No easy answers

Joining other mental health advocates in discussing stigma

Joining other mental health advocates in discussing stigma

In the wake of yet another senseless crime — this one, which struck close to home in Saco — there is a renewed debate about what to do with people who suffer from a mental illness.

Earlier this month, Connor MacCalister allegedly slit the throat of an unsuspecting grandmother, Wendy Boudreau, in a Shaw’s supermarket.

According to a story about the incident in the Portland Press Herald, “[h]orrific crimes like this, committed by individuals with profound mental illness, are rare in Maine, yet each time they occur, the same question arises: How could someone like that be out on the street, in a position to commit such a brutal crime?”

Though I consider myself a self-appointed advocate of mentally ill people, I struggle with the question because it hits home for me.

As mentioned several times throughout this blog, I suffer from a mental illness, with a range of diagnoses.

As of this writing, there are more than 67 reader comments on the Portland Press Herald story. Those comments run the gamut of reactions. Some say we need better access to outpatient mental health services. Others say mental illness is nothing more than a ploy to escape responsibility for a crime. Still others say, patients should be forced to take their medications, while others say we should go back in time and warehouse individuals with mental illness in institutions like AMHI (The Augusta Mental Health Institute).

Admittedly, it’s pretty damn hard to argue for the civil liberties of the mentally ill, especially in the wake of a horrific murder. Where are the advocates for Wendy Boudreau’s civil rights?

Ms. Boudreau’s only mistake was to go to a supermarket to buy ice cream. She had done nothing wrong other than being in the wrong place at the wrong time.

Stigma on a slippery slope

On the other hand, we tread a slippery slope when we generalize mental illness.

For example, how exactly do we define a “profound” mental illness, as the Press Herald story did? How do we know in advance that a mentally ill person is going to commit such a heinous crime?

In fact, violent acts committed by people with serious mental illness comprise an exceptionally small proportion of the overall violent crime rate in the U.S.

Mentally ill persons are far more likely to be the victims of violence, not its perpetrators, according to the National Association of Social Workers (NASW)

In its March 2011 article, “Budgets Balanced at Expense of Mentally Ill,” the NASW newsletter also mentions a new report by the U.S. Substance Abuse and Mental Health Services Administration that documents a nationwide decline in behavioral health care spending as a share of all health care spending, from 9.3 percent in 1986 to just 7.3 percent, or $135 billion out of $1.85 trillion, in 2005.

According to the Centers for Disease Control, one in five Americans suffers from some sort of mental illness. Of course, the statistics include depression, anxiety and treatable bipolar disorders. Put me in that category.

But what do we do with people who suffer from more extreme cases of these symptoms and other issues including paranoid-schizophrenia.

There have been times when I have been in that category, too.

Should the government force me to take medications? Should I be confined to the Riverview Psychiatric Institute?

Every day, I get up, take a shower, get dressed and go to work. Just like you.

I pay my taxes, enjoy the company of my friends and take care of my home and pets. Just like you.

I have been married to the love of my life for nearly 13 years. I successfully raised two stepsons. I give back and volunteer in my community. How do I do all that if I have a moderating mental illness?

First, I take a wide range of medications every day. Two, I see a therapist every two weeks; and third — perhaps most importantly — I have a support network of caring family members and friends, not to mention safe and stable housing.

These things are unfortunately out of reach for many people with a mental illness.

A broken system

I have relatively good and comprehensive health insurance, but even so it took me weeks to get connected to a psychiatrist after my last hospitalization, some two years ago. There is a profound lack of psychiatric beds in the state of Maine.

There are budget constraints to consider. Many mentally ill people — especially those with more profound illnesses — do not have access to premium health insurance. They live on the edge, relying on the minimum benefits of Medicaid (Maine Care). Still other insurance plans offer minimal coverage for mental health services, both for outpatient and inpatient care. For example many plans will pay for only 12 sessions of outpatient therapy (capped).

Supposedly, after three months, you are cured and ready to hit the streets.

