Uncertain Health in an Insecure World – 49

“The Voice”

Like bigotry, stigmatization is a sign of a society that avoids confronting its realities.

Addiction and mental health disorders are chronic illnesses that nobody expects to claim them. Both take an incredible toll on the lives of those affected, and their families. They often co-exist, among patients whose physical addiction and emotional affliction are too entwined to be teased apart – so-called ‘dual diagnosis’ patients.

Half of Finns seeking addiction care report a mental illness. Both can be fatal.

Public policy and healthcare economics complexities in the 60’s and 70’s triggered these deadly epidemics. In that era, many large inpatient psychiatric hospitals were closed, squeezing care into outpatient mode. Pop psychedelic dope culture blossomed like a weed, while tens of thousands of soldiers returned from Southeast Asia with a nasty heroin habit to kick. We’ve touched on some of the pertinent global forces that still propagate these dangerous health and social trends (see posts #8 & #9).

Long overdue change is in the wind!

One big reason for the chronic lack of societal awareness and medical attention to these illnesses has to do with their long-standing stigmatization. The number of people affected has exploded, and such high prevalence has made them unavoidable to the press and public healthcare funders.

As reported by The New York Times’ Katharine Seelye (July 12, 2015), some of the grieving relatives of thousands of people dying from heroin overdoses are talking more openly about the ravages of the disease in obituaries and on social media. She notes that the celebrity obituaries after heroin OD’s of people like Amy Winehouse (July 23, 2011) and Philip Seymour Hoffman (February 2, 2014) usually perseverate on the cause of death.

But the less celebrated die quietly “at home” in an “unexpected” manner. They are often a “Son, Daddy, Brother and Friend”, as well as being an addict. The growing openness about drug fatalities in these families is now joined by law enforcement agencies and policy makers pushing addiction treatment as a public health crisis, instead of a crime or moral failing.

As the U.S. Centers for Disease Control reports, the epidemic is shifting to the old, women (doubling between 2003-2013), and the affluent (up 60% among those making >US$50,000). Some 22 million Americans are now addicted to drugs or alcohol. Heroin-related deaths have quadrupled to >8,200 per year. Change.org and other advocacy groups have forced many U.S. states to adopt naloxone (Narcan™) opioid antagonist kits as lifesaving antidotes in overdoses. 

A good start, but not good enough.

The promise of a better future requires that we put an end to guilt, silence and embarrassment. Only this will save others from the pain and heartache of a heroin death in the family.

Some families that struggle with “this Hell that is Addiction” choose to keep their feelings private. Part of this has to do with the great divide between those that live for years with the weight (i.e., anger, enabling, helplessness), and “people who have NO clue about addiction”. Neither side should judge the other harshly for being outspoken or private in the dealing with a death.

It is highly complex, to say the least.

The Economist (“Out of the Shadows”, April 25, 2015) reports that while the stigma of mental illness is gradually fading, persistent societal prejudices cause many to conceal their diseases and to not seek medical care. We discussed this in the context of the tragic crash of Lufthansa flight 9525 (see post #30).  In all but the most severe cases, mental illnesses can be successfully treated, and those in treatment do not usually pose a threat to their families or co-workers. And when 1 in 5 working age people in developed countries report having a mental illness, it is no surprise that economic impact estimates are 3-4% of annual GDP. 

Given these numbers, any public resistance to real engagement on the issue seems futile, and frankly misguided. 

Talk therapy – openly discussing one’s mental illness – is now becoming acceptable. This could prove cathartic for patients and the broader society. The mental health advocacy group, MIND, has been actively campaigning with the U.K. government and charities to reduce the stigma that perpetuates public ignorance. As a result of this and other initiatives, in 2013 only 13% of Britons felt that a mental illness history should bar a person from public office (down from 21% in 2008).

Half of adults with chronic mental conditions experienced their first symptoms before age 14. The anxiety provoked in teenagers by this condition, fueled by social media pressures and bullying, increases substance abuse and suicide deaths.

Under-treatment of chronic mental illness remains a serious problem. It contributes to the excess suffering and mortality in developed countries, where mental illness outstrips heavily treated chronic conditions like heart disease and stroke. U.K. men with mental illness die 20 years earlier, primarily from non-suicide events.

Who speaks up against all these premature deaths?

Some 200 countries signed on to the 2013 WHO Mental Health Action Plan.

In the 2015 U.S. Presidential Campaign primaries, more questions to the candidates revolve around addiction. In 44 states, the largest mental health facility is a prison.

Last week, Barack Obama became the first U.S. President to visit a federal prison, after he commuted the sentences of 46 drug offenders who were slapped with harsh mandatory minimums. In 2015, 40-70% of prison inmates in E.U. countries have a mental illness.

Society is slowly succeeding at changing systems of care and legal judgment.

Transition to community-based home care by social workers & mental health nurses has been successful in Australia, U.K., Italy and Nordic countries. U.S. mental health courts are making a resurgence, attempting to preemptively divert the mentally ill from prisons to community care.

We in the Square know that putting addicts in jail and mental health sufferers in asylums is ignorance.

When people are ill, not “crazy” and “immoral”, humanity demands that they have a voice. Morality demands that we all listen.