This time I was left waiting. Children screamed and people who may be as impatient as I am moved their legs up and down rapidly. Everyone made a socially concerted effort not to look at each other.

I decided to settle in and read. At the rate the room was moving — sort of like a turnover rate at a bad job — it was clear I had at least 30 minutes longer to wait.

I have always found ‘literature’ in doctors’ offices disconcerting, though equally fascinating. After all, where can you find a magazine on parenting (a beautiful woman is holding a golden-haired toddler) and a celebrity magazine (apparently, Angelina Jolie has adopted five children from Nigeria) sitting side by side?

I noticed a brochure rack across the room, near the receptionist station, full of white and blue pamphlets. It always feels sort of weird getting up in a room full of people sitting down, but I made my way across the room with intent, avoiding people’s shoes and a toddler who had planted himself nearby. It contained the usual assortment of literature: six tips to live a healthy life, fascinating tips on how to get 30 minutes of exercise in each day and a guide to drinking more water.

Arranged in the same area, I found pamphlets on recognizing the symptoms of depression, bipolar disorder and schizophrenia and, to my complete surprise, a bleach-white brochure with the words “Understanding Psychosis” in bold and black text. Last time I was stuck in the office I read the pamphlets on getting enough calcium and the increase in cervical cancer among women under 30 years old.

I grabbed the brochure and walked slowly — the toddler had yet to move — back to my seat. It contained a first-person account written by a man who had lived with periodic psychosis and was now recovered. The symptoms of psychosis and their connection to other serious mental illness such as bipolar disorder and schizophrenia was included. But I wondered, did it make sense to have it in the waiting room, sitting beside the pamphlets on arthritis and increasing your fiber intake?

I decided to ask my doctor how he felt about mental illness creeping through societal cracks and into his sterile office. As a woman living with bipolar disorder, I feel it is long overdue. But what might he think, as a practicing physician who may not be familiar with psychosis? After all, it is usually a term, a diagnosis, associated with psychiatry.

My name was finally called and I soon found myself in his office. I will spare you the details of my appointment. I did not walk out with a prescription to cure me, no, I had a cold. Just like half of those sitting in the waiting room. He stood up, a signal for me to do the same, but I remained in my chair and pulled the brochure out my purse.

I asked him, point blank, how he felt about mental illness becoming more mainstream and handed him the brochure on psychosis.

He looked at it, and then back at me, and said simply: “Natalie, it’s about time people become educated on mental illness. I was not aware we had these in the clinic, but I’m damn happy we do.”

And so am I.

Eli Lilly — you know, that big pharmaceutical company — announced earlier this week that applications for the 2013-2014 school year are now available for the 15th annual Lilly Reintegration Scholarship.

The program provides funding for tuition, books and lab fees to people living with bipolar disorder, schizophrenia and related schizophrenia-spectrum disorders, so they may pursue and achieve their educational and vocational goals.

I think it’s a good thing when a company gives back to the community they serve. So I’m happy to pass this information along to interested readers.

“Reintegration” refers to restoring oneselve’s life in society — getting back to the way things were in your life before your disorder took over. It’s all the things a person might do from the time they start treatment until they meet their recovery goals.

An independent judging panel comprised of psychiatric care professionals review applications annually and select scholarship winners.

Lilly Reintegration Scholarship recipients have studied at Harvard, Yale and MIT, as well as hundreds of state and private universities, community colleges and trade schools. Recent areas of study include engineering, law, psychiatry, culinary arts, graphic design, social work, physics, education and computer sciences.

“Fifteen years ago, the prospects for higher education and a career for a person battling mental illness were small, as were opportunities to earn an academic scholarship,” said Ralph Aquila, M.D., executive director of the Center for Reintegration and chairman of the Lilly Reintegration Scholarship judging panel.

“However, data collected from this program over the years show that we have helped many people achieve their goals. On average, our Lilly Reintegration scholars have a 71 percent graduation rate, whereas the nation’s average for an incoming freshman class is 55.5 percent.

The goal of the Lilly Reintegration Scholarship is to help people with schizophrenia, related schizophrenia-spectrum disorders, or bipolar disorder acquire the educational and vocational skills necessary to reintegrate into society, secure jobs and to improve their lives. Through the scholarship program, Eli Lilly and Company furthers its ongoing commitment to providing tools that enhance the reintegration continuum, allowing people to move their lives forward and achieve their individual potential.

“Since its inception in 1997, the Lilly Reintegration Scholarship has helped hundreds of students to pursue educational opportunities, leading to meaningful jobs and achievement of important life goals,” said Bart Peterson, senior vice president, corporate affairs and communications, Lilly.

“Despite living with the challenges associated with severe mental illness, these dedicated students are an inspiration.”

Additional information about the scholarship and how to apply is available at www.reintegration.com (here’s the application).

Fortunately, a number of treatment practices exist that can assist an individual in adopting positive behaviors. If you or a loved one has been diagnosed with a mental health condition and has problem behaviors, consider talking to a mental health provider about the benefits of Positive Behavior Support (PBS).

What is PBS?

Positive Behavior Support (PBS) is a philosophy for helping individuals whose problem behaviors are barriers to reaching their goals. It is based on the well-researched science of Applied Behavior Analysis (ABA). A key component is understanding that behaviors occur for a reason and can be predicted by knowing what happens before and after those behaviors.

PBS interventions are designed both to reduce problem behaviors and increase adaptive, socially appropriate behaviors. These outcomes are achieved through teaching new skills and changing environments that might trigger problem behavior. Prevention of problem behaviors is the focus, rather than waiting to respond after a behavior occurs. PBS strategies and interventions are appropriate for children and adults diagnosed with a variety of mental health conditions such as schizophrenia, depression, autism, and intellectual disability.