Mental health providers do not choose their occupation to “get rich,” as suggested in the reader comments of the Press Herald Story. Social workers salaries are among the lowest of college-educated professionals. A manager of a fast-food restaurant typically makes more than a social worker.

Social workers do not choose their occupation as a way to get rich quick off the back of taxpayers.

Psychotropic medications are some of the most expensive on the market. Patient records are confidential, and sharing them between providers is a complex, burdensome task.

So what do we do? How do we fix a broken system?

Is it a matter of more money? Do we round up everyone we think might have a mental illness and lock them away? Do we criminally charge people for crimes they may commit in the future?

I do not know the answers to those questions. I do not know if Wendy Boudreau would still be alive today if we had better community-based mental health services. I do not know if her murder was preventable.

But I do know that Wendy Boudreau’s death was utterly senseless, and she did not deserve what happened to her on that hot August day in a supermarket.




Behind Blue Eyes


Winston Churchill suffered from bipolar disorder.

A friend of mine recently brought to my attention something about me that was posted on Facebook.

Apparently, a man I barely know questioned how I — an out-of-the-closet consumer of mental health care — could be trusted to provide professional advice. In fact, this person described me as “mentally unstable.”

I thought about this for a while because I frequently write about the subject of mental illness and stigma on this blog, and I was a bit disheartened that being “mentally unstable” and having a diagnosed mental illness are still too often linked into one convenient package.

Consider this: One in five Americans experienced some sort of mental illness in 2010, according to a report from the Substance Abuse and Mental Health Services Administration.

Are those people all mentally unstable? Hardly.

The vast and overwhelming majority of people with a diagnosed mental illness are very stable and lead productive, normal lives.

They can do this because they seek treatment for their illness. They take medications, participate in therapy and take other measures to ensure that their illness is well-managed. They are no different from people with diabetes, epilepsy or cancer. They did not ask for the disease, they don’t use it as an excuse and they are vigilant in taking care of themselves.

Meanwhile, mentally unstable people do not take appropriate steps to manage their illness. Sometimes, it is because of a lack of mental health services, but more often than not some individuals refuse to acknowledge or treat their illness.

Following the horrific massacre a couple of weeks ago in Charleston, South Carolina, Maine’s Congressional delegation was polled regarding their  attitudes on limiting gun violence. While Congresswoman Chellie Pingree, Senator Angus King and Senator Susan Collins all said they would like to see expanded background checks for the purchase of firearms, Congressman Bruce Poliquin offered a different response.

Poliquin said he would like to see more funding for mental health.

I applaud Congressman Poliquin for his willingness to increase funding for community-based mental health services, but I have some bad news for him: Even with better funding and more services, it is more than likely that Dylann Roof would have still shot and killed nine innocent people. Roof may have a mental illness, but he certainly wasn’t taking care of it.

Last week, the defense attorneys for James Holmes, the young man who killed and shot 12 people in an Aurora, Colorado movie theater, opened their defense by saying their client was legally insane, and thus should not be held accountable for his crime.

Although Holmes did seek psychiatric treatment before his rampage, he stopped seeing his psychiatrist just a few weeks before he entered a crowded theater armed to the teeth.

Like very other type of illness, mental illness does not fit into one convenient package. There are different types and severity of illnesses, from depression and anxiety to bipolar disorders and schizophrenia. All of these illnesses can be managed with the right medication and therapy.

And you might be surprised to know how many famous people suffered from some type of mental illness, whether it’s NFL great Terry Bradshaw or Winston Churchill.

Would you describe them as mentally unstable?

According to the Centers for Disease Control, stigma regarding mental illness is getting better but still has a long way to go. Their own research shows:

  • Most adults with mental health symptoms (78%) and without mental health symptoms (89%) agreed that treatment can help persons with mental illness lead normal lives.
  • 57% of all adults believed that people are caring and sympathetic to persons with mental illness.
  • Only 25% of adults with mental health symptoms believed that people are caring and sympathetic to persons with mental illness.

