I’m about to go speak to NAMI Ohio’s statewide conference, Fulfilling the Promise. These are the remarks I prepared for my speech.
Before I begin, I want to warn you that this talk touches on many triggering subjects, including self-harm and suicide. I also want you to know that I’m speaking from my personal experience, and that if you or someone you know may be living with mental illness, please talk to a licensed and qualified medical professional, because I am not a doctor.
Okay, let’s do this.
Hi, I’m Wil Wheaton. I’m 45 years-old, I have a wonderful wife, two adult children who make me proud every day, and a daughter in-law who I love like she’s my own child. I work on the most popular comedy series in the world, I’ve been a New York Times Number One Bestselling Audiobook narrator, I have run out of space in my office for the awards I’ve received for my work, and as a white, heterosexual, cisgender man in America, I live life on the lowest difficulty setting – with the Celebrity cheat enabled.
My life is, by every objective measurement, very very good.
And in spite of all of that, I struggle every day with my self esteem, my self worth, and my value not only as an actor and writer, but as a human being.
That’s because I live with Depression and Anxiety, the tag team champions of the World Wrestling With Mental Illness Federation.
And I’m not ashamed to stand here, in front of six hundred people in this room, and millions more online, and proudly say that I live with mental illness, and that’s okay. I say “with” because even though my mental illness tries its best, it doesn’t control me, it doesn’t define me, and I refuse to be stigmatized by it.
So. My name is Wil Wheaton, and I have Chronic Depression.
It took me over thirty years to be able to say those ten words, and I suffered for most of them as a result. I suffered because though we in America have done a lot to help people who live with mental illness, we have not done nearly enough to make it okay for our fellow travelers on the wonky brain express to reach out and accept that help.
I’m here today to talk with you about working to end the stigma and prejudice that surrounds mental illness in America, and as part of that, I want to share my story with you.
When I was a little kid, probably seven or eight years old, I started having panic attacks. Back then, we didn’t know that’s what they were, and because they usually happened when I was asleep, the adults in my life just thought I had nightmares. Well, I did have nightmares, but they were so much worse than just bad dreams. Night after night, I’d wake up in absolute terror, and night after night, I’d drag my blankets off my bed, to go to sleep on the floor in my sister’s bedroom, because I was so afraid to be alone.
There were occasional stretches of relief, sometimes for months at a time, and during those months, I felt like what I considered to be a normal kid, but the panic attacks always came back, and each time they came back, they seemed worse than before.
When I was around twelve or thirteen, my anxiety began to express itself in all sorts of delightful ways.
I worried about everything. I was tired all the time, and irritable most of the time. I had no confidence and terrible self-esteem. I felt like I couldn’t trust anyone who wanted to be close to me, because I was convinced that I was stupid and worthless and the only reason anyone would want to be my friend was to take advantage of my fame.
This is important context. When I was thirteen, I was in an internationally-beloved film called Stand by Me, and I was famous. Like, really famous, like, can’t-go-to-the-mall-with-my-friends-without-getting-mobbed famous, and that meant that all of my actions were scrutinized by my parents, my peers, my fans, and the press. All the weird, anxious feelings I had all the time? I’d been raised to believe that they were shameful. That they reflected poorly on my parents and my family. That they should be crammed down deep inside me, shared with nobody, and kept secret.
My panic attacks happened daily, and not just when I was asleep. When I tried to reach out to the adults in my life for help, they didn’t take me seriously. When I was on the set of a tv show or commercial, and I was having a hard time breathing because I was so anxious about making a mistake and getting fired? The directors and producers complained to my parents that I was being difficult to work with. When I was so uncomfortable with my haircut or my crooked teeth and didn’t want to pose for teen magazine photos, the publicists told me that I was being ungrateful and trying to sabotage my success. When I couldn’t remember my lines, because I was so anxious about things I can’t even remember now, directors would accuse me of being unprofessional and unprepared. And that’s when my anxiety turned into depression.
(I’m going to take a moment for myself right now, and I’m going to tear a hole in the fabric of spacetime and I’m going to tell all those adults from the past: give this kid a break. He’s scared. He’s confused. He is doing the best he can, and if you all could stop seeing him as a way to put money into your pockets, maybe you could see that he’s suffering and needs help.)
I was miserable a lot of the time, and it didn’t make any sense. I was living a childhood dream, working on Star Trek: The Next Generation, and getting paid to do what I loved. I had all the video games and board games I ever wanted, and did I mention that I was famous?
I struggled to reconcile the facts of my life with the reality of my existence. I knew something was wrong with me, but I didn’t know what. And because I didn’t know what, I didn’t know how to ask for help.
I wish I had known that I had a mental illness that could be treated! I wish I had known that the way I felt wasn’t normal and it wasn’t necessary. I wish I had known that I didn’t deserve to feel bad, all the time.
