Category Archives: Psychiatric Medications

Welcome to Me (and My BPD?)

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JC Schildbach, LMHC

How important is it that movies and television shows get “academic” concepts right?

Sure, superhero movies, action flicks, and even horror movies routinely violate the laws of physics to create interesting visual sequences, and frequently make up pretend science-y explanations for strange phenomena.

But what about when the academic concept is a mental health diagnosis that is supposed to be central to a character’s actions?

Okay, there are numerous representations of people with mental illness in television and film that are just as ludicrous as, say, toxic chemicals causing superpowers, a plague of giant ants, or an out-of-shape ex-cop (or really anybody) outrunning an explosion.

So what about when the academic concept is a mental health diagnosis that is supposed to be a driving force behind all of the main character’s actions in a film that is comedic, but with serious intent? It would probably behoove the movie-makers to get that right? Right?

In Welcome to Me, written by Eliot Laurence, and directed by Shira Piven, Kristen Wiig stars as Alice Klieg, a lottery-winner who decides to channel her newly-won millions into a sort of variety show all about herself, ostensibly due to the effects of her Borderline Personality Disorder.

Wiig, to her credit, plays a fairly credible person with traits of Borderline Personality Disorder. And the film does not shoot for a lot of cheap laughs or cheap thrills at the expense of those with mental health issues (of course, feel free to disagree with me on those points all you want).

Unfortunately, the film botches some really big clinical points in a really big way.

Spoiler alert!  Spoiler alert!

The first truly jarring error is when Klieg describes her history of mental illness (to a TV audience assembled for an infomercial on nutritional supplements). She says, “When I was 16, I was diagnosed with Manic Depression. In my 20s it was called Rapid Cycling Bipolar Disorder. Now it’s just called Borderline Personality Disorder.”

Excuse me?

Now, it’s true that “Manic Depression” was once the common term for Bipolar Disorder. But “rapid cycling” is a modifier or course specifier for Bipolar Disorder that generally means a person is having abbreviated episodes of depressive and manic states that are running fairly close together. And by “fairly close together” I mean four or more episodes of mania, hypomania, or depression in one year—not “mood swings” multiple times a day.

As the good people at PsychEducation explain, once mood shifts get close enough together, they can become indistinguishable from relatively normal emotional states. Bipolar Disorder is not just some condition of simple emotional lability or emotional dysregulation, although plenty of people use the term “bipolar” incorrectly in this fashion (hopefully not anyone who is actually diagnosing and treating people, though).

Emotional dysregulation is, however, a common component of Borderline Personality Disorder. It is also relatively common for people who are ultimately diagnosed with Borderline Personality Disorder to have been incorrectly diagnosed with Bipolar Disorder prior to the Borderline Personality Disorder diagnosis.

So, if Klieg, had said “First I was diagnosed with Manic Depression, which is now called Bipolar Disorder. Then they diagnosed me with Rapid Cycling Bipolar Disorder. Then they determined the appropriate diagnosis for my condition is Borderline Personality Disorder,” then the explanation would have made a great deal more clinical sense.

As it is, Klieg’s dialog implies that Borderline Personality Disorder is just the new name for Bipolar Disorder. This is completely wrong.

Klieg (played by Kristen Wiig) intrudes on her own skit, startling the actors and the audience.

Klieg (played by Kristen Wiig) intrudes on her own skit, startling the actors and the audience.

Another major problem with the film is the portrayal of the treatment that Alice is receiving from Dr. Daryl Moffet (played by Tim Robbins). It’s troubling enough that Dr. Moffet repeatedly mentions the brand-name drug Abilify—in the sense that a movie about a person with a mental illness essentially uses dialog as a form of pharmaceutical product placement. But what’s even more disturbing is that Borderline Personality Disorder is not itself treated with medication.

Sure, plenty of people diagnosed with Borderline Personality Disorder are prescribed various medications to address other things they might be dealing with, like anxiety, depression, or poor impulse control. They may even be prescribed mood stabilizers depending on the severity of their emotional dysregulation, or anti-psychotic drugs, depending on the severity of their thought disturbances. But the personality disorder itself is not going to respond to a specific drug.

No doubt, plenty of people suffering from Borderline Personality Disorder would love it if there were a drug that would make all their symptoms go away.  Different forms of ‘talk therapy’–most notably Dialectical Behavior Therapy (DBT) developed by Dr. Marsha Linehan–can help people with the disorder develop coping skills to address the various fears, emotional disturbances, and behaviors that are common to the disorder, much better than any pill or cluster of pills is going to manage the range of symptoms.

Beyond the issues of medication, there is a scene where Dr. Moffet tells Klieg that he tried to have her put on a psychiatric hold because he thinks she is a danger to herself. Surprisingly, and probably just to get in a bit of expository dialog, Klieg has to ask him what a psychiatric hold is—despite the ongoing implication that Klieg’s decision to stop taking her medication will lead her to be forcibly hospitalized–an implication that wouldn’t generally exist if such a thing hadn’t happened previously.

Perhaps even more surprising is that Moffet thinks Klieg has done something to warrant psychiatric detention. I can’t imagine there are many places where wasting one’s lottery winnings on a self-indulgent TV talk show would be seen as evidence of being a danger to oneself, even if one is doing things like illegally broadcasting phone calls during that show, or otherwise slandering people. But, really, the people running the TV show should have been aware of the legal problems in all that, and should have put a stop to it.

Still, Klieg’s having gone off her medications is a theme throughout the movie, and one which causes great alarm each time someone hears her speak of it—as if the other characters really know what she is being medicated for, and with, and what the obvious, disastrous consequences will be. It is a theme that culminates in a scene, where Klieg dazedly takes a nude stroll through a casino, apparently in some psychotic, or perhaps dissociative, state. She has to be subdued by cops and hospitalized.

And while such a situation is arguably possible for a person with Borderline Personality Disorder, such occurrences are not generally core features of the disorder, and portrayals of such are certainly not going to contribute to greater understanding of the disorder, particularly when they are shown as a natural consequence of not taking one’s medications—I mean one’s Abilify.

Overall, Moffet’s connection to Klieg is largely unexplored. Mostly he just harps on her about how she should get back on her medication—I mean her Abilify. When he (rightly) gets irritated at her for including him in her TV show, Moffet terminates his services with Klieg, by simply handing her a list of other providers.

