How Aware Are We, Really, About Mental Illness?

On the one hand, it is all around us. With nearly 1 in 5 of Americans suffering from a diagnosable mental illness in any given year, no family is untouched. On the other hand, mental illnesses are sometimes spoken of in whispers, even within families, masking the true impact and facilitating stigma and discrimination. May is Mental Health Awareness Month, and in the spirit of this month, I thought I’d tell you how I became aware of the impact of mental illness—or rather, how the process of becoming aware began.

Awareness for me came slowly. Like most families, mine is affected by mental illness. And like most children of my generation, I was shielded by my family from knowledge about this aspect of our family history. In fact, it wasn’t until I was an adult that I heard anything more than vague references to “nervous breakdowns.”

In college, the core of my effort was devoted to studying molecular biology and the mysteries of the cancer cell. It was midway through my time there that my first direct experience with the burden of mental illness hit. A classmate of mine must have been struggling more than any of us were aware. As is all too common on college campuses, he lost his life to suicide towards the end of our sophomore year. Nothing can erase the shock of learning how he died, nor the memory of his stoic, disbelieving parents greeting us after his memorial service.

I finished college and headed west for medical school. There, even as my interest in neuroscience and the quest to understand the complexity of the brain grew, my awareness of psychiatric illnesses remained mostly intellectualized. For my graduate work, I studied how the environment—through visual experience—shapes the way the brain develops. We learn to see, it turns out, by seeing, and I was fascinated by the notion that this and other complex brain processes might be disturbed in mental illnesses. But the true impact of these illnesses on the individual—that was not something I fully understood.

A few years later that changed dramatically, during my first clinical psychiatry rotation. A trio of patients stands out in my mind from my brief time working on an inpatient unit. The first was a cachectic woman with schizophrenia, her thoughts too disrupted by her mental illness for her to express even her most basic needs. Her speech was a “word salad,” a technical term used to describe the disorganization of language that results in actual words being strung together without regard for meaning or syntax. She was clearly in distress, but there was no way to understand exactly why. After we treated her schizophrenia, she was able to tell us the cause of her distress—her long-neglected, decaying and infected teeth were causing her tremendous pain.

The second was a young woman with borderline personality disorder so severe that she spent hours in a helpless, self-injurious rage and couldn’t stop the impulse to hurt herself. I felt helpless, too, and it took all the skills of the senior attending to break through the rage on the surface to the pain underneath, to convince her that we could help. The third was a young man who came in hearing voices and experiencing paranoid delusions for the first time in his life. This last patient got better over the course of the next few days and signed out against medical advice. He left before we could complete a workup, denying the possibility that was all too likely: that this episode was the first but not likely the last he would experience, and that he needed ongoing psychiatric care. He was a young man—my exact age at the time—with a full life ahead of him, whose illness could derail him from the trajectory he envisioned for himself.

These patients broke through my intellectual defenses, starkly illustrating the tremendous burden borne by those who suffer from mental illnesses. While many of the 1 in 5 Americans noted above are not as severely affected as my three patients from medical school, each of them pays their share of the tremendous medical, financial, and social burdens imposed by mental illnesses. It took me a long time, too long, to become this aware. We cannot successfully accomplish our mission of transforming the lives of those with mental illnesses if we allow them to stay in the shadows. I’ve made sure to tell my children about their family history of mental illness, just as I have told them their family history of other medical illnesses such as cancer and heart disease. Of course, they are also exposed to more information about mental illnesses and suicide than I ever was growing up—even if some of that information isn’t exactly how we mental health professionals would prefer it be presented. At least it is out there, for us to talk about, for us to share, for us to be aware. Awareness is the first step towards being able to do something about an issue. And for mental illnesses, that first step is a big one.