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  1. #1

    Why the Movie "As Good as it Gets" Can Teach Us a Lesson

    The Stigma of Mental Illness: Why the Movie "As Good as it Gets" Can Teach Us a Lesson
    Sunday, February 20, 2005
    by Debra S. Gorin, M.D.

    As a physician specializing in psychiatry, I know that many emotional conditions such as depression and anxiety disorders are true medical illnesses with a biologic (physical) origin. Psychiatry has become more and more "biological" in its diagnosis and treatment approaches during recent years, but a very significant stigma still exists against those who are seeing a therapist. This has become increasingly difficult to understand, but it is a social stigma that is so very important to eliminate.

    Why does an embarrassment or stigma still exist associated with those who are seeking psychiatric treatment? Why do people wait so long before come for help - to the point of becoming nearly non-functional with their families, children and work environment?

    First, many people have a picture in their mind of movies in which psychiatrists are ineffective listeners of problems of patients who are lying on psychoanalytic couches. It is important to remember that psychoanalysis preceded our modern treatment approaches which now have a much higher success rate. We currently have many safe and effective medications, which when used with or without psychotherapy, help many people fully recover.

    Another reason for the stigma is in the use of the term "mental illness". The field of psychiatry has undergone many changes in the past twenty years. Research into the functioning of the brain and nervous system has led to the concept of a "chemical imbalance" as the cause of illnesses such as Major Depression and Panic Attacks. In addition, Obsessive Compulsive Disorder, a condition portrayed so well by Jack Nicholson in the 1997 movie As Good As It Gets, is also caused by a chemical imbalance. Medications were used to help treat the "Obsessive Compulsive" character being played by Nicholson. Many psychiatric illnesses are not "mental" or "emotional", but are now understood to be "neurochemical illnesses".

    Many people are told, "You can do this on your own, be strong, as if a person can easily will themselves out of depression or anxiety. Can someone "Be Strong" and make their diabetes or bronchitis just go away? These types of suggestions only result in a delay in seeking treatment or feelings of failure in the individual who finally does seek help. The stigma of psychiatric treatment also leads many people to seek help at the health food store, or other types of self-diagnosis and self-medications.

    Men in particular have to overcome an additional obstacle. It may seem "Un-Macho Like" to seek professional psychiatric help when one fails to understand or see their condition as an illness, and instead view it as a weakness in their character. Thus, injury to a man's ego often contributes to their long delays in seeking treatment.

    My hope is that the shame and secrecy associated with obtaining professional psychiatric help will gradually diminish and eventually cease to exist. If we understand how the social stigma was established in the first place - the media lack of medical knowledge, societies' understanding or ignorance, etc., then we should realize there is no need to "stay in the closet." Let's wipe out the term "mental illness" and view many of these conditions as "neurochemical illness" with the same non-prejudicial attitude as we do toward diseases such as diabetes or hypertension.
    Last edited by Halo; September 7th, 2006 at 02:28 PM. Reason: Odd Characters

  2. #2

    Why the Movie "As Good as it Gets" Can Teach Us a Lesson

    This article gave me an idea that could possibly be useful in naming conditions--I have had hypothyroid for years, and I am also "hypo-serotonic." Maybe descriptive labels of some sort would be more appropriate. Any other ideas??
    Last edited by Halo; September 7th, 2006 at 02:29 PM. Reason: Odd Characters

  3. #3

    Why the Movie "As Good as it Gets" Can Teach Us a Lesson

    I never thought that the terms "mental illness" would be stigma *causing*. I remember getting support from another parent who was a nurse and every time she said the word "mental illness" I would literally shudder. I wanted to say...no...my son does not have anything wrong with his mental capabilites! It was more painful that it was true rather than the stigma associated with the word.

    I think of "mental illness" as having problems with your ability to think or your cognitive processes which would also include vision, hearing etc. I do see my sons schizophrenia as an illness of mental processess or the brain. I equate mental illness with brain illness rather than emotional difficulties alone.

    I feel a sense of relief that I can use the terms "mental illness" and see it in the above light, without shame. It just is. It's a fact of life. I'm thinking that if we used just "chemical imbalance" that it would still have the same impact on me as my first introduction to "mental illness".

    These are my thoughts but this is interesting to explore more. Maybe your idea, cm, of using specific descriptive words would be better. I'm going to think about a word that would be preferable to psychosis for me. I have never liked that term but have grown accustomed to it. I would really prefer something else.

