* By 2020, behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide.

* Of the more than 6 million people served by state mental health authorities across the nation, only 21 percent are employed.

* More than half of adolescents in the United States who fail to complete high school have a diagnosable psychiatric disorder.

* Between 2009 and 2011 states cumulatively cut more than $1.8 billion from their budgets for services for children and adults living with mental illness.

* In 2009, there were an estimated 45.1 million adults aged 18 or older in the United States with any mental illness in the past year. This represents 19.9 percent of all adults in the U.S.

*Serious mental illnesses cost society $193.2 billion in lost earnings per year.

* The annual total estimated societal cost of substance abuse in the U.S. is $510 billion.

* In 2008, an estimated 9.8 million adults aged 18 and older in the U.S. has a serious mental illness.

With our economy still in the toilet, states and federal government threaten to cut even more dollars in mental health funding, which would result in less or no access to mental health treatment and services for countless Americans. Ultimately the cuts steal the one thing that keeps those of us struggling with chronic mood disorders alive: hope.

Yesterday a group of mental health advocacy organizations hosted a joint symposium titled “Mental Health Hope: Lost People, Lost Dollars, Lost Hope” at the Reserve Officers Association in Washington, D.C. to raise awareness about the imminent threat and impact of such budget cuts. Actress Glenn Close and her sister Jessie, former second lady Tipper Gore, and a handful of prominent doctors and directors of behavioral care centers addressed the symposium moderated by the award-winning journalist Cokie Roberts.

I very much wanted to be there to take notes myself — and to meet my best friends Glenn, Tipper, and Cokie for a cup of coffee — but ironically I couldn’t attend because I need to work so many hours at my day job in order to pay for my mental health care, most of which is not covered by my health insurance plan. Thus, this is an issue I feel very passionate about, and urge you to pay closer attention to yourselves.

“Too often policymakers only see the immediate savings of cutting budgets to mental health services,” said John M. Oldham, M.D., President of the American Psychiatric Association. “We want to emphasize that these programs are already providing significant savings within the health care system and in other sectors of society, by increasing employment and workplace productivity, and by decreasing homelessness, substance use, and overcrowding in emergency rooms.

Mark Covall, President and CEO of the National Association of Psychiatric Health Systems, added:

The work we have done to increase access and quality of care for those in need will be severely threatened without the resources to keep the programs going. We’re already struggling to deal with increased demand due to the down economy. If we see any further cutbacks, the result will be incredibly costly for the wider community.

Actress Glenn Close launched her anti-stigma campaign, Bring Change 2 Mind, to educate the public about mood disorders after watching her sister, Jessie, battle an undiagnosed bipolar disorder for years, and helping her nephew, Calen, who lives with schizoaffective disorder, get the care he needs.

“Access is critical,” Glenn wrote in an op-ed piece published yesterday on the website Politico.com, “because more of us are affected and in need of support than most people realize. Close to 60 million Americans live with a diagnosable mental illness, and one in four families has a relative living with mental illness”

For more information about the symposium, please visit: www.mentalhealthhope.com.

Sybil is one of the most popularly known individuals who had multiple personality disorder, largely because of a book published in the 1970s that detailed her experience and that of her psychiatrist in trying to help treat her.

Now Debbie Nathan, writing in her new book, Sybil Exposed, suggests that the core diagnosis for Sybil — of multiple personality disorder — was made up by the patient to keep in the good graces of her psychiatrist.

NPR has the story, and describes how Shirley Mason — Sybil’s real name — came to have multiple personality disorder:

Shirley Mason, the real Sybil, grew up in the Midwest in a strict Seventh-day Adventist family. As a young woman she was emotionally unstable, and she decided to seek psychiatric help. Mason became unusually attached to her psychiatrist, Dr. Connie Wilbur, and she knew that Wilbur had a special interest in multiple personality disorder.

“Shirley feels after a short time, that she is not really getting the attention she needs from Dr. Wilbur,” Nathan explains. “One day, she walks into Dr. Wilbur’s office and she says, ‘I’m not Shirley. I’m Peggy.’ … And she says this in a childish voice. … Shirley started acting like she had a lot of people inside her.”

So the implication by the book’s author, Debbie Nathan, is that ‘Sybil’ made up her diagnosis in order to keep the attention of her psychiatrist, Dr. Wilbur, and to gain the emotional rewards from such attention. Shirley Mason wouldn’t be the first patient to ever want increased attention from their therapist.

An interesting hypothesis. But is it true?