One would think Dr. Moffet would, at the very least, try to make sure Klieg was actually in contact with another provider, after trying to process with Klieg about how she violated what should have been some clear boundaries, and why he cannot continue to treat her. Given that a fear of abandonment is a core component of Borderline Personality Disorder, and that self harm, suicidal thoughts, and suicide attempts are common among people with Borderline Personality Disorder (in fact, it would have been much more clinically accurate for Klieg to end up in the hospital due to a suicide attempt or self-harm episode after feeling abandoned by her best friend, and her treatment provider, and possibly lashing out at them, than due to a psychotic episode—or whatever that was—from quitting her medications), Moffet’s ‘here’s-a-provider-list-and-a-few-snippy-comments’ therapy termination seems grossly incompetent.  Due dilligence anyone?

And while I’m not advocating for depicting people with a particular mental illness in some format that allows viewers to check the symptoms off a list—that’s ‘disorder of the week’ TV-movie territory—the portrayal of Klieg suffers from being too timid in presenting her struggles. While Klieg is fairly off-putting to many of the people in her life, the filmmakers seemed wary of making her too off-putting. For the most part, she really only lashes out at people from her past through skits on her television show, while recklessly upsetting those around her by being self indulgent or impulsive. The filmmakers tried to keep Klieg quirkily unpleasant, in the kind of realm where one might believe that the right medications can keep her likable enough.

It strikes me, though, that the particular diagnosis is largely unimportant to the story, particularly considering how botched the presentation of the diagnosis-specific information is, and how the “off her meds” theme plays out. The film would have worked just as well (or just as poorly, depending on one’s view) knowing that Klieg was in treatment, and on medications, without having to name a particular psychiatric problem. I don’t think the movie would have suffered if, rather than naming any specific disorder, the characters referred only to Klieg having been in therapy, or hospitalized, or on medications. Hell, without the specific diagnosis of Borderline Personality Disorder, the repeated mentions of Abilify might have been at least slightly less problematic.

At the very least, avoiding the naming of a diagnosis could have provided grad students and armchair psychologists with an exercise in identifying possible diagnoses and rule-outs. As it is, I suppose the film could at least provide valuable material for discussion about whether the Borderline Personality Disorder diagnosis seems correct, the kinds of errors Dr. Moffet makes, and about the need to make sure that clients and the people comprising their support system understand their diagnoses and treatments—that whole ‘psychoeducation’ piece that therapists are supposed to do.

Of course, I suppose having a character with a non-specified mental illness would open up the filmmakers to other complaints—such as portraying people with any old form of “mental illness” as psychotic and needing to be on medications, lest they burn through millions of dollars producing a TV show and end up running around naked in public—rather than suggesting that such a problem is specific to lottery winners with Borderline Personality Disorder.

All that said, I didn’t hate the movie.  I adore Kristen Wiig.  And, like I said, she does a credible job with the material.  The movie also mostly avoids the more exploitative angles of both comedies and dramas involving people with mental illness.  It’s just that they could have had a much richer story if they hadn’t relied so heavily on the medication angle.  Coping adequately with Borderline Personality Disorder takes a great deal of personal work, not just popping a pill–I mean, an Abilify.

And one last thing. I noticed that there was no clear indication from the credits that anybody had been consulted about the accuracy of the Borderline Personality Disorder information. So, I just wanted to float it out there that I’m willing to accept some of that Hollywood money in order to go over scripts and make sure they don’t make a mess out of their clinical details.

*Welcome to Me is currently available streaming on Netflix and Amazon.com, as well as in a variety of other places.

Suicide at the Oscars, part two: ‘The Phone Call’

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JC Schildbach, LMHC

It was a great year for crisis lines at the Oscars—or, rather, for films involving crisis lines. Not only did the documentary, Crisis Line: Veterans Press 1 take home a statue, but so did the short, live-action film The Phone Call. And, while Crisis Line: Veterans Press 1 tried (perhaps a little too enthusiastically) to convey a sense of the actual drama that can occur at a crisis line, The Phone Call comes across as a disturbingly simplistic endorsement of suicide-on-demand and irresponsible behavior by crisis line workers, all while portraying a dangerously inaccurate view of the function of crisis lines.

I will begin with the same bit of disclosure I placed at the beginning of my piece on Crisis Line: Veterans Press 1: Having spent more than five years working full-time for a crisis line, and continuing to work in a position sideways from, and occasionally overlapping with, such work, I can’t help but come to these films with something of a bias. And I will also offer up a spoiler alert for The Phone Call: if you haven’t seen it, and you don’t want to know exactly what happens, stop reading now.

The Phone Call seems to have generated most of its praise based on the acting of Sally Hawkins (as Heather) and Jim Broadbent (as Stanley/John)—which is undoubtedly solid, even given the ludicrous material. But most reactions seem to ignore any other critical angle—like the crass manipulations taking place in order to make The Phone Call happen at all.

To begin with, the call center where the story takes place seems to be lost in time. Despite the opening shot of the movie panning by a sign that reads “City WiFi Zone,” the crisis center apparently has no computers and no Internet hookup.

Now, I don’t know the current state of crisis line call centers in the UK, or really the state of any such call centers aside from the ones I’ve worked in, visited, or seen in documentaries—all in the United States. But I will say that if a call center in this day and age equips workers only with a pad of paper, a pen, a phone, and a lamp—they are verging on worker abuse. Absent the most dire of funding situations, failing to provide crisis line workers with computers and Internet access is simply unacceptable, given the relatively low cost of such amenities—and the necessity of such items in making it possible for workers to track down lifesaving information—or even to assist callers who are simply trying to access other services.

At one point in the movie, we see Sally Hawkins’ character, Heather, get up from her desk—thankfully she sat at the front of the room near the bookshelves—to try and look up the “mystery caller” in the notebooks where past call records are kept—handwritten on paper.

Add to that the script manipulation of having absolutely minimal staffing. Despite there being numerous desks in the call center, when Heather arrives, there is only one other worker there–Daniel.  At the only time Heather even considers enlisting Daniel’s help with Stanley/John, Daniel is talking with another caller, back turned to Heather, and flipping through a phone book, or some other reference material. She immediately (and completely irresponsibly) determines she can’t get Daniel’s attention—as if muting her phone and calling across the room would have been too much trouble to stop somebody from dying.

'Would you look at that? Daniel's busy. Guess you really are going to die today, Stanley.'

‘Would you look at that? Daniel’s busy. Guess you really are going to die today, Stanley.’

