I remember seeing patients come into the emergency room with terrible infections, and we couldn’t figure out what was wrong with them, and we had no treatments, and they invariably died.
Now, this by itself would have been enough to stigmatize this illness. But the fact that it was occurring predominantly in discriminated groups, including homosexuals and intravenous drug users, made its victims virtual pariahs.
But then an amazing thing happened. The AIDS Advocacy Group and community aggressively spoke out. They expanded awareness, and they pressured the government to fund research.
And within five years, 1984, two scientists isolated the human immunodeficiency virus, the cause of AIDS. By 1987, AZT was introduced, the first treatment for AIDS.
And now AIDS is like diabetes. It’s a chronic illness but you could live a pretty normal life with treatment. Contrast the outcome of Rock Hudson, who was diagnosed with AIDS in 1984, and he was dead within a year, to Magic Johnson, who was diagnosed with AIDS in 1991, and he’s still alive living a normal life, I saw him on TV the other day, with treatment.
That is the power of science leading to knowledge and awareness and effective treatments. Treatments don’t just eliminate the symptoms of the illness. They also eliminate the prejudice and the stigma.
Now we’re still learning the causes of mental illnesses, but we already have effective treatments which have helped millions of people around the world. In many cases, these eliminate the symptoms of the person’s illness, but in some cases, they actually transform their lives.
Earlier in my career, I treated a young mother named Sarah, and she suffered from panic disorder, which had kept her housebound for 10 years because she was afraid to go out, a condition called agoraphobia.
To start, I had to make house calls and visit her at home, and when she opened the door to her home at our first meeting, I saw before me this woman in a long, black, shapeless tunic with dark glasses and long dark hair. She looked like Morticia from the Addams Family.
I began with exposure therapy and then gradually introduced medication. And within a couple of months, she was able to come to see me in the clinic, but she insisted on sitting next to an open door with her bike perched just outside so she could dash at a moment’s notice.
But within a year, she changed her attire. She was fashionably dressed, cut her hair. She was going out with her husband, socializing with friends, and picking her kids up at school.
When we ended treatment, she came to our last session, and she came up to me and thanked me, and she said, “I feel like I’ve been let out of prison, like I’ve been given my life back.”
Now, not all disorders have good treatments. Witness Alzheimer’s disease and autism, and not all patients respond as well as Sarah does. A particularly difficult condition that psychiatrists treat is called borderline personality disorder. This affects young people and produces extreme mood volatility, self-mutilating behavior, and stormy relationships with people.
The noxious nature of the behavior drives away family and friends, and even psychiatrists are reluctant to treat patients. One such patient that I treated was named Laurie. She was in her early 20s, a waif-like girl with short hair, large glasses, a very fragile demeanor that could explode into volcanic rage and propel her into aggressive or suicidal behavior.
I worked really hard trying to help Laurie control her mood volatility, stop her from these self-destructive acts. But the treatments I used, the medications I tried, had limited effects, and when she dropped out of treatment, I felt I really hadn’t done very much, and I worried about what would happen for her.
So, we don’t have treatments for every disorder. And not all patients respond well. But make no mistake, there is indisputably a world of difference between modern mental health care today and what existed for all human history prior to the latter part of the 20th century.
So I find it particularly ironic that while people suffered from mental disorders throughout human history because of the fact we had no knowledge and limited or no effective treatments, in the 21st century, when we do have treatments, the biggest barriers are lack of awareness, lack of access to care, and stigma.
So, if there were no stigma, we could launch a public health initiative against mental illness, like we’ve done before successfully such as with infectious diseases, with heart disease, with environmental toxins like asbestos, lead, and smoking, and we would begin with two simple strategies.
The first involves early identification and intervention. And this involves having screening mechanisms in place in primary care settings like family medical clinics, pediatrics offices, obstetrical and gynecologic clinics and offices, and also in schools and in universities, and also in the workplace.
And individuals who were screened for being at risk for, or having symptoms of, a mental disorder, would be referred promptly to a clinic that specialized in providing the array of treatments that would be helpful to their condition.
The goal of this is to get people engaged early, before the illness has effects on their brain, disrupts their lives, and risks them doing something that’d be harmful to themselves or others.
The second strategy would be an approach of providing community-based comprehensive care for people who were already at more advanced stages of the illness and had suffered some disability. This would include medical management, rehabilitative services, and also residential facilities to support people who can’t care for themselves and prevent them from falling through the cracks and ending up on the streets homeless, or in prisons, or sequestered in state mental hospitals.
So we have the means to do this, and this would provide extraordinary changes in people’s lives in many, many ways. People who are depressed, who studies have shown to suffer from symptoms of depression for up to seven years before they get diagnosed and receive treatment, would not have to endure this.
And also at the same time while they’re waiting to be diagnosed and treated, risk the possibility of hurting themselves through suicide attempts or becoming addicted to something through misguided attempts at self-medication.
People who experience trauma from violent crime or accidents or natural disasters would be treated promptly, before they develop symptoms, as they’re treated for their physical injuries, instead of waiting for their symptoms of PTSD to emerge and then having them having to seek treatment.