Who is Trained in PBS? What Do They Do?

Mental health professionals, such as psychologists and behavior analysts, are trained to complete assessments and design PBS interventions. They conduct assessments, called structural and functional behavioral assessments, to determine when, where and why problem behaviors occur. For example, a mental health professional may conduct an assessment of a student who is identified at risk for expulsion and alternative school placement due to profanity and disruptive behavior in the classroom. The goal would be to learn what the student is achieving by using those behaviors.

A typical assessment would include several observations in different locations to determine which behaviors are problematic. It then would identify the environmental triggers that predict when those behaviors will and will not happen. The mental health professional would talk with the student, his or her family, teachers, other treatment providers and friends to answer questions about the problem behaviors.

From there, the professional would develop treatments that match the reason that the student is using the problem behaviors. These treatments include developing strategies to replace problem behaviors with appropriate behavior.

By learning and using new skills, an individual can stop using problem behaviors. For example, an individual diagnosed with schizophrenia may break the ceiling fan in her home because she believes that the fan is yelling at her. The mental health professional will teach her coping skills such as mindfulness, deep breathing, journaling, asking for help, or muscle relaxation. This gives her other, more acceptable behavior options to use the next time she believes that the fan is yelling at her.

While the mental health professional may lead the development of PBS treatments, the individual leads the implementation by learning and using these new skills or replacement behaviors. Additionally, key people in the individual’s life such as family, friends and co-workers learn how to implement PBS treatments to change the environment to support the individual.

Why use a PBS Approach?

PBS emerged in the 1980s to understand and address problem behaviors. As a holistic approach to treatment of mental health conditions, PBS has many attributes:

• It is person-centered. Using a person-centered approach, PBS addresses the individual and respects his or her dignity. This includes listening to the individual, recognizing the individual’s skills, strengths, and goals, and the belief that the individual can accomplish his or her goals. Treatments are developed to fit the specific individual rather than a “cookbook” approach.

• It causes positive changes. Through environmental changes and reinforcement of adaptive behaviors, individuals can reduce problem behaviors. Coping mechanisms such as relaxation can take the place of the problem behaviors. PBS minimizes the need for punishment or restrictiveness such as restraint, seclusion, or removal of privileges.
• It is outcome-focused. PBS places an emphasis on outcomes important to the individual and to society. These behavioral outcomes, such as fewer aggressive incidents, have the ability to make homes, communities, hospitals, and schools safer.
• It provides collaborative support. PBS involves collaboration with those who support an individual, including caregivers, support providers, doctors, nurses, teachers, aides, nurses, social workers, and team leaders. This collaborative process keeps everyone involved in the individual’s treatment and allows for new behaviors and skills to be supported in all settings.

Does PBS Work with Other Treatments?

PBS may be practiced alongside other treatment interventions as part of a multidisciplinary approach to mental health treatment. For example, an individual who is prescribed medication by a physician or psychiatrist for mental health conditions such as schizophrenia, autism or impulse control disorder could benefit from PBS. An individual who sees a dietician to help with specific nutritional needs such as in Prader-Willi Syndrome, or receives occupational, speech, or physician therapy, may also benefit from PBS techniques.

PBS is consistent with other treatment approaches that are person-centered or recovery-based. This means that they can work well when used together. PBS interventions are inconsistent with restrictive or punishment-based interventions. PBS interventions are used instead of these approaches.

Since PBS is a holistic approach, and clinicians consider all aspects of an individual when assessing and developing interventions, it is helpful for a PBS clinician to become a member of an individual’s interdisciplinary team. PBS-trained professionals have experience working directly with other health care professionals to design treatments. For example, a PBS-trained professional may work with speech therapists to develop communication boards for non-verbal individuals who engage in self-injurious behaviors such as head-banging or skin-picking.

Without treatment, the consequences of mental illness are astounding: disability, unemployment, substance abuse, homelessness, incarceration, and suicide. While medication and other interventions have proven to be beneficial in many mental health conditions, a multidisciplinary approach that includes a behavioral component can offer support mechanisms critical in the treatment process.

Talk to a mental health professional about the benefits of PBS.

Joshua talked about the stigma associated with living with schizophrenia and shed light on the reality of the illness: Those living with the illness often lead productive lives.

Rebecca S. Roma also is featured in the documentary. She provides viewers with a unique perspective: She works primarily with chronically mentally ill patients who are living in the community after long-term hospitalization. She has dedicated her life to keeping the mentally ill out of hospitals and the legal system.

Click through to read the interview.

Q. Rebecca, why did you choose to participate in the documentary?

A. I was moved by patients’ stories and I was excited to do something that could be educational to patients, families and others involved in the lives of those living with severe mental illness.

Q. In the documentary you explain that people suffering with schizophrenia often experience their first break during late high school or early college years. I experienced symptoms and was diagnosed with juvenile bipolar disorder at age 12. What are your thoughts on such early diagnosis?

A. I think that people with schizophrenia may have a prodrome (a precursor to the emergence of disease), but psychotic break is not until later. I think it is difficult to label a young person, but you can have a rule-out diagnosis. If there are symptoms as a child I think they should be treated regardless of a definitive diagnosis, if other causes are ruled out.

Q. What is your opinion regarding negative media coverage on schizophrenia? For example, those living with the illness often are portrayed as being violent.

A. I think that often law enforcement agents are not educated enough about how to recognize mental illness. Time and time again I read about situations with unnecessary force being used.

If more people were in treatment and stabilized on medication, perhaps these confrontations could be avoided. The problem is both with access to mental health care as well as not enough education for police and others who may come into contact with persons with schizophrenia.