Stanley/John is also supposed to be a sympathetic character, the main reason being that his wife, Joan, died two years ago after a long struggle with cancer. As Heather questions Stanley/John about other family members he may have, we also find out that he and Joan tried to start a family, but had only one stillborn child, 25 years ago, and then were unable to have any children after that. Certainly, it’s a sad tale. Certainly, we can understand Stanley/John’s despair.

But just imagine being in the same situation as Heather—or really any crisis line worker—being treated the way Stanley/John is treating her. Stanley/John has decided he is going to die, and has decided that whatever random worker answers the phone is going to have to listen as it happens.

John/Stanley sobs, makes vague statements indicating he has taken actions to kill himself, and refuses to provide information under threat that he will hang up to prevent anyone from tracing the call and sending an ambulance. The audience has to accept that either the call center does not utilize caller id—further putting workers in a terrible situation—or that John/Stanley blocked his information, in order for the whole ‘hanging up’ thing to really work as a threat.

Stanley/John eventually reveals that he’s taken “Antidepressants” that he got “from the doctor.” But killing oneself with pills tends to be a lot trickier than most people realize—at least to do it in the calm, and apparently quick way that Stanley/John manages, all while allowing for a conversation and a quick death before the ambulance crew can arrive and try to revive him—and without his body doing its damnedest to try and expel the deadly pills he’s ingested. Then again, perhaps Heather waited a good long while before calling for the ambulance, as she was looking through notebook after notebook to find the right person named John who lived around the corner from the Boston.

The big moment of connection for Heather, where she (mostly) accepts Stanley/John’s decision to die, is when Stanley/John asks in a pressured tone, “Can you just stay there and talk to me? Are you allowed to do that? Can’t you just stay there and talk to me and hold my hand? Isn’t that alright?”

Heather’s answer: “Of course, I can. I’m not going anywhere.”

There are an infinite number of much better answers Heather could have given at that time. For instance: “No, that’s not allowed, Stanley/John. I’m not here to make you feel better about killing yourself. And, to be honest, if I was really doing my job, my co-worker, Daniel, here would know everything that was going on, and probably already have an ambulance heading your way.”

Instead, in the course of the short conversation, Heather passes up numerous chances to make more than just a conversational connection with Stanley/John. For instance, Heather and Stanley/John discuss jazz, including Stanley/John telling Heather he could teach her how to play tenor saxophone properly. Yet, rather than latch onto that, and suggest that Stanley/John maybe teach music, or otherwise get back into music, Heather doesn’t push on that point of Stanley/John’s ambivalence at all.

In fact, beyond asking about immediate family, Heather does nothing to find out if Stanley/John was involved in anything else in his entire life beyond his relationship with Joan. Work? Friends? Family? Hobbies? Pets?

Heather also does nothing to explore what Stanley/John has done to deal with his grief over the loss of his wife. All we know is that he got antidepressant pills from his doctor. Apparently, Heather takes this as evidence that Stanley/John really has made a valiant effort to deal with the kinds of normal struggles anybody feels at the loss of a long-time companion. ‘Oh? You got a prescription? Wow—that was very brave of you. I’m sorry you still ended up feeling something.’

And perhaps the most obvious thing Heather leaves out is asking how Stanley/John’s wife, Joan, might react to Stanley/John’s decision to kill himself. Or maybe we are meant to accept that Joan is the kind of person who would want her husband to die—that she’s something of a monster, and Stanley/John is really stressed out because he’s two years late on following through with their suicide pact.

Throughout the conversation, Heather lets Stanley/John bully her into not talking about the things she should be talking about, all with the threat that he’ll hang up, and the assertion of his ‘needs’—how he just can’t go on without Joan, but really needs someone to ‘hold his hand’ at the end.

We are supposed to find it comforting that once Stanley/John insists that it is, in fact, too late for a rescue, he compliments Heather, saying, “you’ve been wonderful. You’ve been a wonderful friend to me.”

But Heather is not Stanley/John’s friend, and isn’t supposed to be acting in that capacity. And really, if Heather was either doing her job right, or actually acting in a capacity as Stanley/John’s friend, she would have done more to try and help him.

And then we get the most maudlin endorsement of suicide ever committed to film—we see the ambulance arriving outside Stanley/John’s home. The camera switches to an interior shot of the home’s front door. We see someone arrive, and…it’s Joan! We never actually see Stanley/John, only hear him talking to Joan for a while.  She talks about how she’s “been looking for” him, and they both agree that they’ve missed each other. So, we get this reunited-in-death sap that makes this suicide seem cute, since it helped an old couple get back together.

'What, John? You've gone and killed yourself? You go to hell for that, don't you know?'

‘What, John? You’ve gone and killed yourself? You go to hell for that, don’t you know?’

It’s no surprise that director and co-writer Max Kirby comes out of the world of commercials and music videos. The Phone Call is practically a commercial for suicide, with all the depth of the average music video. It’s a concept piece that tries to press emotional buttons, while keeping the audience from engaging in too much thought.

As we watch The Phone Call, we are not meant to think about the value in going on with life, and finding meaning after loss. We don’t even get a serious look at suicide, depression, or mental illness, because we are given only the most surface reasons for Stanley/John to kill himself. We are supposed to take this all as somehow romantic—the sad, old man who just can’t go on without his wife. Isn’t it sweet that he’s killing himself?

And perhaps even more aggravating is the summation of the movie from its official website: “Heather works in a helpline call centre. When she receives a phone call from a mystery man, she has no idea that the encounter will change her life forever.”

I’m not sure exactly what we are supposed to take away from this tagline—that the big change in her life is that she is now carrying the burden of having sat through this man’s death, while being derelict about trying to help him? The big scene we are supposed to take as evidence of change is one in which we see Heather following through on part of the conversation she had with Stanley/John—to go back and visit a jazz club she used to frequent. We see her getting cozy with call center co-worker, Daniel, a potential relationship that was hinted at early in the movie. ‘Gee whiz, isn’t it nice that all it took was the suicide of an old man to make me get out and live a little? Isn’t this rosé delightful?’

To clarify, my reaction to the movie is not meant as some discussion about the right to die, but about the way crisis lines operate, and the absolutely awful way this is portrayed in the movie. It is simply not the job of crisis line workers—paid or volunteer—to just “hold a caller’s hand” while that caller dies by his/her own hand.

It is a hazard of working at a crisis line that one may end up on the phone with somebody as that person dies. But this is much different than such an occasion being the purpose of that work. A police officer has the potential hazard of being shot on the job—but it is not the police officer’s work to be shot on the job. A teacher may be subject to the hazard of being verbally abused or even hit by an angry child—but it is not the teacher’s job to be verbally abused or hit.

