Bob Nassauer prefers the phrase, “Brain Illness” or “Brain Disorder” – but here is a provocative take from Ed Francell, Jr.
The Case for ‘Psychiatric Disorder’ – personally speaking from ED FRANCELL, JR.
QUESTION: Which of the following terms does not belong?
A.Cardiovascular disorder
B.Neurological disorder
C.Mental illness
D.Gastrointestinal disorder
The correct answer is “C – Mental illness.” The correct term is “psychiatric disorder.”
QUESTION: Which of the above classes of medical disorders in Question #1 are often treated by physicians with FDA-approved medications?
1. A and B only
2.A, B, and D only
3.A only
4.All of the above
The correct answer is “4- All of the above.”
In the past 40 years, we have seen extraordinary progress in our knowledge of the medical basis of psychiatric disorders. Unfortunately, we have seen little progress in treatment, rehabilitation, and support for persons and families dealing with severe psychiatric disorders. In fact, things have largely gone backwards. A major reason for this is the continued use of the nebulous, archaic, misleading and non-medical terms “mental illness” and “the mentally ill.”
When the terms “mental illness” and “the mentally ill” came into use around 75 years ago, the biological foundations of bipolar disorder, schizophrenia, obsessive-compulsive, etc., were unknown. The terms were largely popularized by Albert Deutsch, a journalist who wrote two important books regarding the treatment of persons with psychiatric disorders, Care of the Mentally Ill inAmerica(1937) and Shame of the States (1948).
The momentum to view these disorders as biologically based accelerated when a proposed government research institute for psychiatric disorders was proposed in 1946. Originally supposed to be called “The National Neuropsychiatric Institute,” its name was changed to “The National Institute of Mental Health” (NIMH) by advocates wanting to study every peculiarity of human behavior. The focus on severe psychiatric disorders began to be lost.
Referring to persons as “the mentally ill” or as having “mental illness” perpetuates the ongoing misperception of a nebulous, hazy, and imperceptible social problem rather than as a medical disorder in the same class as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis or epilepsy.
Other physical disorders are not subject to such archaic and inaccurate terminology. For example, persons with peptic ulcers are not referred to as “the digestively ill”; rather, they have gastrointestinal disorders. Persons with hypertension are not referred to as “the circulatively ill”; rather, they are persons with cardiovascular disorders. There are no couples I know who are experiencing infertility and would prefer to be called “the reproductively ill.” Why then do advocates continue to use a term that inaccurately describes physical disorders of the brain?
In order to move toward making the care and treatment of persons with severe psychiatric disorders a national priority, the term “mental illness” must be eliminated completely and replaced with “psychiatric disorder” in order to place these diseases on par with other physical disorders (see the quiz at the beginning of this article). “Psychiatric disorder” is not a new term (like “neurobiological disorder”); it has been in use for almost a century; we just never standardized on it. We should have done this long ago.
It is important to note that using “psychiatric disorder” would only be a halfway step towards placing schizophrenia, bipolar disorder, severe anxiety disorders, obsessive-compulsive disorder and others into the realm of neurological disorders where they truly belong – but it would be an important first step. It makes no logical sense to keep using outdated and inaccurate terms which wrongly “de-medicalize” what are clearly medical disorders.
In 1949, during the wave of post World War II advocacy for psychiatric disorders, Barry Bingham, editor and president of the Louisville Courier-Journal, wrote an open letter to fellow newspaper editors asking them to update terminology:
“You can . . . take the stigma out of mental illness. You can do this by discarding from the vocabulary of your paper any possible archaic and stigmatized expressions, and substituting others. Three that I would especially like to urge are PATIENT in place of INMATE, MENTAL ILLNESS in place of INSANITY or LUNACY; MENTAL HOSPITAL instead of INSANE ASYLUM.”
Sixty-three years later, another terminology update is long overdue.
If we want to make severe psychiatric disorders a public priority like HIV/AIDS, breast cancer and others diseases, we must start by correcting our terminology. Such a change is the first step toward helping all citizens accept these diseases as the medical disorders they really are and ensuring the proper treatment that persons with severe psychiatric disorders deserve, but rarely receive. If we continue to use terms that place psychiatric disorders below other medical disorders, the public will continue to place them there too, and grossly inadequate treatment systems, insufficient research funds, and tragic consequences as a result of non-treatment will continue to be our reality.
ED FRANCELL, JR.
EDITORIAL NOTE: Because theTreatmentAdvocacyCenter’s core mission is legal advocacy, and all state civil commitment laws use the term “mental illness,” this is a term we use routinely. It also is the most common term used by the public, which necessitates our using it to help search engines guide people to the information and resources we provide online. That said, we agree that more precise terms “psychiatric disorder” or “psychiatric condition” better reflect and communicate the medical nature of brain diseases such as schizophrenia and bipolar disorder. We continue to we use them alternatively for “mental illness” whenever possible. For Dr. E. Fuller Torrey’s “What’s in a name” about the terminology used for individuals with various psychiatric disorders and their treatment, see the cover story of our Fall 2010 Catalyst newsletter.
Go to: http://bit.ly/w7xPgg
And Now to Celebrate Important People and Accomplishments
Too often, in my opinion, we dwell on the dark side of life with mental illness, and I am certainly as guilty of that as anyone. We get so involved in the desperation, difficulty and ignorance that we forget to celebrate the amazing accomplishments of people who excel even though they live with mental illness.
One of our amazing community is the musician Brian Wilson of the band The Beach Boys. The Beach Boys isn’t just a rowdy early ’60s rock band, it was (along with The Beatles) one of the most important influences in popular music-in any kind of music-of its era. The most important compositions of that group are still played and covered now fifty years later, and the most important author of those compositions was Brian Wilson.
Of course the stigma of mental illness resulted in every imaginable obfuscation to deny that that was Brian Wilson’s reason for fading from the scene of public performance and eventually composition. His publicists even preferred stories of drug abuse rather than admit the truth–after all, aren’t all rock-and-rollers susceptible to drug abuse?
Those of us in NAMI and those of us who have worked with people living with mental illness couldn’t be fooled. The look on Brian Wilson’s face told us everything we needed to know. If he did have a drug problem, it was certainly the common problem of self-medication to quiet the demons of schizophrenia.
But a funny thing happened on the way to quiet obscurity. Brian Wilson and a group of his musician-admirers decided not to let him fade away. A few years ago, Brian came roaring back with a brilliant rebirth to his almost-lost classic composition Heroes and Villains. And this season, Brian Wilson rejoined The Beach Boys, the survivors now all in their 60s and even 70s, for a concert tour.
The New York Times reviewed the most recent concert and you can read the story here.
(Non-subscribers to the NY Times can open a number of articles per month without being compelled to subscribe.)
Look at the photo in the article, and look closely at Brian Wilson. You’ll know that he is one of us. Then play the song God Only Knows and celebrate pure genius.