by Lizzie Simon
When you see a kid shooting other kids in the cafeteria on TV, you're looking at a crazy kid. When you hear about a cult leader bringing his followers into death, you are hearing about a crazy man. When you see Sally Field disrupting her daughter's life on ER, you are looking at a crazy woman. But when you see my picture in the New York Times, and read praise of my work as a producer, you are also witnessing the life of a crazy person. What's the difference between me and them?
I've complied with treatment. They haven't.
I was diagnosed with Bipolar Affective Disorder (manic-depression) seven years ago. Seventeen years old, suffering from a deadening episode of depression and a psychotic episode of mania all in one month, I went from not being able to get out of bed to not being able to sleep at night, from constant thoughts of morbidity to complete and endless euphoria. I had experienced similar episodes all through my childhood, but they were never so severe, so filled with terror. I visited a doctor with my parents and was prescribed lithium, and I've taken it every day, as prescribed, ever since.
Noncompliance is a major issue for all maladies, not just mental illnesses. Most people who are given medicine do not adhere to their doctor's orders or they flirt, as I did, with noncompliance. In my case, the damage was small. Papers turned in late, unnecessary fights with roommates. But noncompliance can be deadly: Of the one percent of Americans reported to have mood disorders, between fifteen and twenty percent kill themselves.
The problem is not inadequate treatment. There are, in fact, over a dozen effective medicines which, when taken, eliminate the destructive powers of the disorder. The biggest problem facing researchers, doctors, families, and those afflicted is the pervasive tendency of people with diagnosable and treatable mental illnesses to resist treatment.
A year ago, I received a grant from the Federation of Families for children's mental Health to travel across the country and interview people under the age of 35 about why they do or do not take their medicines. I found that some of their concerns were practical and physical. Some couldn't afford treatment or therapy. Or they hated the side effects of the medicine they were given. But most of the excuses people gave for noncompliance were emotional, and rather abstract. Many didn't want to be labeled "mentally ill". They were afraid the drugs would deplete their personality, their creativity. They didn't like the idea of being dependent on a drug. They didn't see themselves as being as bad off as the messy freaks they saw portrayed on TV and in film. They were doing better than Sally Field's character as the manic mother in ER, and they thought perhaps they wouldn't need medicine anymore.
Would they take insulin if they were diabetic? Sure, but that somehow was different. They made a strange and deadly leap of logic: If I don't take pills, I won't have to deal with my fears, and I won't be thrown out of my church, my job, my family, my relationship. The payoff for noncompliance was the feeling of release from the pressure and punishment of stigma, from the pressure and punishment of being handed down a diagnosis which signifies horrible things in our culture.
We live in a world where it is not safe to "come out" in the workplace or at school. Bipolar people hear derogatory statements about the mentally ill almost every day of their lives. Even I admit to using words and terms like crazy, insane, nut job, or loco in the coco on a regular basis; if someone in my midst secretly harbored a mental illness, these words wouldn't make the transition to recovery any easier. Stigma is everywhere. Noncompliance, though illogical, is a natural reaction to our cultural climate.
There is no way to measure the damage that noncompliance inflicts on bipolar people, their families, and our society. Noncompliance creates disaster and disruption, hopelessness and despair. When bipolar people weave in and out of treatment, their jobs and relationships are abandoned. Their addictions to alcohol and drugs become fierce. They attempt suicide, and sometimes succeed. These unnecessary and harmful detours are a chronic and painful affliction for those who endure them, their families, and society as a whole.
Yet bipolar people who are treated may even be more effective in the workplace and make better lovers and friends than those who are "normal." They are certainly more mature, more compassionate, and more self aware for having their experiences. There is no legitimate reason why a treated bipolar person cannot triumph in his or her personal and professional life. This is the idea we need to promote, so that a diagnosis doesn't signify rejection from society. The "solution" to suicide (or homicide) lies in the elimination of stigma surrounding mental illnesses and their treatments, and in the creation of a healing recovery process filled with empathy for the spiritual and social and physiological effects of mental illness. We will know we have made improvements when the media bring us the success stories of people who triumph over mental illness, instead of bombarding us with tales of violent sociopaths.
Millions of people with mental illnesses are creating great work and contributing to our society. It's time to shine a light on them.
Lizzie Simon graduated from Columbia College in 1998 and then became Creative Producer at the Flea Theater in Tribeca. She currently writes, produces and speaks publicly about mental illness. She welcomes your feedback using the form below.
You can do both by typing your response below,
submitting it and then copying it, going to MoxieTalk, and pasting it
into the form there for posting a message.
Copyright 2001 Moxie Magazine All Rights Reserved