Saturday, April 04, 2009

Should People With Mental Illnesses Hold Public Office?

After my post Depressed and Running for Governor post, one commenter (MWAK) asked if people with depression should run for governor. Novalis responded with his own post, Uneasy Lies the Head where he says No and gives his reasons for his thoughts.

It got me thinking. As a psychiatrist, we generally feel mental illness should be destigmatized, and life should be more 'fair' for those who suffer from mental illnesses. I have to say, sometimes I struggle with this--- it's nice to be accommodating, but if the symptoms of one's mental illness make one's companionship intolerable, or one's job performance erratic and inefficient, or one's behavior disruptive or dangerous, how much should others be expected to bend?

So Governor or Doug Duncan's case, it seems he personally decided that the campaign itself was too stressful while he was actively symptomatic. Let's suppose that we can agree that we don't want someone with a symptomatic mental illness running our country. Actually, I don't want them driving my bus, train or airplane either, not while they're thinking about how to suicide or dealing with slowed reaction times or poor judgment.

For the sake of argument, let's say our would-be President or Governor, or pilot or bus driver or armed soldier or police officer has a history of mental illness. Let's suppose it was treated with full remission of symptoms and he hasn't been ill for a while.

Novalis says No: psychiatric illnesses are chronic and recurring (and for some reason he thinks hypertension and diabetes are more likely to stay control or be predictable, but I'm not going there), symptoms can be insidious, gradual, and hidden.

I agree, they can be all of these things and I don't want someone in the midst of an episode running a ship if there really are those buttons one can push to blow up the world. Or decisions that need to be made quickly. Here's my sort-of/maybe beef with this logic: people without mental illnesses can : 1) suddenly get them, 2) have bad judgment or make bad decisions in the absence of a psychiatric illness, 3) keel over and die or become disabled with no warning. We need to have provisions for such things, and the fact that it's higher probability with a history of mental illness doesn't change that we need to have perimeters to check on people involved.

One thing seems clear: If you take away someone's job simply because they seek treatment, then you limit the ability of someone to get treatment. I'd rather have a pilot on Prozac who is being closely monitored, then a pilot who's been afraid to tell anyone his dark thoughts about the plane I'm on.

Novalis says, "If or when our understanding of mental disorders progresses to the point where we can more reliably predict and modify their course, then a major mood or anxiety disorder might survive the vetting process."

We can't predict the behavior of anyone (remember that W guy?). If we know someone has a history and an increased likelihood of recurrence, at least it can be openly discussed and some checks can be put into place.

So no answers here. I do wonder why it is that people have been required to have psychiatric evaluations before all sorts of procedures (in vitro, bariatric surgery) and we don't require our presidential candidates to spend a couple of hours being evaluated by a psychiatrist before we let them run.

I will point out that many of our presidents have had serious mental illnesses, including some of the most popular of presidents.

I'm rambling. Hope I didn't say anything too objectionable.

[Edit 4/5/09 11:30: This is Roy. I just wanted to clarify something here. When I first read Dinah's post, I thought "OMG, she's saying people with, say, a history of bipolar disorder shouldn't fly planes or be President." After reading some comments, esp Nonstandard's comments, and then Dinah's reply, I realized that what she wrote does not clearly state what she seems to intend. So, as a way of either clarifying or distancing from what she said, here is what I think : A 'diagnosis' of anything should not -- in and of itself -- prevent someone from taking on a high-responsibility position (IMHO). The question should be about how they are currently functioning. And if a position carries enough high risk (say, the nuclear button-pusher job, prez, airline pilot), then there should be built-in safeguards that require some sort of ongoing assessment of functional capacity, regardless of one's presence or absence of diagnostic labels. Come on, even dealing with, say, a divorce or your daughter's breast cancer could have a negative impact on one's performance in certain positions. I'll put more in the comments, esp asking why the legal system has put us in the situation that Nonstandard Mind points out in the first place. Back to your regularly scheduled program.]
Dinah's Addendum
Arg From Dinah! See my clarifying remarks in the comment sections.
Regarding pilots: I'm not the one who said they can't fly with a history of bipolar disorder, it's the FAA's idea. And the FAA is pretty picky about what meds pilots can take and still fly, psychotropics in general are not allowed, so this pretty much eliminates anyone with a chronic or recurring mental illness. Benedryl is a no-go as well, so no acutely allergic pilots. What surprised me is that they can be on blood thinners or anti-arrhythmics and people who need those medicines generally have underlying illnesses that make them susceptible to strokes or sudden death.