    Cheers
    Last edited by Halo; September 7th, 2006 at 02:29 PM. Reason: Odd Characters

  4. #4

    Why the Movie "As Good as it Gets" Can Teach Us a Lesson

    I'm going to think about a word that would be preferable to psychosis for me.
    I would even prefer the word "crazy" to "psychotic" since "psychotic" is often used to describe killers. "Crazy," on the other hand, appears in happy song lyrics. The real problem is that the word "psychotic" has a more negative connotation in everyday, nonprofessional language.

    For the most part, I didn't have a problem with the word "mental illness" since the death/suicide rate for depression is above the death rate of some cancers, even melanoma.
    Last edited by Halo; September 7th, 2006 at 02:30 PM. Reason: Odd Characters

  5. #5

    Why the Movie "As Good as it Gets" Can Teach Us a Lesson

    Daniel,

    Yeah, I would prefer crazy to psychotic as well. The term psychotic seems to be related to the symptoms of being a psychopath and seen as someone who has no cognitive deficits and purposefully plans the death and torture of others for the pleasure they gain from it.

    I remember when my son was recovering in hospital during the 3rd year of his illness: His hospital is a beautiful new mental health centre which was built on Lake Ontario. We had driven down to an area that was fairly secluded on the grounds and it was a cold fall day. It was just a change space from being inside the building and we were having something to eat. He still was not able to talk very much. On the radio came an ad for the new movie Psycho Three. "I hate that ad", was what he managed to say quite lucidly and I felt more pain than he did. It was an incredibly deep hurt that seemed like all of society was making light of my son's severe disability and our family's pain. One of the more painful stigma moments for us and there have been many.

    University students use the word "psycho" as a put down. When I hear that from someone who is working in schizophrenia research it makes me shudder. There was one research student who used it quite often. Unbelieveable.

    I would rather see the terms *cognitive deficit disorders* for psychotic illnesses.

    Here is the AACAP definition of psychotc illneses.

    "Psychotic disorders include severe mental disorders which are characterized by extreme impairment of a person's ability to think clearly, respond emotionally, communicate effectively, understand reality, and behave appropriately. Psychotic symptoms can be seen in teenagers with a number of serious mental illnesses, such as depression, bi-polar disorder (manic-depression), schizophrenia, and with some forms of drug and alcohol abuse. Psychotic symptoms interfere with a person's daily functioning and can be quite debilitating. Psychotic symptoms include delusions and hallucinations."

    Anyone else have words for psychiatric terms that they would rather see used? Or an objection to what is being used?

    Anyone see the movie Aviator? What a fabulous movie. I saw it Sat night.
    Last edited by Halo; September 7th, 2006 at 02:30 PM. Reason: Odd Characters

  6. #6

    Why the Movie "As Good as it Gets" Can Teach Us a Lesson

    The term psychotic seems to be related to the symptoms of being a psychopath and seen as someone who has no cognitive deficits and purposefully plans the death and torture of others for the pleasure they gain from it.
    Only in the movies, where they continually confuse the terms "psychotic" and "psychopath".

    I would rather see the terms *cognitive deficit disorders* for psychotic illnesses.
    That to me would be more misleading because it would overlap with dementia, various learning disabilities or intellectual delays/impairments, etc. The defining characteristic of the psychotic disorders is the loss of contact with reality and the impairment in rational thinking and capacity for reality-checking. That's quite different from what we normally think of as a cognitive deficit.

    You're both right in that at least some of the connotations of the word "crazy" are gentler, but only when that word is used as a synonym for "eccentric", which really doesn't characterize psychosis well at all.
    Last edited by Halo; September 7th, 2006 at 02:31 PM. Reason: Odd Characters

  7. #7

    Why the Movie "As Good as it Gets" Can Teach Us a Lesson

    That to me would be more misleading because it would overlap with dementia, various learning disabilities or intellectual delays/impairments, etc. The defining characteristic of the psychotic disorders is the loss of contact with reality and the impairment in rational thinking and capacity for reality-checking. That's quite different from what we normally think of as a cognitive deficit.

    Hmmmm. Yeah, cognitive deficit disorder might be better suited to the schizophrenias rather than the psychotic disorders.

    How about *reality deficit disorders* instead of psychotic disorders? "He has bipolar with a reality deficit" I certainly like the sound of that better and it seems to describe the additional problem.

    "Schizophrenia is one of the reality deficit disorders". I like that better too.
    Last edited by Halo; September 7th, 2006 at 02:31 PM. Reason: Odd Characters

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