Q. Within the documentary, you state that patients have a difficult time trusting care providers. Can you elaborate on this?

A. Many times patients have the impression that they have been mistreated by care providers. This is in part due to the fact that many times patients’ insight has deteriorated to the point that they are forced to receive treatment involuntarily.

If people were stabilized on medication such as long-acting injectables, they may gain the insight to form collaborative partnerships with treatment teams. The way health care is set up, oftentimes patients have the impression that not enough time is spent with them. Oftentimes psychiatrists are required to only spend 15 minutes per patient. Therefore developing strong therapeutic alliances with the patient is a challenge.

Q. You talk about the reality of schizophrenia. Millions of people live with this illness. If you could tell our readers one thing regarding that, what would it be?

A. Many people have schizophrenia and other severe mental illnesses. Often persons with schizophrenia are stable and living a fulfilling life. Schizophrenia is not synonymous with aggression or violence. The cases that make the news are the exceptions. Most of us know people who are suffering but they can be “hidden” because their symptoms are under good control.

People living with mental illness are just people. They are not defined by their illness. It is just a small part of who they are or how they live their lives. If you have a mentally ill family member, get them into treatment. Encourage long-acting therapy so that relapses are minimized. Work with the treatment team if you can to help your loved one.

Q. Do you have anything you would like to share with our readers?

A. Schizophrenia is a chronic disease but hope is needed to live a meaningful and fulfilling life. It is not a death sentence!

Q. Do you have a particular book or article(s) you would like to direct our readers to?

A. I think that NAMI is an important group for both persons with disease as well as families. I think also the more people who can actually view the documentary the better.

Dr. Roma received her medical degree from the University of Pittsburgh School of Medicine. She completed residency training in psychiatry at the Western Psychiatric Institute and Clinic, a component of the University of Pittsburgh Medical Center. During her residency, she was a recipient of the American Psychiatric Association/Janssen Resident Scholarship. Dr. Roma is Board Certified in Adult Psychiatry. You can view the documentary she is featured in, “Living With Schizophrenia: A Call for Hope and Recovery” on the Choices in Recovery website. The site is a service of Janssen Pharmaceuticals, maker of psychiatric medications for bipolar disorder and schizophrenia.

This is a description from Richard Noll’s fascinating book, American Madness: The Rise and Fall of Dementia Praecox, of the man who’d become the most influential psychiatrist in the U.S. in the first few decades of the 20th century — and the one who’d bring dementia praecox to America.

Swiss-born Adolf Meyer didn’t just have little formal training in psychiatry; he essentially knew nothing about it. Fortunately, in 1896, 29-year-old Meyer got the crash course he needed when he set off on a tour of European psychiatric facilities.

At the time he was working as a pathologist at Worcester Lunatic Hospital in Massachusetts; the goal of the trip was to get ideas for potential improvements he could make at his hospital.

His most important stop would be in Heidelberg, the location of a small university psychiatric clinic. There, Meyer met psychiatrist and chief Emil Kraepelin – the man behind dementia praecox. During his visit, Meyer read Kraepelin’s textbook, Psychiatrie, talked with Kraepelin and watched his staff at work.

It was in this book that Kraepelin described dementia praecox, an incurable psychotic disorder. Dementia praecox began after puberty, progressively worsening until it led to irreversible “mental weakness” or “defect.” Individuals with dementia praecox could look very different depending on their combination of symptoms.

In the sixth edition of his textbook, Kraepelin categorized dementia praecox into three subtypes “connected to each other by fluid transitions:” catatonia (abnormal movement; usually started with depression and “nervousness,” and led to hallucinations and delusions); paranoid (fixed delusions of persecution and grandiosity are common with auditory hallucinations) and hebephrenic (disorganized thinking and problems with attention, language and memory).

In the introduction, Noll refers to dementia praecox “as a diagnosis of hopelessness from its creation.” The public along with alienists and other medical authorities viewed dementia praecox as “the terminal cancer of mental diseases.”

In the same edition, Kraepelin also introduced “manic-depressive insanity,” which, according to Noll, “encompassed all the insanities whose primary symptoms were based in mood or affect, characterized by periodic manic states, depressed states, mixed states, or varying combinations thereof, which would wax and wane over the course of a person’s life but leave no or little cognitive defect between episodes.” It had a much better prognosis than dementia praecox.

(This later edition had a major impact. Noll says that “Since the 1970s it has been asserted that neo-Kraepelin clinicians created the structure and diagnostic content of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition” (DSM-III) of 1980, and this bias has continued in successive editions until this day, including both clinical practice and research.”)

Back in America diagnosis was a tricky, murky process. And classification simply didn’t exist. There was no such thing as specificity or discrete diseases.

As Noll writes, most American “alienists” – as they called themselves – believed that there was one form of insanity: “unitary psychosis.” Different presentations were simply different stages of the same underlying disease process. These stages were: melancholia, mania and dementia.

After Meyer returned from his European trip, Worcester became the first hospital in America to use Kraepelin’s theory of insanity. And it was at Worcester that the first person was diagnosed with dementia praecox.

As Noll told the Harvard University Press Blog in this interview, dementia praecox would become the most prevalent diagnosis:

Beginning in 1896, as one American asylum after another slowly introduced dementia praecox as a diagnostic box, it became the most frequently diagnosed condition, labeling a quarter to a half of all patients in each institution. How American psychiatrists were making this diagnosis is anyone’s guess—they were probably just snap decisions based on whether someone was suffering from a “good prognosis madness” (such as manic depression) or a “bad prognosis madness” (dementia praecox). What we do know is that being young and male made it more likely someone would receive this diagnosis.

