Dragon... who diagnosed this woman as mentally ill? Who administered a comprehensive diagnostic evaluation?

Gaps Exist In Public's Understanding Of Bipolar Disorder
National Survey Validates Need for Better Education, Improved Diagnosis



CHICAGO, Ill. (July, 1999) - A recent benchmark survey reveals that significant gaps between people's perceptions and attitudes toward mental illness and, in particular, manic depression, also known as bipolar disorder, still exist. As a follow up to an initial survey conducted in 1995, Opinion Research Corporation* polled 1,008 Americans on behalf of the National Alliance for the Mentally Ill (NAMI) and the National Depressive and Manic-Depressive Association (National DMDA), and found that manic-depressive illness is still largely misunderstood.

While general awareness of the physiological nature of mental illness has increased over the past four years (63% vs. 36%), there has been little improvement in people's understanding of manic depression. For example, only 33 percent of respondents know that manic depression is characterized by wide swings in emotion or mood. The latest survey also confirmed that social stigma continues to dictate many people's attitudes toward mental illness - 44 percent believe people with manic depression are often violent, and another 25 percent think people who have mood disorders, or who have manic-depressive illness, are very different than others.

"These statistics are particularly alarming because persistent stigma and ignorance toward bipolar disorder means many people aren't getting proper treatment," says Laurie Flynn, Executive Director, NAMI. "Under-diagnosis of manic-depressive illness represents a true crisis in the United States that demands action."

Although fewer people (11% vs. 22%) view mental illness as an emotional shortcoming than previously, the latest results suggest that many Americans don't realize manic depression, like heart disease or diabetes, is a physical illness requiring medical treatment. In fact, a majority of those surveyed believe people can prevent mood disorders, such as manic depression, by adopting "self-help" techniques, including positive thinking. Additionally, only 35 percent would consult a mental health professional themselves or for someone else experiencing symptoms of manic-depression.

These results are especially disturbing because, if left untreated, manic-depressive illness can have a devastating impact, robbing a person of his or her job, friends or family and leading to reckless behavior, including excessive spending and promiscuity. Manic depression affects more than three million Americans, but only one-third of those affected receive proper treatment.

"We must recognize manic depression is a medical illness, not a character weakness," says Lydia Lewis, Executive Director, National DMDA. "Also, we need to make people realize it is a potentially fatal illness. In fact, if left untreated or mistreated, more than 15 percent of those afflicted will take their lives."

In an effort to address the under-diagnosis and misdiagnosis of manic depression, NAMI and National DMDA have teamed up with leading psychiatrists to form the Bipolar Disorder Diagnostic Aid Advisory Committee (BDDAAC) that will develop strategies to encourage faster, more accurate treatment of the illness. As part of its commitment to increasing diagnosis and helping patients receive proper treatment, BDDAAC currently is researching and developing a diagnostic tool, The Mood Disorder Questionnaire, for physicians and patients to use to assess symptoms of manic depression. BDDAAC representatives will unveil the preliminary findings of the diagnostic tool at NAMI's national conference in Chicago this week.

"Early intervention makes all the difference in the world," says Robert M.A. Hirschfeld, M.D., and Chair, Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch at Galveston. "We hope the Mood Disorder Questionnaire will encourage early and expeditious identification and, ensure that mental health professionals and patients have the capability to more effectively diagnose manic-depressive illness."

Medication is an essential part of successful treatment for those suffering from manic-depressive illness. Currently, only two medications are approved by the Food and Drug Administration (FDA) for the treatment of manic episodes associated with manic-depressive illness: lithium and divalproex sodium (Depakote®).

With more than 210,000 members, NAMI is the nation's leading grassroots advocacy organization solely dedicated to improving the lives of persons with severe mental illnesses including schizophrenia, bipolar disorder (manic-depressive illness), major depression, obsessive-compulsive disorder, and severe anxiety disorders. NAMI's efforts focus on support to persons with serious brain disorders and to their families; advocacy for nondiscriminatory and equitable federal, state, and private-sector policies; research into the causes, symptoms and treatments for brain disorders; and education to eliminate the pervasive stigma surrounding severe mental illness. NAMI has more than 1,200 state and local affiliates in all 50 states, the District of Columbia, Puerto Rico, American Samoa and Canada. NAMI can be contacted at 800-950-NAMI (800-950-6264) or on the Web at www.nami.org.

