Worse Than Chain Smoking

Mental illness can shorten lives more than chain smoking, and America, unsurprisingly, is pretty bad at treating it. From what I can tell, Obamacare will help this a little bit, since even the lowest level of policy has better mental illness coverage than what insurance companies could get away with pre-ACA.

At my old Congressional race blog, I had a conservative commenter who was pretty reasonable, by which I mean that he was willing to accept that Obamacare was essentially a Republican plan and that he could more-or-less accept it. But he was adamant that he should be able to opt out of mental health coverage. He apparently felt that mental illness could only happen to lesser mortals, which is an attitude that is all too prevalent.

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84 replies
  1. 1
    Baud says:

    He apparently felt that mental illness could only happen to lesser mortals, which is an attitude that is all too prevalent.

    You usually don’t find such a strong sense of superiority among conservatives.

  2. 2
    jayackroyd says:

    It’s also the “deserving poor” fetish they have. They’re afraid moochers will be able to simulate mental illness and get the good welfare thereby.

    It’s kinda crazy, but you hear it all the time. People living it up big time on their unemployment checks.

    From a policy perspective, this is nuts. It’s far cheaper to just give the actual moochers money than it is to catch them.

    Actually, it’s far cheaper, and way better for the stability of the economy to just give people a Fed account and just deposit a lump sum into it every month.

  3. 3
    Belafon says:

    I’m pretty sure he’d agree that contraceptives are also for lesser mortals.

  4. 4
    Debbie(aussie) says:

    Would be too bad the day depression jumped out and bit him on the bum, hey. Just like the attitude of ‘I can’t get pregnant, why should I pay for that’. Do any of these persons understand how insurance really works.

    Speaking as one of those lesser mortals: here in Aust major adjustments have been made within our Medicare frame work to support those with mental health issues,

  5. 5
    Patricia Kayden says:

    Illness is illness regardless of whether it is physical or mental. I guess your Republican friend viewed mental illness as something dirty — something only “crazy” people suffer from. It’s that kind of stigma which prevents so many people from seeking help to overcome or treat mental ailments.

  6. 6
    MelissaM says:

    I have fully immersed Fox in-laws, and when their grandson was diagnosed with bi-polar disorder during a bad year of college, grandma wished he would just take his pill and get over it. Because, you know, mental illness is that easy. The fact that she talked about it at all is a wonder.

  7. 7
    aimai says:

    @MelissaM: I think a lot of older people think of mental illness as just a form of malingering or mere neurotic attention seeking.

  8. 8
    big ole hound says:

    How does anyone know if they have mental issues? Acquaintances must do the informing, but to whom? The family doctor, patient, cops? I know someone with issues (nonviolent) and have no idea who to consult.I have talked to this person and get ignored. What evidence is necessary? Some apparatus needs to be promoted to help.

  9. 9
    Morzer says:

    A lot of conservatives have a mythology of willpower (not that they are particularly good at showing it) plus a rejection of science and exaltation of the more cartoon-like and ethical-content-free versions of Christianity and this means, for them, that mental illness is either: a) other people faking it to get perks b) a matter of demons to be cast out by QB Jeebus c) an excuse made up by liberals as a means of justifying taking away white men’s guns d) something to be used when a self-identified conservative does something heinous and the usual excuses don’t quite cut it.

    Anyway, we all know that Reagan solved the problem of government in mental health care by liberating the mentally ill onto the warm and friendly street where the free market would handle all their problems with its usual cost-effective, best practice solutions.

  10. 10
    JGabriel says:

    mistermix @ top:

    Mental illness can shorten lives more than chain smoking, and America, unsurprisingly, is pretty bad. From what I can tell, Obamacare will help this a little bit, since even the lowest level of policy has better mental illness coverage than what insurance companies could get away with pre-ACA.

    That will probably help the people using the exchanges or buying ACA plans directly from insurers, but it doesn’t do much for people on Medicare or Medicaid. Most psychiatrists won’t take patients on Medicare or Medicaid – they say it doesn’t pay enough. Psychiatrists who do take Medicare/Medicaid have their schedules full and won’t take anymore patients who use it.

    They can go to the hospital easily enough for emergency care, but finding maintenance care is difficult at best, sometimes impossible. It’s a real problem, at least here in NYC, though I’ve heard it’s no better throughout most of the rest of the country as well.