Novalis said...

The more I think about this, the more I realize how one's views are shaped on the settings one has worked in. Most of my clinical work has involved: inpatient, ECT, and now community psychiatry. So while I certainly understand intellectually that plenty of, for instance, those with bipolar disorder function very well, thank you (and I've treated some of them), that's not the image that comes to mind when I think "bipolar."

This is not to retract anything specific from my post, but when someone alludes to someone as "bipolar" who hasn't been formally diagnosed that way, my automatic thought is, "Well, they couldn't be too sick then could they if the law hasn't hauled them before a magistrate." There is bipolar and then there is Bipolar, and the same goes for other mental disorders. Similarly, there is diabetic and there is Diabetic (we also wouldn't elect as President someone whose sugars had proven very difficult to manage).

Anonymous said...

Given the variation in severity of mental illnesses, the differing ways that they manifest and the fact that some folks are very well controlled / high functioning I think an a priori ban on mental illness would be counterproductive.

Makes you wonder if a woman of child bearing age could ever be elected president - they have a potentially life threatening condition with an unpredictable course after all....

nonstandard mind said...

Wow. Just wow. This post is so mind-bogglingly wrong on so many levels that it's hard to know where to begin. Since you don't know me, let's just start with my back-story.

I was diagnosed with bipolar disorder at the ripe old age of 51 years after taking an SSRI prescribed by my primary care physician made me crazy. And I do mean crazy. The only reason I didn't lose my position (I'm an attorney currently in unspecified government work) is that I generally do a really, really good job, and my clients really, really like me.

Prior to taking the SSRI I'd had a successful career including appointment to a prestigious federal court clerkship, years of successful experience in federal court litigation (never lost a case, she said modestly), 7 years running a department (mayoral cabinet level) in our local city government (I made decisions involving millions and millions and millions of our tax dollars), blah, blah, blah. I won't bore you with the full resume. It was pretty damn good for a local girl, though. People always thought that eventually I would find my way to the judicial bench. I swear I am not making this up.

I'm utterly appalled that you would take this simple-minded position given the prevalence of misdiagnosis of mental disorders generally, and bipolar disorder in particular. Obviously, there is no objective medical test for bipolar. It all depends on the subjective judgment of a psychiatrist who may, or may not, be particularly competent. It often follows just a brief diagnostic interview (in my case about one hour and twenty minutes). The diagnostic interview may, or may not, follow a formal protocol (mine did not). And then the shrink, with godlike omnipotence, brands you for life with a diagnosis from which there is no appeal. And that diagnosis has some serious implications for a person's sense of self, hopes, dreams, aspirations, everything that gives us life and makes us human. Okay, people, I'm an attorney. I believe in due process and appeals and such.

So here's what happens. A respected attorney with a decent career and a healthy self-image (oh, let's just use me for an example) who is prescribed an SSRI by her primary care physician (let's just say my primary doc) has an incredibly bad reaction (did I mention I could have lost my job). So the attorney, being a believer in science and western medicine, duly schedules an appointment with a busy psychiatrist to determine what happened and what to do about it. The attorney finds herself on the receiving end of a brief diagnostic interview (did I mention it was one hour and twenty minutes?) during which she does not have an opportunity to explain what really happened. At the conclusion of the interview the psychiatrist tosses the attorney the words "bipolar disorder" and "lamotrigine" at the attorney and hurries away. I live in the west, and I've seen cattle branded. Now I know how they felt.

The effect of this on a person's sense of self is something I could describe in great detail, but I won't. It's quite personal and really, it's none of the blogosphere's damn business. But let's just say the word "humiliation" is one of many that I would use to describe it, not because I believe the disorder itself is humiliating, but because of posts such as the one I find here. By your harsh judgment of my capabilities I suppose I should build a time machine and travel back in time to unmake all the many, many responsible decisions I've made. Because, really, a time machine makes more sense than this simpleminded analysis. While I'm back there I should probably just kill myself, because that's where this kind of logic leads.

I recently ran into an old friend who ended up on the judicial bench and wanted to take me to lunch to discuss how he could help me get an appointment. I declined the invitation. That door was slammed shut by a busy psychiatrist and under the current system I have no means to reopen it.