And I didn’t know those things, because Mental Illness was something my family didn’t talk about, and when they did, they talked about it like it was something that happened to someone else, and that it was something they should be ashamed of, because it was a result of something they did. This prejudice existed in my family in spite of the ample incidence of mental illness that ran rampant through my DNA, featuring successful and unsuccessful suicide attempts by my relations, more than one case of bipolar disorder, clinical depression everywhere, and, because of self-medication, so much alcoholism, it was actually notable when someone didn’t have a drinking problem.
Now, I don’t blame my parents for how they addressed – or more accurately didn’t address – my mental illness, because I genuinely believe they were blind to the symptoms I was exhibiting. They grew up and raised me in the world I’ve spent the last decade of my life trying to change. They lived in a world where mental illness was equated with weakness, and shame, and as a result, I suffered until I was in my thirties.
And it’s not like I never reached out for help. I did! I just didn’t know what questions to ask, and the adults I was close to didn’t know what answers to give.
I clearly remember being twenty-two, living in my own house, waking up from a panic attack that was so terrifying just writing about it for this talk gave me so much anxiety I almost cut this section from my speech. It was the middle of the night, and I drove across town, to my parents’ house, to sleep on the floor of my sister’s bedroom again, because at least that’s where I felt safe. The next morning, I tearfully asked my mom what was wrong with me. She knew that many of my blood relatives had mental illness, but she couldn’t or wouldn’t connect the dots. “You’re just realizing that the world is a scary place,” she said.
Yeah, no kidding. The world terrifies me every night of my life and I don’t know why or how to stop it.
Again, I don’t blame her and neither should you. She really was doing the best that she could for me, but stigma and the shame is inspires are powerful things.
I want to be very clear on this: Mom, I know you’re going to read this or hear this and I know it’s going to make you upset. I want you to know that I love you, and I know that you did the very best you could. I’m telling my story, though, so someone else’s mom can see the things you didn’t, through no fault of your own.
Through my twenties, I continued to suffer, and not just from nightmares and panic attacks. I began to develop obsessive behaviors that I’ve never talked about in public until right now. Here’s a very incomplete list: I began to worry that the things I did would affect the world around me in totally irrational ways. I would hold my breath underneath bridges when I was driving, because if I didn’t, maybe I’d crash my car. I would tap the side of an airplane with my hand while I was boarding, and tell it to take care of me when I flew places for work, because I was convinced that if I didn’t, the plane would crash. Every single time I said goodbye to someone I cared about, my brain would play out in vivid detail how I would remember this as the last time I saw them. Talking about those memories, even without getting into specifics, is challenging. It’s painful to recall, but I’m not ashamed, because all those thoughts – which I thankfully don’t have any more, thanks to medical science and therapy – were not my fault any more than the allergies that clog my sinuses when the trees in my neighborhood start doin’ it every spring are my fault. It’s just part of who I am. It’s part of how my brain is wired, and because I know that, I can medically treat it, instead of being a victim of it.
One of the primary reasons I speak out about my mental illness, is so that I can make the difference in someone’s life that I wish had been made in mine when I was young, because not only did I have no idea what Depression even was until I was in my twenties, once I was pretty sure that I had it, I suffered with it for another fifteen years, because I was ashamed, I was embarrassed, and I was afraid.
So I am here today to tell anyone who can hear me: if you suspect that you have a mental illness, there is no reason to be ashamed, or embarrassed, and most importantly, you do not need to be afraid. You do not need to suffer. There is nothing noble in suffering, and there is nothing shameful or weak in asking for help. This may seem really obvious to a lot of you, but it wasn’t for me, and I’m a pretty smart guy, so I’m going to say it anyway: There is no reason to feel embarrassed when you reach out to a professional for help, because the person you are reaching out to is someone who has literally dedicated their life to helping people like us live, instead of merely exist.
That difference, between existing and living, is something I want to focus on for a minute: before I got help for my anxiety and depression, I didn’t truly live my life. I wanted to go do things with my friends, but my anxiety always found a way to stop me. Traffic would just be too stressful, it would tell me. It’s going to be a real hassle to get there and find parking, it would helpfully observe. And if those didn’t stop me from leaving my house, there was always the old reliable: What if…? Ah, “What if… something totally unlikely to happen actually happens? What if the plane crashes? What if I sit next to someone who freaks me out? What if they laugh at me? What if I get lost? What if I get robbed? What if I get locked out of my hotel room? What if I slip on some ice I didn’t see? What if there’s an earthquake? What if what if what if what if…
When I look back on most of my life, it breaks my heart that when my brain was unloading an endless pile of what ifs on me, it never asked, “What if I go do this thing that I want to do, and it’s … fun? What if I enjoy myself, and I’m really glad I went?”
I have to tell you a painful truth: I missed out on a lot of things, during what are supposed to be the best years of my life, because I was paralyzed by What If-ing anxiety.