  11. 11
    MelissaM says:

    @aimai: I disagree, but then, I have family experience with mental illness. My mother (a year older than my in-laws) has cousins, one diagnosed schizophrenic, the other clearly suffering but I think never diagnosed. Their parents had issues, one with alcoholism, the other institutionalized. For my in-laws, I blame a lack of understanding, but then, I believe there also is no desire to understand as well. If only we could de-program them from the Fox noise with a pill.

  12. 12
    Biscuits says:

    @Debbie(aussie):

    They just don’t get it until it happens to them and even then it’s not a given.

  13. 13
    gene108 says:

    @aimai:

    I think a lot of older people think of mental illness as just a form of malingering or mere neurotic attention seeking.

    Including people, who need treatment but feel they are just “weak willed” and need to “tough it out”. EDIT: This includes younger folks, who need treatment. The stigma around mental illness really keeps people, who they are not “right in the head” from seeking treatment.

    ********************************************

    One side effect of anti-depressants and anti-psychotics is they can make the patient get a crazy case of the munchies and gain a ton of weight.

    Being fat and mentally stable is better than being skinny and unstable, but the extra weight is probably taking a few years off a person’s life.

    *********************************************

    The real problem with mental health care is there were some well meaning attempts at reform in the 1970’s, such as making it harder to commit someone – such as a mentally retarded child or other “undesirable” family members – but the follow through legislation and funding needed to address helping the people who were warehoused in mental health facilities never happened.

    Hopefully some attention will start to get paid and the money will start to flow into mental health care, because a lot of the issues cannot begin to be addressed without more money going into the system.

  14. 14
    aimai says:

    @MelissaM: I am not saying that this is my position, just that it is the position of many in the older generation. For a certain type of person the idea of mental health, of psychiatry and psychology, are all tainted with images of neurotics and malingerers getting over on Freudian types.

  15. 15
    JGabriel says:

    @Baud: Heh. LOL’d.

  16. 16
    Tommy says:

    In another lifetime I ran a suicide hotline at a state college. Kind of what I planned to do with my life. I was stunned by the sheer number of people with minor if not serious mental illness that seemed to have no other place to go then to just call us.*

    I found I wasn’t wired for this type of job. I took it too personally. Wanted to help, do more, but there was really only so much I could do. And frankly, it was just too darn depressing. I felt like if I was depressed all the time, well it would be hard to help other people.

    *I should note the highest number of “serious” calls we got, women that had been beaten and/or raped. It was freaking heart breaking to talk with them.

  17. 17
    Morzer says:

    @aimai:

    A lot of the older generation come from a time when mental health issues were perceived as a shameful failure by the family of the ill person and were simply not discussed or acknowledged. Families suffered in silence and tried to keep the ill person out of the public eye as much as possible.

  18. 18
    JGabriel says:

    Debbie(aussie):

    Just like the attitude of ‘I can’t get pregnant, why should I pay for that’.

    I never get that one. Every one of the people who say that spent at least a few months inside a woman’s womb – demon hellspawn like Dick Cheney and Charles Koch excepted of course.

  19. 19
    someofparts says:

    “He apparently felt that mental illness could only happen to lesser mortals, which is an attitude that is all too prevalent.”

    I’m pretty sure that sociopathology is a requirement for anyone who aspires to be an investment banker or hedge fund manager.

    Although, reckoned in human terms instead of bank account size, they obviously are lesser mortals.

  20. 20

    The brain damage from schizophrenia alone would surely weight the numbers, and it’s no surprise depression lowers life expectancy. Mental illness sucks – I should know – and it’s a travesty that making treatment available is considered optional.

    @Morzer:
    I care far more that everyone gets what they earned than about anyone getting what they didn’t earn.

  21. 21
    constitutional mistermix says:

    @JGabriel: Here’s a fun fact straight from a mental health care provider I know: Medicaid coverage is better than a lot of the pre-ACA policies. Doesn’t mean it’s good, just that it’s less bad than some of those low-coverage policies.

    Medicare is worse because it restricts a lot of mid-level providers.

  22. 22
    JGabriel says:

    Debbie(aussie):

    Speaking as one of those lesser mortals: here in Aust major adjustments have been made within our Medicare frame work to support those with mental health issues.