And what kind of horrible people would you be attracting to work at the crisis line if you told them that part of their job was just to listen as people die? What would be considered an appropriate level of intervention if just letting people die was considered an acceptable or even desired outcome?

Heather, like any crisis line worker, when confronted by questions of listening versus intervening, should make it clear that, as much as crisis line workers are there to offer support, they are required to intervene in order to prevent callers from completing suicide. And with experience and training, one will gain a better idea of just when that intervention needs to take place.

In the case of The Phone Call, there was an admission that a suicide attempt was already underway; and for all intents and purposes, Heather did nothing. We are supposed to see that as somehow touching, and even life-affirming.

Don’t just feel about that. Think about that.

 

And now for the obligatory ending: If you or someone you know is having thoughts of suicide, call the national (U.S.) suicide prevention hotline 1-800-273-TALK.

 

Yes, Gina, There is a Bipolar Disorder: Tom Sullivan’s Pretend Apology

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by JC Schildbach, LMHC

I have a hard time believing anybody really cares about anything Fox News Radio Host/Fox Business News Anchor Tom Sullivan said two weeks ago, or a week ago, or ten minutes ago. But, after a segment on his radio show, wherein Mr. Sullivan expressed his belief that Bipolar Disorder is a made up malady, Mr. Sullivan got a bit more attention than he maybe wanted.  And then he apologized.

I feel compelled to share Sullivan’s apology in all of it’s glory, because it is such a perfect example of a non-apology, the kind that one writes when one is drunk, and mad at the people to whom one is being made to apologize–the kind of apology that would properly elicit a playground response of “If you were really sorry, you wouldn’t have said it in the first place.”

You can hear the questionable five minute clip of Mr. Sullivan’s rant–mind you, on the web site for his own show–here: Bipolar “not a problem” and “not a disability” says Tom Sullivan.

To access his apology, you need only scroll down through the Facebook-linked comments on the same page.

Sullivan’s apology starts off thusly: “Gina, Thank you for your email.” From the get-go, it’s just plain weird. Sullivan is apologizing via Facebook to an (alleged) email that nobody can see. I’m not sure if Gina’s email is presented somewhere on Sullivan’s Facebook page, or elsewhere. I have the feeling he doesn’t want anybody to see the alleged email he is pretending to respond to, because Sullivan isn’t actually addressing any concerns that any real person has about what he said. He’s interested in presenting himself as the victim in the ruckus he started, as a means to reiterate some of the same obnoxious points he made in his original rant.

He continues: “May I tell you I have received a number of similar messages but usually laced with profanity. Your message stood out for the kindness of your words.” Oh, poor Mr. Sullivan, bombarded with bad language from nasty people. But, lo—here is one kind soul, just one person moved to express words of concern and seek clarification about just what happened in this horrible controversy that was visited upon the abused Mr. Sullivan.

“First,” Mr. Sullivan goes on (in sharp contrast to his original words for which he is now apologizing), “I need to tell you I do believe in bipolar disease.” I won’t hammer on Mr. Sullivan too much for not using the proper term “Bipolar Disorder” rather than “bipolar disease.” But I do have to question what he means when he says that he ‘believes in’ Bipolar Disorder. Bipolar Disorder isn’t some mythical creature like the Yeti or the Easter Bunny to entertain or scare people or to serve as a fun part of some childhood tradition. It’s not, as Mr. Sullivan says in his audio clip, some disease made up by pharmaceutical companies and the mental health industry for the purposes of financial gain. But, I suppose when you work for a network that promotes the idea that climate change is a hoax, and white privilege is mythical, your sense of reality can get knocked out of whack.

And speaking of having problems with reality, Sullivan then writes, “There is a two minute clip going around of my comments out of a two hour discussion. It is easy to take comments out of context.” Sullivan’s complaint of a two-minute, out-of-context clip is just a few scrolls down from a five minute clip, again, on the web site for his own show, in which he says he does not believe Bipolar Disorder is a real thing, but a ‘created’ illness.

He then repeats his newly-found belief system: “Of course I believe bipolar is real and is a mental illness that needs to be treated.” Well, of course, Tom! Why would anybody think you would have any other view–I mean, aside from the five-minute (not two-minute) clip where you repeatedly say that Bipolar Disorder didn’t even exist 25 years ago, and is completely made up?

Sullivan does a 180 and becomes a champion for those with mental illness--asks why people think he said things he plainly said.

Sullivan does a 180 and becomes a champion for those with mental illness–asks why people think he said things he plainly said.

Sullivan clarifies: “The program began with the subject being the huge increase in disability claims made to the Social Security Disability Fund which is going broke in 2016.” Never mind that what Sullivan means is that the Social Security Disability Fund could be insolvent as early as 2016 if changes aren’t made to the structure or funding of benefits—saying it is going broke in 2016 is much more alarmist and easier for his audience to understand, so that they can get angry like he wants them to.

Then, explaining (well, sort of) why he chose to target people with Bipolar Disorder, Sullivan writes, “The increase in claims is startling and the number one reason for the big increase in claims is mental illness and a subset (according the way Soc Security categorizes) of mood disorder.” Sullivan doesn’t bother to explain that what now comes under multiple categories of “Mental Disorders” used to be categorized as two separate categories: “Mental Retardation” and “Neuroses and Psychoses.” It wasn’t until 2010 that Social Security broke down those two categories any further, to include numerous items, including the “mood disorders” that so irk Sullivan.

Sullivan pouts, “All I was trying to do was to point out that out of that big increase I suspect there are people who are not sick but looking for a disability check.” Yes, “all” Mr. Sullivan was doing was accusing people on disability of trying to cheat the government. No big, deal. Everybody likes to take pot shots at people on disability, right? But Mr. Sullivan didn’t just voice his ‘suspicions.’ He outright said that Bipolar Disorder is “not a disability.” In other words, Mr. Sullivan said that anybody receiving disability payments due to a diagnosis of Bipolar Disorder is cheating the government. In fact, the title of the same page of Tom’s website where he posted his pretend apology is “Bipolar Woman Says She DESERVES Disability Benefits. Tom Tells Her She’s WRONG!”