I'm incredibly saddened and disappointed. I expected better of you. By the way, I'm currently in some serious therapy with an M.D. shrink to try and undo some of the damage this "diagnosis" has done to my inner world. She does not think I have bipolar disorder. But she can't change the diagnosis in my medical records, she can't make me insurable again and, really, she can't give me my good name back. You just really f***d up my day.

I originally wrote an angry, sarcastic screed in response to this post. I deleted it and wrote a more thoughtful response because I thought it would better serve the interests of "people like me."

You're not God. Please reconsider your position.

Midwife with a Knife said...

The reason I vacilate on this is that, it is true, one's judgement may be altered by mental illness, there are a number of things that could alter your judgement... illness of all kinds, overwhelming ego, substance use or abuse, any one of a number of personal circumstances, etc.

And so, although mental illness is of concern (let's face it, someone who is depressed and feeling suicidal probably should not be president, or fly a plane, or any one of any other possible things... heck, maybe they should be taking time off to get better!), neither should anybody who is too arrogant to realistically assess their decisions and mistakes. People who are febrile probably shouldn't be doing these things (yet how many times to people who are ill come to work anyway)?

I don't know.. I can see it both ways...

Nobody said it was impossible or even unlikely for them to do a good job, just that the possible consequences are concerning... and they are.

nonstandard mind said...

One more observation. Since my "diagnosis" I've been studying the profession of psychiatry quite a bit--the pharma company scandals, the revision of the DSM, stealthily and in secret by docs with serious pharma company ties, to include every human condition under the sun (including Compulsive Reading of Shrink Rap Disorder), the shoddy "science" behind various studies, the stunning overdiagnosis of bipolar disorder, Biederman (need I say more?), the whole package. I'm a capable litigator, and I believe I could easily have the DSM-IV excluded from admission as scientific evidence in federal court because it does not meet the Daubert standard. Give me Dr. Carlat and about half a day of testimony and I swear I could do it with ease. With all due respect, I suggest that ya'll get your own professional house in order before you start proposing to exclude whole classes of persons from positions of responsibility based on the dubious judgment of some of your professional kin.

And Novalis, please explain, with the scientific rigor one would expect from an M.D., the difference between "bipolar" and "Bipolar" and how you would make a diagnostic distinction between the two. You may refer to the DSM-IV if you wish.

Ooops. The lawyer's coming out to play. Sorry. This post really touched a nerve.

Novalis said...

Implicit in a distinction between bipolar and Bipolar is the overdiagnosis of same that you refer to.

And it should go without saying that no psychiatrist ought to be President either--too controversial.

Alison Cummins said...

Lots of people in office - including the last US president - have psychiatric disorders. The most common and socially accepted one is substance abuse disorder.

Dinah said...

Psychiatric disorders (sort of like all other illnesses) seem to be a diverse group of illnesses, with diverse course, prognosis, and response to medications. 90% of people who have a psychotic episode once will have future episodes. Maybe we should be talking more about the 10% who don't.

US presidents have had major mental illnesses-- Teddy Roosevelt likely had bipolar disorder, JFK had notable issues (I believe with anxiety, pain, use of pain killers and sleeping pills).

Nonstandard, you want me to reconsider my position but I'm don't think I have one. I did clearly state that I don't want someone with a SYMPTOMATIC illness or "in the midst of an episode" in certain jobs, but it's the issue of active impairment. I believe my implication in countering Novalis was that I didn't think that a past diagnosis, without on-going impairment, should exclude people from certain jobs.

Over-diagnosis? Under-recognition? I don't know, I don't want to vote on this one either. If a distressed person comes to a doctor seeking help and a treatment helps, that's great. I'm not so sure I care what we label things, the usefulness of labels is limited, it's helpful for research, sometimes it's helpful to direct treatment. Often the "label" aspect is about sticking a code on a form so the patient can get reimbursed from insurance and people often pay out of pocket to avoid the consequence of any labels (accurate or otherwise).

Anonymous said...

I agree with you Dinah. They should be treated in the same way that someone who has diabetes or had reaccuring cancer. Provided the person is insightful enough to see when their reasoning might be underminded, there shouldn't be a problem.

Mr Ian said...