    What kind of changes? As I noted above, it can get pretty difficult to find maintenance care for mental health issues on Medicare/Medicaid. What’s Austin doing to alleviate that?

  23. 23
    NorthLeft12 says:

    My in-laws are of the opinion that all mental health problems can be resolved with a swift kick in the ass with a frozen boot [we are in Canada, eh]. Needless to say, we have been dealing with some serious addiction and depression issues with some of them. My wife [the sanest of them all IMO] even says some people need a “good shake” once in awhile. It’s not easy to forget/ignore everything you were brought up to believe.

  24. 24
    Lee says:

    OT: The Tea Partiers won big time in Texas last night.

    I really want that to mean that the Dems now have a fighting chance in Texas, but I’ve lived here too long.

  25. 25
    MelissaM says:

    @aimai: Yup, I got it. I will say, my willingness to talk about it in general, and my own issues specifically, probably come from my family history. Then again, I was raised by democrats anyway. ;-)

    In general, I feel hopeful because more and more public figures are talking about their own histories with mental illness. Here’s hoping.

  26. 26
    boss bitch says:

    Obamacare was essentially a Republican plan

    I hate to break it to your friend but I’ve read a number of articles that says the only “Repbulican” part of Obamacare is the mandate.

  27. 27
    Morzer says:

    @Frankensteinbeck:

    Well, good for you.

  28. 28
    JGabriel says:

    mistermix @ top:

    Medicaid coverage is better than a lot of the pre-ACA policies. Doesn’t mean it’s good, just that it’s less bad than some of those low-coverage policies.

    Medicare is worse because it restricts a lot of mid-level providers.

    I can believe that. I guess a fair number of states provide for mental health issues better in their Medicaid programs

    Unfortunately, I’m on a Medicare, my provider who took Medicare just retired, and I’m kind of screwed right now. He wasn’t able to find anyone to take on his Medicare patients.

  29. 29
    Tommy says:

    @NorthLeft12: I think that is very true. How my parents think. I mentioned in another comment many years ago I ran a suicide hotline. The most frequent calls we got were from students, often foreign exchange, that felt alone. Isolated. Out of their element not behind around friends and families. They would often say they tried to talk to their parents and they were basically told most of the time to just suck it up. Be a man. That never seemed to help I might add.

  30. 30
    Citizen_X says:

    OT (or I could have said, “Speaking of mental illness: Newsmax”), Newsmax headline at right: “Media Push Global Warming Despite Bad Ratings.”

  31. 31
    JasonF says:

    My wife suffers from bipolar disorder, which she has been treating, with my support, for over a decade. And in that decade, I’ve learned a lot about mental health.

    I’ve been suffering, for at least a year and probably much longer, from untreated situational depression. The combination of the two, spiked by a trauma my wife suffered after which I was emotionally incapable (due to my own depression) of giving her the emotional support she needed, has led to a marital separation. I am finally — after far too long in denial — getting treatment for my own issues, and hoping that as I get healthy, my wife will be willing to try to rebuild our marriage.

    I guess my point is that if I — someone who knows that mental illness is real, knows the damage it can do, and knows the importance of treating it — if I was willing to waste years of my life thinking “I just need to tough it out,” how much harder for someone coming to it cold?

    May is mental health awareness month, and I would beg each of you to take care of your mental health. There is no more shame in going to a therapist — whether for a chronic disorder like bipolar or schizophrenia, or for a situational depression — than there is in going to an MD to treat a physical ailment.

  32. 32
    JGabriel says:

    @Morzer:

    Anyway, we all know that Reagan solved the problem of government in mental health care by liberating the mentally ill onto the warm and friendly street …

    That explains the Tea Party.

  33. 33
    RSA says:

    @jayackroyd:

    They’re afraid moochers will be able to simulate mental illness and get the good welfare thereby.

    Conservatives invert Blackstone: “It is better that ten good people suffer than that one moocher get away with some minor thing.”

    On mental illness, I’ve run into conservatives (Randian libertarians, specifically) who don’t believe in it. In their “philosophy,” illness is a malfunctioning of the physical body, but thoughts per se can’t be categorized as healthy or unhealthy in an objective way. I think this is crazy, but that’s just me.

