Mental Illness & Mental Retardation

By Kurt Sass

My son “little” Kurt has been diagnosed with both mental retardation/developmentally disabled and manic depression. He has been on lithium as well as other medications for the last nine years. He also sees a psychologist on a long-term, continuing basis.

As I recently found out in an article titled: “Forgotten: The Other Dually Diagnosed” by Joseph Fodero, Action Chair of the Alliance for the Mentally Ill of Ostego County, Kurt is fortunate to be receiving the mental health services and treatments for his manic depression since the fact is that for many people who are mentally retarded and mentally ill, the mental illness is not addressed or even diagnosed.

According to Mr. Fedora’s article, although the dual diagnosis of MICA (Mentally Ill Chemical Abuser) has received a great deal of attention recently, the dual diagnosis of MRDD/MI (mentally retarded developmentally disabled/mentally ill) has not been addressed to any great length, even though the rate of mental illness for persons with mental retardation is estimated to be from 20 to 35 percent, as compared to 16 to 20 percent of the general population.

Mr. Fedora goes on to say the majority of persons with IQ scores above 70, the cut-off number usually used to determine a diagnosis of mental retardation, but under 100 are caught in a tug of war between the service spheres of mental health and mental retardation/developmental disabilities and are pigeonholed into one service or the other. Another problem is the myth that persons with mental retardation/developmental disabilities are immune to psychological or psychiatric disorders, although this belief has been disproved scientifically on many occasions.

An informal survey of four organizations which service the mentally retarded/developmentally disabled population performed by me arrived at mixed results. While I learned that many clients were receiving treatment for psychological and psychiatric disorders in addition to their mental retardation/developmental disabilities, such as medication and counseling, others who seemed to have possible signs of mental illness (e.g. constant overly aggressive behavior or excessive crying and long periods of sadness) were found to have no treatment plan, diagnosis or even screening for the possibility of mental illness.

What is the answer to this problem? Mr. Fedora says the mental health and the mental retardation/developmental disabilities systems must be compelled to coordinate their efforts so there can be an integrated approach to services. This would include cross-training of professionals from both fields to enable them to effectively recognize, assess and provide appropriate treatment plans taking both diagnoses into consideration.

As for my son, as stated earlier, he has been on medication and has been seen by a psychologist for the last nine years. Why didn’t he fall through the cracks that many others have of not being dually diagnosed? Perhaps the reason was that in this one instance, the fact that there is a history of mental illness in his family actually helped him. I myself suffer from major depressive disorder with episodes of mania. My father (little Kurt’s paternal grandfather) suffered from depression his entire life and his mother (little Kurt’s paternal great-grandmother) was placed in countless asylums before she committed suicide in 1963. The fact that there was such a long history of mental illness in his family of people without mental retardation/developmental disabilities might have helped get him the mental health treatment he deserved.

As for how little Kurt is doing now, the answer is fairly well. Technically, he can no longer be called “Little Kurt,” as he is now 18 years old and at 5’ 11” is two inches taller than his father. He attends a 12-month full-time school program and has started working at Pathmark two to three times a week. He has had a setback recently though, as the Board of Health announced that one of the medications he has taken for years, mellaril, could cause long-term heart damage and even death. Although he is being tapered off slowly, some of his manic depression is returning. It is hoped that by increasing his lithium that he will return to his old, happy self, but if needed, another medication such as zyprexa might be added to the equation.

Kurt Sass is a regular member of the Manhattan Awakenings support group and has led the group on occasion.