We must never give up on the potential of people to recover

From: www.theglobeandmail.com
by CAROLYN ABRAHAM, The Globe and Mail
June 20, 2008

Psychiatrist David Goldbloom talks about the stigma surrounding mental illness in Canada and some essential first steps in changing things for the better

David Goldbloom is the vice-chair of the Mental Health Commission of Canada, a professor of psychiatry at the University of Toronto and the senior medical adviser of education and public affairs at the Centre for Addiction and Mental Health, where he was also the inaugural physician-in-chief. Dr. Goldbloom has worked in psychiatry for more than 23 years treating patients, teaching young doctors and schooling the public about mental illness and the stigma that it still carries.

One of the main goals of the Mental Health Commission is to combat stigma. Why — in this age of reality television, tell-alls and a general tendency to publicize the personal — are people still so reluctant to talk openly about mental illness?

It can't be because it's a rare phenomenon. The reality is that one in five Canadians over the course of their lives can experience mental illness in one of its many manifestations, and what that ultimately means is that every single family in Canada has in some way been affected by mental illness. There's nobody in our country who can stand up and say, "Not my family, not my aunts or uncles or cousins or grandparents, children, siblings, spouse or self." And yet the reluctance to talk about it, to acknowledge it openly, to treat it as a form of human suffering like any other illness, relates in part to how threatening this set of illnesses is to our sense of who we are.

It's about the core of our identity.

That's right. If you break your leg, you're still you. If your mind is somehow broken by mental illness, you're not you in the eyes of yourself and you're often not you in the eyes of other people.

Your mental abilities are the last frontier of acceptable discrimination at work. Do you agree?

We're living in an increasingly postmodern world, which means that the things for which we're often most valued in the workplace is our above-the-neck capacity, our cognitive abilities, but also our relationship abilities and other manifestations of our minds and our brains. The problem is that when mental illness hits — and I should point out, it doesn't discriminate on the basis of intelligence — and if we think about it in the context of the workplace, it's not simply that it makes you feel sad. It interrupts your cognitive abilities — your ability to concentrate, pay attention, make decisions, remember things, feel motivated — and it leads to judgment by colleagues and managers that your productivity has dropped off, you shouldn't be here.

You've been travelling the country, going to workplaces from Empress, Alta., speaking to oil rig workers, to Bay Street, speaking to wealth-management groups. What's that about?

What we're seeing is a growing awareness in the Canadian workplace that this is a hot-button issue. Good data now shows us that in the Canadian public sector and in the Canadian private sector, these are the leading causes of short-term disability. It has a profound economic impact on the workplace. So it's enlightened self-interest for business places to understand this set of problems better and it's also a compassionate response.

And, unlike other medical conditions that tend to strike later in life, mental illness most often hits people in their prime.

That is a distinguishing characteristic. When you think of the other sets of illnesses that we have championed as a nation, whether it's heart and stroke or cancer or dementia, these hit, in the mean, a different age group than the people who are affected by mental illness. Most mental illness has its onset in late adolescence and early adulthood, just as people are coming into their own personal identities, their work identities, starting to form long-lasting relationships at an adult level. So the disruption is substantial. The World Health Organization predicts that by the year 2020 depression will become the No. 2 cause worldwide of years lost due to disability. That's a profound impact. A large, palpable, expensive set of human problems has been neglected far longer than any other set of problems in the context of the health of Canadians.

What similarities are there between the oil-rig workers in Empress and the financial wizards on Bay Street when it comes to mental illness?

People are ultimately concerned about the same things: themselves and the people they care about in their immediate sphere, and the barriers they face.

I had the experience a little while ago of a woman who was very friendly and chatty with me just before I went up to the podium. She was a woman in her mid-50s and she said, "How do you like my new haircut?" and she had very short hair. I said, "It looks nice, it looks kind of punky," and she said, "Well, you know what, I had breast cancer last year and I had radiation and chemo and all my hair fell out. I used to have shoulder-length hair and now I'm thinking of keeping it this way." And I said, "Tell me, you and I just met two minutes ago. If you had been hospitalized for depression last year, do you think you would have told me in the first two minutes?" And she said, "Absolutely not."

The interesting coda was she said, "And you know something? I know depression, my husband has been hospitalized for depression." Despite her intimate familiarity with that type of suffering, she was able to recognize in herself she would have felt a greater barrier to divulging her depression than to divulging her recent breast cancer, and that speaks volumes.

What are the consequences of not talking about it?