National DMDA is the nation's largest patient-run, illness-specific organization. Founded in 1986 and headquartered in Chicago, Ill., National DMDA has a worldwide grassroots network of 275 chapters and support groups. Its mission is to educate patients, families, professionals and the public concerning the nature of depressive and manic-depressive illnesses as treatable medical diseases; to foster self-help for patients and families; to eliminate discrimination and stigma; to improve access to care; and to advocate for research toward the elimination of these illnesses. National DMDA can be contacted at 800-826-3632 or on the web at www.ndmda.org.


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The survey was funded by Abbott Laboratories.

Fact Sheet

Taking A Closer Look
Survey Reveals Myths and Misperceptions About Manic Depression

Results from a recent mental illness awareness survey echo initial findings uncovered in 1995 - a significant gap exists between people's perceptions and awareness of mental illness, and in particular, manic depression, also know as bipolar disorder. The Opinion Research Corporation survey* of 1,008 Americans, conducted on behalf of the National Alliance for the Mentally Ill (NAMI) and the National Depressive and Manic-Depressive Association (NDMDA), found that general awareness of mental illness has increased, but manic-depressive illness remains a commonly misunderstood condition. The following highlights point out the gaps in understanding that still exist and must be overcome:

More Education Needed


The good news - awareness of mental illness has increased significantly over the past four years. In 1995, only 36 percent of Americans correctly identified the true nature of mental illness; however, by May 1999, more than half the respondents correctly attributed the true nature of mental illness to physical/chemical imbalance (42%) or inherited disease (21%).
While awareness of mental illness has risen since 1995, 67 percent of those surveyed were unable to accurately describe manic depression. Only 33 percent correctly characterized manic depression as wide swings in emotion or mood.
Thirty-three percent (33%) incorrectly believe manic depression is a more serious form of depression and only 43 percent were able to identify symptoms of mania.
Misperceptions Persist


Social stigma continues to dictate many people's attitudes toward mental illness - 44 percent agreed people with manic-depression are often violent, and another 25 percent think people who have mood disorders or who are manic-depressive are very different than others.
Twenty-one percent (21%) of those surveyed said they would feel uncomfortable being in the presence of a manic-depressive person.
Unfortunately, some people erroneously believe that mental illness is a personal failure, not a physical disease. Nineteen percent (19%) of those surveyed feel depressed or manic-depressive individuals are personally responsible for the development of their own mood disorders.
A Friend in Need


Forty-six percent (46%) of those surveyed said they know someone who exhibits signs of manic-depressive illness.
When asked if they have ever approached this person about seeking help, 40 percent said no.

Going It Alone


Ninety-three percent (93%) of respondents agreed that manic depression is a medical condition requiring professional treatment. Yet, only 35 percent would consult a mental health professional themselves or for someone else experiencing symptoms of manic-depression.
Although the majority of respondents (54%) accurately stated manic-depressive illness most often occurs in teens and 20s, this age group was the least likely to seek help. An overwhelming 81 percent (81%) of those aged 18-24 said if they were experiencing symptoms of manic-depression they would rather solve the problem themselves than consult someone about symptoms. Forty-two percent (42%) of those aged 25-34 would avoid asking for help because they wouldn't want to admit there was a problem.
Twenty-five percent (25%) believe manic depression can be self-controlled.
Seeking Help


An overwhelming 81 percent agreed that people suffering manic-depressive illness are often misdiagnosed.
When asked about treatment options for manic-depressive illness, 56 percent mentioned medication, 53 percent said consultation with a therapist, psychologist or psychiatrist and 21 percent noted group therapy.
Fifty-six percent of those surveyed said that treatment for manic depression includes taking medication of some sort.
*Survey results are based on telephone interviews conducted among a national probability sample of 1008 adults comprising 504 men and 504 women 18 years of age and older, residing in the US. Interviewing was completed during the period May 20-23, 1999.