A couple of years ago, I was interviewed by Maine Public Radio about my mental illness. “No one would know I have a mental illness unless I chose to tell them,” I told the reporter. (Listen to the interview here)

The people who really know me would agree: having a mental illness is not synonymous with being unstable.

When U.S. Senator Thomas Eagleton was selected as George McGovern’s running mate for the 1972 presidential election, he kept his mental illness a secret. But once it was discovered that Eagleton had been treated for depression, McGovern dropped him from the ticket like a hot potato.

I’d like to believe that we have made some progress since then.

Maybe. Maybe not.

Take Five

LePageMy wife, Governor Paul Lepage, Bill Nemitz, a charity auction and the in-patient psychiatric unit at Maine Medical Center.

How did these random things become connected last week, causing a bit of a stir on my Facebook page last night?

Let’s start at the top.

Last week, just days before the election, Governor Paul LePage joked that Portland Press Herald columnist Bill Nemitz should be placed on a “suicide watch,” speculating that he was going to win his re-election bid and his nemesis might jump off the Penobscot Narrows Bridge as a result.

Boom! Instant controversy. Once again, the governor found himself in familiar territory with his foot in his mouth.

The governor’s critics (Democrats) went wild, talking about how insensitive the governor is to issues regarding mental illness.

Reportedly, some people who have lost loved ones to suicide were also  angry and upset about the remarks.

Other folks (Republicans) said the governor was joking and the comment was no big deal, pointing out that many in society make lighthearted jokes on similar topics.

Stop and think if you have ever said “I’m going crazy.” “That is a crazy idea.” “That guy is a nut job.” Have you ever laughed when hearing a joke about hearing voices? Late night talk show hosts had plenty of fodder more than a decade ago when actress Margot Kidder was found partially clothed, hiding in the bushes of an LA suburb.

The subject of mental illness makes us nervous. We laugh about it as a relief valve for our own anxiety and fear. But can you take it too far?

Who’s saying what

My wife  has multiple sclerosis. It is a progressive illness with no cure. She often makes jokes about her illness, speculating about when she will need a wheelchair and telling me we will need to completely renovate our home to accommodate her decreasing mobility. She laughs about these very real topics, appearing on the surface light-hearted.

Her jokes about MS really bother me. They trigger a rush of feelings and incredible anxiety. I know that her jokes are just part of her coping methods, but still I cringe when she talks about putting “bling” on her cane.

When Laura jokes about her MS, I try to give her a pass because she has MS, not me. It is her coping strategy.

It’s sort of like the “N” word. An African-American man can use that word in public without recrimination and make jokes about its connotation and meaning.

If I did the same thing, I could possibly lose my job, certainly many friends.

Society draws a line. If you got it, you can talk about it. Otherwise, keep your trap shut.

Unless it’s Hollywood or the media , and then all bets are off, especially when it comes to mental illness.

In the days following the 2007 massacre at Virginia Tech, “Nightly newscasts reported “no known motive” and focused on the gunman’s anger, sense of isolation, and preoccupation with violent revenge. No one who read or saw the coverage would learn what a psychotic break looks like, nor that the vast majority of people with mental disorders are not violent. This kind of contextual information is conspicuously missing from major newspapers and TV,” wrote Richard Friedman in “Media and Madness,” an article published in the June 23, 2008 issue of The American Prospect.

Friedman goes on to explain that “Hollywood has benefited from a long-standing and lurid fascination with psychiatric illness,” referencing movies such as Psycho, The Silence of the Lambs, One Flew Over the Cuckoo’s Nest and Fatal Attraction.

According to Friedman, “exaggerated characters like these may help make “average” people feel safer by displacing the threat of violence to a well-defined group.”

Since the 2011 Tucson shootings, I have been an out-of-the-closet consumer of mental health services. I have testified before the legislature, published an op-ed in the Portland Press Herald, spoken at community forums.

My mission is to show, in a tangible way, that mental illness is generally not scary and more often than not impacts everyday people: your friends, your co-workers, your neighbors and even your social media contacts.

