Memes of Mental Illness

Here are a few that struck me. I'm not huge on memes because little discourse is visibly peripheral to them (outside of academia). While the comments show appreciation and can reflect popularity, through methods of voting, they rarely delve into the root social commentary. Though simplistic and "off the cuff", they provide a rich account of our culture that can be examined, discussed and dissected and provide unique reflection on higher social processes.
These specialized memes are harder to find and less "liked" on the generalized meme sites however there are a few mental illness specific ones created by and for those who suffer from mental illness. Since they reflect these higher social processes, I've found that they can be applicable to a variety of mental illnesses and are generally well received within the community. For the most part, I find memes overwhelmingly prevalent online and while some are amusing, many are an utter waste of time.
These specific memes share personal experiences of the mentally ill that aren't easily expressed publicly and without the anonymity of this particular form of media (which can broadly be defined as "social-media" however begs for further analysis). Let's view and discuss the following.

This is an accurate expression of the symptomology of bipolar disorder. Now to appreciate these facial expressions, other memes must be viewed. Loosely, the first segment (upper left) reflects the dramatic and sudden shift to a heightened state of excitement. True, everything may seem funnier, "lol", but really I see here a depiction of the adrenaline and norepinephrine that surges when in a manic phase and these really intensify life on all facets. Upper-right, we have the attitude narrowed, that of high feelings of self-worth, feelings of omnipotence and righteousness even. These attitudes can rub people the wrong way and that coupled with feelings of importance leads to interpersonal conflict. Mid-left, we see the subject having the feeling of being able to take on any challenge and the zealous creativity and energy that characterizes mania and bottom, the after-math. Post-mania, a depression follows and true to life, memory of the manic episode is patchy at best. Bipolar disorder is grossly understood and while depictions in media are becoming more accurate, we often are majoritively presented with the extremes of the upper segments while the bottom segment, possibly the most devastating, is left out. Based on my research with bipolar support group outlets, the manic phases are sometimes sought out, induced even, by bipolars so the emphasis on this phase wrongfully ameliorates the imminent depression.

This meme really hits home the feelings I've seen expressed numerous times during my research. If we are to legitimize mental illness as a biological pathology, like cancer or HIV, we have to move past the elusive quality of it. By definition, mental illness is organically based in the brain, a mostly invisible (outside of the eye) organ. Many medical pathologies are invisible however, so in doing this we risk ignoring its status as an illness, something that should carry no blame, therefore perpetuating stigma. As an anthropologist, I recognize that the bio-psychiatric model of mental illness only accounts for a certain account and certain biological processes and that cultural specificities can adjust these, despite all clinical intuition and diagnostic paradigms. Stigma, however, persists in part because of the invisibility of the illnesses, making them difficult to define discretely. As Andrew Lakoff, professor of Anthropology, Sociology and Communications at University of Southern California argues, "The biomedical model seeks to rescue the person from the stigma of mental illness by treating it as something external to the self"(Lakoff 2005:106). Here Lakoff illustrates how the attempt by the "ignorant" person to find the mental illness in appearance can tie the illness and the self together too completely, taking import away from the biomedical perspective which can help equate mental illness to other "invisible" disorders such as cancer. Mental illness has yet to reach the level of medical respect cancer has and can, in part, vilify its sufferers.

Here we have an observation of what is a popular sentiment regarding current prescribing practices of service providers of mental health care. Over-prescribing and over-medicating are strongly supported claims in the public eye and can be drawn out of proportion. Accounts from actual patients include instances of patients wanting medications but their provider refusing (yes, they can do this). Providers fall into categories where their prescribing practices reflect their personal attitudes towards pharmacological treatment. Many take holistic approaches and give credence to whatever therapy is best suited but there are those who fall to the extremes. Patients often complain about this because the process of switching psychiatric service providers if the suggested therapy is not desired is arduous, expensive and can exacerbate symptoms of certain illnesses. Sometimes providers aren't up front about their pharmaceutical philosophy and this is only to be discovered at the worst time, when you need a medication adjustment. That being said, from my research, I find that while there is certainly complaints about being over-medicated, or at least being suggested to be as the patient ultimately makes the choice for him or herself, there are just as many accounts of patients feeling they need to increase a dosage or add a medication but their providers won't comply. More medication can be good in certain cases or even necessary to maintain a certain level of recovery. There are other therapies that can substitute certain medications, anxiety can be treated pharmacologicaly or through talk-therapy or meditation, but every option has a certain lifestyle it can fit into. When someone is suffering extreme anxiety that is keeping them from leaving the house and working, treating it pharmacologicaly, which is relatively instant, may be preferable to prescribing talk-therapy which can take away time from work and may take much longer for acceptable results. Mentally ill people want productive lives too and pharmaceutical treatments often are the best option to maintain these lives economically and socially.

