Part of the stigma that surrounds mental illness is caused by nothing less than ignorance.  Most people aren’t educated about mental illness because they think it will never happen to them.  Slowly, but surely, this is changing as people realize that one in four families are effected.  Every time I give a presentation to a group of people, from a few to hundreds, I always ask the question, “how many of you in this room know someone who has a mental illness?”  If I had to guess, I would say that it’s almost 90% every time.  I also find during the discussions, that once the barrier is lifted and people feel comfortable talking about it stories that have long been kept private because of stigma are articulated in compelling and often cathartic ways.

One common confusion is that people believe that a psychopath and a person experiencing psychotic symtoms like those suffering from schizophrenia, are one and the same. Nothing could be further from the truth.  Schizophenia is a thought disorder that can cause delusions (psychosis) and psychopathy or sociopathy consists of a certain set of personality traits and behaviors.  Superficially charming, psychopaths tend to make a good first impression on others and often strike observers as remarkably normal. Yet they are self-centered, dishonest and undependable, and at times they engage in irresponsible behavior for no apparent reason other than the sheer fun of it. Largely devoid of guilt, empathy and love, they have casual and callous interpersonal and romantic relationships. Psychopaths routinely offer excuses for their reckless and often outrageous actions, placing blame on others instead. They rarely learn from their mistakes or benefit from negative feedback, and they have difficulty inhibiting their impulses.

Psychotic disorders are characterized by distortions of reality and disturbances of thought and language and can cause withdrawal from social contact.  People with schizophrenia, bi-polar or even acute depression can experience psychosis.  The good thing is, that these mental illnesses are treatable and most can and do achieve mental health recovery.

One of the first populations to be targeted to loose the most when state funding is decreasing is the community of people living with serious mental illness. Local mental health advocates have seen the writing on the wall and Governor Brewer confirmed it with her State of the State address yesterday.

Governor Brewer wants to repeal the measures passed in 2000 requiring that all those below the Federal Poverty level be covered by the Arizona Health Care Cost Containment System, the state’s Medicaid System. If this is repealed, estimates of up to two thirds of the state’s citizens diagnosed with a serious mental illness will loose their coverage.

It’s obvious where they will go, or in worst case scenarios where these most vulnerable residents will be sent. Our emergency rooms will continue to be inundated with people seeking treatment for mild to serious symptoms and our prison system, already stretched to the limit will continue the latest trend as the nation’s mental health hospitals. Even the few lucky people that are able to afford an occasional visit to a private psychiatrist will have a difficult time paying for their medications. Many will have to make the choice between medication and food. Our homeless population already underserved and in crisis, will continue to grow.

Effective community based treatment is proven to be a more cost effective way to treat people living with mental illness. Hospitalizations and incarcerations are the most expensive, yet that seems to be where we are headed, especially now that the City of Tucson is also stopping funding for the mental health courts (another questionable cost saver). 

It seems like the dream of health care reform is turning into a nightmare.

The American Psychiatric Association thinks so, or is history repeating itself?  The new DSM-V, the medical profession’s bible for diagnosing, is set to come out in May after delays caused by several areas of controversy.  But, the APA has a legacy of uneasy relations with the lesbian, gay, bisexual and transgender community, having included homosexuality in the DSM‘s list of psychiatric disorders until 1973.  Some transgender activists want issues of gender identity kicked off the list of mental illnesses too.

Transgender is an umbrella term used to describe people whose gender identity (sense of themselves as male or female) or gender expression differs from that usually associated with their birth sex. Many transgender people live part-time or full-time as members of the other gender. Broadly speaking, anyone whose identity, appearance, or behavior falls outside of conventional gender norms can be described as transgender. However, not everyone whose appearance or behavior is gender-atypical will identify as a transgender person.

Wikipedia says:  Beginning therapy is recommended for all people who are frustrated by their gender, especially if they desire to transition. People who experience discord between their gender and the expectations of others or whose gender identity conflicts with their body benefit by talking through their feelings in depth with someone who will listen indefinitely. However, gender identity is new to psychology and research is still in its infancy.

Some believe a person with a diagnosed Gender Identity Disorder (GID) experiences distress and/or disability and it may manifest as depression or inability to work and form healthy relationships with others. This diagnosis is often over-simplified to mean that simply being transgender means a person suffers from GID which is not true. This has caused much confusion to transgender people and those who strongly seek to either criticize or affirm them. Transgender people who are comfortable with their gender, whose gender does not directly cause inner frustration, or impair their functioning, do not have GID and are not applicable for a related mental disorder. GID is not permanent and is usually resolved through therapy and transitioning, especially its social aspects. GID does not refer to people who feel oppressed by the negative attitudes and behaviors of others.

Transgender issues are new in the scientific field and affect relatively few people, so understandably many mental healthcare providers know little about transgender issues. People seeking help from these professionals often end up educating the professional rather than receiving help.

 The issues around psychological classifications and associated stigma have recently become more complex since it was announced that colleagues from The Centre for Addiction and Mental Health (CAMH), a consortium of mental health clinics at several sites in Toronto will serve on the DSM’s Sexual and Gender Identity Disorders Work Group. CAMH has aims to ‘cure’ transgendered people of their ‘disorder’, especially in children.

 The issue is that a person who is unclear about his gender identity, just like a person who is  lesbian or gay should not have to face cruelty and stigma based solely on their sexual preference or identity. Kudos to President Obama for making history on New Year’s Eve when he appointed the former Mitchell Simpson, who now identifies himself as a female named Amanda, to a position as a senior adviser in the Commerce Department. Simpson apparently is the first transgendered individual become a presidential appointee to the federal government.

  Amanda Simpson now serves as a senior advisor in the Commerce Dept.

People in the LGBT community can experience double stigma when they also live with a mental illness. The National Alliance on Mental Illness supports the LGBT community in its Multi-cultural Action Center.  For more information visit www.nami.org