*tosses a rose to nonstandard mind and applauds*

The issues for me revolve around what the diagnoses means.
Literally, nothing. It's a cluster of behaviours that amount to an opinion on a person's nature by someone who has very often little experience or understanding of the context of the person they are labelling.

But the argument about a diagnosis and it's relationship to judgment, suicidality and unpredictability is non-sequitur anyhow.

As a nurse who works with forensic clients - I am yet to be satisfied that the prediction of risk, and subsequent interventions, is anything more than a biased fear factor in the face of misunderstood or illogical reason.
The predication of risk to a mental illness diagnosis is flawed.

More crime against the person is committed by people who are drunk or on illicit drugs - whether this is contributory or not is arguable - but no more arguable of the contributory status of a MI condition. (I personally object to substance use being a "mental illness" or psychiatric disorder. It certainly has a frequently recognised co-morbid alliance - tho chicken-egg comes to mind. It's either a personality choice or a physical addiction and not a psychiatric illness but a potential sign of someone with MI).

An important factor is that most conditions are self limiting.
A depressed person is hardly likely to even get out of bed to go to work.
Suicidal people rarely want to take everyone else down with them. Their beef is with themselves - not everyone else in the world.
Psychotic processes of a significant nature are not easy to hide - so it can become clear that someone is not well at work - just like it can for someone having a heart attack or hypoglycaemic crisis. So do what you normally do - and help your colleague out.
Get some treatment and follow the normal pathways to recovery - or long term sick leave - or stepping down. Which appears to be what the Doug Duncan did. No shame in that. Just bad timing for the chap. He could equally have had urgent heart surgery need and done the same.

There are however certain characteristics of some mental disorders that decrease the capacity of the sufferer. But this is not a given with any of the labels proviuded - and the individually relevant criterion that puts someone 'at risk' still needs to be formally identified and acknolwedged.
Otherwise it's like saying "If you have a respiratory infection you cannot go to work" - which does not recognise the difference between infectious and non-infectious conditions.
If someone can identify the component behaviours AND show me a measureable objective test to demonstrate people who pose such risk - then I'd back it. But at the moment, all we have is an 'opinion'.
Even the most robust measures we have (HCR; PCL-r) are limited in specificity and sensitivity.
So if you're going to apply some filtering system to obviate 'potential avoidable error' - then we might want to rule out some other characteristics that might influence our opinion. They are not DSM/ICD listed as 'syndromal' as far as I know but are certainly undesirable traits and have lead to immeasurable costs to human well-being and even life.
I'll start the list off... feel free to add:
money hungry
religious fanatic

I will touch briefly on how much work contributes to mental illness. Including PTSD - and recognise the high rates amongst servicemen (predominantely).

One final significant oversight with this thought - what makes anyone think we don't have many people already in these roles with mental illness?
1 in 5 people have mental illness - 20%.
The (US) unemployment rate (Mar, 2009) is at 8% - so there's 12% of people in work who have a mental illness.

Anonymous said...

ANYONE who would WANT to be president right now, in our current mess, has got to be a little crazy!

Anonymous said...

Non Standard, I am having insomnia thanks tapering off of psych meds so forgive me if I have missed something.

You do realize that bipolar reactions to SSRIS are a side effect right and do not in themselves indicate that someone has BP? You seem to infer that but I couldn't tell in my insomniac induced state.

No matter what, I find your story heartbreaking and is a perfect example of how ridiculous it is to exclude someone from higher office due to a mental health diagnosis. Even if your BP dx was accurate and it sure doesn't sound like it was, you sound exactly like the type of person society wants on the bench vs. some of them on there right now. The story of the judge in Pennsylvania jailing kids for profit is a perfect example. Give me the judge with a mental health diagnosis who knows his/her limitations any day over a so called normie who has scarred kids for life with his despicable actions.


Anonymous said...

Midwife: I do not think that it should be possible to get through medical school without knowing how to spell.

When I was diagnosed Bipolar, I was told that I was in good company since so many successful people across many fields had Bipolar.

I have known a number of doctors who live with their own mental illness. Should they be be allowed to practice? What if they suddenly become sick and write a presciption for the wrong drug? Or worse.

Kay Redfield Jamison has Bipolar. She is very well respected in her field.Of course she is tucked away in academia so I imagine Novalis is not concerned.

This is all very disgusting. Anyone can have suicidal thoughts and act on them. There is not a human on this planet who is immmune to mental or physical illnesses.

