"Mental illness is something to be treated, not feared, say experts"

By: RUTH MARVIN WEBSTER - Staff Writer, North County Times
March 25, 2007

Ann Cummings of Vista started her adult life with hopes and dreams. A freshman on a scholarship to Stanford University, she was smart, talented and hardworking. On the outside, she seemed to have everything.

But with her mental breakdown the first year, all those hopes and dreams came to an abrupt end.

Cummings is among the one in four of all Americans over 18 who suffer from mental illness, according to the National Institute of Mental Health. But unlike many who go through their lives undiagnosed and without treatment, Cummings has regained control of her life with the right combination of medication and support.

Many mental disorders manifest in the early 20s or earlier, in adolescence. In fact, half of all lifetime cases of mental illness begin by age 14, according to the National Institute of Mental Health.

Particularly for young adults, it may be difficult to recognize the symptoms, know the language to describe them, or seek help.

"That's why parents who start children on antidepressants need to be really on top of it," said Cummings. "They need to pay extra attention, take courses and have therapy to help kids express their feelings without self-medicating with drugs and alcohol."

Cummings is chairwoman of consumer programs for the National Alliance on Mental Illness, which is hosting a 5K Walk for the Mind of America on April 21 in Balboa Park (see sidebar). She speaks often to civic groups to encourage people to step out from under the shame of mental illness and find treatment for their disease, which experts now consider a biological brain disorder ---- an illness, just like diabetes or heart disease.

'It took me decades'

When Cummings sought help at the student health clinic back in the '70s, tranquilizers were prescribed. "I thought I was lazy, inept, stupid," she said. "It took me decades to be diagnosed, to be treated and to face up to it."

Cummings believes severe and persistent depression runs in her family. Her grandfather committed suicide by jumping off a 14-story building in Seattle. Her father did the same by leaving the Veterans Hospital in La Jolla and lying down behind a big rig, where he was crushed to death. And her 13-year-old son hanged himself on a tree in their front yard.

These days, Cummings keeps a large plastic box of prescription pill bottles in the back of her car. Some are antidepressants and anti-anxiety drugs; other drugs minimize their side effects. She swallows one handful of pills when she wakes up. Another handful at midmorning. Another at lunchtime. More in midafternoon, in the evening and at bedtime. Every day, 365 days a year, she must take the correct mixture of medications to live a full and productive life.

"I hate the idea of taking medication my entire life," she admitted, "but they help me to become who I should have been.

"I hadn't laughed since I was 15, and there I was in a room ---- laughing. I had not experienced that joy for so many years. I have finally found myself. I can pay my bills and go shopping. I can go to a football game, which used to be too stimulating. And although I don't have those hopes and dreams I had before, I am creating new ones."

'A lot of shame'

Today, Cummings supervises a number of support programs for the mentally ill and their families through the National Alliance on Mental Illness chapter in North County. Called consumer programs, they serve people with severe and persistent mental illness and their families.

She's particularly proud of the Peer to Peer Recovery Education course and In Your Own Voice, which encourages people to speak about their own experiences with mental illness. By sharing experiences, journeys and stories, participants hope to open minds and change public attitudes. Eradicating the stigma surrounding mental illness is the hope.

"You don't feel like you're a bad person if you have high blood pressure or a thyroid condition," said Dr. Alvin Mirow, medical director of Tri-City Medical Center's Outpatient Behavioral Health Services and Cummings' psychiatrist. "But with mental health disorders, they threaten the core of who we are. It goes to identity, and there is a lot of shame for what others can think of as a lack of control.

"Mental illness has been seen as a kind of character deficiency, so I'm not that surprised by the stigma, but it has been improving," said Mirow. "There is more sophistication on the part of the general population, and it has been accepted in many quarters now. You see celebrities admit they have some sort of mental health issue.

"Yes, the stigma is still a huge problem, no question. But it is getting better slowly."

Many are affected

Much of the public recognizes schizophrenia, bipolar disorder and severe depression as mental illnesses. But other conditions, including anorexia and bulimia, autism, post-traumatic stress disorder, Alzheimer's and phobias are also mental illnesses, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition.

According to the National Alliance on Mental Illness, the most serious mental conditions affect 5 million to 10 million adults (2.5 to 5.4 percent) and 3 million to 5 million children ages 5 to 17 (5 to 9 percent) in the United States. But many people have conditions in varying degrees along the continuum.

"I would not hesitate to say that every family deals with mental illness on one level or another," said Aaron Byzak, assistant public affairs officer for Tri-City Medical Center. "It's not just the stereotypical view of people with mental illness, but people with obsessive compulsive disorder, panic attacks and others."

"Every family" includes that of Debbie Divis of Vista. As she grew up, she said, her upper-middle-class family appeared unexceptional. Divis, however, has suffered from bipolar 2 disorder for most of her life and left a wake of chaos until she began treatment. Able to work full time now, she is also a presenter in the In Our Own Voices program. She said it wasn't until her brother was killed by a drunken UC Santa Barbara student in 2001 that she started to come to terms with her mental illness.

