As I mentioned earlier, I've written a post over on PsychologyToday about how I believe the upcoming NAMI election and the question of whether NAMI will cover a 'big tent' or a 'small tent' -- a focus on severe mental illness versus all mental illness-- is about forced psychiatric care.
One the candidates for office, DJ Jaffe, responded to my PsychologyToday post and said it's wrong, and I should change it. It's an opinion, not a statement of fact, so I'm hanging out with my first amendment right to free speech. Mr. Jaffe included his whole campaign speech and you're welcome to check it out. His contention is that in broadening the tent to include all, the SMI (serious mental illness) agenda has been pushed out into the rain, not included, and goes point-by-point through why this is so. I'm moving the discussion here because it's an easier venue for me to negotiate (PsychologyToday has a more difficult template and requires editorial approval).
Just some thoughts:
Mr. Jaffe writes:
For example, in almost all their communications NAMI National has replaced the phrase “mental illness” with the phrase “mental health conditions” as if mental illness were a dirty phrase not to be uttered in polite company.My feeling is that I'm a psychiatrist and I treat psychiatric conditions, just as a dermatologist treats dermatologist conditions, or one might see a nephrologist with a kidney condition. Mental health conditions, mental illness, psychiatric disorder. The truth is that we don't really have a definition for this: DSM-V has nearly 300 diagnosis, it's easy to get into a box if you want. The SMI folks tend to focus on diagnosis as though it's absolute and accurate and each one has a uniform prognosis, specifically schizophrenia, bipolar disorder, and severe depression. Diagnosis can be wrong, it can have a variety of prognoses, and other illnesses-- such as severe obsessive compulsive disorder, severe anxiety, and eating disorders --can be terribly disabling and can cause incredible psychic torment. "Minor" problems such as adjustment disorder, can result in suicide. My pet peeve is with calling psychiatric disorders "behavioral disorders." Many of the people I treat are lovely human beings who behave just fine, thank you.
Mr. Jaffe says that anosognosia is far more important than access to services in keeping people from getting care. Clearly, Mr. Jaffe has not tried to get care using his public insurance at a clinic in Baltimore.
Finally, in terms of words, I'm told that it's objectionable to those who advocate for the SMI population to use the words Hope and Recovery. Who could be against Hope? Who wants to go see a psychiatrist to be told there is no hope, that they will never get better? Of course people get better, why else would they come? All better? What does that mean? Most people experience a decrease in symptoms. Many find that therapy helps them to understand their issues and communicate in a more functional manner, which makes their lives go more smoothly. (Oh, but much of SMI advocacy is about medications with little thought to therapy). Many people come in looking horribly sick, tormented and suffering, and then do get better: they return to work or to school or to having meaningful relationships. It often takes time; it's unfair to tell people that they won't get better and have a poor prognosis because we just don't know. SMI often gets to be about forced medications, and distress about homelessness and incarceration. If you want people to be housed, might I suggest providing them with housing?
And finally, I am perplexed that NAMI objects to the term 'suffering.' It's an important word for the sake of helping to convey your psychic pain to another human being, and I often ask people if they are suffering or tormented, and those who look quite well, often say yes.
Ah the words. So much power to injure, but these particular words don't have much power to heal.