The pout goes on: “My further point was by doing so, those people were hurting those who really are sick and need help, i.e. funding, treatments, etc.” In other words, people who get disability payments for mental illness are not really sick—people who can’t walk, or who have cancer are sick!! This is perhaps the best part of Sullivan’s whole apology—the part where he truly demonstrates that he’s learned nothing from the reaction he provoked with his ignorant comments by engaging in the exact type of behavior/speech/thinking that demonstrates classic stigmatization of people with mental health issues: the ‘you don’t really have an illness, you just feel bad’ way of thinking.

And then comes the righteous indignation of a true champion for those with mental illness: “I have for years advocated on my program for more funding and insurance coverage of mental illness. Too many have ignored it and as a result our jails are now the ‘mental institutions’ where the people get zero help.” First of all, if you have advocated so long for “more funding and insurance coverage of mental illness” but are now mad that there is more funding and insurance coverage of mental illness, what is it you really want? Where is this funding and insurance supposed to come from? What form is it supposed to take. Oh…I get it. You mean that when there have been mass shootings, you’ve complained that we do not need gun control, but we need more funding for mental illness. Got it. The jails…right. So, yeah, more mental health funding to stop people who might go on a shooting rampage—but anybody else can step off. Way to advocate, Tom.

Sullivan then writes, “I apologize to those who were hurt by the clip of my comments.” I think he might be apologizing to himself right here, as he seems to think he’s the victim in all of this, and the only one who was really hurt by the unfair “clip” of his comments—which he maintains is all out of context. It’s one of those classic ‘I’m sorry you got upset about what I did’ apologies. He doesn’t actually say he’s sorry for what he said—he says he’s sorry if you had a stupid reaction to it.

Mr. Sullivan then explains that he is just misunderstood: “I am a somewhat jaded person who thinks some people are gaming our system due to their greed.” Yes, plenty of people are out there pretending to have Bipolar Disorder because of their all-powerful greed–the kind of greed that drives them to want to live off of an $1100/month disability check. I can see how life as a corporate accountant and media figure has caused you to see the true evils in life and become hardened by them, Tom.

“But,” he goes on, returning to his sensitive side, “I also believe mental illness is a very serious problem that is ignored by too many.” Well, at least you aren’t ignoring it, Tom, like those “many” others.

Quick switch back to victim: “This episode shows how easy it is to distort a persons (sic) comments, especially when the subject is very important.” Wait, where’s the distortion, Tom? You do realize that there is a five-minute audio clip of you talking smack about people with Bipolar Disorder and mental health professionals, right on your web page, just slightly above your apology—don’t you?

Then, he brings the powerful close: “It will and has reinforced my commitment to making mental illness on a (sic) equal par with physical illnesses instead of the stigma it currently receives. Again, thank you for your email and your concern, Tom Sullivan.” Well, it’s a good thing Tom’s had his commitment reinforced, because in that five-minute clip there, it sounded a whole lot like he was super-supportive of stigmatizing people with mental illness—especially phony mental illnesses like Bipolar Disorder. And, really, could that sentence about stigma be any worse? It’s like somebody read over the rough draft and said—‘Not bad, just make sure you add in some bullshit about stigma and how mental illness is just as important as physical illness in there at the end,’ but Tom wasn’t quite sure how to properly use the word “stigma” in a sentence, and didn’t feel like taking the time to look it up.

In the end, Sullivan wants to be viewed as someone who is just the victim of vicious attacks, with his words taken out of context. Unfortunately, it’s hard to have much sympathy for someone claiming his words were taken out of context when, well, they weren’t, but also when he made no effort to provide any context for anything he said in the first place, such as by touching on the way Social Security disability operates, the different categories now used, and why those changes were made. The simplest explanation (although there are a wide range of factors) is that there has been an evolution in the way “disability” is viewed and understood—in terms of both physical and mental illnesses. And, in terms of Social Security disability, there have been changes in the ways statistics have been kept and various issues have been categorized.

To give some credit, there is support for Sullivan’s complaints that the number of disability claims for “mood disorders” is increasing substantially. However, that increase is not grossly out of proportion to the increase in overall numbers of disability cases, particularly when one considers that mood disorders such as Bipolar Disorder and various forms of Depressive Disorders are more widely understood today than they were 25 years ago (when Mr. Sullivan apparently thinks the mental health community, in cahoots with pharmaceutical companies, fabricated the idea of Bipolar Disorder as a way to make money).

So, as I said in an earlier piece about Sullivan’s original comments (which you can read here), we can either find legitimate ways to address issues like the funding of Social Security disability, and support those suffering from mental illness, or we can demonize them and…uh…let them…er…receive stigma like always. And now, at least we all know where Mr. Sullivan stands—right, Gina?

Bipolar Illusion: Tom Sullivan, Rand Paul, and the Economics of Disability

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by JC Schildbach, LMHC

Back on Wednesday, January 28, in a discussion of Social Security disability benefits on his Fox News Radio show, Tom Sullivan, who also serves as an anchor for Fox Business Network, said some incredibly stupid things about Bipolar Disorder. Sullivan, or whoever is responsible for the content of his web page, then proudly promoted Sullivan’s ignorance by posting what I can only hope is the worst part of that day’s show in a brief written piece, and a 5-minute audio clip, which you can see here: Tom Sullivan argues that Bipolar Disorder is a myth.

Among his statements, Sullivan called Bipolar Disorder “the latest fad,” adding, “We all have good days and we all have bad; and I don’t consider that an illness; and I don’t consider it a disability.”

Sullivan said plenty of other amazingly idiotic things, like suggesting people are talked into thinking they have Bipolar Disorder, and that it is a “made up” condition, as well as vilifying the entire “mental health business” and “big pharma.” (Wait–I thought Fox “News” liked big pharma.)

Broadcasting live from the Fox studios in the depths of hell, it's the Tom Sullivan Show. Today's topic: Yes, you should hate and fear your neighbors.

Broadcasting live from the Fox studios in the depths of hell, it’s the Tom Sullivan Show. Today’s topic: Yes, you should hate and fear your neighbors.

On top of that, Sullivan asked a question that anyone with the most rudimentary knowledge of psychology, or the skill to do an Internet search, could answer: “What were these people called 25 years ago before they came up with this Bipolar diagnosis?”  (He didn’t mean that as a question that had an actual answer, but in the sense that he believes Bipolar Disorder was dreamed up by psychologists and drug companies 25 years ago).

I could let Jimi Hendrix answer Sullivan’s question in a song from 48 years ago, but I’ll let the good people at Healthline take this one.  Read their answer here: Bipolar Disorder just may have been recognized more than 25 years ago.

