Behavior: Essay

Few begin life thinking they will go mad, and I was no exception. My childhood was one of close family, friends, laughter, and sports. I loved school and delighted in imagining the future. There was nothing in childhood to prepare me for losing my mind and yet, when I was 17 years old and a senior in high school, I did just that. After a period of long nights and wild enthusiasms—a hint of the more violent manias that would come later—I sank into a psychotic, profoundly suicidal depression. It was awful beyond reckoning, although the bouts of mania and depression I went through later were infinitely worse. The experience forever changed how I looked at myself, the gods, and the mentally ill; it was clear that the line between the mad and the not-mad had dissolved for me, and along with its dissolution went a packet of dreams and my faith in what the future might bring.  

Like many with mental illness—in my case a severe form of manic depression (or bipolar disorder)—I resisted seeing a doctor for a disturbingly long period of time. And, because when one is not ill one can in fact be quite well, I successfully wended my way through college and graduate school and subsequent clinical training. The years were uneven—terrifying, tumultuous, but often wonderful—and it was only after joining the faculty of the UCLA Department of Psychiatry, when I went ravingly manic, that I was forced into treatment.  

I was lucky. I could afford, and I received, excellent medical care. Most people with psychiatric illnesses do not receive treatment, cannot afford it, and, even if they can afford it, do not get good care. The major psychiatric disorders usually first occur, as mine did, in the late teens and early twenties, yet there are few national or state programs designed to inform young people about the symptoms of mental illness and the importance of knowing their family’s psychiatric history. They should know that most psychiatric disorders are treatable. Refusing or forgetting to take medication is a major clinical problem, especially in the young, but there is very little research into innovative ways of addressing that problem. I carried on a long personal war against lithium, a medication that I would, a few years later, be encouraging others to take.  

For the tens of millions of Americans who suffer from major mental illnesses—schizophrenia, bipolar illness, depression, and anxiety disorders—the suffering is dreadful and usually inexpressible to others. They and their families are torn apart by pain, ostracized by stigma, and left to cope as best they can in a world inhospitable to their needs. Federal, state, and local governments do not even begin to address the public health issues associated with mental illness. Few know where to turn for help and, even if they do, the existing system of public care is a mockery of what it should be. Far too many die unnecessarily through suicide, violence, alcohol and drug abuse, and related cardiovascular disease.  

There have been recent attempts to remedy this. When he was surgeon general of the United States, David Satcher launched a campaign to redress inequities in the health care delivery system for those with mental illness. Congress has debated legislation to establish parity between psychiatric and medical insurance coverage. The World Bank and the World Health Organization have concluded that psychiatric disorders are among the most disabling of all illnesses, and their work has given institutional credibility to the extent and seriousness of the public health problem. Yet, what we know scientifically from genetics, clinical trials, neuroimaging, and psychopharmacology far exceeds what we do in our public awareness and treatment programs.  

Excellent research and effective treatments are to no avail if people do not or cannot take advantage of them. Those who need psychiatric care will not receive it until public health measures catch up with public needs. I and many millions of other patients with psychiatric illnesses are only too painfully aware of this. But our collective faith in what the future might bring will remain shaky until society recognizes the extent of the untreated problem in its midst.