Nathan suggests a letter Shirley Mason wrote in 1958 to her psychiatrist (2 years after first being diagnosed with this then unheard-of condition) reveals the truth:

At one point, Mason tried to set things straight. She wrote a letter to Wilbur admitting that she had been lying: “I do not really have any multiple personalities,” she wrote. “I do not even have a ‘double.’ … I am all of them. I have been lying in my pretense of them.”

Wilbur dismissed the letter as Mason’s attempt to avoid going deeper in her therapy. By now, says Nathan, Wilbur was too heavily invested in her patient to let her go.

But this is a truth already pretty well-known and accepted in the profession. According to Reiber and his colleagues (2002), only 40 percent of psychology professors didn’t know that Sybil’s case may have been a case of malingering (or “faking it”). Herbert Spiegel, who also occasionally saw Shirley Mason as a surrogate therapist at the time, also said as much in a 1997 interview (Borch-Jacobsen, 1997). Rieber (1999) published a journal article on the issue, and then wrote a book describing the case more in-depth in 2006 (Lynn & Deming, 2010).

We may never know the “real” truth, as Shirley Mason died in 1998.

The case remains an intriguing and interesting story in the history of psychiatry. Rather than a classic example of multiple personality disorder, Sybil may instead serve better as an example of the power of co-dependence and transference in the therapeutic relationship.

Just as importantly, the malingering or faking of a single patient decades ago should in no way denigrate or de-value the experience of people who have dissociative identity disorder today. Dissociative identity disorder — the modern term for multiple personality disorder — is a recognized and valid psychiatric diagnosis. And while it indeed may have been a diagnosis that was abused in the past, I hazard to guess that few clinicians do so today.

• Learn more about multiple personality disorder

• An introduction to multiple personalities

Read the full story: Real ‘Sybil’ Admits Multiple Personalities Were Fake or listen to the podcast.

References

Borch-Jacobsen, M. (1997). Sybil—The making and marketing of a disease: An interview with Herbert Spiegel. In: Freud under analysis: History, theory, practice: Essays in honor of Paul Roazen. Dufresne, Todd (Ed.); Lanham, MD, US: Jason Aronson, 179-196.

Lynn, S.J. & Deming, A. (2010). The “Sybil tapes”: Exposing the myth of dissociative identity disorder. Theory & Psychology, 20, 289-291.

Rieber, R.W. (1999). Hypnosis, false memory and multiple personality: A trinity of affinity. History of Psychiatry, 10, 3-11.

Rieber, R.W., Takooshian, H. & Iglesias, H. (2002). The case of Sybil in the teaching of psychology. Journal of Social Distress & the Homeless, 11, 355-360.

I mean, even those who claim they are normal may, in fact, be the most neurotic among us, swimming with a nice pair of scuba fins down the river of Denial. Having my psychiatric file published online and in print for public viewing, I get to hear my share of dirty secrets—weird obsessions, family dysfunction, or disguised addiction—that are kept concealed from everyone but a self-professed neurotic and maybe a shrink.

“Why are there so many disorders today?” Those seven words, or a variation of them, surface a few times a week. And my take on this query is so complex that, to avoid sounding like my grad school professors making an erudite case that fails to communicate anything to average folks like me, I often shrug my shoulders and move on to a conversation about dessert. Now that I can talk about all day.

Here’s the abridged edition of my guess as to why we mark up more pages of the DSM-IV today than, say, a century ago (even though the DSM-IV had yet to be born).

Most experts would agree with me that there is more stress today than in previous generations. Stress triggers depression and mood disorders, so that those who are predisposed to it by their creative wiring or genes are pretty much guaranteed some symptoms of depression at confusing and difficult times of their lives.

I think modern lifestyles — lack of community and family support, less exercise, no casual and unstructured technology-free play, less sunshine and more computer — factor into the equation. So does our diet. Hey, I know how I feel after a lunch of processed food, and I don’t need to the help of a nutritionist to spot the effect in my 8-year-old son.

Finally, let’s also throw in the toxins of our environment. Our fish are dying… a clue that our limbic systems (brain’s emotional center) are not so far behind.

Maybe the same amount of people have genes that predispose them to depression as in the Great Depression. But the lifestyle, toxins, and other challenges of today’s world tilts the stress scale in the favor of major depression, acute anxiety, and their many relatives.

Of course we can’t forget today’s technology and cutting-edge research of psychologists, neuroscientists, and psychiatrists. Because of medical devices that can scan our brains with impressive precision and the arduous work of scientific studies done in medical labs throughout the country, we know so much more about the brain, and its relationship with other biological systems within the human body: digestive, respiratory and circulatory, musculoskeletal, and nervous. All of that is a very good thing, as is knowledge and awareness.

