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Some form of mental illness affects almost one out of every five Canadians at some point in their life, yet it remains a disease shrouded in stigma and dogged by misconceptions that have evolved into myths. While celebrities such as Canadian actress Margot Kidder and Margaret Trudeau, former wife of the late Pierre Trudeau, have openly discussed their bouts of depression, other conditions, such as anxiety disorders, psychosis and schizophrenia, often remain in the shadows.
People with mental illness are often afraid to tell their friends or employers, and may be shunned by their families or face certain prejudices. Others are told to just "snap out of it." Yet mental illnesses are medical disorders that can be treated, often with excellent results.
Canadian Living magazine asked three top psychiatrists in Canada to dispel 10 of the more common myths about mental illness. Dr. Patrick White is a clinical professor and the chair of psychiatry at the University of Alberta in Edmonton. Dr. Stanley Kutcher is the Sun Life Financial chair in adolescent mental health at the IWK Health Centre and a professor in the department of psychiatry at Dalhousie University in Halifax. And Dr. David Goldbloom is the senior medical advisor for education and public affairs at the Centre for Addiction and Mental Health (CAMH) in Toronto as well as a professor of psychiatry at the University of Toronto.
Myth 1: Psychiatric disorders are not true illnesses like heart disease or cancer; people who have a mental illness are just "crazy."
Unlike a broken leg or heart attack, which are easily detected by simple tests, mental illness has traditionally been an invisible disease. This inability to see what's wrong may add to the public perception, and even fear, of mental illness. But, like heart disease, mental illnesses are bona fide medical conditions. They involve complex physiological processes, as well as changes or imbalances in brain chemistry, according to White.
With today's sophisticated brain imaging technology, such as positron emission tomography (PET) and magnetic resonance imaging (MRI), it's now possible to actually observe differences in the brains of people with mental illnesses, says White. "With illnesses such as psychosis, schizophrenia and others, we can see very real changes in the brain," he says.
This sort of technology will eventually help predict who is at risk for these conditions and find ways to prevent onset. One day these technologies may well help monitor how well treatment is working.
Myth 2: All people with schizophrenia are violent.
Unfortunately, Hollywood often portrays mentally ill people as dangerous axe-wielding murderers, says Goldbloom. The reality, he says, is that "very little violence in society is caused by people who are mentally ill." The most common types of violence – gang fights, domestic abuse, even road-rage – aren't caused by people with a mental illness such as schizophrenia. "People with a major mental illness are more likely to be victims of violence than perpetrators," says Goldbloom.
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Myth 3: Children don't get depression or other mental illnesses; their emotional problems are just part of growing up.
Parents naturally want their children to do well, so some may brush off or explain away behavioural problems or other childhood difficulties as being mere growing pains. However, numerous psychiatric conditions, including depression, eating disorders, obsessive compulsive disorder and anxiety disorders, can and do occur in childhood, according to Kutcher. In Canada, only 1 out of 5 children who need mental health services receives them.
Myth 4: Schizophrenia means split personality.
The term schizophrenia was coined in 1908 by Swiss professor Eugen Bleuler, who combined the Greek words schizein (splitting) and phren (soul, spirit, mind). His goal was actually to replace an earlier name for the disorder, dementia praecox, with more accurate terminology. The belief that schizophrenia means split personality is way off base, says Kutcher. People with a split personality have a completely different – and rare – disorder called multiple personality disorder. The misuse of the term "split personality" to refer to people with schizophrenia may have come from misuse in old movies and in the media.
But, says Kutcher, the term does apply to people with schizophrenia in that when their disease is at its worst, they live in two worlds. On the one hand, they're part of the real world; but on the other hand, they may have hallucinations (seeing or hearing things that aren't there), delusions (believing things that aren't real) or paranoia (fear that there is a conspiracy against them or that people are following them) that put them in another – fanciful – world. This is quite different from exhibiting different personalities.
Schizophrenia typically manifests itself in late adolescence or early adulthood. The good news is that there are various treatments that help keep the symptoms of schizophrenia under control. Schizophrenia affects about one in every 100 Canadians.
Myth 5: Addiction is a lifestyle choice and shows a lack of willpower.
An addiction, whether to drugs or alcohol, is a complex condition that is often chalked up to a lack of self-control on the part of the sufferer. But the problem is not that simple; addictions involve complex factors including genetics (alcoholism, for example, often runs in families), the environment, and sometimes other underlying psychiatric conditions such as depression. When people who become addicted have these underlying vulnerabilities it's harder for them to simply kick the habit, says Goldbloom.
In addition, complex chemical brain processes that are part of the brain's "reward mechanism" add to the craving of substances. This reward mechanism is largely regulated by the brain chemical dopamine, which can create a feeling of satisfaction and relief once the substance is used. When not using that substance, people with addictions may feel a huge, insatiable craving.
Treating addiction is often a long-term process. It can involve talk therapy and medication to treat both the addiction and any other mental illness. There is also the issue of learning how to deal with outside influences (such as friends who encourage use of the addictive substance) that reinforce the addiction. It takes a huge amount of work by, as well as resolve, dedication and time from, the person who is addicted to overcome his or her addiction.
It's rare that a person can simply stop drinking or kick a drug habit cold turkey, though it can happen. But judging people as weak can make the problem worse by making them feel so bad about themselves that they indulge as a means of escape, says Goldbloom.