  34. 34
    Tommy says:

    @JasonF: This is a topic I could rant on for hours. Mental health, or just health in general, I want everybody to get the care they need. First off it is just the right thing to do. But second, and this is kind of selfish, but I want you and your wife to be healthy, productive citizens. I want you working if you can. I want you paying taxes. The cost to get folks care is far outweighed by them being productive citizens. I don’t understand why the “free market” Republicans can’t understand this. It ain’t rocket science.

  35. 35
    Higgs Boson's Mate says:

    Lack of mental health education may be a part of the problem. Although mental illness may be anything from mild OCD to delusional psychosis I think that many people may tend to lump them all into one package labeled “Crazy.” Who wants to be Crazy? Who wants to suggest to a friend or relative that they might be Crazy? I only have significant experience of America and it seems that in some important areas Americans are woefully undereducated.

  36. 36
    JGabriel says:

    @RSA:

    On mental illness, I’ve run into conservatives (Randian libertarians, specifically) who don’t believe in it. In their “philosophy,” illness is a malfunctioning of the physical body, but thoughts per se can’t be categorized as healthy or unhealthy in an objective way.

    Well, if unhealthy can be defined as that which may lead to an early death, then I’m pretty sure suicidal ideation fits even the most rigid of Randian objectivist criteria for unhealthy.

  37. 37
    Yatsuno says:

    OT: Maya Angelou has passed.

    http://www.bbc.com/news/entert.....s-27606776

  38. 38
    JGabriel says:

    Higgs Boson’s Mate:

    I only have significant experience of America and it seems that in some important areas Americans are woefully undereducated.

    Just some?

  39. 39
    Elizabelle says:

    Maya Angelou has died. Aged 86.

    She and Gabriel Garcia Marquez will perhaps share a beverage tonight?

  40. 40
    Tara the Antisocial Social Worker says:

    I lost a good friend to mental illness. He was a talented writer and the best editor I’ve ever known, and a really decent person. It was a major shock when he killed himself, and the letter he left suggests that it was a psychotic break rather than depression by itself.

    It’s so frustrating when people talk about mental illness as if it was a character flaw. He didn’t choose this. He was killed by a disease, no different than if he’d died of cancer.

  41. 41
    Tara the Antisocial Social Worker says:

    @Yatsuno: Noooooooooooooo!!!!!!!!!!!!!!!

  42. 42
    Elizabelle says:

    @Yatsuno:

    Good morning, pal.

  43. 43
    Morzer says:

    @JasonF:

    You’ve done something very courageous here. Thank you. I hope things work out for you and your wife.

  44. 44
    Barbara says:

    It would be really useful to look at more successful models in other countries. I suspect that they reflect greater public funding (monitored and safe group living arrangements) as well as slightly more coercive elements, e.g., a less rigid standard for involuntary commitment. But it has been my experience with relatives that less coercion and greater peer support makes individuals more receptive to treatment, and thus, more likely to accept it even after it is no longer mandatory. And not every society uses drugs as the front line for treating even psychotic episodes, something I find fascinating. In some cases, people who hear voices can be taught to reason with or ignore them, perhaps after initial drug treatment has calmed the most outrageous delusions.

  45. 45
    JasonF says:

    @Morzer: Thank you, Morzer. That means a lot.

  46. 46
    Tommy says:

    @Elizabelle: I didn’t become a reader until I was kind of 22 or so. One Hundred Years of Solitude was the first book I read that wasn’t a text book (I was one of those Cliff Notes users for English classes). That first page, well the whole book changed my life.

    Many years later, as he faced the firing squad, Colonel Aureliano Buendía was to remember that distant afternoon when his father took him to discover ice. At that time Macondo was a village of twenty adobe houses, built on the bank of a river of clear water that ran along a bed of polished stones, which were white and enormous, like prehistoric eggs. The world was so recent that many things lacked names, and in order to indicate them it was necessary to point. Every year during the month of March a family of ragged gypsies would set up their tents near the village, and with a great uproar of pipes and kettledrums they would display new inventions. First they brought the magnet. A heavy gypsy with an untamed beard and sparrow hands, who introduced himself as Melquíades, put on a bold public demonstration of what he himself called the eighth wonder of the learned alchemists of Macedonia. He went from house to house dragging two metal ingots and everybody was amazed to see pots, pans, tongs and braziers tumble down from their places and beams creak from the desperation of nails and screws trying to emerge, and even objects that had been lost for a long time appeared from where they had been searched for most and went dragging along in turbulent confusion behind Melquíades’ magical irons. ‘Things have a life of their own,’ the gypsy proclaimed with a harsh accent. ‘It’s simply a matter of waking up their souls.’