The public was introduced to dementia praecox by a 1907 piece in the New York Times that recounted the testimony in the murder trial of architect Stanford White. The superintendent of an asylum in Binghamton, N.Y. testified that the murderer, Harry Kendall Thaw, might’ve been suffering with dementia praecox.

In the late 1920s to the 1930s, dementia praecox started making its exit, replaced by Eugen Bleuler’s “schizophrenia.” At first, Noll says, these terms were used interchangeably in both clinical practice and research (which, naturally, made things very confusing). But these disorders had distinct differences.

For instance, the prognosis for “schizophrenia” was more positive. Bleuler, Carl Jung and other staff members at Burgholzli psychiatric hospital – where Bleuler was director – showed that many of the 647 “schizophrenics” were able to get back to work.

Bleuler also viewed some symptoms of schizophrenia as being directly caused by the disease process, while others as “…reactions of the ailing psyche to environmental influences and its own strivings.”

Unlike Kraepelin, Bleuler viewed dementia as “a secondary result of other, more primary symptoms.” Other secondary symptoms included hallucinations, delusions and flat affect.

The symptoms that were directly caused by the disease process were, writes Noll:

The simple functions of thought, feeling and volition that were disturbed were associations (how thoughts are bound together), affectivity (feelings as well as subtle feeling tones), and ambivalence (“the tendency of the schizophrenic psyche to endow the most diverse psychisms with both a positive and a negative indicator at one and the same time”).

Unfortunately, Americans put their own spin on schizophrenia. According to Noll in his interview:

By 1927 schizophrenia became the preferred term for inexplicable madness, but the Americans reframed Bleuler’s disease concept as a primarily functional or psychogenic condition that was caused by mothers or maladjustments to social reality. When Bleuler visited the United States in 1929 he was horrified to see what the Americans were calling schizophrenia. He insisted it was a physical disease with a chronic course characterized by exacerbations and remissions of hallucinations, delusions and bizarre behaviors.

Dementia praecox officially vanished from psychiatry in 1952 when the first edition of the DSM was published – and the disorder was nowhere to be found.

But, while it wasn’t around for long, dementia praecox had a significant impact on the field of psychiatry. According to Noll in American Madness: 

Dementia praecox was the vehicle through which American psychiatry reentered general medicine. It descended into American asylums from the Valhalla of superior German medicine and presented American alienists with a divine gift: its first truly specifiable disease concept.

…

There could have been no modern medical science of American psychiatry in the twentieth century without dementia praecox. There can be no biological psychiatry in the twenty-first century without schizophrenia.

Further Reading

Be sure to check out the excellent book American Madness: The Rise and Fall of Dementia Praecox by Richard Noll, Ph.D, associate professor of psychology at DeSales University.

Bipolar disorder often is associated with intelligence, creativity, highs and lows. But schizophrenia is viewed differently. Society often is confronted with negative imagery: A homeless man or woman, dirt under their fingernails, mumbling to themselves; bars on hospital windows where they are confined and, above all, violence.

The stigma connected to schizophrenia, and to those who live with the illness, is different from that connected to people living with depression or bipolar disorder. It is harder to shatter; it is harder for people to understand.

Stepping out and putting a face and a name to my illness was anything but easy. But more people are doing this, and in doing so, we can lessen the stigma.

I had the pleasure of interviewing Joshua, who is featured in the documentary “Living With Schizophrenia: A Call for Hope and Recovery.” Joshua was diagnosed with schizophrenia at the age of 17 following psychotic symptoms. He describes his experience living with the illness. Joshua effectively puts a face and name — a life story — to a horribly stigmatized illness.

Q. Joshua, you were an integral part of the documentary “Living With Schizophrenia: A Call for Hope and Recovery.” Was it difficult for you to put a face and a name to an illness which carries a great deal of stigma?

A. It is a little difficult to be open about my illness when I think about some of the stigma out there. I chose to do it because I want to help promote the fact that we’re not all axe murderers.

Q. What do you hope viewers and readers can gain from your experience?

A. I hope to provide a little insight for your readers regarding schizophrenia and the surrounding issues of stigma. It was exciting to work on the project and I don’t mind being labeled.

Q. Joshua, you were diagnosed with paranoid schizophrenia at the age of 17. It is difficult for people who do not live with the illness to understand the confusion surrounding it. How do you describe your first episode?

A. I was definitely confused … My family and I were in denial when I was initially diagnosed. It’s hard to describe the nightmare without reinforcing negative stigma.

Q. Those living with schizophrenia often are deemed “violent.” It might surprise people to know that the attempted suicide rate is a staggering 50 percent. What are your thoughts on this?

A. Probably many of the suicides are related to the stigma. I imagine that many people experience persecution or discrimination because of the stigma.

Q. Law enforcement often intervenes before a person can be diagnosed and treated. Do you think that those in the field could benefit from more education on the illness?

A. I believe law enforcement fulfills an important role for folks who don’t want help but may need it. My advice for field officers would be to sign up for crisis intervention team training. I think there should be incentives for those who volunteer.

Q. In the documentary, you talk about the importance of family—your father is a fantastic support to you. What advice would you give to those who do not have family support? Mental illness can be isolating and lonely.

A. There are a lot of folks who do not have family support for one reason or another. They might have treated their family really bad and burnt bridges … Maybe the family is embarrassed due to the views of society. Whatever the case, it helps to have support. There are many programs and centers out there that offer peer-to-peer support … Peers can help fill the void when family support is not there.

Q. You state that being able to share your experience with mental illness is a “privilege” as it works to keep you stable. Can you elaborate?