A few years ago, psychiatrist and bestselling author Peter Kramer penned an interesting article for Psychology Today rebutting the claims of popular authors — spawning a new genre of psychological literature — that doctors are abusing their diagnostic powers, labeling boyishness as “ADHD,” normal sadness and grief as “major depression,” and shyness as “social phobia.” Because of their rushed schedules and some laziness, doctors are narrowing the spectrum of normal human emotion, slapping a diagnosis on all conditions and medicating people who would be better served with a little coaching, direction, and psychotherapy.

As I explained in my piece, “Are We Overmedicating? Or Is Our Health Care System Inadequate?,” I believe the problem is far more complicated than overmedication. I’d be more comfortable labeling it “really bad health care.” And if I had to pick a culprit, I’d point my finger at our health care insurance policies, not the doctors themselves. But I don’t even want to get into that, because it causes my blood pressure to rise and I’m trying really hard lately to live like a Buddhist monk.

What I liked about Kramer’s article is that he doesn’t deny that there are more diagnoses today, and yes, some people may feel the damaging effect of stigma. However, more often than not, diagnosis brings relief and treatment to a behavior, condition, or neurosis that would otherwise decay certain parts of a person’s life, especially his marriage and relationships with children, bosses, co-worker, and dare I say in-laws? Kramer writes:

Diagnosis, however loose, can bring relief, along with a plan for addressing the problem at hand. Parents who might have once thought of a child as slow or eccentric now see him as having dyslexia or Asperger’s syndrome—and then notice similar tendencies in themselves. But there’s no evidence that the proliferation of diagnoses has done harm to our identity. Is dyslexia worse than what it replaced: the accusation, say, that a child is stupid and lazy?

People afflicted by disabling panic or depression may fully embrace the disease model. A diagnosis can restore a sense of wholeness by naming, and confining, an ailment. That mood disorders are common and largely treatable makes them more acceptable; to suffer them is painful but not strange.

Then Kramer asks this question: What would it feel like to live in a world where practically no one was normal? Where few people are free from “psychological defect?” What if normalcy was a mere myth? He ends the article with this poignant paragraph:

We are used to the concept of medical shortcomings; we face disappointing realizations—that our triglyceride levels and our stress tolerance are not what we would wish. Normality may be a myth we have allowed ourselves to enjoy for decades, sacrificed now to the increasing recognition of differences. The awareness that we all bear flaw is humbling. But it could lead us to a new sense of inclusiveness and tolerance, recognition that imperfection is the condition of every life.

Amen to that.

In last week’s post I said we have a right to our anger if it’s there. Here’s the rub: How do we keep it from going nuclear, or imploding into depression?

Anger Management is about doing the following three things effectively:

1) The healthiest way to express anger is in an assertive, direct and not aggressive manner. How?

➢ Clearly define what you are angry about and tell, directly, those who need to know. “I am really angry because now I can’t retire like I planned to” is better than silently glaring at your spouse who may be thinking you are angry with her. If you can’t identify why you’re angry, say, “I’m angry right now but I don’t know why. I do know it isn’t you.”

Give yourself permission to walk away if it feels like a conversation is in danger of spinning out of control.

➢ Channel the anger through an action plan. A plan to address what’s making you angry, without hurting others, can be a huge relief. Brainstorm; problemsolve and execute your plan.

After a week or so of being laid off and seething in shock and anger, I began to form a plan to redirect my career. With the help of friends going through the exact same thing, planning provided a vent. The anger didn’t go away, but at least it wasn’t going to kill me.

Anger over financial losses is much tougher. A few weeks ago at a gathering of local financial planners, the concern and frustration these professionals had for their clients (and their own) situation was palpable. During a discussion of how to help their clients understand the importance of currently doing nothing with their money, someone said, “I tell my clients patience is an action plan.”

➢ Anger can mask fear. Once you pull the fear out into the light of day, it shrinks like a vampire. Shame and embarrassment can isolate us. Talking with people who ‘get it’ really does help.

➢ Be respectful of yourself and others. The golden rule applies here. Now is the time to be kind even if it feels strange. Listen to feedback. If your spouse is telling you you need to get a grip don’t get defensive. Ask for specifics so that you can make changes. Raising our voices, frightening our children and spouses is like that old adage of peeing where you eat.

➢ Remember that we are more than our jobs, our 401Ks or the value of our stuff. Sadly, women are reared to base our self-esteem on how others see us. Men often base their self-worth on what they do, their jobs. On such shaky self-esteem foundations today’s economic crisis can easily smack us down, making us very angry.