My life-long struggle with mental illness is not particularly funny, but I do make jokes about it. Have you ever tried to eat a chicken cutlet with a spork? (They don’t give you silverware on the psychiatric unit. )

Did you know that nine out of 10 psychiatric units have aquariums? Fish, apparently, relieve anxiety and stress.

I make these jokes and others when speaking publicly because humor helps break down communication barriers.

I got in trouble

p6On Friday evening, Laura and I attended the Biddeford-Saco Chamber’s annual holiday auction and dinner. By pure coincidence, my bidding paddle was labeled P-6,  the abbreviation of Maine Medical Center’s in-patient psychiatric unit (located on the sixth floor of the Pavilion wing.) I held up the photo and had Laura take a shot of me and my label.

I posted that picture on Facebook.

Some people thought it was funny. Other people did not, questioning why I could joke about mental illness but Gov. LePage could not.

The tricky thing about humor is its intent.

For the record, I chuckled when LePage said Nemitz should be placed on a suicide watch. The two men have been battling for four years, and frankly, I’m not sure who hates who more.

But either way, I think humor is okay, so long as its intent is somewhat calculated and not malicious in nature.

As someone with severe and chronic mental health issues, it’s not up to me or anyone else to tell you what you can joke about. All I ask is that you think about the consequences and lighten up just a tiny bit.


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Conscience does make Cowards of us all

20120709_202235Several months ago, I posted a blog entry that compared how people react to physical illnesses versus mental illnesses.

In that post, I detailed the overwhelming support I received after breaking my arm in two places.  I also bragged about how I refused to let it slow me down. Using only one arm, over a holiday weekend, I was able to produce fact sheets and other collateral materials for a very large and important client during a deadline crunch.

I also shared some aspects of my much less obvious illness:

Imagine a disease that rarely allows you to sleep through an entire night. A disease that constantly impacts your perception of the world around you; a disease that clouds your judgment, alters your reality and makes it almost impossible to get out of bed.

Imagine an intense level of pain that without medication would have you think every hour of every day about ending your life; a disease that inhibits your ability to maintain relationships and function as a productive member of society. Imagine having a disease that is commonly ridiculed and often dismissed as nothing more than “feeling sorry for yourself.”

I live with the challenges of that disease every day. I fight it with every fiber of my existence, only to know that it will never go away; that there is no cure or remedy.

Today is one of those days when I pretend that it is all so manageable. Generally, I pretend by using social media to argue and rant about politics or current events, anything other than the reality surrounding me. Presenting a false illusion of confidence and optimism.

It would be more convenient — certainly less difficult — for my friends, family and coworkers, if I could be more consistent in masking this disease.

Many of them, in fact, would prefer that I not talk about this subject, but I make no apologies, and I am not asking for much.

I would ask only, that on days like today, you treat me the same as you would if you saw my arm in a cast.

When I broke my arm, only one person told me I was “just feeling sorry for myself.”  Only one person expected me to type a 300-page report or maybe sling a hammer and just “get over it by doing something productive.” Only one person told me I was too self-absorbed and ungrateful for all the amazing gifts God has bestowed upon me.

That one person was me, and it is the voice I imagine that others whisper when I am not in the room.

Judge me if you want, but also know this . . . you will never judge me more harshly than that voice inside my head

 So, why do I write this shit? What’s the point? I have no answer. But if you click this link, you will find a wide range of others who share some unique insights and perspectives about a disease that remains invisible and generally misunderstood.

Alpacas, Obamacare and the thin line

alpacasIt’s been a tough week for a lot of us.

The days are getting shorter, the economy remains anemic and political rhetoric is intensifying in the face of a so-called government “shutdown.”

Just in the last seven days, our nation has witnessed some stunning and bizarre examples of citizen unrest.

On Thursday, a woman suffering from depression attempted to crash the White House barriers. She had her infant daughter in her car. She then headed to the Capitol, where she was eventually shot to death by police. Fewer than 24 hours later, a man set himself on fire near the National Mall.

Of course, two weeks earlier, Aaron Alexis went on a killing rampage that left 12 people dead at the DC Navy Yard.