In case you didn’t bother to check the Healthline article, it basically notes that the first modern diagnosis of the illness that was eventually deemed “Bipolar Disorder” was first established in the mid-1800s, but that the basic condition was recognized in one form or other going as far back as the time of Aristotle and even before.  And prior to the Bipolar Disorder moniker, it was common to call the condition Manic Depression or Manic Depressive Illness, among other, similar things.

Sullivan’s staggering ignorance of mental health issues (and classic rock) aside, the truly insidious question that he asked in all of this was, “So what are you going to do when the money runs out?” By “the money,” Sullivan meant the Social Security disability fund, which he claimed will be bankrupt by 2016.

Beyond the more obvious stigmatizing of people with mental health issues, Bipolar Disorder in particular, Sullivan’s big question, and his chosen targets, may just be another entry into the vast library of right-wing fear-mongering about Social Security, and why it needs to be privatized. I’m sure it is. But it’s also part of a discussion that’s (once again) rumbling up about “entitlements” and poor people defrauding the government.

In fact, it appears Sullivan’s ill-informed rant about Bipolar Disorder may have been inspired by earlier comments from Rand Paul. As “support” for the items on Sullivan’s show that day, Sullivan’s website features a clip of Rand Paul, Republican Senator from Kentucky/compassionate ophthalmologist, speaking to a crowd in New Hampshire about how at least half the people on disability payments are collecting those payments fraudulently. You can see the clip (from CNN of all places) on Sullivan’s website here: Rand Paul is a medical expert who knows you’re not hurt, you crybaby!

Paul tells the (New Hampshire) crowd that, “everybody in this room knows someone who’s gaming the system.” Now, I’m not the kind of person to show up at a Rand Paul event, but I have to wonder about the people who do, if they all know somebody who is “gaming” the disability system. Then again, maybe Paul is just jaded, since his home state of Kentucky ranks third among the states in terms of the percentage of total population collecting disability payments. (I got that information from looking at the actual source of some of the Social Security Administration stats that were posted in an incomplete image on the same page of Sullivan’s website with the Rand Paul video) One might also ask what those stats, and Paul’s claims of fraud, could possibly say about doctors in Kentucky, who are signing off on all those disability claims.

Among those actually deserving of disability payments, Paul counts only paraplegics, quadriplegics, and the “horrifically disabled,” noting that “half the people on disability” are no worse off than anyone else, only “anxious, or their back hurts.” Paul’s standard for not deserving any kind of disability payments: “if you look like me and you hop out of your truck.” So, I guess a whole lot of white males with trucks are headed toward losing their disability payments, unless they’re careful to avoid getting caught hopping out of said trucks.

One would think that Paul’s background in medicine, as well as his position as an elected official might lead him to realize it’s his job to productively address problems with the way government systems work—particularly if those systems are tied to an area of his expertise. Likewise, Sullivan’s background in economics, along with his national platforms on both radio and television, should mean that a discussion of how to fix the Social Security disability system’s funding problem might be in Sullivan’s wheelhouse.

But rather than seeking out ways to tackle, say, the potential of those receiving Social Security disability payments to find work through job training programs; or promoting ways of obtaining additional funding, like removing the income cap on Social Security taxes, we get more condemnation of the poor–calling them lazy thieves.

Instead of having an informed discussion about the needs of those on disability, and why somebody who doesn’t “look disabled” might actually be struggling with things that many of us take for granted, we get accusations that people coping with mental illness are faking it and claiming to have conditions that don’t even exist.

Hell, Sullivan and Paul could even look into ways to make the disability system more functional by addressing the ways disability payments are established and rewarded.

But, no—we get wealthy white guys complaining that people with disabilities are a bunch of cheats, stealing from their neighbors. We get those with tremendous privilege trying to pit the poor and middle class against those with disabilities—’Hey! Let’s all pile on people who’ve been injured! Let’s knock down those who suffer from mental illness!! Get ‘em!!’

There are plenty of other things absent from these discussions of the Social Security disability system, like that those receiving the payments have to periodically have their status as “disabled” validated by doctors or mental health professionals, or that many of them end up assigned to a “payee” who controls the way their money can be spent, or that they have limits on things like what portion of their disability check can be used for housing. They are often confined to extremely limited options for government-approved housing, where their homes are subject to inspections, including being warned with ‘corrective actions’ if they aren’t keeping things clean enough.

Perhaps Mr. Sullivan and Mr. Paul think that those taking in, say, $1100 a month for being diagnosed with Bipolar Disorder (which is roughly the average monthly payout) are scamming us all, and stealing our tax dollars because they’re lazy. But the amount of money one can earn is hardly worth the effort that goes into obtaining it in the first place, or keeping it over time.  It might be a fun and entertaining exercise to have either Paul or Sullivan attempt to live on that amount of money for a month, and under the same restrictions.

Yet when one is so completely ignorant or out of touch as to think that Bipolar Disorder is make believe, or that we are surrounded by people stealing from the government through the Social Security disability system, then one has given up any credibility in the discussion of how to address the problems of vulnerable populations in our society–or even the discussion of how to address the possibility of fraud in the Social Security disability system.

Demonizing fellow citizens by claiming they have phony injuries or fabricated mental illness is a great way to stir up righteous anger among the poorly-informed. It may even achieve the goals of getting votes, or making disability requirements even harder to meet, or of having Social Security privatized or partially privatized.

So, don’t be surprised if you start hearing more and more about scammers bankrupting the Social Security disability system, or even more about mental illnesses being phony. Even if Sullivan did attract the ‘wrong’ kind of attention with his obnoxious comments, all he needs to do is get the poison in the stream. Then, Rand Paul and his ilk can still seem educated and rational and folksy enough that they appear sensible by comparison.

Sylvia Frumkin’s Place

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by JC Schildbach, LMHC

I’d venture a guess that many who enter the mental health field, as with any potentially dramatic profession all the way from police to executives, do so with visions informed by Hollywood. One of the main Hollywood portrayals of the mental health worker is is that of the therapist/psychiatrist as a well-compensated genius, ensconced in a plush office, treating the worried well or other “eccentric” or “neurotic” types, while constantly being admired by clients for one’s observational skill and ability to call forth ‘breakthrough’ moments. The other end of the spectrum is the heroic social worker who, through sheer tenacity, overcomes all the problems an impoverished neighborhood can throw at her, overcoming multi-generational patterns, and very recent traumas, to really, really make a difference in the lives of an entire community.