"The news networks came to our house and put a microphone in my face," she recalled after her brother's death. "Everyone at my job knew I was depressed. I had to go behind the racks and cry all of the time."

It was not until she tried to commit suicide in Hawaii years later that she sought medication and therapy, and she had to face down her fears to do it. "I saw 'One Flew Over the Cuckoo's Nest,'" she said, referring to its negative depiction of mental hospitals.

Divis' father was diagnosed late in life as bipolar also. An alcoholic, he died in his aunt's guesthouse at age 57. His body wasn't discovered for five months ---- too late to determine the cause of death, though Divis believes it was probably suicide.

Delaying treatment

Though public attitudes have improved, many people are still reluctant to reveal they have a mental illness. The U.S. National Institute of Mental Health has found there are often delays --- sometimes decades long --- between the onset of symptoms and when people seek treatment.

"One of the problems I often run across is that people don't make the distinction between drugs of abuse and medication for a disorder," said Mirow. "'I don't want to be on drugs,' they say ---- as if they are going on (drugs) for the purpose of getting high instead of for the purpose of getting well."

Many of today's medications for serious mental illness are highly effective. According to the National Alliance for the Mentally Ill, between 70 percent and 90 percent of individuals have significantly reduced symptoms and improved quality of life from medicine and therapy.

Still, the mentally ill as well as their families often deny the illness. It's all in their head, they say.

According to a recent survey by the National Mental Health Association, 55 percent of those who have never been diagnosed with depression know that depression is a disease and not something people should "snap out of." In a 1991 survey, only 38 percent saw depression as a disease.

"My husband used to tell me to 'Buck up,'" remembered Dawn Sizemore, 40, a divorced mother of two sets of twins from Carlsbad, who said she suffers from bipolar disorder. Diagnosed at age 23, she went off her medication for a time and suffered psychotic episodes almost immediately. Sizemore said she was even jailed overnight when her husband called the police during one episode.

Today, she said, it is somewhat of a relief to come to terms with her illness, said Sizemore, who said she used to own her own business and work in retail management, and now cleans houses for a living. The psychotic episodes, though she doesn't remember all of them clearly, woke her up.

"I know now I have to do this ---- medications, therapy. And group (therapy) has helped. I suppressed my anger and my feelings for so long, growing up. Now I'm just happy to be able to do the little things ---- get out of bed, iron and be there for my kids."

Public understanding

With education and awareness, the public is increasing its understanding of mental illness.

Joyce Kistler, a registered nurse and health and psychology teacher at Carlsbad High School, has taught a unit on mental health for many years. She said that she used to bring health professionals in to talk to the students, but she also has had students and family members come in to discuss their experiences with mental illness.

"We have parents come in and share," she said. "I think they realize the stigma and in their own small way, are more open and accepting ... a lot of them have been in therapy, and that used to be such a stigma too, but they realize they're not crazy and that it helped them."

Kistler is also in charge of a peer advocate program on campus where students go through a long interview process and more than 200 hours of training before speaking with other students suffering with mental health issues.

"I see them come in to talk with their peers because the room is right next to mine," she said. "I see these kids with their shoulders slumped, their hoods on and dressed all in black, and they come out with a smile. It is working. They have security that it is other kids they are speaking to, and everything is confidential. We don't give advice, but we refer them to help."

Charlene Moore, community liaison coordinator for Tri-City Medical Center's outpatient behavioral health services, said the hospital has been working toward adding services for the community, including a walk-in mental health assessment center for adults that would operate 24/7; adding crisis beds; and expanding Psychiatric Emergency Response Teams, which train police to recognize those suffering from mental illness and assess the level of care they need.

"I don't think we need more institutions," she said, "just more support and help so people can take care of themselves. I think everyone wants to do that. They don't want to be taken care of ---- some just need help to live an independent lifestyle."

Contact staff writer Ruth Marvin Webster at (760) 740-3527 or rwebster@nctimes.com.

Info Box:

The National Alliance on Mental Illness is a nonprofit, self-help, support and advocacy organization for those with severe mental illness such as schizophrenia, major depression, and bipolar, obsessive-compulsive and anxiety disorders, and their families and friends.

The group is sponsoring the NAMI San Diego County Walk for the Mind of America 5K Walk on April 21 in Balboa Park at 6th and Laurel streets. Call (619) 584-5564 to register, visit www.namiwalksandiego.org or e-mail to shannonjaccard@namisd.org.

Local chapters:

NAMI North Coastal, PO Box 2235, Carlsbad CA 92018; (760) 722-3754

www.nami-northcoastal.org

NAMI North Inland, PO Box 300386, Escondido CA 92030; (760) 745-8381

Tri-City Medical Center, Behavioral Health Outpatient Services, 510 W. Vista Way, Vista CA 92083; (760) 940-5050

Palomar Outpatient Behavioral Health Services, 125 Vallecitos de Oro, Suite A, San Marcos CA 92069; (760) 510-8585