Archive for the ‘advocacy, politics, and stereotypes’ Category

Please go read Mind Hacks’ entry on disorders, rhetoric, and politics. It says some stuff I would like to say, and will say later anyway, but it says it better. I’m working on an entry right now about motives driving people’s distinction between “biological” and “situational” depression.

(This entry brought to you by Panera’s free Internet, which extends out into the parking lot, so I’m publicizing them because I didn’t buy anything. Thank you, Panera.)

A friend asks: do you know if there’s been any progress informing the public about the difference between “psychopathy,” “psychosis,” and “psychotic axe-murder?” which should probably be “psychopathic axe-murderer,” now that I think about it.

I don’t know, but it’s probably similar to when other terms have been adopted by the public and used pejoratively (like “idiot,” “imbecile,” and “moron,” originally specific technical designations). Then we switch to different terms like “mentally retarded” which the public then starts using as an insult, and move on to “developmental delay,” “developmental disability,” “intellectual disability,” etc.

All of these terms have been used to refer to very similar things, which interested parties want to destigmatize, some people merely wish to describe accurately, and many people want to mock and insult. Linguist Steven Pinker calls this the euphemism treadmill.

I think it’s virtually certain that words for mental illnesses and symptoms will continue to be turned into words that mean “completely unresponsive to social norms, and violent” or “SUPERDANGEROUSWILLKILLYOU”.

So what if instead we gave them a word or phrase to name the kind of person they’re trying to name: the kind of person everyone is afraid of, someone who is not merely malevolent and physically dangerous, but so mentally unbound from laws and rules and social demands that nothing you can do will stop them?

Such as “horror movie killers”. Or “Jasophrenics” (after Jason of the various horror movies, but with “phrenic” (“minded”) added because most people named “Jason” are not horror movie killers. Or “berserkers” (though I think that’s kind of mean to the originals. I wonder if they had to go around after battle explaining to people that they weren’t the equivalent of horror movie killers?). I also came up with the idea of “Voldemorts” since everybody loves Harry Potter, but I’m told that he’s not violent enough.

And then we would have the word “Jasophrenic” to describe something that probably doesn’t exist as a discrete clinical entity, just as a catchy mental concept, and we might make more headway in explaining that “psychotic” covers a great deal of ground that doesn’t involve it, and so does “schizophrenic” and “crazy” and “mentally ill,” and even “psychopathic” does too. That might be a lot of education gained for a pretty cheap memehack.

Stimulant medication helps with acceptance of noise in AD/HD study (pubmed abstract). “Acceptance of noise” appears to basically mean “how much background noise you’re willing to put up with when listening to speech” and was initially coined to refer to how much background noise hearing-impaired people were willing to put up with in a hearing aid before refusing to use it at all.

(anecdote warning) When I first started a stimulant medication, I was floored by how calm I felt, but more surprised by how different sensory input was – it was like a bird passing overhead was a solid, coherent bird object, rather than a set of discoherent pictures. Not on the level of vision, but on the level of attention. The “background noise” was turned down.

This is one of those interesting things that doesn’t get much play in most peoples’ conceptions of mental disorders: ADHD is about being hyperactive and distractible, mood disorders are about mood, schizophrenia is about psychosis, etc. All of those things are true (I mean, we do call them mood disorders etc for a reason), but mental disorders involve multiple systems, often in non-intuitive ways. Depression and heart disease, for example, or schizophrenia and apathy.

The APA has argued that when you treat mental disorders, you don’t need to spend as much on physical healthcare, for a variety of reasons.

The linked article contains references to a bunch of studies, but is remarkably not like an APA paper in that it doesn’t mention and address any studies that were not favorable to its conclusion (something you have to do in science). It’s not possible to tell from reading it what the obstacles are to implementing better psych treatment, and it doesn’t seem targeted – i.e., it doesn’t mention and probably doesn’t address the concerns of the people it’s aimed at.

I really wish it did. I would much rather be writing a blog entry about how APA was carefully attempting to address the issues involved in convincing insurance companies (hospitals? other healthcare providers? the government?) to offer cheaper/better mental health treatment.

It’s so easy to do advocacy focused on showing you’re right, and so hard to do advocacy focused on removing the obstacles preventing your target audience from doing what you want them to do. But you don’t have to go all out to acknowledge why they aren’t taking your position, and to address those reasons.