There is a tremendous difference between having a mental illness and being disabled by it.

Next step: round us all up and create a ghetto. Don't let us out.You never know what we might do! When you have finished with that, starting from today and moving back as far as history will allow, wipe out the contributions to society that have been made by people with mental illness. You will have a lot less great literature, music and art. In politics, it would be interesting to see how the world what the world would look like had it only eve been run by "sane" people. While you are at it, find me a sane person.

Roy said...

Please see my clarifying edit at the end of the original post.

I really liked many of the points nonstandard mind brought up. But, without turning this into a trite doctor-vs-lawyer comment, it is the legal system that has helped to perpetuate. If you read Dinah's post literally, she is not taking a "simple-minded opinion', but is, in fact, quite nuanced to emphasize functional capacity rather than diagnostic labels.

While the insurance industry requires us to focus on a "diagnosis", psychiatrists actually tend to focus more on symptoms within the context of broad diagnostic categories (ie, a mood disorder, a thought disorder, an anxiety disorder, a substance disorder, a cognitive disorder, a developmental disorder, and a personality disorder).

But it is the legal system that has to "rethink our position." We cannot predict the future, as much as judges would like to think that we can to some degree. We cannot "brand" someone for life with a diagnosis (imo), though society may permit this or one may allow it to define them, but it doesn't have to. People with, say, diabetes, have a huge variation in other personal qualities, and the same goes with folks with bipolar disorder.

I wish we, as a society, could get out of the tendency to put people in buckets which constrain what is expected of us. Yes, that even applies to those of us in the psychiatrist bucket and the attorney bucket.

But that is how our brains work; we lump things into categories. By people speaking out about how they don't fit into a neat bucket, that is how we can learn that "bucket-people" are, in fact, multidimensional.

Roy said...

Oh, I also disagree with Dinah's comment that "90% of people who have a psychotic episode once will have future episodes."

That is simply wrong. Most single psychotic episodes are drug-induced. I am looking around PubMed for a reference, but not successful so far. Anyone got a Kaplan & Sadock handy?

Dinah said...

I feel sooo misunderstood!!

I wasn't including drug-induced or fever-induced psychotic symptoms as an "episode" or even psychosis as part of delirium from any cause. I meant as a symptom of a primary psychiatric disorder.

Round up the mentally ill and stick them in a ghetto? Great idea (pleeeeease note the sarcasm!)--community studies show that half (50%, 1 in 2) of all people experience an episode of psychiatric disorder during their lifetimes, I wouldn't be surprised if this was an under-estimate, so it's gonna be one big ghetto, maybe we could rent out California and Texas for the purpose? Funny, but the study I linked to said 49% of presidents have likely had mental illnesses, so fit right in with the populations.

Roy is right: my point was not the Label, it's the issue of ability to function --- the screen shouldn't be "do you have a mental illness" to be a pilot, or anything else, it should be a test of reaction time and alertness before you get on a flight.

My guess: if we emptied public offices of anyone who has ever had a diagnostic label, there would be very few people left to run.

My thoughts on damning "labels": later.

nonstandard mind said...

*takes a deep bow in the direction of Mr. Ian and laughs uproariously*

Hey, it's me, nonstandard mind, posting under a variation of my original name, because I can't get the blogger software to believe that my password is my password, and I can't figure out how to retrieve what the software thinks my password should be.

I truly appreciate Dinah and Roy for taking the time to address me seriously.

Dinah, I'm sorry. I seem to have gone off on you unjustifiably. When I started to read your post yesterday I jumped over to Novalis post and first read it. By the time I got back to your post, I was worked up into a pretty fair (or, apparently, unfair) state of righteous anger and I admit I didn't take the time to fully understand or consider your views. Instead I came to the comments and created an alter ego so I could vent. And vent I did, though I deleted those ill-considered remarks without publishing them.

With regard to what I did publish I stand by the content of the first comment. The story is true. However, the term "simpleminded" in no way should be applied to you. I've always found your posts to be nuanced and thoughtful. I hereby remove from you the extremely hasty and ill-advised stigmatizing diagnostic label of "simpleminded" and apply it instead to Novalis. I may someday remove it from Novalis if he's good because, unlike the psychiatrist who originally diagnosed me, I am willing to take into account that I am human and reconsider my opinion.