Stop cutting and pasting articles that have nothing to do with the point. It's beyond ridiculous.

Very few on here even put into consideration that she has mental problems. It is a great possibility considering the little information we were given. I am considering that as part of the problem. I am giving another human the benefit of the doubt that is commendable I would think.

They are relavent.

first of all...don't you think some people can read the same articles and fake it? you can't diagnose based on what you have read. have you ever suffered from it yourself?

Let’s Talk About Sex


For Young Adults with a Mental Illness, Learning to Navigate the World of Sex and Relationships Is Vital


Young adulthood is the time many individuals first become sexually active. It can become problematic when an individual who is just coming of age sexually must also deal with the first manifestation of mental illness. So while counseling all young adults on issues of sex and relationships is essential, it becomes even more critical when that individual has been diagnosed with a mental illness.



Amy Marracino, LCSW, is a team supervisor at the Department of Mental Health and Addiction Services, Young Adult Services Division in Connecticut, one of the few programs in existence today specifically targeted to help young adults, ages 18-25 cope with mental illness:



“Counseling young adults on issues of sexuality is important, in addition to helping them to deal with their psychological issues,” she says. “They are at a developmental stage where they are still trying to discover who they are and how to develop age appropriate relationships. At the same time, because of their mental health issues, they are more vulnerable – their ability to make sound decisions may be compromised and they are at greater risk of being abused and exploited.”



Sexual Abuse and Mental Illness
It is all too easy for young adults with mental illness to become victims of sexual abuse and exploitation. Their lack of experience combined with impaired judgment makes for a dangerous combination. In the euphoric stages of bipolar disorder, for example, many patients may exhibit hypersexuality or promiscuity. Insufficient understanding of their condition and its inherent dangers can therefore leave many mentally ill young people at risk.



Young adults with a mental illness need to be educated on what constitutes a healthy relationship – what is acceptable behavior and what is not – in order to protect both themselves and others.



Risky Behavior and Unintended Consequences
The impaired judgment and loss of inhibitions that accompany some serious mental illnesses can lead to other unforeseen complications as well—and these complications can be deadly. Young adults may become promiscuous, binge drink or abuse drugs as a result of an uncontrolled mental illness, and find themselves at increasing risk for a variety of sexually transmitted diseases, including the incurable herpes virus and deadly HIV.



Young women are at greater risk for an unplanned pregnancy at a time in their lives when they are not equipped to handle the responsibilities of raising a child. Additionally, loss of inhibitions and impaired judgment also place these individuals at greater risk of becoming victims of violent crimes such as sexual assault and forced prostitution.



“Young adults with psychiatric illness may be at increased risk of engaging in high-risk or unsafe behaviors, such as during episodes of mania or psychosis, which may increase their risk of victimization by others,” explained Ms. Marracino. “So within the context of treatment, it is important to provide young adults with support and education around age and developmentally appropriate relationships, including sexual relationships.”


Medication and Side Effects
Given how dangerous uncontrolled mental illness can be, it is important for young adults to be treated as soon as possible, and medication is often a critical part of treatment. Some medications though, may have sexual side effects and young adults need to be educated about these potential problems in advance.



There is anecdotal evidence suggesting, for example, that some individuals (both male and female) taking antipsychotics suffer some loss of sexual function. This loss of function can run the gamut from decreased libido and inability to orgasm to premature ejaculation and impotence. Moreover, consumers are likely to stop taking their medications altogether if it interferes with their sex lives.



“Medication non-compliance is a serious problem with young adults, so the more information they have about the potential side effects beforehand, the more likely they will continue on a course of treatment,” said Amy Marracino.



“Young adults also need to be aware that side effects can usually be fixed by an adjustment of their medication,” she added. “It is more dangerous to stop using the medication altogether, so patients need to be counseled to let a member of their treatment team know about any problems, so they can be addressed as soon as possible.”



