One in six U.S. adults lives with a mental disorder. A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
Mental disorders are usually associated with significant distress in social, occupational or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior — political, religious or sexual — and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual.
The entire society suffers as a result of mental illness because of the constant stress and burden of absorbing the care of the mentally ill. The cost of mental health care in the U.S. is equivalent to the cost of cancer care. But unlike cancer, much of the economic burden of mental illness is not the cost of care, but the loss of income due to unemployment, expenses for social supports, and a range of indirect costs due to a chronic disability that begins during prime years in life.
Mass media is one of the public’s primary sources of information about disorders affecting the brain, such as bipolar disorder, schizophrenia and depression. With the advent of technology, media utilization has become one of the instrumental activities of daily living. It begins the moment we take the first sip of coffee in the morning gazing through our smart phone or tablet, all through the day, intermittently keeping abreast with the world by navigating buttons on a smart phone or a computer at work and at the end of our day by glancing through different channels, briefly pausing if there is breaking news on CNN or Fox.
There is no denying the fact that with our unrelenting thirst for instant gratification and wanting to know everything in the here and now, coupled with media’s ability to control information and shape our views of events and personalities to their liking, we are living in a world of “alternative facts.” Obviously, information slanted toward one’s way of thinking is not objective, but carries the risk of unintended consequences when information is misrepresented or if psychiatric terminology becomes a part of the common parlance.
Emphasis on interpersonal violence in news coverage of mental illness is concerning given that most people with mental illness are never violent and only about 4 percent of interpersonal violence in the United States is attributable to mental illness. The moment there is a breaking news flash about a mass shooting, most of us automatically and erroneously correlate it with perpetrator being a “psycho.” Psychosis is a state of mind associated with an altered perception of reality, whereas the term “psychopath” often relates to extreme violence and anti-social behavior, not a mental illness.
Media utilizing psychiatric terminology that inculcates misconceptions about mental illness, such as “insane,” “loony,” “freak,” “numskull,” “spastic,” “screw loose,” “bonkers,” “nuts,” referring to someone with a mental illness as a “victim,” or defining someone by their mental illness, such as referring to a person as “a schizophrenic’” or “his or her bipolar is kicking in” stigmatizes mental illness and perpetuates discrimination.
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Research suggests that exposure to negative media stories has a direct effect on attitudes about people with mental illness, which are difficult to alter by subsequent exposure to positive stories, that people who read negative articles about mental illness express more negative attitudes toward people with mental illness, and last but not the least, depiction of suicide by media potentially has the power to influence the vulnerable among us, resulting in copycat acts. A 10 percent increase in suicides — nearly 2,000 additional deaths — was recorded in the U.S. in the four months after Robin Williams took his own life in 2014. Specifically suffocation suicides paralleled the time and method of Williams’ death.
Remote diagnosing is a controversial practice among mental health professionals. In the 2017 book, “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President,” President Donald Trump is noted having a severe personality disorder, with the most frequent diagnosis being narcissistic personality disorder. The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, which became known as the Goldwater Rule, applicable to public figures states: “[I]t is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.” The book has been condemned by the American Psychiatric Association, and past APA president Jeffrey Lieberman wrote in Psychiatric News that the book is “not a serious, scholarly, civic-minded work, but simply tawdry, indulgent, fatuous tabloid psychiatry.”
Virginia Gov. Ralph Northam, a pediatric neurologist, recently called Trump a “narcissistic maniac.” With mental health experts being at crossroads regarding mental health of President Trump and medical professionals, such as Northam using terminology not in sync with APA’s publication, “Diagnostic and Statistical Manual of Mental Disorders,” that defines and classifies mental disorders, one can only imagine the confusion created in the minds of most citizens with no or limited mental health experience when they hear terms used by media describing mental state of President Trump, such as “intellectually impaired,” “narcissistic,” “megalomaniac with impulse control issues” and “patient zero for Donald Trump Syndrome.”
History is replete with individuals we recognize as geniuses and heads of state who have displayed behavior which most of us will consider eccentric. For example, Albert Einstein picked cigarette butts off the street and used the tobacco for his pipe; Benjamin Franklin sat naked in front of a window every morning and let the air circulate over his body, calling it an “air bath;” and in 1978, the Prime Minister of India Morarji Desai, a longtime practitioner of urine therapy, spoke to Dan Rather on “60 Minutes” stating that urine therapy was the perfect medical solution for the millions of Indians who cannot afford medical treatment.
Normality has been subject to redefinition as a result of various pressures, including political and economic ones. In statistics, a bell curve has been designed as a way of establishing “normal distribution” over a data range. It refers to the curve that is created, with the highest number of instances in the center building the peak of the curve and the other lesser values on either side, creating the slopes of the bell curve. In addition to personality traits, other measures that follow the bell curve include intellectual functioning, blood pressure, weight of people of certain age, etc. Using the bell curve paradigm, any sort of abhorrent behavior results in a skewed distribution along the curve, but with our rudimentary understanding of the brain, qualitative interpretation of the skew is complicated and nonintuitive.
“The amount of eccentricity in a society has generally been proportional to the amount of genius, mental vigor and moral courage it contained. [T]hat so few people now dare to be eccentric marks the chief danger of our time.” — John Stuart Mill, 1859
Dr. Shobhit Negi is a board-certified child and adolescent, adult and forensic psychiatrist. He see patients in Carroll and Howard counties. Reach him at firstname.lastname@example.org.