With regard to the second comment, well, it was simply intemperate and uncivil, and I won't be at all offended or accuse you of censorship if you remove it. Please consider that this issue has worked me over in ways you can't imagine and has nearly wrecked my life over the two years since I first took an SSRI and the one year since the original diagnosis of bipolar disorder. Or for Novalis, I suppose that would be Bipolar Disorder, because the diagnosis was BP type 1. I only recently started therapy and I'll freely admit that I have a significant issue with anger and hostility over the whole situation. In that regard, I suppose I was a "ticking time bomb." Sorry, I couldn't resist. Actually I sided with Dinah on that issue.

Roy, you'll get no quarrel from me over the many, many failings of the legal system in this country. Though I don't believe it's the whole of any problem I do believe it's a significant part. If I were a member of the plaintiff's bar, I'd probably be suing everybody in sight, but I've spent much of my career defending civil legal actions, the vast majority of which I considered to be frivolous. I'm sure we could have some lively discussions about the legal system and its flaws, and while I'll bet we'd have some significant points of disagreement, I'm equally certain we'd find some serious commen ground.

Having said my piece, I have one question, and I can't ask it of my therapist, given therapeutic boundries and all. Dinah remarked that the diagnostic label sometimes may be insurance-driven. I believe she also stated something to the effect that to her the labels don't mean much. My question is, do you folks ever consider how the label might affect the patient? Because, seriously, upon hearing the words "bipolar disorder" my sense of self blew out of me like arterial blood.

As for the bench, ah, well....I'll find another goal to pursue. As for the diagnosis, at some point I'll find a way to appeal and get it reversed. But not until I get my insurance company to pay for a whole buncha therapy. Because their system helped get me into this mess.

I apologize for a couple of long-winded posts. It's been a long couple of years, and I seem to have a lot to say. Thanks for granting an old litigator a forum. I shall now resume lurking, much to everyone's relief.

Anonymous said...

I seem to remember that our former president, George W. Bush, is an alcoholic. And I seem to recall that the information was pretty widely spread before his election. But he still got elected. Isn't alcoholism considered a disease?

But the US public still elected him.

Mr Ian said...

The question should be about how they are currently functioning. And if a position carries enough high risk (say, the nuclear button-pusher job, prez, airline pilot), then there should be built-in safeguards that require some sort of ongoing assessment of functional capacity, regardless of one's presence or absence of diagnostic labels

Almost, but not quite, my point already made.
And as Dinah says:
the screen shouldn't be "do you have a mental illness" to be a pilot, or anything else, it should be a test of reaction time and alertness before you get on a flight.

There; we're all agreed.

I'm appalled at the FAA regs based simply on medications. That just sustains the ignorance.

Anonymous said...

No kidding it would have to be one hell of a big ghetto. That was my point.
It wasn't Dinah's post that got me riled. It was Novalis. He and his type are the reason people want to hide under a rock and die.

Fat Doctor said...

I just want to say that I know many physicians who have mental illness.

Whether or not they have been diagnosed is not known to me, but they are clearly ill.

Mentally ill politicians probably couldn't do worse things than mentally ill physicians.

Just sayin'.

Heather said...

:) I just wanted to comment that I love your blog! I read it regularly.

I do want to comment myself on this topic, as I have been toying with this issue.

Who I am: I'm a psychology major who plans to go to graduate school and such.

Apparently my grammar has been shot by writing papers, forgive me.

I think that if someone is functioning then I see no problem with them holding a higher up position.

Even if someone is suicidal, I would be okay with them flying a plane as long as they are not homicidal. Many times if someone is suicidal, they are not going to kill others in the process.

Before I sound even more incompetent, I'm going to go.

Take care and keep up the blog!

Alison Cummins said...

And, um, somewhat previous to the most recent alcoholic president we had the clearly impaired by alzheimer’s president. It seemed to be generally known and understood. There must have been some discussion even while he was running for his first term, because I remember he reassured reporters that his doctor would tell him if he showed any signs of senility and that he would step down immediately. But towards the end of his second term it had progressed to the point that it was visible to television viewers.

So actually, an argument can be made that it doesn’t really matter who a US president is as long as they appear sympathetic on television. They can have all the impairments they want.

FooFoo5 said...