I do think APA is probably right – and even if they’re not, I believe that appropriate mental health care (and physical health care) should be available to everyone, everywhere.

Senators John Kerry and Olympia Snowe have reintroduced a bill that would make Medicare mental health co-pays equivalent to non-mental health co-pays, instead of two and a half times as much. See Shrink Rap for details and please write your senators.

Here is a copy of the letter I sent my senators. If you agree with what I say, please feel free to use it yourself, editing as much as you like.

I am asking you to please support the Medicare Mental Health Copayment Equity Act of 2007 (S.1715). Non-discriminatory coverage for mental disorders benefits everyone, both by reducing unnecessary human suffering and by reducing the financial and social costs involved when these disabling medical problems are left untreated. Equating co-pays is a small step toward non-discriminatory coverage, and I ask you to contribute to that by supporting this bill.

This NY Times article on mental illness and the right to vote shows some different motivations people have for wanting to remove the Constitutionally-granted right to vote from some people with mental illnesses.

Some people pretty clearly don’t want mentally ill people to have political influence (crazy people are irresponsible and dangerous, omg, etc.). Your standard (and boring) ignorance, prejudice, fear. (On a side note, I think it’s interesting that the usual fear – physical danger – is replaced here by something non-physical that seems to carry the same emotional intensity. I wish I knew how exactly they’re worried about some mentally ill people misusing their vote. Vote for the opposing Presidential candidate? Raise or lower property taxes? Revoke leash laws?)

A separate set of people seem to want to restrict the right to vote because they are worried that people who are not competent will be manipulated by others into voting accordingly. That does concern me some – it makes me think of facilitated communication, in which children with autism who lacked the ability to communicate were basically used as Ouija indicators by practitioners who (often entirely unintentionally) inserted their own expectations and neuroses into the output, which in some cases resulted in false accusations of sexual abuse, among other things. So you do have to have some mechanism for preventing abuse.

But.

Phrasing this like it’s about mental illness makes it sound like it’s a mental illness issue per se. And it’s not. It’s something that happens in mental illness sometimes, but not always. What it is, is a competency issue. They mention the elderly in the article, for example. Some, but not all elderly are not competent to make decisions for themselves. Some people are temporarily or permanently disabled after a stroke and may not be competent to make decisions for themselves. And on and on.

The point is that if voting is about being mentally competent enough to not be manipulated by someone else, that’s what it’s about. Like how many traditionally male, or traditionally female jobs aren’t (or shouldn’t be) about having to meet certain requirements only if you’re the wrong gender – they’re about everyone having to meet the same set of requirements to perform to job adequately.

And then either you get a consistent law (that probably won’t get consistently applied, but oh well) or you get a lot of people up in arms because it was okay to have that competency requirement when it was just for crazy people, but it’s not okay to try to apply it to them. (There are a lot of old people, and they vote.)

Check out these two articles together:

Let’s not reject our geniuses: Genetic screening risks losing a future Dickens

Joyce’s ADD and not talent made him a genius

The latter is a spoof, but it satirizes something common that shows up in the first article: We must retain mental disorders because society needs geniuses.

Most people with mental disorders, like most people without mental disorders, aren’t geniuses (duh). Mental disorders impair the ability to function normally (for all people – that’s why they’re disorders), rather than providing talent (for most people). Most aren’t even associated with genius and creativity. Bipolar disorder is, but I haven’t found any plausible research for any other disorders (someone correct me if I’m wrong here).

Maybe at some point we will deliberately keep some mental disorders around because society values so strongly the minority of sufferers who have associated talent. Via genetic screening, or a decision not to fix things in children when we can, whatever. (I really hope we make this choice based on actual associations between a disorder and creativity.)

If so, society and its individual elements are going to owe a debt to all the people they’re causing to suffer in obscurity, because they’ll be sacrificing all those individual peoples’ welfare to get a few people who get to be geniuses. And society better pony up compensatory resources.

People with mental disorders who are not geniuses are valuable to society in many other ways, and I’m not ignoring that. I’m just saying that if society makes a deliberate decision to keep mental disorders to get geniuses, it needs to take responsibility for the other effects of that decision, and to thoroughly recognize the value of the people it’s compensating, above and beyond that of regular human beings with medical disorders (which it sucks at now), as people who contribute to genius.