It’s like playing basketball with only one good player. What we need is a deeper bench. Remind yourself of past accomplishments, trials successfully overcome, large and small, illnesses you’ve endured, skills and knowledge you own, the love of family, and your kids. This and more is who you really are and no one can take that away from you.

2) Convert or re-direct anger. Don’t confuse this with suppression. Find your own creative outlet. Beat the hell out of a punching bag, write a story about your enemies getting their just deserts, volunteer for Habitat for Humanity and hammer some nails. All this is better than acting out destructively.

Your anger, like electricity, is energy. Without constraints it can strike and burn in an instant. Harnessed and channeled it can light up a city for a week.

3) Calm down and let it go. Take steps to lower your heart rate and soothe your mind:

➢ Give yourself a media break. Turn off the TV, radio, Internet. Set aside the paper and pick up a paperback.

➢ Yoga breathing (Slowly, deeply, breathe in Peace, breathe out Anger)

➢ Use a mantra, something personal. Mine is Serenity. It brings to mind the entire Serenity Prayer, which is very soothing to me. Use your mantra in combination with the breathing.

➢ Visualize a peaceful place, like floating on your back in warm tropical waters or, if it suits you better, visualize being Muhammad Ali dancing around Joe Frazier.

The Zen Master says be the surfer riding the wave of anger with finesse and control. That is how I can calm down, not by denying myself my mad, but by riding it out, running, writing, talking with others and then letting it go through meditation, prayer and remembering to laugh. His Holiness, the Dalai Lama, with all he has to be angry about, is one the happiest men on the planet. Adam, a Buddhist, had wise words to say about this in his comment on Part One.

In Controlling Anger — Before it Controls You, Dr. Charles Spielberger, an expert in the study of anger, says, “When none of these three techniques work, that’s when someone—or something—is going to get hurt.”

That’s when it’s time to reach out to your pastor, rabbi, a mentor, your doctor or psychologist. Many communities have excellent counseling services that are provided by your tax dollars. Take advantage of them. As powerless as the economy makes you feel, you still have the power to give yourself this gift.

Coming up:
➢ Build Healthy Resilience to Financial Fury
➢ When Anger Consumes Your Loved One

You may have your own suggestions for managing financial stress anger. Please share them in the comments section.

Dissociative identity disorder is not as rare as one would expect. Dr. Richard Kluft, the show’s psychiatric consultant, explains, “there are many DID patients that are so subtle and so disguised that their spouses, their co-workers, their friends don’t notice anything amiss for years and years and years and some are…over the top.” Tara is certainly “over the top.” Nonetheless Toni Collette’s portrayal of Tara accurately depicts the emotional experience of DID.

Most of us with DID do not have alters that appear as extreme as Tara’s. While our friends, family, or co-workers may find us moody and forgetful, rarely would they consider the possibility that we have DID/MPD. I prefer the term “multiple personality” to “dissociative identity disorder.” I tend to use the terms interchangeably, but for me, multiple feels right.

Every multiple has an intricate system connecting her alters, emotions, and awareness. Discovering how this system works is the challenge of recovery. Becoming aware of my various personalities has often been painful and occasionally paralyzing. On the other hand, DID has a positive side, one which I am having trouble letting go of.

Without a doubt I have accomplished a great deal because of — rather, in spite of — my ability to dissociate into various personalities. For example, I am fully capable of watching television, reading a book, and writing a lesson plan simultaneously. Throw in answering the nonstop questions of a toddler or five-year-old, and still, on a good day, I can do it all. Test me later on any of these activities and I will remember the details of them all — at least as long as I have access to the various parts of me who had participated.

About a year ago, someone I know (who has no idea I have DID) commented that it must be awfully strange to have multiple personalities and actually believe you are more than one person. The problem people with DID have, though, is not that they mistakenly believe they are more than one person, but that they literally have more than one “personality.” Because of the way DID rewires a person’s brain, it’s possible to suffer from the disorder for years and not even know it.

The Heart of Dissociative Identity Disorder

The heart of dissociative identity disorder lies not in personality, but in memory. DID is not an organic or chemical disorder but a creative coping mechanism that protects us from recalling trauma and terror experienced in the past. Unfortunately, this memory loss expands beyond just a particular incident or series of traumatic events.

A person with DID may find herself in the middle of a shopping mall with no idea how she got there. I remember finding clothes in my closet that I knew were not mine. I had definitely not bought them. Yet, they were my size. They were there. They certainly didn’t belong to my husband. That was terrifying. What if I had a brain tumor? Maybe it was early-onset Alzheimer’s? Maybe I was hallucinating? Or maybe I just forgot I bought them. Always I could convince myself I had just “forgotten” and then forget what I was so worried about. I would feel distracted and suddenly have to write or work out or watch TV or take a nap. Once I was accurately diagnosed and began to understand how my system worked, I understood that my memory gaps were the result of my “switching“ to different alters.