All the things that people do when they are living their lives … all those experiences that make up a life, my anxiety got in between me and doing them. So I wasn’t living. I was just existing.
And through it all, I never stopped to ask myself if this was normal, or healthy, or even if it was my fault. I just knew that I was nervous about stuff, and I worried a lot. For my entire childhood, my mom told me that I was a worry wart, and my dad said I was overly dramatic about everything, and that’s just the way it was.
Except it didn’t have to be that way, and it took me having a full blown panic attack and a complete meltdown at Los Angeles International Airport for my wife to suggest to me that I get help.
Like I said, I had suspected for years that I was clinically depressed, but I was afraid to admit it, until the most important person in my life told me without shame or judgment that she could see that I was suffering. So I went to see a doctor, and I will never forget what he said, when I told him how afraid I was: “Please let me help you.”
I think it was then, at about 34 years-old, that I realized that Mental Illness is not weakness. It’s just an illness. I mean, it’s right there in the name “Mental ILLNESS” so it shouldn’t have been the revelation that it was, but when the part of our bodies that is responsible for how we perceive the world and ourselves is the same part of our body that is sick, it can be difficult to find objectivity or perspective.
So I let my doctor help me. I started a low dose of an antidepressant, and I waited to see if anything was going to change.
And boy did it.
My wife and I were having a walk in our neighborhood and I realized that it was just a really beautiful day – it was warm with just a little bit of a breeze, the birds sounded really beautiful, the flowers smelled really great and my wife’s hand felt really good in mine.
And as we were walking I just started to cry and she asked me, “what’s wrong?”
I said “I just realized that I don’t feel bad and I just realized that I’m not existing, I’m living.”
At that moment, I realized that I had lived my life in a room that was so loud, all I could do every day was deal with how loud it was. But with the help of my wife, my doctor, and medical science, I found a doorway out of that room.
I had taken that walk with my wife almost every day for nearly ten years, before I ever noticed the birds or the flowers, or how loved I felt when I noticed that her hand was holding mine. Ten years – all of my twenties – that I can never get back. Ten years of suffering and feeling weak and worthless and afraid all the time, because of the stigma that surrounds mental illness.
I’m not religious, but I can still say Thank God for Anne Wheaton. Thank God for her love and support. Thank God that my wife saw that I was hurting, and thank God she didn’t believe the lie that Depression is weakness, or something to be ashamed of. Thank God for Anne, because if she hadn’t had the strength to encourage me to seek professional help, I don’t know how much longer I would have been able to even exist, to say nothing of truly living.
I started talking in public about my mental illness in 2012, and ever since then, people reach out to me online every day, and they ask me about living with depression and anxiety. They share their stories, and ask me how I get through a bad day, or a bad week.
Here’s one of the things I tell them:
One of the many delightful things about having Depression and Anxiety is occasionally and unexpectedly feeling like the whole goddamn world is a heavy lead blanket, like that thing they put on your chest at the dentist when you get x-rays, and it’s been dropped around your entire existence without your consent.
Physically, it weighs heavier on me in some places than it does in others. I feel it tugging at the corners of my eyes, and pressing down on the center of my chest. When it’s really bad, it can feel like one of those dreams where you try to move, but every step and every motion feels like you’re struggling to move through something heavy and viscous. Emotionally, it covers me completely, separating me from my motivation, my focus, and everything that brings me joy in my life.
When it drops that lead apron over us, we have to remind ourselves that one of the things Depression does, to keep itself strong and in charge, is tell us lies, like: I am the worst at everything. Nobody really likes me. I don’t deserve to be happy. This will never end. And so on and so on. We can know, in our rational minds, that this is a giant bunch of bullshit (and we can look at all these times in our lives when were WERE good at a thing, when we genuinely felt happy, when we felt awful but got through it, etc.) but in the moment, it can be a serious challenge to wait for Depression to lift the roadblock that’s keeping us from moving those facts from our rational mind to our emotional selves.
And that’s the thing about Depression: we can’t force it to go away. As I’ve said, if I could just “stop feeling sad” I WOULD. (And, also, Depression isn’t just feeling sad, right? It’s a lot of things together than can manifest themselves into something that is most easily simplified into “I feel sad.”)
So another step in our self care is to be gentle with ourselves. Depression is beating up on us already, and we don’t need to help it out. Give yourself permission to acknowledge that you’re feeling terrible (or bad, or whatever it is you are feeling), and then do a little thing, just one single thing, that you probably don’t feel like doing, and I PROMISE you it will help. Some of those things are:
Take a shower.
Eat a nutritious meal.
Take a walk outside (even if it’s literally to the corner and back).
Do something – throw a ball, play tug of war, give belly rubs – with a dog. Just about any activity with my dogs, even if it’s just a snuggle on the couch for a few minutes, helps me.
Do five minutes of yoga stretching.
Listen to a guided meditation and follow along as best as you can.