  47. 47
    Xantar says:

    @big ole hound:

    I don’t know what your friend’s issues are, but speaking from personal experience, it may be that there’s nothing to be done until things come to a crisis point. Our system is set up so that if a person is not dangerous, then they will only get help if they themselves decide they need it. As long as people are somewhat functional, they usually don’t admit that they need help. The best thing to do is make sure the person is aware this issue exists, that there are others going through the same thing, and that help is available (both in the form of professionals and in the form of friends like yourself).

  48. 48
    Elizabelle says:

    @Tommy:

    I am going to reread (let’s be honest; finish reading!!) “Solitude” soon. Maybe we can do a Balloon Juice thread.

    Look forward to it with pleasure.

  49. 49
    Elizabelle says:

    @Tommy:

    I am going to reread (let’s be honest; finish reading!!) “Solitude” soon. Maybe we can do a Balloon Juice thread.

    Look forward to it with pleasure.

  50. 50
    Elizabelle says:

    @Tommy:

    I am going to reread (let’s be honest; finish reading!!) “Solitude” soon. Maybe we can do a Balloon Juice thread.

    Look forward to it with pleasure.

  51. 51
    JGabriel says:

    @Elizabelle:

    She and Gabriel Garcia Marquez will perhaps share a beverage tonight?

    Oh, to be a fly on the wall for that conversation. Provided one didn’t have to be a dead fly, of course.

  52. 52
    Elizabelle says:

    @JGabriel:

    I fear them are the terms, but yes.

  53. 53
    maurinsky says:

    My ex-husband is mentally ill, and the nature of his illness (which hasn’t been diagnosed but appears to track with depressive schizo-affective disorder) prevents him from seeking treatment – high levels of paranoia with some delusions keep him from wanting to share any information about himself with people unless he decides he trusts them, and he doesn’t trust doctors.

    On the other hand, my younger daughter, who is bright, cheerful, has an active social life, lots of friends, participates in bunch of activities, and has absolutely zero symptoms of depression, was diagnosed as depressed by the therapist she went to when we were going through the divorce. The therapist wanted to put her on anti-depressants, which I know can be life saving but also have some serious side-effects. How does a kid with no symptoms of depression get diagnosed with depression?

  54. 54
    catclub says:

    @Morzer:

    Cartoon-like and ethical-content-free versions of Christianity

    I just saw the Poverty and Justice Bible. An ordinary Bible with all the poverty and justice passages highlighted – there were thousands.

    Unlike the Hate the Gays Bible which has about three passages highlighted.

  55. 55
    Mnemosyne says:

    @JGabriel:

    Debbie is in Australia, not Austin. :-) To make it extra confusing, their universal healthcare system is also called Medicare (though theirs covers everyone, not just 65+).

    If your meds are currently working, would you be able to get them from your general practitioner? I know it doesn’t help on the therapy side (which is equally as important) but it would at least keep you going until you can locate a new psychiatrist or psychologist.

  56. 56
    Tyro says:

    @Morzer: A lot of conservatives have a mythology of willpower

    Well, some people are capable of re-inventing Cognitive Behavioral Therapy on themselves, but for the most part, it is more effective for people to be guided through that kind if treatment by a qualified provider.

    And as we get older, our capacity to hold out anxiety and depression demons at bay starts to weaken. And yes we could keep “fighting” the daily struggle every day, or we could go through medical treatment. Why bother suffering? We don’t expect people with physical maladies to “work around” their problems as a sign of personal strength– we treat them and fix them.

  57. 57
    Mnemosyne says:

    @maurinsky:

    How does a kid with no symptoms of depression get diagnosed with depression?

    I don’t know your kid, but it’s possible that she’s putting up a good front for everyone but is feeling bad inside. At a minimum, you should probably get her some talk therapy, which by itself can be almost as good as medication by itself (the current ideal is medication along with ongoing therapy).

