Larry McCleery would really rather not suffer from severe depression. But his reluctance apparently comes as a surprise to many Utahns.
According to a just-released survey, 44 percent of Utahns questioned believe that the severely mentally ill choose to be ill. And 35 percent think that sicknesses like McCleery's are caused by "sinful behavior." Bad parenting and "emotional weakness" are also seen as likely culprits.
These and other findings have led the Utah Mental Health Planning Task Force to conclude that "there are significant gaps and misconceptions in Utahns understanding of severe mental illness _ gaps that can seriously impair our ability to gather support that will allow us to help these unfortunate individuals."
The survey, conducted by the University of Utah Survey Research Center, questioned 506 randomly selected adults throughout the state. The findings were released this week in advance of public hearings on the Utah State Mental Health Planning Committee's "Blueprint for Action." The three-year master plan is aimed at filling in gaps in the state's public mental health system.
Hearings are set for Nov. 30, from 2 to 4 p.m. and from 7 to 9 p.m. Hearing locations are: Salt Lake City (commission chambers, County Complex, 2001 S. State St.), Brigham City (library auditorium, 26 E. Forest St.), Price (Carbon County Courthouse, 120 E. Main St.), and St. George (commission chambers, 197 E. Tabernacle St.).
Although medical treatment of the mentally ill no longer includes shackles and chains, public perceptions about what it means to be mentally ill have not kept pace with other advances. As evidenced by the survey, the public often has a limited understanding of illnesses such as schizophrenia, profound depression and manic-depressive illness.
The problem with misperceptions is that they sometimes turn into prejudices, and these often lead to a lack of support for the mentally ill on issues such as the placement of group homes.
According to the survey results, people over 65 years old are particularly poorly informed about mental illness. "They tend to believe that the severely mentally ill are incurable, hopelessly disabled, sinful and willfully ill."
Among the misperceptions revealed in the survey:
- 95 percent of those surveyed feel that severe mental illness is caused by alcohol or drug use. In reality, says Dr. David Tomb, task force member and director of child and adolescent psychiatry at the University of Utah School of Medicine, severe mental illness is not caused by drugs and alcohol, although some severely mentally ill persons may try to self-medicate themselves with these substances. The misperception serves to blame the mentally ill.
- 45 percent believe that the severely mentally ill choose to be ill. "Unfortunately, that's a particularly powerful misperception," says Tomb, "because if you believe that, you're not inclined to help them." Actually, says Tomb, the severe mental illnesses are believed to be both genetic and chemical in origin.
- 65 percent feel that mental illness is caused by bad parenting. This misperception, says Tomb, is especially painful for parents of the mentally ill. Until as recently as 15 years ago the psychiatric community, failing to understand the role of heredity in mental illness, did place at least some blame on parents. There was believed to such a thing as a "schizophrenic mother" _ one who was such an ineffective parent that she caused her children to hallucinate and hear voices.
- 30 percent feel that treatment should consist of "repenting of their sins." This moralistic overlay to psychiatric problems is obviously more prevalent among churchgoers, although no one church seemed to have a monopoly on the idea.
- 80 percent feel that "schizophrenia" is equivalent to "split personality." There is no relationship between the two conditions, says Tomb. But this mistake leads the public to fear that schizophrenics can instantly become "crazed." In fact, he says, schizophrenic symptoms come and go gradually.
- 90 percent feel that a major treatment should be psychotherapy. In reality, says Tomb, psychotherapy in the traditional sense _ an examination of forces, such as upbringing, that might lead to emotional problems _ is not very helpful. Insight does not appear to heal these kinds of brain malfunctions.
- 60 percent believe that severe depression is very difficult to treat. Actually, says Tomb, "profound depression is one of our bright spots." Most people with this illness can be treated successfully with medication. It is low-level chronic depression, he says, that is harder to treat.
- 60 percent would recommend that a severely mentally ill person receive treatment from his family physician. But family physicians often are not trained in psychiatry, says Tomb, "and have very little experience dealing with these folks in their day to day practice."
- 47 percent recommend treatment by religious counselors. While well-meaning, says Tomb, religious counselors may not be well-versed about severe mental illness. "This is an interesting state to practice (psychiatry) in," he notes. "It's not uncommon for us to see end-stage psychiatric disease that has never been treated."
- 95 percent feel that patients don't seek treatment because of "mental confusion." "What that says to me," says Tomb, "is that the image the public carries around in their heads about mental illness is of some person picking butterflies out of the air." Most patients, he says, spend "99.9 percent of their time not confused."
- 40 percent feel that medication is used just to tranquilize patients who are unmanageable. "We don't want to tranquilize our patients at all," explains Tomb. "We want patients who can think clearly." Unfortunately, many of the medications used to clear up thinking have a tranquilizing side-effect.
Summing up the survey findings, the task force notes that "an informed public with realistic, positive attitudes towards the mentally ill can make all the difference in their lives."
But, it adds, "if people continue to believe all the stereotypes and myths that surround the mentally ill, their chances of recovery are limited. They will continue to be denied care, housing and work opportunities _ important aspects to recovery."