Finally, please trust me and know that this shitty, awful, overwhelming, terrible way you feel IS NOT FOREVER. It will get better. It always gets better. You are not alone in this fight, and you are OK.
Right now, there is a child somewhere who has the same panic attacks I had, and their parents aren’t getting them help, because they believe it reflects poorly on their parenting to have a child with mental illness. Right now, there is a teenager who is contemplating self harm, because they don’t know how to reach out and ask for help. Right now, there are too many people struggling just to get to the end of the day, because they can’t afford the help that a lot of us can’t live without. But there are also people everywhere who are picking up the phone and making an appointment. There are parents who have learned that mental illness is no different than physical illness, and they’re helping their children get better. There are adults who, like me, were terrified that antidepressant medication would make them a different person, and they’re hearing the birds sing for the first time, because they have finally found their way out of the dark room.
I spent the first thirty years of my life trapped in that dark, loud room, and I know how hopeless and suffocating it feels to be in there, so I do everything I can to help others find their way out. I do that by telling my story, so that my privilege and success does more than enrich my own life. I can live by example for someone else the way Jenny Lawson lives by example for me.
But I want to leave you today with some suggestions for things that we can all do, even if you’re not Internet Famous like I am, to help end the stigma of mental illness, so that nobody has to merely exist, when they could be living.
We can start by demanding that our elected officials fully fund mental health programs. No person anywhere, especially here in the richest country in the world, should live in the shadows or suffer alone, because they can’t afford treatment. We have all the money in the world for weapons and corporate tax cuts, so I know that we can afford to prioritize not just health care in general, but mental health care, specifically.
And until our elected officials get their acts together, we can support organizations like NAMI, that offer low and no-cost assistance to anyone who asks for it. We can support organizations like Project UROK, that work tirelessly to end stigmatization and remind us that we are sick, not weak.
We can remember, and we can remind each other, that there is no finish line when it comes to mental illness. It’s a journey, and sometimes we can see the path we’re on all the way to the horizon, while other times we can’t even see five feet in front of us because the fog is so thick. But the path is always there, and if we can’t locate it on our own, we have loved ones and doctors and medications to help us find it again, as long as we don’t give up trying to see it.
Finally, we who live with mental illness need to talk about it, because our friends and neighbors know us and trust us. It’s one thing for me to stand here and tell you that you’re not alone in this fight, but it’s something else entirely for you to prove it. We need to share our experiences, so someone who is suffering the way I was won’t feel weird or broken or ashamed or afraid to seek treatment. So that parents don’t feel like they have failed or somehow screwed up when they see symptoms in their kids.
People tell me that I’m brave for speaking out the way I do, and while I appreciate that, I don’t necessarily agree. Firefighters are brave. Single parents who work multiple jobs to take care of their kids are brave. The Parkland students are brave. People who reach out to get help for their mental illness are brave. I’m not brave. I’m just a writer and occasional actor who wants to share his privilege and good fortune with the world, who hopes to speak out about mental health so much that one day, it will be wholly unremarkable to stand up and say fifteen words:
My name is Wil Wheaton, I live with chronic depression, and I am not ashamed.
Thank you for listening to me, and please be kind to each other.
What Anthony Bourdain and Kate Spade’s Suicides Say About Depression
This story discusses suicide. If you are looking for help or know someone in crisis, please call the National Suicide Prevention hotline at 1-800-273-8255.
Chef and author Anthony Bourdain is dead at 61 in apparent suicide
To the outside world, fashion designer Kate Spade seemed to have a charmed life that she worked hard to create. Yet behind closed doors, “…there were personal demons she was battling,” her husband, Andy Spade, said in a recent statement following the designer’s death by suicide on June 5 at 55.
“She was actively seeking help for depression and anxiety … seeing a doctor on a regular basis and taking medication for both depression and anxiety,” Spade said, stressing that her death was a “complete shock.”
The world is waking up to another shocking headline today: Anthony Bourdain, the popular chef and television personality, has died by apparent suicide at age 61.
Depression is the leading risk factor for suicide. It’s also the leading cause of ill health and disability worldwide, according to the World Health Organization, with more than 300 million people suffering from the disease.
Rates of depression are on the rise among Americans from all age groups, but a lack of support for mental health issues combined with a common fear of stigma means many do not get the treatment they need to live healthy, productive lives.
For someone living with depression, being able to talk to a loved one or someone they trust is a first step to finding treatment and recovering. Depression increases the risk of several major diseases and disorders including addiction, suicidal behavior, diabetes and heart disease, which are themselves among the world’s biggest killers.
And if you are concerned about a loved one, it’s important to express your concern.
“Some people have the misconception that asking a person about suicide will increase the risk, but, in reality, asking doesn’t increase the risk of suicide, but can save a life,” said Dr. Jeffrey Borenstein, president and CEO of Brain & Behavior Research Foundation.