Despite those horrific incidents, the nation remains bitterly, stubbornly focused on an intensely partisan battle that is still raging on Capitol Hill. These other incidents were mere blips on the radar screen, generally ignored like those blips that signaled the advance of Japanese fighter planes approaching Oahu on December 7, 1941.

It is mind-numbing stuff; stuff that is too difficult to even think about,  much less the sort of stuff that we are willing to discuss in the sphere of public policy.

We avoid this stuff because it’s much harder to point fingers and assign blame. It’s not as convenient or simple as arguing about Obamacare. It’s stuff that we generally want to avoid.

What does this have to do with alpacas?

As a so-called “consumer” of mental health services, I have a wide range of my own diversionary tactics, a boat-load of coping tools I can deploy to ignore the obvious and the overwhelming.

I am also a semi-professional pundit, not to mention a professional consultant who spends the bulk of his time crafting public policy messages and strategies to help clients achieve their goals.

When those two worlds intersect, I need a distraction as much as anyone else. So, I began focusing on alpacas.

Go ahead and laugh. I will wait.

This week is also the week of the annual Fryeburg Fair. For many years, I have represented various clients at that fair, staffing booths in the Natural Resources building and thus unable to enjoy the fair like most people with my family.

Of all the animals on display at the fair, I have always had a soft-spot (literally) for alpacas. I have long fantasized about how cool it would be to have a pet alpaca.

It’s just a fantasy; it’s not the real thing

This year I did not have to work at the fair. Laura and I decided that we would go on Saturday. Our youngest son, Matthew wanted to join us and bring along his girlfriend. We began planning this day almost three weeks ago.

This year, we had other things to consider about attending the fair. Laura’s MS has been progressing. On Monday, the neurosurgeon ordered her to stay home from work. For the first time, I had to get serious about wheelchairs and their cost, function. Maybe I would not need it this year. But it is part of our family’s new reality.

Earlier in the week, I once again dreamed about how great it would be to own an alpaca. The little kid in me got very excited about this prospect. Matthew, in fact, suggested that we would name our alpaca Cameron.

I am terrified thinking about my wife’s MS. I want things to stay the same. The future looks so uncertain. This is the Fryeburg Fair, dammit. I just want an apple crisp, wager on a few races, smell maple syrup and hear reports about the Red Sox and their progress in the ALCS.

What happens if Laura can’t go back to work? What happens to our health insurance? How will we be impacted by Obamacare? What if . . .?

I went to bed early on Tuesday evening in a mix of anticipation about seeing the alpacas at the fair and worrying about my wife’s health. I wept like I have not wept in years.

I really wanted an alpaca. I researched alpacas, and the adult that also lives in me tried to be as gentle as possible. But reality won on Tuesday. Our yard is too small. Alpacas live in herds. We have no business, whatsoever, in even considering the purchase of an alpaca.

It was the clashing of reality and fantasy. This tool of distraction would soon need to be replaced. What do I do now?

Sometimes a fantasy is all you need

We had so much fun on Saturday. Despite the heavy traffic, the difficulty in finding a parking spot, we all laughed so much. People of all stripes, sizes and colors packed the fairgrounds. Yes, we saw the alpacas, and we even found Cameron.

The alpacas, goats, sheep and cattle all seemed somewhat oblivious to the incessant buzz of human activity that surrounded them. They were content to gnaw on hay, to root in piles of sawdust.

For several hours, I did not hear one word about John Boehner or President Obama. I did hear that the Sox scored another run in the bottom of the fourth. The air became cooler all around us, the night sky settled in quickly.

And then it dawned on me. There is a thin line that separates reality from fantasy, dreams from nightmares.

We spend so much energy fretting about the unknown.

Sometimes all you need is some hot apple crisp, a home run by the Red Sox, the company of those you love and the experience of petting an alpaca. That way, the buzz of human activity that surrounds you becomes little more than just another day at the fair.