Shame. And shame is a pretty profound and negative human emotion. When people get depressed, the way they perceive themselves typically becomes more negative. That happy me that people saw before was a sham. That successful, productive me was fake. The silence that surrounds that person in the workplace or among friends only confirms that self-perception.

Can you talk about the impact of language?

There's a study that compares 764 newspaper citations when they searched for the word cancer and when they searched for the word schizophrenia. In 28 per cent of citations that involved the word schizophrenia, it was used as a metaphor — "The weather is acting schizophrenic today." It's an archaic notion of split personality, but for somebody with schizophrenia, to see this word casually tossed about, not reflecting either the reality of the illness or the suffering. And when they looked in the obituaries, schizophrenia was never mentioned once, but you can be sure that people with schizophrenia die. In fact, they die earlier than people without schizophrenia. Cancer was mentioned with very high frequency in obituaries. So even in death, the language banishes people to silence.

Is there reason for optimism?

I think there is. We're seeing around the developed world a whole new set of initiatives, a whole new level of investment, a whole new level of public awareness. The establishment of the Mental Health Commission here in Canada was a watershed event. We are the only G8 country that lacks a national mental-health strategy. The goal is to have a strategy that actually generates action.

What would the benefits be?

If we look at other jurisdictions that have had mental-health commissions, such as New Zealand, it has resulted in very tangible things. One is an increase in per capita funding spent in support of people with mental illness. Another thing is a re-skilling of people who work in the mental-health arena to bring their skill levels up to the evolving knowledge base in our field.

Looking to the future, in terms of the way primary care works, how will it look?

Primary care is the first stop for most Canadians when they experience mental illness. And our primary-care physicians across Canada will be the first to tell you that they are under-resourced in terms of health professionals as well as more informal supports — social agencies, community groups, things like that. But primary care is a linchpin in making change happen.

I've heard you quote a figure on the number of suicides linked to depression in Canada.

The number of suicides over all in Canada is almost 4,000 people a year. The vast majority occur in the context of mental illness and/or substance abuse. For people aged 15 to 24 in Canada, suicide is the No. 2 cause of death, second only to motor-vehicle accidents — and some of those single-vehicle accidents may also be suicide. We also know the rates are high for men over the age of 55 — it's another high-risk group for suicide. And that's an enormous problem.

I was struck by the talk you gave recently at the MaRS Centre, a medical research facility here in Toronto, where a staff member had recently killed herself after battling depression. A lot of people turned out and you began the talk with a very compelling letter.

The letter was written in 1841 by a young lawyer to his law partner and he wrote as follows: "I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would be not one cheerful face on Earth. Whether I shall ever be better, I cannot tell. I awfully forebode I shall not. To remain as I am is impossible. I must die or be better, it appears to me." Those words were written by Abraham Lincoln in 1841 about 19 years before he assumed the presidency of the United States and changed the face of his nation forever. It's not only an eloquent statement of self-perception, it's a testament to recovery. We must never give up on the potential of people to recover from mental illness.

Abraham Lincoln's family sent him away.

They sent him away to stay with relatives because there was no treatment for his suffering. They thought: in the absence of treatment, containment. Keep him in a cabin and keep him away from the edge of the river.

You have also mentioned other historical figures who suffered mental illness and the euphemisms that were used around their absences — suddenly they discovered the need to "spend time with their family" or they were "suffering from exhaustion." But there has been progress — with what happened with the Western Australian premier, for example.

Yes, it's happening around the globe. Congressman Patrick Kennedy in the United States has been very candid about his struggle with depression. The former democratic presidential nominee Michael Dukakis, the former governor of Massachusetts, his wife, Kitty Dukakis, has written a marvellous book about her depression and her need for electric convulsive therapy.

Most recently in Western Australia, the premier, Geoff Gallop, was an extraordinarily popular politician who went on television in January, 2006, and read to a surprised electorate the following announcement: "It's my difficult duty to inform you today that I'm currently being treated for depression. Living with depression is a very debilitating experience which affects different people in different ways. It has certainly affected many aspects of my life, so much so that I sought expert help last week. My doctors advised me that with treatment, time and rest, this illness is very curable. However, I cannot be certain how long I will need. My commitment to politics has always been 100 per cent plus. I need that time to restore my health and wellbeing."

And with those words, he exited the political stage, got treatment, made a recovery and is now back at work. And he was celebrated in Australia for his plain speaking, his candour — he just said what it was, that it's debilitating, there's hope, and I will get better but I don't know how long it's going to take. Those statements are true whether you're a Bay Street wealth manager or an Empress, Alta., pipe fitter.