Some people with depression may experience very severe symptoms, and seek help. Others may have such subtle symptoms they don’t think depression is the problem. People with smiling depression may be able to put on a show in public, at work and even at home with their families, even though they’re suffering on the inside.
Alarmingly, if a person is exhibiting a sudden sense of calm and happiness after being extremely depressed, it could mean he has made a decision to attempt suicide, according to Helpguide.org.
Like the classic signs of depression — persistent low mood and loss of pleasure — these more subtle symptoms can also affect “ … how well a person is doing and how well a person is functioning,” said Dr. John Zajecka, professor of psychiatry at Rush University Medical Center.
A common misconception is that people need to be weepy and sad in order to be diagnosed with depression, Zajecka said. But some people may feel numb or angry, instead of hopeless.
Although “… one symptom does not a diagnosis make,” there are some subtle clues to depression that people should be aware of, especially if they persist, said Dr. Holly A. Swartz, professor of psychiatry at the University of Pittsburgh School of Medicine.
1. YOU NOTICED CHANGES IN SLEEP.
Maybe you used to be a person who used to sleep soundly. Now you don’t. Maybe you always functioned well with 6 hours of sleep per night. Now you find yourself sleeping the weekend away.
Changes in sleep patterns could indicate depression, Swartz said. “Sleep makes people function well, so the real problem is that for a depressed person, sleep isn’t restorative, and they aren’t refreshed or rejuvenated.”
People may also experience what’s called “psychomotor agitation,” which can cause restlessness and an inability to get comfortable, said Dr. Joseph Calabrese, a professor of psychiatry and director of the Mood Disorders Program at University Hospitals Cleveland Medical Center.
2. YOUR MIND SEEMS MUDDLED.
“One of the things people really need to be mindful of is how well they are functioning cognitively,” Zajecka said. “Sometimes people can’t sit down for 30 minutes and watch TV or read or do anything that requires some focus.”
Other subtle signs of depression may include a kind of “slowness of thinking,” forgetfulness and difficulty in making decisions, he adds.
3. YOU WORRY TOO MUCH AND THINK TOO MUCH.
The clinical name for excessive worry and over-thinking life situations or events is called “rumination.” Rumination can increase the chance of becoming depressed and make episodes of depression last longer.
“With rumination, people basically get caught in a loop of replaying negative situations or looking at neutral situations in a negative way or over-analyzing things,” Zajecka said.
Some research shows the “ruminators” among us do seek social support. But eventually that support lessens.
“A little self-reflection is good, but with rumination someone can become very self-absorbed and they talk about the same things over and over again, which becomes tough on the people around them,” Zajecka said. Those people may turn away, which can cause more rumination, depression and feelings of low self-worth and low self-esteem.
4. YOUR WEIGHT HAS CHANGED.
Weight changes can be a warning sign of depression. Some people may start to eat too much. Others may lose interest in food.
These changes in your eating patterns may be accompanied by fatigue and a loss of pleasure. “Most people enjoy a good meal, and those who are depressed lose energy and interest, even in eating,” Calabrese said. Or they may overcompensate and just eat too much.
Overeating or loss of interest in food may have little to do with hunger since depression can affect chemicals or parts of the brain linked to both pleasure and appetite control.
5. YOU’RE NOT AS ENGAGED OR EXPRESSIVE.
If you notice that someone who was previously social and engaged with family, friends, work or the community but now “pulls back” from usual activities there’s a chance that person may be depressed, Swartz said.
Social withdrawal and isolation are indeed hallmark symptoms of depression. But another symptom to look out for is a “flat” or “blunted” affect, basically a decrease in emotional expression. You can even see it in a person’s face since facial muscles are less active, she added.
6. YOU HURT A LOT.
Depression does hurt and may be the cause of many unexplained physical problems, including headaches, digestive issues and back pain, among others. “The pain is very real and some people may only see their doctors for vague physical pains and never get a diagnosis of depression when that’s the real problem,” Zajecka said.
Pain and depression share some of the same brain chemicals. These chemicals travel along specific nerve pathways. The end result is that depression can change how sensitive the brain is to pain, he added.
Depression and heart disease also go hand-in-hand. Research shows those with depression and heart disease are at greater risk of death. And depression, like high blood pressure and high cholesterol, is actually a risk factor for heart disease.
IT CAN BE TREATED:
If you have any concerns that you may be suffering from depression, or if any of these symptoms describe you, talk to your doctor. The good news: If you have depression, it can be treated.
Depression is generally treated with medication, psychotherapy (talk therapy) or a combination of both. “Depression is very common and there is good help,” Zajecka said. “A person doesn’t need to suffer. They really aren’t alone.”
This updated story was first published in 2016.
Pete Davidson Reminds Us That Having a Mental Illness Doesn’t Mean ‘You Can’t Be Happy and in a Relationship’
Pete Davidson is clearing up misconceptions about dating with borderline personality disorder. After some folks on Twitter suggested he was unable to be in a stable relationship with Ariana Grande because of his BPD diagnosis, the Saturday Night Live star took to his Instagram Stories on Thursday with a PSA.