Many in the field are drawn to books by Yalom, or Rogers, or perhaps even some acolytes of Oprah, who tell us that just by listening and accepting our clients, or by throwing the right bit of tough-love advice a client’s way, true transformation will take place, and clients will make huge leaps forward, forever changing their lives for the better.

Susan Sheehan’s “Is There No Place on Earth for Me?” is perhaps the perfect antidote to the pie-in-the-sky visions of one’s brilliance and dedication making all the clinical difference in the world. It balances out the ideas about the wondrous gift of therapy with the reality of chronic and severe mental illness, and its resistance to ‘ah-ha moments’ and dramatic progress. It pushes past that “we don’t need no medications” mantra, which can, in fairness, apply to a lot of mental health issues.

“Is There No Place on Earth for Me?” was first published as a four part series in The New Yorker in 1981, then published as a book in 1982. For it, Sheehan won the Pulitzer Prize for General Non-Fiction in 1983. A new edition of the book was released roughly a year ago, including a new afterword by Sheehan. On reading about the re-issue in the online version of the New York Times in January of 2014, and having never read it before, I put it on my ‘to read’ list, and eventually checked out an old edition from the library.

Frumkin cover

The book, written from the perspective of a journalist, and not of a therapist trying to convince the readers of the efficacy of particular approaches to treatment, is involved in ways that few case studies can be. Sheehan spent over two years with Sylvia Frumkin (not her real name), a woman diagnosed with schizophrenia. Sheehan had a great deal of access not only to the information on Frumkin’s treatment and behavior during the period when Sheehan shadowed Frumkin, but also to family members and others, getting a great deal of background on Frumkin’s life prior to her diagnosis, and the progress and setbacks that took place before Sheehan had ever met her.

Having had numerous contacts with clients diagnosed with schizophrenia, or suffering from other forms of psychosis, most often from a distance, it took me a while to get through the book. That is, the kinds of delusions, rants, and flights from treatment that plague Frumkin and those trying to help her, and which Sheehan documents in detail, were familiar to me—of course, with Frumkin’s behaviors being particular to her own case. Still, it was like trying to read about many of the most frustrating aspects of work during one’s down time.

For the uninitiated, I imagine the book is much more compelling, rather than overly familiar, and thus, somewhat draining. In discussing “Is There No Place on Earth for Me?” with colleagues, I’ve most often likened it to Kafka’s “The Trial”—a book that is deliberately tedious in its depiction of a bureaucracy more intent on sustaining itself than serving any clear purpose—although, that comparison probably has much more to do with what I bring to the reading of Sheehan’s book than to what she has documented in such depth of detail. Also, I don’t think the mental health system—either now or at the time—is deliberately set up to be frustrating…it just frequently is, particularly for those most in need of help.

In addition to capturing the daily details of the behavior of a (this) client with schizophrenia, Sheehan also does a masterful job of explaining, simply and concisely, some fairly complicated legal, medical, and treatment-related concepts. For instance, Sheehan outlines the concept of “least restrictive” forms of treatment, both the bane and the beauty of our mental health system, which has been around since well before the current lack of options made it so completely mandatory.  In doing so, she answers that most familiar of questions about why we can’t “just lock up” people suffering from chronic forms of mental illness who can become rather taxing to a variety of public and private resources.

The most fascinating elements of Frumkin’s story to me, though, were the ‘side treatments’—pointless, and sometimes dangerous, programs that Sylvia was subjected to. Without going into a great deal of detail, the treatments ranged from moving in with a relative and his family who believed that all Frumkin needed was a good dose of Jesus and discipline to overcome her laziness and wicked ways, to a doctor who felt that manipulating the insulin levels of patients to extreme degrees could cure them of schizophrenia.

Ultimately, what works for Frumkin (or worked back around 1980) is what still works for clients today: a small number of medications that prove effective in treating schizophrenia, as well as (to greatly simplify things) a structured environment and supportive professionals. Unfortunately, said medications can lose their effectiveness over time, or the side effects can become increasingly detrimental to the clients. It is also quite common for clients to simply quit taking their medications, feeling them unnecessary or viewing them as the root cause of various forms of discomfort or other troubles in their lives. In addition, the structured environments can only be maintained for as long as clients are compliant with treatment, and as long as the treatment remains effective, and as long as funding and various programs allow. On top of that, anything from the restructuring of institutions, to changes in law and other policy, to the career changes of providers, to differences of opinion between providers and family members, can lead to new doctors and other providers making changes, sometimes rather arbitrarily, to a client’s medication regimen or support systems. In Frumkin’s case, alterations to her treatment and medications were made numerous times, in the most haphazard of fashions, often by doctors and other providers who seemed ignorant of her case history, or of how the medications work.

One might also note that this book was written back before the U.S., under President Ronald Reagan, decided that people with chronic mental illness enjoy the freedom that homelessness brings. So, Frumkin’s movements within the system are relatively easy in terms of her various forays into decompensation leading to fairly quick, and relatively long-term inpatient placements, with step-downs to semi-independent housing, and other supports that are much rarer today (and for most of the last three decades).

Ideally, Sheehan’s book would be taught in graduate schools, or maybe at earlier levels, by instructors who are familiar with the clinical aspects of schizophrenia; the current and historical treatments for it; and the current and historical state of affairs with regard to mental health facilities, available inpatient beds for clients with mental health issues, and legal and systemic complications to accessing those beds or other program options.

To be clear, it is necessary, as therapists, or in other capacities in the mental health field, to come equipped with a belief that we can make a difference. Without a bit of the dreamer in us, we would never head down this path to begin with.

But it is also necessary for providers at all levels to understand just what they are up against, particularly given that almost all providers in the mental health field will end up doing at least a round or two in the public mental health system–from practicums/internships to early jobs to entire careers–where the most challenging of clients often end up by default—frequently after being abandoned by families and other support systems, including insurance companies.

Frumkin’s family, as dysfunctional as they are, and as frequently detrimental to her treatment as they can be, at least hang in there to the extent that they can—which I imagine was at least somewhat less difficult when hospital beds and supported living options weren’t at such a premium as they are today. In the end, though, this isn’t a story of a family hanging together and triumphing over a terrible disease. It’s the story of a debilitating mental illness, and the toll it takes on the client, as well as those around her, and the wildly inconsistent efforts by a variety of people and systems to help her cope.

Welcome to Sylvia’s Place.