A. I could not have told someone six or eight years ago that recovery is possible. I feel privileged to be able to share that with people. Every time I’m able [to share] it makes me feel better about myself and my recovery.

Q. Do you have anything you would like to share with our readers?

A. I have been a long time e-mail subscriber to PsychCentral.com and I truly appreciate the articles and opinions expressed here.

Joshua has worked for the National Alliance on Mental Illness (NAMI) and has run peer-to-peer programs, sharing his story. In addition, he worked in a local jail, helping individuals with mental illness in the justice system. “The most meaningful thing about that work is [that] I’m using the same system to give back to the community that has actually given me the life I’m living,” he said.

You can view the documentary Joshua is featured in, “Living With Schizophrenia: A Call for Hope and Recovery” on the Choices in Recovery website¹ .

1. Choices in Recovery is a website published by Janssen Pharmaceuticals (makers of psychiatric medications used to treat bipolar disorder and schizophrenia).

Brief psychotic disorder could be most simply thought of as a form of short-term schizophrenia, since many of the symptoms of the disorders are exactly the same. The primary difference is that in a brief psychotic disorder, the psychosis is less than 30 days.

Let’s delve more into brief reactive psychosis and talk about how one “gets it” (don’t worry, it’s not catching).

Brief Psychotic Disorder is characterized by the presence of one or more of the following symptoms:

• Delusions
• Hallucinations
• Disorganized speech (e.g., frequent derailment or incoherence)
• Grossly disorganized or catatonic behavior

The duration of an episode of brief psychosis is at least one day but less than one month, with eventual full return to previous level of functioning. It is most often found in adults in their late 20s or early 30s.

Generally, you might make this diagnosis over a diagnosis of schizophrenia because the psychosis hasn’t yet reached 30 days. Once you get past that one month mark, however, a diagnosis of schizophrenia would usually be more appropriate.

The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) is silent on the causes of this disorder (as it is generally for all mental disorders). But the article claims that “extreme stress” was the cause of it in Russell:

“The preliminary diagnosis he received is called brief reactive psychosis, an acute state brought on by extreme exhaustion, stress and dehydration,” Danica Russell said. “Though new to us, the doctors say this is a common experience given the great mental, emotional and physical shock his body has gone through in these last two weeks.

“Even for us, it’s hard to understand the sudden transition from relative anonymity to worldwide attention — both raves and ridicules, in a matter of days.”

While I don’t discount Danica Russell’s beliefs, nor the explanation she was given by his doctors, the truth is that — like most mental disorders — we really don’t know what causes brief reactive psychosis. After examining the research on the causes of brief psychotic disorder, I have to say there’s just not a whole lot there, because it’s such a rare and uncommon disorder. There are no lab tests for it, nor other medical procedures that can tell you with any certainty that X has caused it.

I believe that Jason Russell’s doctors do a disservice to the complexity of mental disorders and the people who suffer them by suggesting a cause is readily known when, in truth, there’s no way they could make such a determination. I know doctors don’t like to say, “We don’t know what caused it, but it might’ve been…” or, “We don’t know what caused it, but the good news is that we have a lot of treatments that seem to work in most people…” Yes, these are more nuanced and complex explanations, yet they are so vitally important to ensuring we don’t “dumb down” mental disorders to the point of repeating ignorance.

We don’t really know what causes brief psychotic disorder — in Jason Russell or anyone else.

But we do wish him a speedy and complete recovery.

Read the news story: Wife: ‘Kony 2012′ director suffers from psychosis

On a completely unrelated note, I also wanted to point out our Schizophrenia Screening Test — one of the few available online. Few people actually have schizophrenia — a disorder characterized by hallucinations and delusions that severely impact a person’s life. But this disorder often rears its head in a person’s 20s, so it’s something to be aware of if you’re concerned about inexplicable symptoms in yourself or a friend. Take the 12-question quiz now to find out if you might benefit from consulting a mental health professional.

Schizophrenia, like all mental disorders, is treatable. The key to getting treatment, though, is recognizing there’s a problem to begin with.

Neither of these quizzes — like all the psychological tests we publish — are meant to diagnose you. Instead, they are just here to give you a general idea about a certain set of symptoms or characteristics about yourself. We hope you find them useful.

When Costello’s oldest son is diagnosed with paranoid schizophrenia, she traces her family’s history of mental illness and makes some surprising discoveries — such as her grandfather’s well-guarded suicide.

A Lethal Inheritance is a must-read for anyone who’s been touched by mental illness, especially parents who feel helpless and hopeless. Costello shatters the myth that mental illness is a death sentence, along with countless other misconceptions.

She also recounts how she and her sons coped with their mental illness and achieved full recovery. And she does an excellent job of simplifying complex concepts and informing readers of the newest research.

In the book, Costello shares three powerful lessons she’s learned “on [her] journey through mental illness.” First, she admits to doing things in the wrong order, such as not seeking treatment for her own depression. She writes, “If we, as parents, get treatment for our own psychological or addiction issues, our children will suffer far fewer mental illness.”

Second, she learns that it’s important to intervene early with mental illness rather than “picking up the pieces later.” And third, she learns that “…although we’re each born with inherited liabilities and assets, throughout our lives, our minds become largely what we make of them. Put simply, nurture can trump nature.”

Below, Costello reveals other lessons as she explains what inspired her to write A Lethal Inheritance, the signs of mental illness caregivers should watch out for, how mental illness can be prevented and much more.

Check out Costello’s website for more information on A Lethal Inheritance.

Q: What inspired you to write A Lethal Inheritance?

