Published Tuesday, October 19, 1999, in The State

Mental health: Shattering the stigma

Jean Popowski, leads the anti-stigma charge as a member of the state Mental Health Commission participates in the 1999 Mental Health Recovery Walk.

Photo:  Richard Alan Hannon/ The State

Staff Writer

In the grips of severe depression and devastated to learn she had Hodgkin's disease, Victoria Cousins tried to commit suicide in 1985. 

"I decided I was going to kill myself," she recalled recently. "I went through the motions of gathering together pills, and went to a hotel room and tried five different ways." 

Hotel workers and police found her in time, and she was admitted to a psychiatric hospital. But she returned to work after only 20 days of care, carrying on as if nothing were wrong. .

Like many mentally ill people, Cousins feared the stigma and rejection from friends, relatives and the world at large. She waited five years to seek professional help.

"Nobody really wants to have anything wrong with the way they think," said Cousins, who is now director of consumer affairs at the state Department of Mental Health. She takes medication to manage her condition of bipolar disorder, also known as manic depression.

"Nobody wants to think that someone can look at them and say boy, there's something wrong with you," Cousins said.

Approximately 50,000 South Carolinians and 50 million Americans suffer from long-term mental illnesses such as schizophrenia, manic depression and clinical depression. The onset of mental illness may be traced to genetics, stress, chemical imbalances in the brain and other causes.

Although the problem is often beyond the sufferers' control, and can almost always be managed with prescription medication and therapy, some people feel ashamed to seek help because of the stereotypes associated with mental illness, said Linda Austin, a psychiatry professor at Medical University of South Carolina in Charleston.

Admit to a mental illness, they fear, and you risk becoming an outcast among those do not know how to handle the news.

"I get a lot of calls from people who say, 'My mother-in-law needs to see someone but won't go,' or, 'My son is a schizophrenic but won't go,' " said Austin, host of the National Public Radio talk show, "What's on Your Mind," which airs Fridays at noon. "That leaves everyone else around them frustrated. They refuse to go because they don't want to admit it to themselves."  

The state Division of Mental Health has embarked on a campaign to eradicate the stigma of mental health, a goal they admit is a tall order. On Friday, mental health specialists and clients ran a daylong conference on the state hospital grounds, focusing entirely on stigma. Then on Saturday, about 1,000 people marched in the 12th annual Mental Illness Awareness Walk through Columbia, intent on busting stigmas that can prove debilitating to the mentally ill.

"I thought being depressed meant I was weak, I was not grateful, I was self-centered," said Jean Popowski, a lawyer who is leading the anti-stigma charge as a member of the state Mental Health Commission. Popowski is bipolar, and takes medication that allows her to live a functional life.

"I thought if I could just 'buck up,' I could be like everybody else," she said. "I had bought into the stereotypical attitudes." 

Erasing the stigma will not be easy. Public perceptions of the mentally ill are shaped by television, the movies and real life. Some of the most infamous crimes in America were committed by men with mental illness.

The six Son of Sam killings that terrorized New York in 1976-77 were perpetrated by David Berkowitz, who pleaded insanity. The shooting deaths of two police officers at the capitol in Washington, D.C., last year were at the hands of Russell Weston Jr., diagnosed years earlier as a paranoid schizophrenic. In the Columbine High School killing spree last April, one of the gunmen was Eric Harris, a teen who had been taking antidepressants.

Those cases lend a bad name to the masses of mentally ill who are not dangerous to others but rather, simply trying to live functional lives. The link between being dangerous and being mentally ill is so ingrained that people hesitate to seek treatment for their problem, for fear of disclosing it to family and friends.

"Incidents involving people with mental illnesses who are just terribly, terribly violent contribute greatly to this stigma," Cousins said. "It's unfortunate, because they're such a small number.

"There's a huge amount of us out there who are just pussycats. All we want to do is be a part of society, have a friend, have a lover, be regular people." 

Mental illness affects one of four families in America. Nationally $14 is spent for research for every person diagnosed with schizophrenia, in contrast to $1,000 for patients with muscular dystrophy and $4,300 for cancer patients.

Despite the shortfall in research funds, scientists have been able to identify the three brain chemicals that most often trigger mental illness: serotonin, norepinephrine and dopamine. Imbalance of serotonin has been linked to problems including depression, obsessive-compulsive disorder and schizophrenia. Norepinephrine imbalances have also been linked to depression. At excessive levels, dopamine can trigger psychosis.

A greater variety of prescription drugs is available to treat all of these chemical imbalances effectively, with fewer side effects than ever before. A patient being treated for depression 30 years ago would have been more likely to face severe side effects. Lithium, for example, could cause obesity, kidney problems and more. 

"If I had to choose between being mentally ill in 1960 and 1999, it would be an easy choice," Austin said. "Our ability to diagnose accurately, and to treat effectively, is vastly improved  over 20 years ago."   

Finding the proper medication balance is not always simple, however. Debilitating side effects can still occur, leading some mentally ill patients to stop taking their medication. That perpetuates a dangerous cycle of dysfunction -- not only for themselves, but also in their relationships with friends and family members who grow frustrated at the erratic cycles of behavior.

"I start feeling better and sometimes I feel I don't want to take the medication. Then I relapse," said Bonnie Pate, director of S.C. SHARE, or South Carolina Self Help Association Regarding Emotions. That consumer advocacy organization has set up 40 support groups around the state to help its 3,500 mentally ill members.

Pate said that a huge problem for people who go public with their illness is the shame they face. It is something that sufferers of many physical diseases never encounter. 

"When you have a physical illness, something like cancer or heart disease and you're diagnosed, people send you flowers and tell you to get well and visit you," Pate said. "For mental illness, they back off," because the dilemma is not physically visible, she said.

"I think people don't want to understand it sometimes because they feel like they might they catch it," said Pate, who was diagnosed with clinical depression. "I think the family member suffers a lot of shame, too, thinking that maybe they did something to cause this. That in turn tells the person who has a mental illness there is something wrong with them." 

Insurers also impose limits on mental health benefits that deter people from getting the care they need. Health insurance plans typically provide less coverage for mental health and substance abuse treatment than for general medical and surgical services, according to a study by the U.S. Substance Abuse and Mental Health Services Administration.  

"There are severe limitations on what the insurance companies will cover," Austin said. Addressing this lack of insurance parity would dramatically help to eradicate the stigma, she said. More employers are offering psychological care benefits than ever before, but many of those benefits packages fall short, she said.

For the vast majority of the mentally ill, professional treatment is all that is needed to restore productive lives, experts say. Visiting a therapist -- an act that would rarely be publicly discussed among friends or family 20 years ago -- is now creeping into mainstream acceptance, drawing fewer sneers.

The stigma has been decreasing as a growing number of high-profile people begin to publicly speak about their illnesses, some say. Tipper Gore, wife of Vice President Al Gore, has publicly spoken about her depression. So have television reporter Mike Wallace and actors Winona Ryder and Rod Steiger. Such public pronouncements help spread the word that people with disorders are functioning in society, even if they must take medication to do so. 

Efforts also are unfolding at the national level. Donna Shalala, secretary of the U.S. Department of Health and Human Services, announced an anti-stigma poster campaign earlier this month. The National Mental Health Association launched a voter empowerment project to get more people with mental illnesses into the voting booths to have a greater impact on policy-making.

"Folks don't think that people with a mental illness can actually work," said Michelle Lee of the state Mental Health Association, an advocacy group. Lee is a manic depressive, which means her moods may swing between elation and despair.

"But treatment works," she said. "If it didn't, I wouldn't be where I am today." 

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