    If you’re uncomfortable with medication right now, you can try making sure she has a good diet and gets exercise (preferably outdoors) every day.

  58. 58
    Mnemosyne says:

    Also, too — willpower doesn’t work. For anything, really, but definitely not for mental illness.

  59. 59
    a hip hop artist from Idaho (fka Bella Q) says:

    May is indeed mental health awareness month, and I (quelle surprise) have lots to talk about on the topic, in terms of stigma and treatment access. It sounds like I’m bragging (I am) but I’m headed out, in about 15 minutes, to our local College of Medicine Psych Dept to accept a teaching award for presenting to the 4th year psych residents.

    So you are spared (for now) my pontifications. I’ll suggest it’s topic worth another FP post before the end of the month, and I’m happy to send any educational links to any FP – or “commoner” – poster who wants some, after Thursday afternoon. I’m collecting attendees for my final annual NAMI dinner before my chapter is swallowed by a bigger one, until then.

  60. 60
    Shakezula says:

    It isn’t as common but you do hear people make the same stunningly moronic argument about diseases and conditions they believe are preventable. Lung cancer, diabetes and heart disease, to name a few.

    In short, there are assholes who like to blame the less fortunate and while people with mental illnesses are easy targets, they’ll just as readily take aim at other people.

    However, part of the problem with the way mental health is covered is down to what you might call the “serious” medical community’s long-standing snobbery towards mental health treatment. You say you can make someone better just by talking to them? We don’t buy it. Well ok, now you’ve got some studies that shows it does work, but we’re not going to pay you that much for it because it sounds cooky. Oh, you’ve got some real medical treatment for them now? Well writing a script doesn’t take that much effort so we still won’t pay you that much.

    And if you don’t have MD after your name, here’s a quarter.

  61. 61
    Shakezula says:

    @maurinsky: Why not get a second opinion?

  62. 62
    PurpleGirl says:

    @JGabriel: Have you thought about investigating what programs you might be eligible for in a City hospital? I’m currently in group therapy at a City hospital. Years ago the behavioral health programs weren’t considered good but they have improved over the years. (Note the department I’m attending is called behavioral health and not mental health.)

  63. 63
    Tyro says:

    @Mnemosyne: that essay was just using an inflammatory article as a “hook” and then went on to explain how to train yourself to make willpower work more effectively.

  64. 64
    Higgs Boson's Mate says:

    @JGabriel:

    One of the side effects for me of Memorial Day is anger. I try to be very careful in the following days not to let the anger out in inappropriate venues. Besides, who wants to read another rant about the paucity of practical education provided by NCLB and the Race to the Top?

  65. 65
    Xecky Gilchrist says:

    He apparently felt that mental illness could only happen to lesser mortals, which is an attitude that is all too prevalent.

    Yup, even still way too common to have “sack up” be the advice for dealing with depression. It’s a shitload less stigmatized than it was 30 years ago, but it’s still horrible, and I be the toxic-masculine conservatives are the worst about it.

  66. 66
    Rafer Janders says:

    @maurinsky:

    On the other hand, my younger daughter, who is bright, cheerful, has an active social life, lots of friends, participates in bunch of activities, and has absolutely zero symptoms of depression, was diagnosed as depressed by the therapist she went to when we were going through the divorce.

    Being bright, cheerful, with an active social life and lots of friends and participating in many activities does not preclude being depressed. Lots of very depressed people put up a good front in public while they are quietly miserable inside or when on their own. Putting on a good front may even exacerbate the depression, as the gulf between the outside appearance and the inner reality becomes harder to reconcile.

    If your therapist diagnosed her with depression, you should consider it. Children are very, very good at hiding from their parents what’s really going on inside them.

  67. 67
    maurinsky says:

    But she literally has not a single symptom. She sleeps well, but not too much – even for a teenager (she is typically asleep by 10:30-11pm, and up at 6:30 am, sleeping in later on weekends). She talks to me all the time about all kinds of things going on in her life. She eats well, exercises regularly….I am not averse to talk therapy at all, but I was concerned about taking her to a doctor who saw her 3 times, diagnosed her with depression and wanted to talk about medicating, and got a little pushy about the medication when I hesitated and wanted to do some research.