“Normally I wouldn’t comment on something like this ’cause f— you,” he wrote. “But I been hearing a lot of ‘people with BPD can’t be in relationships’ talk. I just wanna let you know that’s not true. Just because someone has a mental illness does not mean they can’t be happy and in a relationship. It also doesn’t mean that person makes the relationship toxic.”
Davidson opened up about having BPD last September after receiving a diagnosis in December 2016, telling Marc Maron that he’s managing his BPD with the help of medication. “It is working, slowly but surely,” he said on WTF with Marc Maron, per Rolling Stone. “I’ve been having a lot of problems. This whole year has been a f—ing nightmare. This has been the worst year of my life, getting diagnosed with this and trying to figure out how to learn with this and live with this.”
The comedian elaborated on seeking mental health treatment for BPD in his Instagram Story on Thursday. “Everybody is different and there are a lot of treatments for mental illnesses and I have done/am doing all of them,” Davidson continued. “And I encourage those who struggle to seek help as well[;] it has changed my life for the better. I just think it’s fucked up to stigmatize people as crazy and say that they are unable to do stuff that anyone can do. It’s not their fault and it’s the wrong way for people to look at things.
“I may be crazy but at least I’m aware of it and not afraid to be honest about it and I’m not hiding behind a Twitter or Instagram account,” he added. “I’m simply writing this because I want everyone out there who has an illness to know that it’s not true and that anyone who says that is ill and full of shit. Mental illness is not a joke[,] it’s a real thing. There’s kids out there killing themselves. And it’s f—ing horrific. For all those struggling[,] I want you to know that I love you and I understand you and it is going to be okay. That’s all. Love to everyone else.”
Previously, news broke that Davidson was reportedly dating (and getting matching tattooswith) Ariana Grande following the latter’s break-up with Mac Miller. Although neither celebrity has explicitly commented on the relationship, Grande took to Twitter this past Wednesday with a reality check for one internet commentator who was romanticizing her time with her ex.
“How absurd that you minimize female self-respect and self-worth by saying someone should stay in a toxic relationship because he wrote an album about them,” she wrote, adding, “I am not a babysitter or a mother and no woman should feel that they need to be. I have cared from him and tried to support his sobriety [and] prayed for his balance for years (and always will of course) but shaming/blaming women for a man’s inability to keep his shit together is a very major problem.”
“Of course I didn’t share about how hard or scary it was while it was happening but it was,” Grande continued. “I will continue to pray from the bottom of my heart that he figures it all out and that any other woman in this position does as well.”
These experiences have convinced me that in order to achieve its mission of transforming the understanding and treatment of mental illnesses, the number one priority of the NIMH has to be excellent science. When considering what to fund, the most important criteria should be whether the research proposed is well designed, whether those conducting the research adhere to the highest standards of rigor, and crucially, whether the results will be impactful. These should be our guiding principles, first and foremost.
Within the context of excellent science, we should be guided by the notion that diversity is the cornerstone of a strong research portfolio. Diversity in research takes many forms. For the NIMH, this means diversity in subject matter—basic, translational, clinical, and implementation science—as well as diversity of the workforce that investigates this subject matter, and the diversity of the individuals who participate in this research. Importantly, we must also have diversity of time frames. We must invest in research that has the potential to improve clinical care over the short, medium, and long-term. For while it is essential to deeply investigate the brain and its interactions with the environment to build our knowledge base and search for the truly transformative treatments of tomorrow, we must not neglect opportunities to fully investigate new treatment targets as they arise. Nor can we forget that research is often needed to help currently available, efficacious treatments reach all patients who need them.
These are my priorities: excellent science, and within the realm of excellent science, diversity. I have lots of other ideas that I hope to work on. Areas of particular interest include neural circuits, computational and theoretical approaches to psychiatry, and suicide prevention, each of which I will be writing about in the near future. Of course, I am aware of the several challenges facing the NIMH, including maximizing the utility of the RDoC and experimental therapeutics approaches, as well as weighing the relative contributions of consortia-driven “big science” vs. hypothesis-driven “small science.” For now, though, I will stick to my plan, and like my son, focus on learning—in my case, from those inside and outside of NIMH whose insight can help inform the future directions of our research programs.
The Modern Asylum
By CHRISTINE MONTROSS, FEB. 18, 2015
LAST month, three ethicists from the University of Pennsylvania argued in the Journal of the American Medical Association that the movement to deinstitutionalize the mentally ill has been a failure. Deinstitutionalization, they wrote, has in truth been “transinstitutionalization.” As a hospital psychiatrist, I see this every day. Patients with chronic, severe mental illnesses are still in facilities — only now they are in medical hospitals, nursing homes and, increasingly, jails and prisons, places that are less appropriate and more expensive than long-term psychiatric institutions.
