West 47th Street: The Face of Mental Illness

• Introduction
• Debunking Myths

Introduction

Mental Illness and the Media

Many people learn about mental illness from the media. Unfortunately, Hollywood tends to promote stereotypes and inaccuracies about mental illnesses, especially schizophrenia and manic depression.

Some examples of films that got it wrong:

Me, Myself and Irene (2000) -- portraying schizophrenia as split personality

Girl, Interrupted (1999) -- female patient as seductress

Scream (1997) -- violent tendencies

Silence of the Lambs (1991) -- violent tendencies

Halloween (1978) -- violent tendencies

Psycho (1960)- portraying schizophrenia as split personality, violent tendencies

Films/TV that got it right:

ER (on-going) - Sally Field character, Maggie

A Beautiful Mind (2001)

Benny and Joon (1993)

Frances (1982)

Next: Find out more about the myths surrounding mental illness.»

Although nearly one in five Americans will personally experience a mental illness in his or her lifetime, myths and misconceptions about mental illnesses persist. This lack of understanding has stigmatized these very real and physical illnesses. The Surgeon General of the United States reported in 1999 that stigma was the single largest barrier to the successful recovery of people with mental illness, making it harder for people to get treatment as well as find housing, jobs and friends.

Three years before the Surgeon General's landmark report, the company that produced West 47th Street, Lichtenstein Creative Media, conducted groundbreaking research into stigma. Hired to develop an anti-stigma campaign for the City of New York, LCM engaged top advertising executives and market researchers (the kind of people who work for Nike and Coca-Cola) to find out what stigma really is, how widespread it is, and how to defeat it. It was the first major research into what people in a single city thought about mental illness and what it would take to change their attitudes.

Researchers began with quantitative studies, calling more than 400 New Yorkers at home to assess their attitudes about people with mental illness, and then followed up with a series of focus groups. The findings were startling. In the phone interviews, more than half of all New Yorkers said they knew someone with mental illness. About those whom they knew, they felt compassionate, supportive and empathetic, and believed that more tax dollars should be spent to help them. But when a focus group of decision-makers -- including lawyers, insurance executives and teachers -- was assembled and asked about perceptions of "the mentally ill," the floodgates opened. The group said that they felt they needed to keep their guard up at all times, and that mentally ill people were unkempt, social outcasts and menaces to society. Group members talked about fearing mentally ill people as unpredictable, expressing concerns that one might "go berserk" and shoot or stab someone. In their professional lives, researchers found, these decision-makers "tended to interact with the mentally ill with apprehension and a lack of compassion."

Asked where they got their perceptions of "the mentally ill," all agreed: from TV and movies, off the front page of tabloid newspapers and by seeing people on the street. What became clear was that the images that drive public perception of mental illness are just the tip of the iceberg, and that the vast majority of people with mental illness -- recovered people who take their medication, go to treatment, go to work every day and raise families -- just aren't visible. When asked if they want to hire someone with mental illness or rent an apartment to them, many people immediately think of a guy sleeping on the street or a man who pushed a girl onto the train tracks -- not about the people that they know in their own lives to be responsible and trustworthy.

So what will help change these attitudes? The research indicated that the best weapon against stigma is the simple experience of getting to know someone with a mental illness. These positive personal experiences can help challenge and change negative images fostered by television, movies and the press.

-- June Peoples

• Introduction
• Debunking Myths

Debunking Myths

 Fountain House member Fitzroy Frederick

Society has long had a very difficult time dealing with mental illness. It has been widely misunderstood as everything from a moral failing to demonic possession. And though today we know much more about the genetics and physiological bases of these illnesses, myths still abound. While modern, evidence-based treatments are now available for all forms of psychiatric illness, ignorance and stigma still hamper many people from getting the help they need. The following information can provide a clearer picture.

Mental Disorders Are Common

• More than 54 million (or nearly one in five) Americans have a mental disorder in any given year (Surgeon General's Report on Mental Health, 1999)
• Depression and anxiety disorders -- the two most common mental illnesses -- each affect 19 million American adults annually (National Institute of Mental Health, 1999). Currently, clinical depression is one of America's most costly medical illnesses, resulting in economic losses due to absenteeism from work, lost productivity and direct treatment costs. It affects nearly twice as many women as men (National Mental Health Association, online, 2003).
• One or two Americans in 100 is affected by manic depression, also called bipolar disorder, which can cause extreme highs and lows in mood [Lifetime and 12-Month Prevalence of Psychiatric Disorders in the U.S. (Archives of General Psychology National Comorbity Survey)].
• In the U.S., one in a hundred people, about 2.2 million, has schizophrenia, a disorder which can cause confused thoughts and perception.

Mental Illnesses Can Be Fatal

• Major depressive disorders account for between 20 percent and 35 percent of all deaths by suicide. (Surgeon General's Report on Mental Health, 1999)
• The risk of suicide makes untreated manic-depressive illness more fatal than heart disease and some forms of cancer. [Goodwin, Frederick K. and Kay Jamison, Manic Depressive Illness (1990, Oxford University Press)].
• Suicide is the single largest cause of premature death among individuals with schizophrenia. [(Fenton WS, McGlashan TH, Victor BJ, et al: Am J Psychiatry 154:199-204, 1997)].