One of the scariest parts of living with DID is the blackouts. A “blackout” can last from seconds to hours. What is happening during this time is that whoever is present becomes overwhelmed for some reason and retreats. Alters generally take over in order to protect the “main” personality or the system as a whole. An alter may step in to protect the rest.

For example, I was at the doctor’s today. All weekend I have had chest pains and shortness of breath, but I have mainly written that off as allergies and the humid weather — maybe a little stress too. At any rate, I was seeing Dr. K to discuss the fact that I am gaining weight, more tired than usual, and irritable. I am thinking maybe it’s my thyroid. One of my alters, probably Victoria or Joanne (Victoria is the “perfect one” and Joanne is my “organizer/adminstrator”), must have told Dr. K about the chest pains. I have no memory of mentioning them to him, but he insisted on an EKG based on what I “told him.” I realized then that another part of me must have shared the information for the benefit of the “whole.”

My many parts are as much a blessing as a curse. Nonetheless, just keeping track of myself can be an exhausting, uphill battle. My brain, like a computer, sometimes works quickly and efficiently. It retrieves information from many different folders and files and feelings stored by my various selves. At other times, though, it slows down. Files become blocked. Sometimes I will freeze or get stuck in a loop. I need to hit “ctrl-alt-del” and use “task manager” to shut down. Then I can regroup and retrace where I’ve been.

The safeguards my mind has constructed create obstacles that can be difficult to maneuver. Sometimes I am overwhelmed by the challenge of simply remembering where I am and what I am doing. Sometimes I find my emotional self trapped in one alter even though a different alter is out and controlling our actions. The younger parts of me are beginning to understand that even though they still “exist” per se, they no longer exist in the same form or physical body that they were in when they were born or became trapped.

One of the strangest effects of DID is what I call mirror shock. There are times when I am unable to recognize the person reflected at me from the mirror. I catch a glimpse of myself and I am shocked. “That’s not me,” I think. Then I realize that it is me even when it isn’t. Although I can see subtle changes in my facial features based on who is most present, my outward body doesn’t always match my inner construction.

The mind is a brilliant and beautiful creature. Mine has constructed itself in such a way that its various facets co-existed for many years without my even knowing it. As my therapy gradually unfolded and I began to learn more and more about DID the pieces of my life started falling into place. That “wow, this explains everything” moment of realization was proof at last that I wasn’t crazy; I was coping.

The way my system has been developing awareness and integrating feels natural. I am not pushing the process as much as I am allowing it to unfold. I worry, though, whether I will still be able to multitask the way I do once (if) I am fully integrated. Will I still be able to tap into the energy and resources switching alters provides me? Hopefully, The United States of Tara will examine that question.

The United States of Tara debuts tonight at 9:00pm ET on The Movie Network.

The problem is, most celebrities don’t want to give more fodder for the paparazzi, and health issues are generally a private thing for most of us.

So it’s always refreshing to not only see a celebrity share his or her mental anguish with others, but do so on their own terms.

This month’s Men’s Health has a nice piece by the Counting Crows’ front man Adam Duritz about his grappling with a dissociative disorder. His first-person account is helpful in understanding the disturbing symptoms behind this kind of disorder — a complete disconnect with reality to the point of losing time (and in some cases, place):

This was not depression. This was not workaholism. I have a fairly severe mental illness that makes it hard to do my job — in fact, makes me totally ill suited for my job. I have a form of dissociative disorder that makes the world seem like it’s not real, as if things aren’t taking place. It’s hard to explain, but you feel untethered.

And because nothing seems real, it’s hard to connect with the world or the people in it because they’re not there. You’re not there. That’s why I rarely saw my family back then: It’s hard to care when everything feels as if it’s taking place in your imagination. And if you’re distant with people, especially women you’re romantically involved with, they eventually leave.

What makes my case even worse is that every night I go out on stage and have this incredible emotional connection between me, the band, and the audience. Then, just like that, it’s over. I go backstage, back to the bus, back to my hotel room, and sit there all by myself. That deep connection is yanked away in an instant. It’s like breaking up with your girlfriend over and over again, every night.

He’s found help, and encourages others who have a disorder like this to do the same.

I’ve always enjoyed Duritz’s voice and the Counting Crows in general, so I especially enjoyed the article. I hope you do too.

Read the full article: Mental Illness