Unfortunately, lengthy sessions with service providers are still financially out of reach for many and 15 minute "med-management" sessions cost proportionately less however only have one objective. For example, in Seattle, for the uninsured, a med-management session with a psychiatrist is around $75-$100. A full session, which usually combines medication management and talk-therapy is closer to $300 and lasts 50 minutes. These are pretty standard numbers. Insurance is still out of reach for plenty of the mentally ill, especially considering the likelihood of having full-time, insured positions and even with insurance, co-pays and mental health coverage can vary. I see these economic barriers as part of the perceived problem of over-medicating and patient accounts certainly reflect that. Regardless, Peter Kramer, psychiatrist and clinical professor at Brown University, in his groundbreaking memoir of antidepressants, Listening to Prozac, explained that"psychopharmacology (is) an impressionistic art" and this meme reflects the conflicts that can manifest from this.




References:

Kramer, Peter
1993 Listening to Prozac: A Psychiatrist Explores. New York:Penguin Books.

Lakoff, Andrew
2005 Pharmaceutical Reason: Knowledge and Value in Global Psychiatry. New York: Cambridge University Press.

A Woman's Proper Place

For those of you who read my blog, you'll notice I like pharmaceutical ads. They say a lot, more than we care to recognize, and are extremely effective in increasing sales. The power they hold over the patient/consumer population is astonishing. They are also controversial and induce resistance from many. In the manner that "any publicity is good publicity", these ads inspire some and anger others but the bottom line being, they speak to us all. Not only do they have the ability to depict the subtleties of mental illness, and they truly do, they have immense sociological directives as well. Whether or not these directives are with socio-political purpose or simply a means of hitting the biggest consumers of mental health care remains behind a smoke screen that can and will shift with any given temporal context.

I stumbled across this ad and it struck me.

The image on the left says "patients hospitalized for many years", while the image on the right says "are now at home".
This is an advertisement for Thorazine, a anti-psychotic commonly used in the 1950's. Prior to the de-institutionalization, psychotic patients were often hospitalized long-term for lack of proper treatment, and in some part because of the way the mentally ill were seen in society (outcasts, "mad", dangerous, low intelligence). The reference here is that once on thorazine, a patient was sufficiently treated to return to "normal" family life at home. Note the children's toys below the feet of the image on the right. This normal family life clearly involved raising children, while also remaining fashionable enough to wear patent heels and a dress. We all are familiar with the 50's housewife; loving wife, devoted mother and with a composed and "put-together" appearance. The ad promises thorazine can do this, and no doubt it may have, in some lucky cases.
In that time, thorazine was great. There weren't many options to treat any mental illness, let alone psychotic symptoms. Thorazine is sedating and neutralizing and could certainly bring a wife and mother back to reality. In an attempt to stay neutral in this analysis, I want to point out that this ad gives little hope for those where this life trajectory wasn't likely. Regardless, the scenario is not at all implausible and the role of the woman depicted was the "ideal" role for all women of child-bearing age however it's hard to land a man and have a child with a mental illness so this ad overbearingly assumes a more privileged situation than many had. To not fulfill this role was cause for concern and certainly could be a sign of mental illness, perhaps leading to faulty pathologization. By returning to the home, this woman escaped social persecution and took her expected place in society. Thorazine has some pretty gnarly side effects however, and is now not the first line of treatment psychiatrists use. These side effects, including weight gain and lack of emotional expression which certainly doesn't bode well for a wife or a mother, are not addressed in the ad but this was before the stricter FDA regulations on DTC (Direct to consumer) marketing of pharmaceuticals today.
I am glad I was able to share with you this depiction of our 1950's history of women in the mental health care industry. While this archetype persists today, life-styles that accommodate severe mental illnesses are becoming more acceptable for women and men.
I think the guy below may still be a problem though...

The Paradigms of My Life

If you do a Google image search for "researcher", the results suggest that it is all about pie charts and petri dishes. I was trying to find a cartoon that I felt applied to my research, specifically working on my proposal, and while I did find an amusing one (see below), I still was made to feel like because I don't have lab equipment and molecular models that my research doesn't really fit into the nation's view of what research means and what it produces.
The cartoon I did find, however, suitably epitomizes my sentiment at the moment. Anthropology simply has so many influences, and likewise has influenced many areas of study, that I am liable to get lost in a sea of theories, paradigms, criticisms and nodes of thought. I was excited to see a favorite Bio-Ethicist of mine, Carl Elliot, MD, PhD, to be cited in numerous pieces on psychopharmacology I've been reviewing. I had taken an online course on Bio-Ethics last summer and had been in correspondence with Elliot regarding some of his works. These recent citations prompted me to track down what materials I had and re-visit them.
So then I took a detour into philosophy and now I’m trying to track down a hard to find Derrida, with little forethought on how to get back to the main hi-way. The dilemma here is I am realizing I need to revisit my roots in the humanities to get through any complex piece of anthropological writing. Learning how to straddle multiple disciplines in order to enrich my anthropological work will be an immense challenge indeed.