    *sigh*

    I was a teenager who didn’t share anything with my parents at all, so I know how little parents can know about what is going on in their kids minds. I don’t know what to do.

  68. 68
    Stella B. says:

    @maurinsky: What everybody else said.

    Depression is as prevalent as hypertension. If you don’t think that insurance should cover one, then why should it cover the other? Other than the facts, of course, that they both shorten lives, they both lead to missed days of work and lowered productivity. Milder cases of both may improve with some non-pharmaceutical lifestyle changes. We’re not entirely clear about the mechanisms causing either. There are a lot of cheap generic medications that work for some people, but sometimes you have to try a few to find the one that works. In other words, I can’t really find much of a gap between the “acceptable” disease and the other one.

  69. 69
    Xantar says:

    @Rafer Janders:

    I agree with this completely. Like people suffering from other kinds of mental illness, people with depression can develop coping mechanisms and socialization that hides their mental state from others. After a while, you figure out what’s socially unacceptable and stop doing it.

    In my case, it made things worse because it created a situation in which it felt as if nobody knew the real me and nobody ever would.

  70. 70
    RaflW says:

    This thread is probably winding down soon, but I just gotta post this Lexington Herald-Leader editorial that is basically calling McTurtle a liar. It’s well done, their examination of how he holds his own voters in contempt (by baldly lying to them) is excellent.

    Say again, Senator, ACA unkynected?
    Sen. Mitch McConnell has some explaining to do.
    What in the world did he mean last week when he told reporters that repeal of the Affordable Care Act — “root and branch,” as he has demanded many times — is “unconnected” to the future of Kynect, Kentucky’s health insurance exchange?

  71. 71
    Shelly says:

    44.3% of those with a mental illness diagnosis are smokers (NAMI). That’s more than double the smoking rate of the average adult population in the US (20%). 40% of cigarettes smoked in the US are smoked by people with a diagnosed mental illness. And, the staff who serve this population also smoke at a much higher rate than the average adult population.

    That means more smoking, more exposure to secondhand smoke, more death from smoking related illness (heart disease, heart attack, a multitude of cancers, COPD and diabetes). It is not surprising that the two figures (death from mental illness and death from smoking) are similar since they are counting many of the same people.

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    Shelly says:

    I’m sorry – a correction – 40% of all cigarettes smoked in the US are smoked by those with diagnosed mental illness …. not 40% of all smokers. The number speaks to how heavily this population of smokers actually smokers.

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    gorram says:

    @Barbara: That’s my experience in the US too, as I’ve seen a lot of people with something going on mentally have to get treatment from and avoid being harmed by the same system. A lot like our prison system and our drug policies, the US tends to take a very controlling and punitive stand on this issue (unless you can pay for good treatment, of course).

  74. 74
    gorram says:

    @maurinsky: That honestly sounds more or less like about what my sleep schedule was at that age. I might have had an undiagnosed… something (probably PDP) but if I had that I was honestly fully functional with those sleep habits and no medication. (I still am not medicated for a long list of reasons including that there isn’t really a pharmaceutical solution for PDP).

    I think the above recommendations were good – therapy is almost always a good thing – but if you’re concerned I would seek out a second opinion. A lot of mental health diagnosis is done in the short time span you mentioned, but which obviously can allow doctor’s personal biases to come out of the woodwork. Depression is actually kind of a catchall term for a couple of very closely related mental illnesses, so it might be worth having two doctors for them to evaluate what’s going on (if anything). That’s of course assuming that it’s covered by your insurance or otherwise within your means though.

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    Gene108 says:

    @Mnemosyne: @maurinsky:

    I agree the kid can be good at masking it in public. I was good at it, which is one reason I never got diagnosed with mental illness until I got out of control.

    If you are not sure I would get a second or third opinion, just like we do sometimes, when we have a physical ailment.

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    EthylEster says:

    He apparently felt that mental illness could only happen to lesser mortals, which is an attitude that is all too prevalent.

    Denial, not just a river in Egypt.

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    eataTREE says:

    I seem to recall that there is a high correlation between mental illness and smoking, and that this may be a form of self-medication due to nicotine’s mood-stabilizing properties.

    If this is true it would also contribute to an apparent correlation between mental illness and shortened lifespan.

