of Public Health, and author of Patients Shouldn’t be ‘Punished’ for Seeking Support