A: The initial inspiration for writing this book came in 1998 when my then 18-year-old son Alex had a psychotic break, along with his subsequent treatment and recovery from a diagnosis of paranoid schizophrenia.

Facing Alex’s crisis forced me to take a hard look at my own lifelong, untreated depression. It spurred me to dig into my family history where I found a trail of hidden mental disorders and addictions.

Dealing with all of this became a decade-long journey: beginning in the psych emergency room with Alex and concluding with a trip to my father’s ancestral family farm in Western Ireland where I made emotional peace with this family legacy.

Over the course of this decade, I used research skills I’d acquired in my work as a journalist to explore the science of mental illness. Since many things I learned helped me and my sons personally find our way to recovery, I felt I had to share this information with others.

In the end, our family’s experiences served as a case study to help readers understand that mental health problems such as ours are common, and, most importantly, treatable and preventable.

Q: In your book you mention the early signs of mental illness that you missed in your son Alex. Even as a baby, you write that he seemed different. What signs can parents watch for?

A: Some of the early signs resemble those linked to autism, for which parents are already told to monitor their toddlers and preschool children. Newer research is now establishing the existence of signals that can indicate a higher risk for schizophrenia — particularly if the child also has a family history of a psychotic illness such as schizophrenia and some types of bipolar disorder or suicide.

Some developmental signs include sitting, walking and talking later. The child may also have a preference for solitary play at 4 — usually a very sociable age — something that was very true of Alex.

In an older child, social withdrawal, anxiety, antisocial behavior and acts of self-harm are also associated with a higher risk.

There are also risk factors for schizophrenia in genetically vulnerable children over which parents can have at least some control, such as maternal malnutrition and depression; bullying and child maltreatment; and cannabis smoking by adolescents. No one or two of these signs should be seen as red flags. Only in combination do they merit parental concern.

Q: You talk about the importance of knowing your family’s mental health history. Why is this so critical?

A: Even after I started putting the personal and the scientific pieces of this story together, I didn’t initially have the intention of going back three generations and looking deeply into my family mental health history. In fact, I resisted it.

Like most people I thought of our family’s troubled past—so much depression and alcoholism, my sister’s drug use, and at least one likely suicide by a grandfather that had always been represented as a tragic accident—as “dirty laundry,” better left covered up.

However, when I looked at the connections researchers were finding between different mental disorders and addictions that appear in successive generations of families like mine—and then took into account my depression and the depression and anxiety disorder that arose in my youngest son—I found patterns that helped me understand why we were are such high risk for these disorders.

I could also see that we were an example of the finding that as these disorders remain untreated in families, they grow more severe with each passing generation. I knew this type of information could help other parents know their children’s risks and possibly even avert these disorders before they took hold.

Q: The individuals in your family who also struggled with mental illness were called “weak” or “no good.” Unfortunately, even though there’s more information and education today, our society still tends to think the same way. Why do you think there’s so much stigma surrounding mental illness?

A: There are many reasons why stigma is still so strong. One is the outmoded belief that a diagnosis of schizophrenia is akin to a “death sentence.” This refusal to see that many people with a severe mental disorder can reach sustained recovery, along with the parallel reality that those with initial symptoms can be treated so they don’t have to progress to a full-blown state, seems intransigent within society and, sadly, even in psychiatry.

I’ve come to think that one of the better ways out of this stuck place we seem to find ourselves in is for us all to recognize that mental illness exists along a spectrum of severity, and, on the less severe end of the spectrum, mental illness is actually a nearly universal experience.

Only when symptoms such as paranoia or social withdrawal begin to make a person’s life unworkable would they need mental health treatment. In this model, perhaps, we could begin to deal with cognitive or emotional disturbances as we do a “physical illness”—encouraging people to get treated as soon as symptoms develop and not wait until after the disease has had months or years to reshape their brains and behavior for the worse.

Q: You write that in many cases mental illness can be prevented. How so?

A: To prevent mental illness you must know your genetic risks for a particular disorder based on your unique family history. If you know there’s a history of depression, or bipolar disorder, you can look for early symptoms connected with those disorders.

For example, ADHD appears more often in offspring of parents and grandparents with bipolar. With that history you might look at a child’s attention problems or signs of hyperactivity differently. If they continue or grow worse, you would consider intervention. Initially, that might mean targeted parent education to show you how to step in and calm a hyper or irritated child, or both of you might go for parent-child interaction therapy.

Prevention, with or without a family history, also means taking concerted “neuroprotective” actions such as consciously building family emotional resilience by doing more talking and playing together, honoring differences of temperament and interests in your children, and building true self-esteem by rewarding their efforts over performance.

Q: Anything else you’d like readers to know about your book or mental illness in general?  

A: After Alex received a diagnosis of schizophrenia at age 18, I was given the message by his doctors that Alex’s prognosis was bleak; his life would now be about symptom management and repeated hospitalizations.

Being the stubborn type, I refused to accept it. Now there has been a decade-long track record showing the positive results of early interventions such as Alex received. Had we waited the conventional six months or more for his symptoms to take hold, I don’t think Alex would have recovered as fully as he fortunately has today.

In order for others like him to have this option, I think parents should get informed about issues such as the pending revisions of the DSM-5 that would allow and encourage early treatment of conditions such as psychosis, ADHD, bipolar disorder—not to start kids or teenagers on medication, but to begin a therapeutic process that acknowledges the suffering that young people are experiencing and parents are seeing, and allows for the right treatment choices for that individual and family to be available just as they would for any other illness.

***

In addition to being an Emmy Award-winning science writer, Victoria Costello also is a board member of the MHA of San Francisco. She speaks to parents and mental health providers about preventing mental illness in at-risk families, and resources for achieving mental wellness. Costello writes about the latest research on child and adolescent mental health at her excellent blog www.mentalhealthmomblog.com.