People Can and Do Recover

• Recovery rates for mental illnesses surpass the treatment success rates for many other physical illnesses, including heart disease. Recovery rates include: schizophrenia, 60%, bipolar disorder, 80%, major depression, 65% to 80%, and addiction treatment, 70% (Report of the National Advisory Mental Health Council, March 1998).
• Medications introduced over the past 10 years have greatly improved the prognosis for people with schizophrenia; most people with schizophrenia can now expect to hold a job, raise a family and otherwise contribute to society (National Mental Health Association "Barriers to Recovery" study, Harris Interactive, 2003).
• Depressive disorders are among the most responsive to treatment: better than four out of five people with clinical depression will respond to medication, psychotherapy or a combination of the two (National Mental Health Association, 2003 and Goodwin, Frederick K. and Kay Jamison, Manic Depressive Illness 1990, Oxford University Press). However, a recent study found that more than half of the people who receive treatment for major depression, the most serious form of depression, are receiving inadequate treatment (Kessler, et. al., Journal of the American Medical Association, 2003).

Stigma Is A Major Barrier To Treatment

• Nearly two-thirds of all people with diagnosable mental disorders do not seek treatment. Stigma surrounding the receipt of mental health services is among the many barriers that discourage people from seeking treatment. Concern about stigma appears to be heightened in rural areas in relation to larger towns or cities (Surgeon General's Report on Mental Health, 1999).
• Many people would rather tell employers they committed a petty crime and served time in jail than admit to being in a psychiatric hospital (SAMHSA, February 2002).

Budget Cuts Are Eroding Mental Health Care

• More than half of the mental health services delivered in the United States are provided through the nation's public mental health system, including services for the most seriously ill and vulnerable Americans (Department of Health and Human Services, 2000).
• Across the country, mental health services are currently endangered by budget cuts, which are forcing state and local mental health and substance abuse programs to close their doors and/or cut off many people from services (SAMHSA Behavioral Health Headline Database, online).

Racial Inequities Are Widespread

• Adult Caucasians who have either depression or an anxiety disorder are more likely to receive treatment than adult African Americans with the same disorders, even though the disorders occur in both groups at about the same rate, taking into account socioeconomic factors (Surgeon General's Report on Mental Health, 1999).
• More than half of all African-Americans and American Indians are anticipated to use public insurance such as Medicaid to pay for inpatient mental health treatment, compared to 34% of Caucasians (Substance Abuse and Mental Health Services Administration, 1998).
• The rate of suicide among American Indians and Alaska Natives is about 50 percent higher than it is in the general population (Centers for Disease Control: Homicide and Suicide Among Native Americans, 1996).

Homelessness and imprisonment can result

• Currently in the United States, an estimated 700,000 people are homeless on any given night. Of these, one out of four are estimated to have a severe, untreated psychiatric illness. That figure is even higher among chronically homeless people, among whom schizophrenia is the most common diagnosis (SAMHSA, Center for Mental Health Services, 2001).
• Over the course of a year, 10 million people enter U.S. jails; nearly 700,000 of them have a serious mental illness (National Mental Health Association, 2003).

Media images are often inaccurate

• Violent acts committed by persons with mental illness represent a small fraction of the violence perpetrated in our country, yet these acts are frequently highly sensationalized by the media and lead to the continued stigmatization of persons with mental illness. In fact, studies have found that people with mental illness are no more violent than the general population (Henry J. Steadman, Edward P. Mulvey, et al, "Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods," Archives of General Psychiatry, Vol. 55: 393-401, 1998).

Substance abuse is a common symptom

• Approximately 15 percent of all adults who have a mental illness in any given year also experience a co-occurring substance abuse disorder, which complicates both diagnosis and treatment (Surgeon Generalís Report on Mental Health, 1999).
• Children of alcohol- and drug-addicted parents are up to four times more likely to develop substance abuse and mental health problems than other children (National Association for Children of Alcoholics, 1998).

Schizophrenia

Another frequent topic of myth is the disease schizophrenia, a thought disorder characterized by confused thinking, false beliefs and hallucinations. Schizophrenia is often confused with split or multiple personalities, but they are not the same thing; the confusion arose because the word schizophrenia comes from two Greek roots meaning, "split mind." The splitting or fragmentation referred to is the breakdown of an individual's thinking and feeling processes, not a division of the person into two separate personalities. The popular use of the word "schizophrenic" to describe a mixture of contradictory qualities is completely different from the correct psychiatric medical use of the term (Open the Doors Project).

Though we do not yet have a cure for schizophrenia, advances in medications have made it possible for substantial numbers of people with the disease to live and work in the community. Although there is a widely held belief that people with schizophrenia are dangerous, in general, they are more likely to hurt themselves, and patients with schizophrenia are more likely to be a victim of a crime than to perpetrate one. Refusal to take medication is a common issue because the illness itself can keep people from recognizing that they are sick and because some medications can have unpleasant and sometimes severe side effects.