Grappling With Stigma: Influence of Social Media

A while back, href="http://scienceblogs.com/gregladen/2007/11/sherwin_nuland_a_history_of_el.php">Gred
Laden and href="http://ectweb.blogspot.com/2007/10/video-of-lecture-on-electroconvulsive.html">Dr.
Shock independently linked to a remarkable video.
 In it, a famous author-surgeon-professor reveals that he had
had an episode of severe depression.  Moreover, he underwent
treatment with electroconvulsive therapy.  It worked, he got
back to work, and went on to have a distinguished career.  The
video can be seen here -- href="http://www.ted.com/talks/view/id/189">Sherwin Nuland:
My history of electroshock therapy.



His point, I suspect, was really to help destigmatize mental illness.
 

As an aside, the thing I found most interesting in his talk, was
something that was apart from his main message.  When he sank
into a severe depression, he was hospitalized.  His most
troubling symptoms were obsessions.  Here, I mean obsessions
in the technical sense: intrusive, repetitive, horrific thoughts
(and/or images) that are accompanied by great anxiety.



His experience highlights an important point about psychiatric
diagnosis.  

If his treatment providers had looked only at the most prominent
symptoms at the time that the treatment was considered, ECT would not
have been considered very highly.  If the clinicians just
looked at symptoms, and ignored the history, they might have given him
a diagnosis of obsessive-compulsive disorder, not major depression.
 At that point in time, there was little or no evidence that
ECT could be effective for OCD.  But by considering both
the history and the symptoms, they arrived at the
correct diagnosis and the correct treatment.  



Treatment guidelines for OCD are href="http://www.psychguides.com/ocgl.html">here.
 Note that ECT is not the first line, or the second-line
treatment.  It is mentioned, only in passing, in the section
on treatment-refractory OCD with comorbid depression.  Of
course, such guidelines are not always correct or comprehensive; there
is a least some
evidence that ECT can help OCD independent of its effect on
mood.  



Anyway, back to the main point.  I thought of the video when I
read the NYT article in the Sunday paper, about a burgeoning movement
to destigmatize mental illness by discussing it, openly and personally.
 

href="http://www.nytimes.com/2008/05/11/fashion/11madpride.html?partner=rssuserland&emc=rss&pagewanted=all">'Mad
Pride' Fights a Stigma

By GABRIELLE GLASER

Published: May 11, 2008



...Like many Americans who have severe forms of mental illness such as
schizophrenia and bipolar disorder, Ms. Saks and Ms. Spikol are
speaking candidly and publicly about their demons. Their frank talk is
part of a conversation about mental illness (or as some prefer to put
it, "extreme mental states") that stretches from college campuses to
community health centers, from YouTube to online forums...

This is not entirely new.  Nuland's lecture occurred in 2001.
 Even before that, href="http://video.google.com/videoplay?docid=-7735503718341713729">Kay
Redfield Jamison, a clinical psychologist, published her
autobiography (An Unquiet Mind) in 1995.
 In it, she discusses her experience with bipolar disorder.
 William Styron published Darkness Visible: A Memoir
of Madness, in 1989.  There are many others; these
are just the ones that came to mind first.  



I can't say, now, whether there really is a trend toward more openness
and acceptance, but that has been my impression over the past couple of
decades.  



One of the impediments to an effective advocacy movement had been the
absence of a way for advocates to find each other.  I suspect
that socially-oriented electronic media are making it easier for people
to connect, and speak out.  While that is not the same as
connecting in person, it may be that the electronic connections can
facilitate personal connections.  It also may be the case,
that some people can make better use of electronic connections as
opposed to face-to-face interaction.



However it is done, the more this information is out in public, the
more readily it will be accepted as part of the mainstream culture.