The ethicists argue that the “way forward includes a return to psychiatric asylums.” And they are right.
Their suggestion was controversial. Critics argued that people should receive treatment in the least restrictive setting possible. The Americans With Disabilities Act demanded this, as has the Supreme Court. The goals of maximizing personal autonomy and civil liberties for the mentally ill are admirable.
But as a result, my patients with chronic psychotic illnesses cycle between emergency hospitalizations and inadequate outpatient care. They are treated by community mental health centers whose overburdened psychiatrists may see even the sickest patients for only 20 minutes every three months. Many patients struggle with homelessness. Many are incarcerated.
A new model of long-term psychiatric institutionalization, as the Penn group suggests, would help them. However, I would go even further. We also need to rethink how we care for another group of vulnerable patients who have been just as disastrously disserved by policies meant to empower and protect them: the severely mentally disabled.
In the wake of deinstitutionalization, group homes for the mentally disabled were established to provide long-term housing while preserving community engagement. Rigorous regulations evolved to ensure patient safety and autonomy. However, many have backfired.
A colleague of mine who treats severely disabled patients on the autism spectrum described a young man who would become agitated in the van on outings with his group home staff. Fearing the man would open a door while the vehicle was moving, staff members told his family that he would no longer be permitted to go. When the parents suggested just locking the van doors, they were told that this infringed on patients’ freedom and was not allowed.
Group homes have undergone devastating budget cuts. Staffs are smaller, wages are lower, and workers are less skilled. Severe cognitive impairment can be accompanied by aggressive or self-injurious impulses. With fewer staff members to provide care, outbursts escalate. Group homes then have no choice but to send violent patients to the psychiatric hospital.
As a result, admission rates of severely mentally disabled patients at my hospital are rising. They join patients who are suicidal, homicidal or paranoid. We have worked to minimize the use of restraint and seclusion on my unit, but have seen the frequency of both skyrocket. Nearly every week staff members are struck or scratched by largely nonverbal patients who have no other way to communicate their distress. Attempting to soothe these patients monopolizes the efforts of a staff whose mission is to treat acute psychiatric emergencies, not chronic neurological conditions. Everyone loses.
The problem is compounded by the fact that group homes often refuse to accept patients back after they are hospitalized. One of my patients with severe autism and a mood disorder is on his 286th day of hospitalization. Another with autism and developmental disability has been on the unit for more than a year. Insurance companies won’t pay for inpatient admission once patients are no longer dangerous, so the cost of treatment is absorbed by the hospital, or paid for by taxpayers through Medicaid.
So institutionalization is already happening, but it is happening in a far less humane way than it could be. The patient with autism who has spent a year in a psychiatric hospital is analogous to the patient with schizophrenia who has spent a year in prison: Both suffer in inappropriate facilities while we pat ourselves on the back for closing the asylums in favor of community care.
Modern asylums would be nothing like the one in “One Flew Over the Cuckoo’s Nest.” They could be modeled on residential facilities for patients with dementia, who would have languished in the asylums of yore, but whose quality of life has improved thanks to neurological and pharmacological advancements.
Asylums for the severely mentally disabled would provide stability and structure. Vocational skills would be incorporated when possible, and each patient would have responsibilities, even if they were carried out with staff assistance. Staff members would be trained to address the needs of minimally verbal adults. Sensory issues often accompany severe intellectual disability, so rooms with weighted blankets, relaxing sounds and objects to squeeze would help patients calm themselves.
Facilities for chronically psychotic patients would have medication regimens and psychoeducation tailored to the needs of those living with mental illness.
Neither my chronically psychotic nor my mentally disabled patients can safely care for themselves on their own. They deserve the relief modern institutionalization would provide. Naysayers cite the expense as prohibitive. But we are spending far more on escalating prison and court costs, and inpatient hospitalizations. More important, we are doing nothing about the chaos and suffering in patients’ lives.
We can’t continue to abandon our most vulnerable citizens in the name of autonomy.
Christine Montross, a staff psychiatrist at Butler Hospital in Providence, R.I., is the author of “Falling Into the Fire: A Psychiatrist’s Encounters With the Mind in Crisis.”
A version of this op-ed appears in print on February 18, 2015, on page A21 of the New York edition with the headline: The Modern Asylum.
Face of Woman Tasered In Fairfax Jail: Calling for Treatment, Not Punishment
This photo shows Natasha McKenna, a 37 year-old woman with schizophrenia, when she was booked into the Fairfax County Jail. Seven days later, she left that jail in an ambulance with two black eyes, a missing middle finger, severe bruising the length of her left arm and unconscious. She didn’t survive.
What happened in that jail?