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    daveNYC says:

    @Shelly: Self-medicating with whatever seems to help. I suspect there are similarly depressing numbers for booze and the harder drugs.

    Aren’t anti-depressants an iffy thing for teenagers? Thought there was something a few years ago about a potential increase in suicide there.

    I think people have a hard time getting past the idea of a mind-body dichotomy. They can get the idea that your brain is a mechanism and that it can break (strokes, aneurysms, etc), but the idea that your brain is your mind, and that any number of mechanical and chemical issues with your brain are straight up physical diseases that have symptoms that manifest themselves in your mental state seems to be a hurdle.

    Perhaps a re-branding and marketing campaign might work. Just need some way to try and get people to understand that mental illness, at the gross level, is no different from any other physical ailment.

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    Mnemosyne says:

    @daveNYC:

    Aren’t anti-depressants an iffy thing for teenagers? Thought there was something a few years ago about a potential increase in suicide there.

    It depends on which kind is prescribed — Prozac is approved for use in teenagers, but other SSRIs are not. I agree with everyone else that maurinsky should get a second opinion, because it’s better to deal with it now than to let it fester into her 20s wondering why she keeps bouncing around in low-level jobs and crying as soon as she gets home every night. Ask me how I know.

    One thing to watch out for is that it turns out that some of the generics are not, in fact, “bioidentical” once they get into the human body. It was a major problem for people taking Wellbutrin because they were switched to a generic and suddenly the medication stopped working. I think the manufacturers are still trying to fix the problem.

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    TooManyJens says:

    @maurinsky:

    On the other hand, my younger daughter, who is bright, cheerful, has an active social life, lots of friends, participates in bunch of activities, and has absolutely zero symptoms of depression, was diagnosed as depressed by the therapist she went to when we were going through the divorce.

    You’ve just described me as a teenager, and then when I went to college I experienced two years of what I now realize was probably dysthymia, followed by a full-blown major depressive episode. (Those Hyperbole and a Half depression posts? It was pretty much exactly like that.) If I’d seen a professional when I was in high school, would they have seen something coming? Looking back at some of the stuff I thought and wrote at the time, maybe.

    That said, antidepressants do have side effects, and if the depression is mild to moderate it’s likely to respond at least as well, if not better, to talk therapy. A good cognitive-behavioral therapist could help your daughter to work on any destructive thought patterns she might have, or prevent them from developing. I sometimes think the depressive episodes themselves haven’t had as much of a negative effect on my life as the self-hating thought patterns I developed during them. Those can take a long time to heal.

    If she really is distressed and tries therapy but hits a brick wall, then medication in conjunction with therapy is worth considering.

    Good luck to both of you.

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    Mnemosyne says:

    @Tyro:

    Sorry, I mostly skimmed it. IMO, when it comes to food issues, there’s a difference between willpower (“I’m not going to do it! I’m not!!”) and making a choice (“I have decided not to eat that cheesecake so now I don’t have to think about it anymore.”)

    When we’re talking about mental health issues, obviously the right choice is to start treatment rather than trying to use your “willpower” to get better.

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    Col. Klink says:

    The reality is that for many forms of mental illness there simply is no treatment or it is very limited in what it can do. When it comes to mental health we’re basically decades from real progress. There is an understanding of the basics, but the brain, being by far the most complex organ in the human body, is still much harder to decode than say, cancer or diabetes. Mental health is also sort of like the Supreme Court’s ruling on pornography – you know it when you see it. If you’ve never seen it, you really can’t imagine it exists, but oh, it sure does. Try and imagine a Class 5 hurricane running through your brain knocking everything to and fro in all possible directions. Some die because of it, some quit life and withdraw, some get totally lost, and a lot of people fight on and on with no one in the outside world ever guessing the pain they’re going through…

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    Debbie(aussie) says:

    @JGabriel: they have set up mental health assessments (by GP)that allow six visits to a psychologist paid by Medicare (as with all Medicare there is a scheduled fee). This would usually have to be paid for by ones self or from private insurance. You are able to have this extended if required. Although I have private health insurance I have been able to take advantage of this over the last three+ years.

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    mclaren says:

    On the other hand, this research finding offers good news in the sense that we won’t have to endure the gibberings of commenters like raven and Martin and mnemosyne all that much longer.

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