I think I’m turning Japanese

Two stories I found on the pages of the Portland Press Herald today:

  • [Maine’s] Riverview Psychiatric Center faces the loss of an estimated $20 million in federal funding because the federal government has decided that the hospital in Augusta has not solved staffing and governance problems.” Full story
  • The mother of a Connecticut woman who was shot to death by police after trying to breach a barrier at the White House said her daughter was suffering from post-partum depression. Mother: Daughter in Capitol chase was depressed

Considering the earth shattering news that Republicans are opposing Democrats, it’s understandably tough to remember things that happened a couple of weeks ago, like the Navy Yard shooting where Aaron Alexis, a former Navy reservist, used a shotgun to begin a massacre that left 12 people dead.

A few weeks before, Alexis called police in Rhode Island, telling them that he was getting messages from his microwave, according to the Associated Press.

“The mass of men lead lives of quiet desperation,” wrote Henry David Thoreau.

But just look what happens when those desperate folks stop being quiet.

It’s easy and sexy to argue about the Affordable Care Act, gun control . . . my guy versus your guy.

But the silence becomes deafening if we dare mention other topics that (not surprisingly) have a direct and immediate impact on all the other stuff we love to debate.

Fewer than 24 hours after the incident in which a depressed woman was shot (justifiably) by Capitol police, that story has already become buried under the weight of Congressional bickering.

And the Aaron Alexis story did not fit into any of the convenient arguments for or against gun control. Don’t expect any tearful Congressional testimony there.

I return you now to the sport of pointing fingers and assigning blame. Enjoy.

It’s all been done

We are weary of these stories.

We are frustrated, exhausted, confused, angry and overwhelmed.

The outrage, speculation, ranting and debates were not nearly as strong this time. The evidence is on Twitter, Facebook and CNN. So many of us are tired of arguing about it, Many of us are worn down. Ready and longing for the next distraction so we can go back to ignoring it.

Some things didn’t change, however.

Once again, there was the consistent pointing of fingers at the usual suspects: Guns, violent music, video games and mental illness.

Think about that and these indisputable facts:

1.) The vast and overwhelming majority of people who enjoy rap music or play video games do not become violent criminals.

2.) The vast and overwhelming majority of people who own guns do not use them in the commission of a crime.

3.) The vast and overwhelming majority of people with a mental illness do not go on shooting rampages or commit other violent crimes.

But these are the most common denominators in the growing escalation of senseless massacres, so it’s easy to understand why we focus on these convenient subjects.

It seems harder, however, to face the cold, hard reality that this problem will require a lot more than a knee-jerk reaction and a single-issue focus.

My friends on both sides of the political aisle better wake up.

To the NRA and folks who prefer the right side of the political aisle, you talk a good game about mental illness, when are you going to acknowledge that system of service is broken and essentially unavailable to those on the lower end of the economic spectrum? Is it a priority yet? Or do we need more six-year olds slaughtered in their classrooms, more veterans and federal employees shot where they work? Are we ready to fund those programs? They are expensive.

Can you concede that better background checks are just common sense?

To my friends on the left, how much are you willing to compromise on the individual liberties of the mentally ill and their ability to purchase firearms? What lines of accountability will you hold to your Hollywood friends? Can we require mentally ill people to take their medications? How far down that slippery slope are you willing to slide?

Even while we debate the expansion of Medicare in Maine or the pros and cons of the Affordable Health Care Act, mental illness treatment is the last rung on the priority ladder. In fact, Governor King, Governor Baldacci and Governor LePage have all allowed cuts to mental health spending. Chew on that common denominator for a bit.

Just a few weeks before he waged his own war at the Washington Navy Yard,  Aaron Alexis complained to Rhode Island police “that people were talking to him through the walls and ceilings of his hotel rooms and sending microwave vibrations into his body to prevent him from sleeping,” according to the Associated Press.

In politics they say you should never let a crisis go to waste.

Funny, we keep wasting these crisis opportunities over and over again.

P.S. If you are still stupid enough to blather on about arming teachers to keep students safe, especially following two deadly massacres at U.S. military installations, be prepared for me to vomit on your shirt.