A desert or a swamp: Food sources in urban environments

In response to The New York Times’ article:
“Studies Question the Pairing of Food Deserts and Obesity”
Gina Kolata
April 17, 2012


One of many issues this article averts, or avoids, addressing is all the qualitative data that can sway the "food desert" hypothesis' weight. I think this Roland Sturm, one of the researchers who concluded poor, urban areas are in fact replete with healthy food opportunities, should try living in a low-income, densely populated urban neighborhood and shop for healthy food there for a week and compare it to living in a more affluent location. Then he should revise his study and make an effort to find more truthful results on this critical issue. He should also do so without a car or a budget for a cab ride and throw in only having time to visit one grocery store for all his needs, regardless of selection or quality. It is just so tempting for privileged people in positions of power to tell the public what the "results" show, in this case denying those living in poor, urban environments should have any trouble finding healthy food choices. This is a positively systematic way to take power away from populations that already struggle.

Studies that can capture more accurate depictions of urban life would not be hard to design; they could be fairly classic ethnographic studies with some biometrics thrown in. It wouldn't take much work at all to see the quality differences evident even between grocery stores just a mile apart. So much is being left out of these conclusions including the safety of the grocery stores and surrounding areas, business hours and accessibility, cleanliness of the store and helpfulness of the staff. I'd also like to see him take into consideration prices. Grocery stores do stock varying foods at varying prices. Though quality can be poor in low-income neighborhoods, prices may be equivalent to stores in more affluent areas.

I thank Dr. Helen Lee from the Public Policy Institute of California for recognizing the study's potentially complicated methodologies. She suggests distance matters too. I second this and contribute that although Dr. Sturm finds that within a few miles of your given urban area, “you can get basically any type of food,” a "few miles" can make or break the feasibility of grocery shopping all together and should not be discounted.

Dr. Roland Sturm
RAND Corporation
Senior Economist; Professor, Pardee RAND Graduate School
(310) 393-0411, x6164
Roland_Sturm@rand.org


Dr. Helen Lee
Public Policy Institute of California
Policy Fellow
(415) 291-4418
lee@ppic.org

Seattle's Waning Shrinks

It is an established fact that there is a shortage of psychiatrists in Seattle. Both of the insurance companies I've been with in the last few years displayed a restricted selection of female psychiatrists within 2 miles of my house, in network of course. Many that were suggested were at Seattle Children's Hospital and were specifically for children and adolescence but were listed anyways. The choices offered were spread out over the city, some in difficult to access neighborhoods. At the on campus health center for students, the psychiatrists offered were nearly all residents, psychiatrists in training, with one or two supervising psychiatrists for the entire floor. Swedish Medical Center, my primary care provider, focuses on inpatient and simply recommends nearby private practitioners for services rather than partnering with them. These private practitioners can be extraordinarily expensive and some have agenda driven treatment approaches that does not flex depending on the patient. There are also numerous community clinics meant for low income or no income individuals and most focus on dual diagnosis with some form of substance dependency. Long discussions with my own provider also has confirmed my initial observations. Fortunately, with the VA and two major University teaching hospitals, the UW Medical Center and Harborview, inpatient and emergency psychiatric care is not lacking.

I always wondered why this deficit exists because I mistakenly assumed that because of our large knowledge economy and being such a highly educated city that more use of biomedical approaches to mental health would be made therefore resulting in a plethora of psychiatrists.
While I don't have a hypothesis for this unexpected paucity, I do plan on looking further into this, hopefully to come out with some accountability. This article published by Thomas Insel, the director of the National Institute of Mental Health, provides some good base evidence for the shortage of psychiatrists, as according to Insel, psychiatry in general is becoming less attractive as a field to pursue compared to neuroscience, which is progressively becoming more connected with psychiatry with new advances in research.

I still feel like there is something missing here. Seattle also has an unmatched prevalence of Multiple Sclerosis, of which depression is a symptom. There is the cloudy, raining weather as well which effects many, not just those with Seasonal Affective Disorder. I don't have SAD and I've tried sun spectrum lamps and still nothing raises my serotonin like a sunny day and nothing makes things more miserable than they already are like rain and clouds. Seattle should have a healthy roster of psychiatrists, but it doesn't. More questions are to be asked!



Picture above from Seattle Etsy artist, faunafindsflora. Mixed media.