All in the Family

Mental Illness and Caregiving Across the Generations

People With Mental Illness Need a Stonewall Inn

Only if they come out of the closet can we address the mental health care crisis

As Pennsylvania became the 19th state to recognize same-sex marriages, I thought about how much progress gay rights activists have made over the past few decades — and how much those affected by mental illnesses could learn from them.

45 years ago, when I was in high school, people didn’t talk about homosexuality. Men attracted to other men hid their feelings from their families and society. Women drawn to other women did likewise.

In 1969, when patrons of the Stonewall Inn fought back after the New York police raided the Greenwich Village gay bar, no one imagined the federal government would ever recognize the rights of two women or two men to marry.

But the Stonewall Inn riots had the effect of inducing many among the homosexual community to stop hiding. Instead, members of the gay and lesbian communities launched a movement for social and legal equality.

That activism achieved results faster than any other human rights/equality movement. In just four decades, homosexuals have broken through many legal barriers in many states that once blocked their path to the pursuit of happiness — equal employment and housing, property ownership, inheritance rights and adoption and custody rights. Progress was made because people stopped hiding and demanded others accept them, and the homosexual community has benefited greatly.

Our mental health system is in tatters. Jail cells, homeless shelters and coffins have replaced hospital beds. Nearly 40 percent of adults with severe mental illness receive no treatment. Suicide claims the lives of 38,000 Americans each year. Mental illnesses cost America $444 billion each year, mostly in disability payments and lost productivity.

There has been a great deal of finger-pointing and hand-wringing over how things got to be so bad. Some blame lack of funding. Others blame misguided priorities. Democrats blame Republicans. Republicans blame Democrats.

This blame game misses the forest for the trees. There is a single underlying cause of the current mess.

Secrets.

I know about mental illness and I know about secrets. I was 12 when my mother was diagnosed with manic depression, now usually called bipolar disorder. I didn’t understand what caused her crippling sadness and tears, but I did know that I wasn’t supposed to talk about it. I feared my friends would shun me or think poorly of my mother.

Nine years later, after my mother killed herself, I continued my secret keeping, telling friends I met after her death that she’d died in a car accident.

My secrets kept me from getting the support I desperately needed. But my secrets did far more than harm me; they contributed to the misery suffered by people whose daily lives are disrupted by serious mental illness today.

You see, I’m not the only one who kept secrets about mental illness. The vast majority of those affected by serious mental illness — many tens of millions of Americans — did, too.

We are responsible for the lack of progress made in terms of diagnosing and treating mental illness because we’ve successfully hidden the magnitude of the problem. Why should Congress or state legislatures allocate funds to fix a problem that flies under the radar?

Today, there are more people in our country whose lives have been touched by mental illness than not. What’s more, mental illness is by far the most prevalent disease in the United States, with an estimated 78 million Americans suffering from a diagnosable mental illness. This is greater than the number of Americans who suffer from cancer (13 million), diabetes (19 million) and heart disease (27 million) combined.

Yet, even now, the National Alliance on Mental Illness estimates that 60 percent of people who have experience with mental illness keep their experiences secret. People with mental illnesses still hide, and their families still hide, too.

Despite the experiences I had with my mother’s mental illness and despite my becoming a psychologist, when my adopted daughter was diagnosed with bipolar disorder in 2009 and borderline personality disorder in 2010, I again kept her illnesses secret.

My 18-year-old daughter’s decision to stop taking medications, cease therapy sessions and run away with a heroin addict broke my heart. But it also made me recognize the toxic mix that is mental illness and secrecy — and vow to help break the destructive spiral it creates.

It’s time for those affected by mental illness to have our Stonewall Inn moment. We need to come out of the closet and hold our heads high. If we don’t, we will make little progress diagnosing and treating mental illness, people with mental illness will continue living on the streets and filling our jails, and lives that could be productive will continue to be wasted.

 

 

 

This blog post was originally published as an Op-Ed piece in Pittsburgh Post-Gazette on Sunday, July 6, 2014.

 

Rachel Pruchno, Ph.D. is Endowed Chair and Professor of Medicine at Rowan University School of Osteopathic Medicine. Her memoir Surrounded by Madnessis available at online bookstores.

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