So even though schizophrenia can often be treated fairly effectively with medications and psychotherapy, it often is not because medication compliance becomes a significant ongoing issue.

This results in many people with schizophrenia going in and out of inpatient care. Because inpatient psychiatric care is virtually non-existent in most states any longer, this means a primary treatment point for people with chronic, serious mental illness defaults to the local hospital emergency room (ER).

While most ERs are setup to handle people with a serious mental illness fairly well, ERs aren’t exactly known for their warm-fuzzy, emotionally-supportive environments. So people slip through the cracks.

In this case, the woman with schizophrenia who slipped through one hospital ER’s cracks was Cindy Ciarafoni, a mother of two, who died when she apparently wandered out of the ER and tried crossing a busy highway. She was struck by a car and later died from her injuries. Now her family wants to know what happened, but the hospital is being tight-lipped.

Cindy’s story is that she had a history in the past three years of deteriorating behavior. In the past 6 months alone, she had been hospitalized about once a month, according to her family.

On New Year’s Day, she was acting strangely in a local Toronto coffee house. Police were called, who then called paramedics to take her to the hospital when it was apparent Cindy was suffering from a mental illness and needed treatment.

She was dropped off at the hospital just before 5:00 pm, and signed in by the triage nurse to the emergency room at Humber River Regional Hospital’s Church St. campus.

Her family was notified by the police of her hospital admission, but since it had become a commonplace occurrence, her family was not concerned for her safety or well-being. They knew she’d be kept under observation for at least 72 hours.

A day later, they got another phone call from the police. This was not as good a call, because Cindy had been hit by a car 10 kilometers north of the hospital.

Here’s the kicker. The hospital has refused to answer questions about the incident, citing “patient confidentiality.” But when the family has tried to get answers, all they’ve gotten is a stone wall:

Danny said he never received a call to tell him his wife had left the emergency department without being assessed or admitted. The family said the hospital has been uncooperative about telling them what happened that night.

“They’re not even calling us back, so it’s frustrating,” Ciarafoni-McGrath said.

Why is the Humber River Regional Hospital stonewalling? What have they got to hide, except for the fact that a patient was dropped off in their ER, and they didn’t notice when she left on her own long before being seen by a doctor.

But the hospital emergency record obtained by the family shows that when a physician attempted to begin a preliminary assessment six hours later, at 11:36 p.m., there was no answer — indicated by a slashed zero and the word “answer.”

This is the problem when hospital ERs become dumping grounds for people with serious mental illness who need special attention and care. Some hospitals are just ill-equipped and their staff aren’t properly trained to help such people.

This tragedy could’ve been prevented had the hospital had a procedure in place to ensure that people with special mental health needs are properly taken care of once signed in. Not left in the waiting room like someone with a broken arm. Staff training is also a must, because they need to be alerted about the needs of people with a mental health issue.

Hopefully answers will be forthcoming. In the meantime, hospitals should take this opportunity to review their own ER procedures to ensure they take into account the needs of people who have a mental health concern.

Read the full story: Family seeks answers after woman with schizophrenia dies on road

Photo: Renee Ciarafoni-McGrath with her mother, Cindy, at Renee’s wedding supplied by the family.

But schizophrenia, like all mental illness, can also be a teacher. Albeit often a hard one.

Dr. Anne Aspler, writing in the Globe and Mail earlier this week, recounts her experiences in what she’s learned in growing up with a mother who suffers from schizophrenia, and the fear she lived in during her early adulthood that she, too, might suffer from this disorder.

She recounts her fear in knowing her mother’s diagnosis:

My mom is afflicted with schizophrenia. Despite never having had signs or symptoms, I used to live in constant fear that, one day, I might develop it. The path of my life was driven by this fear. I overworked myself to ensure a livelihood that would enable escape from the stigma of mental illness and unemployment. Becoming a doctor seemed the best I could do to champion my own mental sanity, and to further understand an illness that has never made sense to me.

But I found her musings about the nature of mental illness and what living with someone with a serious mental illness most insightful:

I understand now that “mentally healthy versus ill” is an often unhelpful dichotomy. The psyche of the population exists on a spectrum. Scientifically, we have constructed an arbitrary standard. Past a certain point of dysfunctionality, some will be labeled, recommended for therapy and medically treated.

The rest of us can retain our status as “normal” and obtain socially acceptable therapy in the form of free counseling from family members and friends, self-therapy in the form of reflection, and perhaps moderate doses of self-medication.

Even for one individual, mental wellness fluctuates immensely over time. Practicing medicine has reaffirmed for me that there is not one among us who is 100-per-cent mentally sound in all day-to-day exchanges and decision-making. Most of us could probably cite one or two mental hang-ups they could do away with. Thankfully, we escape any permanent labeling and write these off as a mood, an anxiety, impulse or worry. [...]

The reality? My mother is a great parent. With age, I’ve come to appreciate that her demeanor has given me a positive outlook on life; and it has imbued me with an inordinate capacity to tolerate chaos and disruption

While I don’t believe it’s true that every cloud has a silver lining, I do believe that even the most negative life experiences can teach us something that we can take into the future with us. It’s often hard to see or appreciate what those specific things are when we’re in the midst of them. It’s often only later on, with time and hindsight, that we begin to appreciate what we’ve learned.

Many people have negative experiences associated with serious mental illness like bipolar disorder or schizophrenia. But sometimes there is something we can learn from the experience nonetheless, as long as we keep an open mind.