And I am concluding that we will be [forced] (funny, you can't use "strikethru" text in comments in Blogger) obligated to report mental disorders (though I'm not exactly sure to whom) akin to seizure disorders to the Dept. of Motor Vehicles? 23 (and now 24) comments and only ONE lawyer? The legal ice here is so thin that the old axiom - "never anger a nurse or a lawyer" - has seemingly been forgotten! Nurse? Lawyer? Nurse? Lawyer? Kids, bet your money I'm standing with nonstandard mind, and with a hard hat.

Anonymous said...

To Nonstandard mind:

More flower throwing in your direction from the peanut gallery!!! You saved me from "having" to write a very similar post.

I am another person with a very similar story to yours (I was 55). I didn't lose my health insurance, though. With the inefficiency of the system, I doubt that anyone will long remember a single diagnosis of bipolar that my current psychiatrist disagrees with. In addition to negating the bipolar diagnosis he also suggested I go off all psych medications which I did about 2 years ago. I agree that the circumstances rocked my world. The psychotherapy with my wonderful psychiatrist has enriched my emotional life, however (unlike the psych meds I took for a while which effectively took all feelings away).

I don't think the diagnosis will actually affect my life longterm. I have been able to make a career change into teaching without being asked about my mental health history. If a 100% clear mental health history were required for a variety of jobs fewer people would seek help when they need it.

Anonymous said...

Maybe this should be included in the informed consent: "I understand that I may be saddled with a diagnosis/misdiagnosis that would forever prevent me from entering certain occupations, may make me feel even more despondent, etc..."

I wonder how many people are out there like Nonstandard Mind who have received psych meds, had a bad reaction, and now have to pay for this crap diagnosis for the rest of their lives. Considering the numbers of people diagnosed as bipolar today I would imagine that's a lot of people.

I don't think doctors think enough about the impact of these diagnoses on their patients' futures.

Sarebear said...

Oh, I'm gonna try to never get near another lawyer again, if I can help it. I accidentally triggered my Social Security lawyer's "Attack Lawyer" mode, and it was aimed squarely at me, on a phone call several years after my case, when I aired a regret I had (he must have been thinking cover his ass big time but I wasn't accusing, not tone, phrasing, language, anything, geez!!!! it was long over!!!!) And right to appeal had been given up, although I think I was unduly pressured although I said nothing about THAT, to do so, at the time.

Anyway, I'd rather go in front of a firing squad than go near a lawyer again, but that's B&W thinking, and old (and not active, just habitually ingrained) suicidal thinking I suppose.

Plus major anxiety disorders and panic about it, I was sent into the back of my head when he did it and the rest of whoever was me said whatever it had to to get me through and out of his attack on me.

UGH!!! This from someone who claimed to defend and protect the mentally ill. He turned from his pleasant Southern Gentleman charm, on a dime, to a Shark, faster than you can snap your fingers.

Anonymous said...

"My guess: if we emptied public offices of anyone who has ever had a diagnostic label, there would be very few people left to run."

And absolutely nobody who would want to.

Unknown said...

Good to hear the discussion. I'm not sure what my views are. It would seem that if a person is capable of being elected, easily one of the most difficult aspects of public service, they are capable of holding office. If the public votes to elect someone who has a form of mental illness, I don't see any policy as neccesary to prevent that. I should assume a number of psychologists are inspired go into the feild because they had seen the benefits of treatment themselves. Should they be barred from working as psychiatrists or psychologists in a blanket fashion?

It seems also that as far as we have come in understanding the brain and treating it, participants in the coming decades of research will likely look back on today's approaches as primitive. Our diagnosis is constantly evolving and becoming more nuanced.

My primary concern in light of this is the civil rights of the mentally ill. Once we limit the civil rights of the mentally ill, we walk a very dangerous precipice.

Additionally there is an issue of economic status. If a teenage girl in Hackensack is sexually abused and begins to withdraw or act out, and her parents can not afford a good therapist, she may be put into the adolescent mental health system. I should assume medication and diagnosis appear quick on the table. Because then she can recieve Medicare, and treatment.

An African American can be often unjustly pulled over and arrested by a police officer in an episode of racial profiling. Even if released the next day, this person's new criminal record will prevent obstacles.

Similarly with mental illness, it would appear that the amount of individuals given diagnosis to recieve treatment does not neccesarily match the amount of people with actual mental illness.

Lastly our ability to treat mental illness will undoubtedly improve, radically, over time.