More studies need to be done, but there is also evidence to indicate that switching from typical to atypical antipsychotics can leave women at an increased risk of pregnancy. This is because the older antipsychotics have been shown to suppress the hormone prolactin, which in turn impacts the female ability to ovulate and menstruate. Second-generation antipsychotics on the other hand, do not suppress prolactin and therefore do not negatively impact fertility. Sexually active young women therefore should speak to their doctor about the increased (and decreased) risk of pregnancy from certain medications.



Getting Help
Unfortunately, specialized programs for young adults with mental illness in the U.S. are few and far between – and programs specially geared to help young people understand issues of sex and relationships within the context of mental illness appear to be non-existent altogether. Many, having transitioned out of the child mental health system, are simply lumped into adult mental health programs, usually with individuals considerably older than they are. Richard Giugliano, Ph.D., Director of Mental Health and Rights of Passage transitional living program at Covenant House in New York City, and an advocate for supported mental health programs specifically for young adults, states:


“A practice that would be completely unacceptable on a college campus—having persons aged 18 to 25 years old room with persons aged 40 to 45—is accepted practice in the mental health system, even though it violates the basic principles that underlie the organization of social relationships.”


Mentally ill young adults are therefore at a disadvantage, not only in terms of the issues they already face with their illness, but also because of the lack of age-appropriate treatment. So where else can a young person go for help? Amy Marracino has this to say:



“Young people can start by seeking out a trusted adult — someone they feel safe and comfortable talking to — someone like a guidance counselor, social worker, or medical doctor. That person can then make a referral to a mental health professional or organization they can trust. They can also call Infoline to connect with community resources focused on young adult issues.”



The Internet is another place to turn for help, especially if an individual is not yet comfortable speaking about their issues openly. Message boards such as PsychForums.com, for example, allows members to anonymously discuss hundreds of mental-health-related topics, including issues of sexuality.



In the end though, states and communities must first acknowledge the need then begin to develop treatment programs geared specifically towards mentally ill young adults.

“Young adults with mental illness will continue to be neglected as a group, and therefore more vulnerable, unless they are recognized as a population with specific psychosocial needs,” said Dr. Giugliano. “States need to establish bureaus of young adult services and partner with nonprofit agencies, such as Covenant House, to help those young adults who are suffering, and to provide the care, the education, and the opportunities they need in order to develop as full persons.







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The Media and Mental Illness

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One on One With Author Joshua Wolf Shenk

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I don't think that making assumptions based on actions known only by a summary from a news article is commendable in any way, manner, form, or fashion.

I'm not considering she has mental problems because I would never assume that she does because she has 12 kids.

Are you wanting someone other than you to commend you?

Personal question, none of anyones business.

how about IN YOUR OWN WORDS answer the questions asked of you...like the contradiction you made in your diagnosis of the woman in question

you are right but if you only know what you read and not walked a mile in someone's shoes....what qualifies you to diagnose?

Nope, don't need help knowing I stand right in not considering all possibilities before judging someone.

Cutting and pasting... you call that talking?

Please. I call that googling. And all based on your opinion. It is sort of funny. Really funny actually.

You come in here and say we are all being judgmental. Here you are diagnosing her as mentally ill and you know NOTHING about her.

Noone knows my shoes. Others have judged me falsely so how is that relavant?

funny...someone told me she disappeared to find things to cut and paste. i would much rather hear her own words and to explain her contradiction

IMO she is obviously not right. It is not rational for a single person to have 12 children to raise alone. A rational person would not want to be that poor with that many children.

I can't imagine the exhaustion and sleep deprivation. I can just see her having post-partum depression or depression.

She obviously has poor decision making skills and any of the aforementioned items could conceivably be a contributing factor.

At least I considered it a possibility from the information given.

because you are doing the same...judging based on what you want to read from what others post.

my point is....training doesn't make someone qualified or not. understanding and thos who have suffered does

Nope you said she obviously was mentally ill. It was not a "possiblity" you brought up. It was your diagnosis. By the way... we are not reading your cut and pasted stuff. So don't bother. I scroll right past it to actual words.