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Myth 6: Electroconvulsive therapy (ECT), also known as shock therapy, is painful and barbaric.
ECT has been around since 1938, long before drugs such as antidepressants like Prozac and Zoloft were developed, says Goldbloom. As with many therapies, ECT was overused when it was first discovered. Back then, understanding of the best use of the therapy was limited. Now, however, ECT is one of the most effective treatments for people whose depression is so severe that antidepressant medications just don't do the job and who are debilitated by the depression, says Goldbloom.
ECT got a bad rap from the movie One Flew Over the Cuckoo's Nest, which inaccurately portrayed the therapy, says Goldbloom. For one thing, ECT was used in the film as a form of punishment, not as a treatment. Today patients are anaesthetized and their muscles are relaxed before ECT is administered, so that they have no awareness of the treatment and very minimal physical evidence of seizure activity.
Many frustrated patients actually request this therapy after other treatments fail. "Electroshocks to restart the heart are not considered barbaric, so why should ECT be?" asks Goldbloom.
There is still some debate in the field of psychiatry about possible long-term effects on memory and other cognitive functions in some patients, although most experts say the benefits far outweigh the risks. Researchers continue to refine the best ways to use this treatment.
Myth 7: People with a mental illness lack intelligence.
"This is completely false," says Kutcher. "Intelligence has nothing to do with mental illnesses or brain disorders." On one hand, many people with mental disorders are brilliant, creative, productive people. On the other hand, some people with mental disorders are not brilliant or creative. Certain mental illnesses may make it difficult for people to remember facts or get along with other people, making it seem like they are cognitively challenged. Overall, the level of intelligence among people with mental illness likely parallels the patterns seen in any healthy population.
Myth 8: People with a mental illness shouldn't work because they'll just drag down the rest of the staff.
People with mental illness can and do function well in the workplace. They are unlikely to miss any more workdays because of their condition than people with a chronic physical condition such as diabetes or heart disease, says White. Employees may not even be aware that a coworker suffers from a mental illness – proof that mental illness in the workplace may not even be an issue.
However, White points out that a stress-riddled workplace may be a breeding ground for the development of stress-related mental illnesses, such as depression and anxiety disorders, and threaten the delicate work-life balance. "Stress is probably the most common, most pervasive factor causing depression in society," he says. Stress is also associated with increased risk for physical conditions such as heart disease and cancer.
The real problem is the prejudice against hiring people with mental illness, says White. The resulting unemployment leaves them isolated, a situation that can add to their stress, and make it more difficult to recover from the illness.
As individuals and as a society, "we need to interact with others in a much more emotionally aware and understanding fashion," he says.
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Myth 9: Mental illness is a single, rare disorder.
Anxiety disorders, mood disorders, personality disorders, addiction disorders, impulse control disorders, sexual and gender disorders…the list goes on. There are multiple types of mental illness, each with its own features and underlying causes. "Saying mental illnesses are all the same is just like saying that all cancers are the same," says Goldbloom. Using the cancer analogy, he points out that while in skin, brain and liver cancers cell growth is out of control, the causes of and treatments for these different cancers are all different.
Similarly, each mental illness is a variation on the theme of brain chemistry gone awry, affecting things like mood and perception. But each of these illnesses has its own specific causes, features and approaches to treatment.
Myth 10: People with a mental illness never get better.
Treatments for mental illnesses are more numerous and more sophisticated than ever. As well, researchers continue to discover new treatments. Because of these advances, many people do recover from mental illness, and others are able to keep the condition under control, says White. For instance, a person who experiences depression triggered by a family loss can recover fully if the depression is treated.
Indeed, today's pharmaceutical treatments are better able to target the specific parts of the brain where treatment is needed. While some conditions, such as schizophrenia, might wax and wane in severity throughout a person's adult life, symptoms can be kept under control with proper treatment.
The treatment goal of a full recovery is not unreachable, says White. That goal, he adds, involves more than just drugs; it also includes being socially and physically active because recovery means getting people back to leading normal lives.
Finding help online:
Do you still have a question or concern about a mental health issue? Check out these websites:
• Centre for Addiction and Mental Health (CAMH)
The centre's website offers links to treatment programs, information in 17 languages and publications on new research in mental health and addiction.
• Canadian Mental Health Association
This charitable organization raises money for mental health awareness and research. Its site has a large section devoted to debunking mental health myths and providing information on mental illness in children and adults.
• Mood Disorders Society of Canada
This charitable group's website features a section with facts on mental illness and addiction, as well as information for "vulnerable groups" like women, children, homeless people and Aboriginal Peoples. The site hosts real-time, online discussion forums and has a question submission page so that you can "Ask an Expert" a question on mental health.
• Mind Your Mind
At this website, youngsters can get information and resources, and meet others who deal with stress, anxiety or mental health problems, or are facing crisis situations.
• Children's Mental Health Ontario
This group encompasses 81 children's health centres across Ontario; its website has information for parents and youth, plus an extensive resource and link guide for all aspects of mental illness relevant to those under 18.
• Public Health Agency of Canada
This government site offers information and statistics on mental health (including children, youth and postpartum depression), as well as a list of frequently asked questions. It also includes an evaluation of mental health services and programs available in Canada.
– Katie Drummond
• 4 ways parents can support their children's mental health
• How to help a loved one with a mental health issue
• Why the mental health system deserves your money
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