Because people with mental illness are not “them.” They are us. It touches each and every one of our lives, and we need to stop thinking of people who have a mental illness as “someone else.” Stories like this one go a long way in helping us understand that.

Read the full article: Blessings from schizophrenia? Believe me, they exist

* 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.

Well, it took five patrol cars, 6 officers, tasering 37-year-old Kelly Thomas numerous times, and beating him so badly that he went into a coma. And then died a few days later.

What was Thomas’s alleged crime that resulted in his death? Breaking into cars, looking for things to steal.

Welcome to our more violent America, where citizens stand by while the police beating took place, too afraid to intervene and save Thomas’s life. Is this what we’ve come to?

Kelly Thomas was a long-time member of the Fullerton homeless community, and apparently had schizophrenia. While sometimes scary looking (as not bathing and not having access to regular changes of clothing and grooming accessories does to many people), people on Fullerton Stories mostly remember Thomas as a “quiet and polite” man, someone who was “gentle and childlike.” But of course, untreated schizophrenia can result in strange and unpredictable behavior — behavior that some might take as threatening or hostile.

Gawker has the story:

Thomas—who suffered from schizophrenia, and was homeless—caught the attention of the police after someone reported that a burglar was breaking into cars parked near a Fullerton bus station. When officers approached Thomas in the depot parking lot and tried to arrest him, he resisted.

So his apparent crime was breaking into cars. Why do you need to use such force against a common thief?

To me, this is just another example of poorly trained police officers who immediately jump to conclusions about a person — “He’s homeless, he must be drugged up, he must be looking for his next high, he won’t know what hit him” — and let the chips fall where they may.

What police are forgetting is that nowadays, people are everywhere with their camera phones and other video recording devices. They can no longer hide behind their paperwork and “let’s all tell the same story and stick together” mentality — the video will tell the truth.

And while the person who shot the video below was way too far away to actually shoot anything happening (even the distant sounds are hard to make out, especially over the running commentary by the person shooting the video), it’s still pretty interesting from a perspective about the psychology of a small group of citizens looking on to a show of force by their own police.

Here’s a small group of people who, from their comments, are pretty clearly upset and adamant that the police are going too far in this situation and beating a single person — 6 against 1. But instead of forming a cohesive group and bringing their concerns to one of the officers, they stand back, far away from the action with a “It’s none of my business” mentality. The group is afraid — fear keeps them back and nonconfrontational.

This may also be an example of the power and pull of authority on groups of people, as illustrated by famous experiments such as the Stanford prison experiment by Philip Zimbardo in 1971 or the Milgram experiment by Stanley Milgram in 1961. We may be inclined to obey authority figures without question, even when doing so goes against our own personal morals and values.

And, after all, if our own local police department can do this to a man — a man who was doing nothing more than allegedly breaking into cars — what might they do to me if I try and intervene on another human being’s behalf?

An investigation into the six officers behavior has been opened by the district attorney’s office, so only time will tell whether “reasonable force” was used in this situation. But by all accounts, here was a man who was mentally ill who didn’t deserve to die for his crimes.

Video of the incident (taken from afar):

Witness who saw the beating describes it:

“They kept beating him and Tasering him. I could hear zapping, and he wasn’t even moving,” said Turgeon. “He had one arm in front of him like this, he wasn’t resisting. And they kept telling him, ‘He’s resisting, quit resisting,’ and he wasn’t resisting.”

Interview with Ron Thomas, the man’s father and a former sheriff’s deputy:

Read the full article: Police Beat ‘Gentle’ Homeless, Mentally Ill Man to Death

Photo courtesy of The Fullertonian.

We commend Andrew Brown for his calling out Professor Nutt in trying to dumb down the portrayal of mental disorders to simply “brain diseases.” Mental disorders remain complex disorders that involve all aspect of a person’s functioning and life — their brain and biology, their psychological makeup and personality, and their social interactions and relationships with others. The cause isn’t just one of these things in the vast majority of people who have a mental illness — the cause is all of these things, in differing proportions.

I’ve written about this in the past and in fact, I tag it as one of the top 10 myths of mental illness — because it still is. Even well-meaning family physicians and psychiatrists still refer to the false chemical imbalance theory as though it were fact. A theory, by the way, that has never enjoyed strong research support.

Depression, like all mental disorders, is caused by a complex and still poorly-understood confluence of a combination of factors. Anyone who says, “We know what causes depression, it’s _______________,” is either badly misinformed or simply ignorant. The truth is that we don’t know what causes depression. It’s not genetics or a single gene. It’s not simply a poor upbringing or horrible family situation. It’s not just a “depressive” personality or some other psychological factor. It’s most definitely not simply a “brain disease,” that is a disease of the brain that can be cured by simply shocking it (as in ECT) or drugging it (as in giving it antidepressants).

It doesn’t help, either, when major national mental health organizations refer to mental disorders as being “serious medical illnesses,” as though medicine could explain everything and is the only profession that offers treatment for them. Medicine is a part of the understanding and treatment of mental disorders, but it is not the whole picture. Proper treatment nearly always requires other professions — especially those from psychology and even social work — to be clinically effective. If you’re getting treatment for something serious like depression only from a physician (who isn’t a psychiatrist), you’re getting some of the worst treatment possible for it.

There are a lot of clinically-proven, effective treatments for depression and other mental disorders. Yes, they include the use of psychiatric medications when appropriate. But more often than not, they should also include the use of psychotherapy, and other therapeutic modalities and support when appropriate (such as social skills training programs, day programs, support groups, etc.).

Mental disorders are not simply brain diseases. If you hear a professional referring to them as such, you should take everything else they say with a grain of salt.

Read the full article: Depression is not a ‘brain disorder’

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.