Why Asking “Are You Off Your Meds?” Isn’t Funny

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If somebody were to quit using their insulin, or stop taking their heart medication, would a company use that situation as a humorous way to try and sell soft drinks, power tools, or airline tickets?

In recent months, I’ve repeatedly heard a radio commercial involving a married couple discussing a particular service, which is supposed to be so great, at such an unbelievable price, that on hearing about it, the wife asks the husband, “Are you off your meds?”

Sadly, “off your (his/her/my/their) meds” is one of those expressions that is used so casually and so often that it is treated as a perfectly acceptable phrase to describe someone who is viewed as irrational, or who is behaving in any way that is deemed unacceptable by the person using the expression.  If the saying weren’t so accepted, it wouldn’t be used as a joke in a radio ad, in a way that the advertisers assume will cause no offense to anyone, and will actually draw people to the company that paid for the ad.

At base, when people use the phrase “off your meds” to take a dig at someone, they are indicating that they believe the target of that phrase is delusional, or foolish in some way that is indicative of mental illness.  Stripping that phrase down to its core, using “off your meds” as a joke is essentially saying that mental illness is something to be laughed at, and people who use medications to manage mental illness are appropriate targets of ridicule.  In such a context, the symptoms of mental illness that might lead to a diagnosis or to a prescription for psychiatric medications are symptoms that make a person entertaining, or perhaps annoying, in such a way that it is perfectly acceptable to mock them.

Hey, you know what would be really funny? Debilitating psychiatric symptoms!!

Hey, you know what would be really funny? Debilitating psychiatric symptoms!!

For people working in the mental health field, and for a number of connected disciplines, such as medical practice or law enforcement, it is common to end up in situations where questions about a person’s psychiatric medications must be asked: “Are you prescribed any medications?,”  “Have you been taking your medications?,”  “Is your prescriber aware?,” and so on.  Such questions are not jokes to be taken lightly, but queries to get a read on potentially serious problems.

Mental illness that is being treated with medication is much like any physical condition being treated with medication, in that it is ideally guided by a skilled practitioner with a well-informed client, and with the client’s best interests in mind.  If medication is not being used properly, as directed by the prescriber, it becomes nearly impossible to know if medication is effective for a client, or if adjustments need to be made, or if new strategies altogether need to be employed.

So, what exactly does it mean to be “off one’s meds”?  The answer to that question depends on the nature of a particular mental illness, the severity of the illness, and a huge variety of factors in the life of the person taking the medications, much the same as it is for any physical illness being treated with medications.  Some mental illnesses may require use of medications over extended periods—years, or even decades—just to ensure a client’s ability to engage in daily functions.  Other mental illnesses may be subject to cycles where medications can be used over much shorter periods, when symptoms intensify, rather than as a long-term, critical part of everyday routines.

For some, being “off their meds” is the difference between stabilization and falling into debilitating psychiatric symptoms which are likely to lead to an inability to manage even simple tasks.  Intentional, or unintentional self-harm leading to hospitalization may be consequences of people being “off their meds.”  For people falling into this most severe category, maintaining a medication regimen without both professional and personal supports can be extremely difficult.

People with chronic, severe mental illness are also most likely to repeatedly go off their medications without warning, and without informing their friends, families, or professional supports of their decisions.  They are likely to do this with the thought that they are capable of handling their symptoms regardless of signs to the contrary.  Many who fall into the category of chronically mentally ill are also at risk of pursuing self-medication via alcohol, street drugs, or by tampering with the dosages of prescribed medications.

For people who need medications to manage psychotic symptoms, going “off their meds” can make a return to those medications extremely difficult.  Imagine, for example, trying to convince a client suffering from paranoid delusions that they need to take medications when that client views everyone urging the use of such medications as conspirators in a plot to poison and/or control that client.  In such cases, the unfortunate outcome may be that mental health conditions need to deteriorate to the point where the clients can be involuntarily hospitalized before they can get the help they need.

At the same time, for a number of people struggling with mental illness, being “off their meds” is a perfectly reasonable goal, one which they may achieve after a brief period of using medications, or one which they may find they need to pursue multiple times throughout their lives.  Such people may reach a point where they feel they have learned enough coping skills and health strategies to ease off their medications, as they try to maintain a healthy balance of the various elements in their lives, with the support of family, friends, and professionals.  Such attempts to live medication-free can lead to careful, deliberate lifestyle choices that allow for long-term, medication-free, satisfying relationships and careers.  But such attempts can also lead to disappointments, for example, when stressors become overwhelming, and people find that they need the support of medications to achieve periods of stabilization when things are at their worst.

For the purposes of full disclosure, I will say that I feel that the use of psychiatric medications without the support of counseling is almost always a mistake.  Medications without other professional mental health supports can keep clients from “checking in,” both with themselves, and with professionals who can help clients establish and/or strengthen coping skills.  Since it is becoming less and less common for prescribers to have the time for more than brief check-ins with clients, having mental health supports beyond just medication is crucial.

Let me also say that I know that people who call attention to such language issues are frequently accused of lacking a sense of humor, or of being overly sensitive.  Those who make such accusations are also quite fond of demeaning people for taking offense at something that is “just a joke.”  And, no doubt, there are also those people who fall into the potentially-offended group (people on psychiatric medications) who will say that phrases like “off your meds” do not offend them, because they have a sense of humor.

To such people, I say, go ahead and say what you want to say.  I can’t stop you, and I agree it is your right to do so.  But just know that you have a choice to say, or to not say, things that are potentially offensive.  If you feel that it is more important to make jokes about people being “off their meds” than it is to maybe find a different way of expressing yourself, then just don’t demand that others not get offended by your words.  You don’t have any more a right to expect a particular reaction to your words (especially after the potential offense has been pointed out) than anybody has a right to tell you that you can’t say something.

In the United States, we have a convoluted relationship with psychiatric medications, counseling, and mental illness in general.  We rail against people wanting to take pills to solve their problems, then turn around and rail against people who don’t take medications they need.  We say people need counseling to work out their issues, but then condemn counseling as something for people who are too weak to manage their own problems.  And we simultaneously blame untreated mental illness for heinous events, while laughing at people with untreated mental illness.

So how about if we agree that psychiatric medications, when used appropriately, can have a great many benefits, rather than shaming people who use them?  How about if we agree that counseling, entered into in good faith between practitioners and clients, is something that can be of great help?  And how about if we agree that you don’t get to blame untreated mental illness for gun violence (which is a ridiculous argument) and then turn around and laugh about how funny untreated mental illness is (which is an asinine thing to do)?