A blog that I posted about McKenna on Tuesday of this week (2-11-15) asked that question. Thankfully, reporters in the Washington area who read my blog set out to find answers. The Washington Post published an editorial today (2-13) and our local NBC and CBS affiliates also investigated. WTOP radio picked up the story. My goal was to tell the public that persons with mental illnesses need treatment, not incarceration.
When I look at her face, I think about my own son, who was tasered by Fairfax Police one night when when he was delusional. I think about how fortunate I am that he did not end up as she did.
Natasha McKenna had a mental illness. That shouldn’t have been a death sentence.
A DEATH IN THE FAIRFAX JAIL RENEWS QUESTIONS
By Editorial Board, The WASHINGTON POST
NATASHA McKENNA, a 37-year-old who had been diagnosed as a child with schizophrenia, died Sunday, five days after she struggled with guards at the Fairfax County Adult Detention Center. The struggle ended when they shot her with a stun gun, apparently multiple times. As Ms. McKenna lay on life support in a hospital before dying, her mother took photos of her battered body — two black eyes, a missing or amputated finger, severe bruises running the length of her left arm.
Fairfax County authorities — the sheriff’s department, which runs the jail, and the police department are investigating — now face a choice: They can promptly release full details of the circumstances that led to her death, including video of the incident at the jail. Or they can delay, stonewall and attempt to evade accountability — a pattern of conduct in another recent case that has tainted the county’s reputation.
Ms. McKenna, an African American woman with a 7-year-old daughter, has a history of erratic behavior but no serious criminal convictions. She was detained Jan. 15 after making a commotion in public, then struggling with Alexandria police officers who tried to restrain her. She punched one officer in the face and tried to bite others.
Rather than jail her, Alexandria police did the sensible thing: They brought her to a local hospital for psychiatric evaluation, then moved her two days later her to Inova Mount Vernon Hospital in Fairfax, where she received psychiatric care for several more days.
Then the system broke down. Rather than being transferred to a state psychiatric facility, Ms. McKenna was picked up on Jan. 26 by Fairfax County police. Acting on a felony-assault warrant from Alexandria for punching the cop, they delivered her to the detention center, the main jail in Fairfax. There she sat for eight days. Why? That’s the first question.
The violent encounter took place Feb. 3, when the Sheriff’s Emergency Response Team — at least five officers in black helmets, visors and heavy padding — tried to transfer her to Alexandria.
According to Pete Earley, a writer in Fairfax who often covers mental health issues, the officers entered her isolation cell, struggled with Ms. McKenna, who stood about 5 feet 3 inches tall and weighed 130 pounds, and shot her with the stun gun. Transported to a local hospital, she never regained consciousness.
Fairfax Sheriff Stacey Kincaid, who oversees the jail, Police Chief Edwin C. Roessler Jr. and Sharon Bulova (D), chairman of the county Board of Supervisors, are all promising a prompt and transparent investigation.
That must include releasing the video of the violent encounter (whose existence county officials confirm), the medical examiner’s report and relevant documents from both the sheriff’s and police department’s investigations. The public also deserves to know whether guards at the jail, including the emergency response team, have received training in crisis intervention — training that Ms. Kincaid, in¬cred¬ibly, has suggested is not important for officers who deal with inmates.
Full disclosure would be a departure from the county’s 18-month exercise in foot-dragging and obfuscation in the death of John Geer, the unarmed man shot by a Fairfax police officer in 2013 as he stood in the doorway of his home. The handling of Ms. McKenna’s death will determine whether the county has learned any lessons.
Here is a report from Washington’s NBC affiliate WTOP RADIO By Andrew Mollenbeck:
While numerous questions surround the death of a woman repeatedly hit with a Taser stun gun, her own mental health — and the handling of it — has emerged as a key concern. Natasha McKenna, of Alexandria, Virginia, died after being taken off life support on Sunday. Fairfax County sheriff’s deputies had earlier used a Taser multiple times to restrain her while she was being transported. Not long after that, she had a medical emergency and never fully recovered. “Why in the world did this woman end up being handled by people who were not trained to deal with folks with mental illness?” says Pete Earley, a former Washington Post reporter who now writes and speaks about mental illness. “This is just an outrageous incident, and an example of how people with mental illness need to be taken to treatment centers, not to jails and prisons that don’t know how to handle them,” he says. The entire incident is under investigation, but McKenna’s mental health was in doubt early on. According to Alexandria police, McKenna punched an officer and tried biting others when they responded to a call about a disruptive person. “Officers were concerned about her,” says Crystal Nosal, a spokeswoman for the Alexandria Police Department. “They thought she might have some mental health issues.” Once in custody, she was assigned special mental health considerations. Earley, whose son battled mental illness, says he believes the incident with the deputies didn’t comport with McKenna’s condition. “You shouldn’t end up with an encounter with law enforcement [and] end up dead because you have a mental illness,” he says.
CLICK HERE TO SEE PEGGY FOX’s REPORT ON WASHINGTON’S WUSA. Here is the second NBC segment played late last night.
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