Crazy Every Day: America's Mental Illness Epidemic

How many families have to be devastated by the impact of this disease before we make mental illness a priority in this country? One in four is sick. If it were influenza, it would be an epidemic.
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On Oct. 3 when Miriam Carey drove her car at break-neck speed toward the White House gates, her 19-month-old daughter Erica in the vehicle with her, she was under the delusion that President Obama was stalking her. According to her sisters Valarie, a retired police sergeant and Amy, a nurse, Miriam Carey suffered from postpartum depression and psychosis. Police found medications for schizophrenia in her condo in Stamford, Conn.

Carey was shot and killed by police last Thursday after a high-speed chase near the White House that had much of Washington on lockdown and much of the nation watching the continuous news feed, wondering if this was another terrorist attack, with the president as the target.

As we now know, it wasn't terrorism. It was instead another person suffering from severe, untreated, mental illness. Carey died trying to hunt down her demons.

Aaron Alexis, Adam Lanza, James Holmes, Jared Lee Loughner, Seung-Hui Cho-these young men, all allegedly suffering from severe mental illness, have also made headlines recently. Each used guns to address their paranoid delusions. The number of dead from their shootings: 92, the number of wounded, well over 100.

Miriam Carey didn't kill anyone, but she died as a result of her illness.

Because no one else was killed when Carey tore through Washington on whatever mission was in her mind, because her little girl was in the car with her, because she was a woman, her death reads as tragic. News accounts have referred to her as a "troubled soul."

But every one of those other names, from Cho, the Virginia Tech shooter, to Loughner who shot Rep. Gabby Giffords, to Alexis was a "troubled soul." Mental illness is troubling-to the person suffering from it as well as those around them. But "troubled soul" implies something other than serious illness. Yet mental illness is as serious as a heart attack. We just don't treat it that way and the end result is people die.

On June 20, 2001, Andrea Yates, a Texas mother of five, drowned her children, ranging in age from six months to seven years, in the bathtub while her husband was at work. Like Carey, she suffered from postpartum depression and psychosis. She thought she was saving her kids, not killing them.

Yates didn't get the "troubled soul" media treatment. Rather, she was described like those young men with their guns-as a monster. Yet anyone could see from her vacant stare and impassive face that something was terribly wrong.

I remember the day Yates was arrested. The look on her face gave me a frisson of fear. I knew that look well. My mother, who was severely mentally ill for most of her life, had that look for most of my childhood.

Mental illness isn't like anything else. Having a mentally ill family member isn't the same as having a family member with a chronic but potentially life-threatening illness, like diabetes or heart disease. It should be, but it isn't.

The stigma that attaches to mental illness prevents people from getting help. Carey's devastated sisters explained the severity of Miriam Carey's illness, and the extreme delusions she lived with, some of which led her to call herself the Prophet of Stamford. Yet they insisted, like the families of so many mentally ill people, that she "wasn't crazy."

Except she was. Carey thought President Obama was monitoring her every move. She thought her city was going to be put on special lockdown by the president. She thought she was a prophet. So yes, she was crazy. But instead of stigmatizing her or her family for her illness, we should, as a nation, be helping people like her. We should be helping people like those young men who turned into mass murderers even as many people around them noted how sick they truly were in the days, weeks and months prior to the shootings.

Miriam Carey's daughter is 19 months old. For 19 months Carey was suffering from the kind of psychosis that accompanies some postpartum depression. My mother suffered from it for decades. It led her to violence against herself and her children. It led her to catatonic depression that kept her housebound for 17 years.

My school friends thought my mother was really dead, that I just couldn't bring myself to acknowledge it. Our house was like a tomb. No one ever saw my mother nor heard her. Where my friends' mothers were fixing dinner, their kitchens alive with laughter and noise, our house was silent. Dinner was always made by me, my mother rarely at the table.

My mother was too crazy to attend my high-school graduation, too crazy to go shopping for groceries, too crazy to clean or wash clothes or iron. Yet she knew seven languages, had attended a Seven Sisters school on scholarship as the first person in her family to go to college, had prepared to go into the diplomatic corps. She could regale us with stories from history and literature, teach us useful phrases in this or that language, explain the vagaries of math and science or specifics about art and music. Before she was lost to her illness, she and my father were civil rights workers.

But untreated mental illness, like any other illness, gets worse, not better. My mother couldn't function in the ways most of us take for granted. Just leaving her bedroom for the first floor of her own house made her anxious. The thought of going outside, even into our own back yard terrorized her. Yet this was a woman who had planned to travel the world, doing simultaneous translation. This was a woman who had stared down KKK members. But now, when she wasn't afraid, she was angry-frighteningly angry. Screaming, cursing, hitting. I can only imagine what she would have done with a gun or even a car.

Family photographs tell a heartbreaking story of obvious madness. Christmas morning with children tearing open gifts and a beautiful young mother staring vacantly past the tree, her desolation in sharp counterpoint to the smiles on her children's faces.

My mother, Miriam Carey, Andrea Yates-these women weren't anomalous. Postpartum depression is common. Postpartum psychosis is less so, and if treated, can resolve. What my mother, Carey and Yates all shared was that they went untreated. Carey is dead at only 34. My mother lived for 40 years in and out of psychosis, able to work in brief spurts, then unable to even speak, rocking slightly in a chair, silent, her brilliant mind riven with demons. And Yates will be for another 30 years.

In March 2013, the Journal of the American Medical Association, Psychiatry published a study of 10,000 women on postpartum depression. One in seven suffered from it. Of those, another ten percent had elements of psychosis.

But postpartum depression and/or psychosis is just one of many mental illnesses suffered by Americans. According to the National Institute of Mental Health (NIMH), an estimated 26.2 percent of Americans ages 18 and older-one in four adults-suffer from a diagnosable mental disorder in a given year.

All those Americans suffering while both society and the health care industry do very little to address either the suffering or the stigma that attaches to this, but not other illness. All those families like my own, Carey's or any number of others'. The death toll from Carey's illness was just one. But she shouldn't have had to die. My mother shouldn't have suffered her whole life. Yates shouldn't have been driven to kill her children. All those young men shouldn't have been driven to murder and mayhem.

Yet even as most health care providers offer incentives to lose weight to prevent diabetes and high-blood pressure or to stop smoking or any number of other health-related concerns, most health care plans offer nothing to treat mental illness. If you need to see a therapist, either for a long-term problem or episodic depression, you must pay out of pocket. And while most general practitioners will prescribe anti-anxiety meds or anti-depressants to address those short-term issues, without concomitant follow-up from a mental health professional, those meds are often mere band-aids on a gaping head wound.

Several years before my mother's death-a death that came more than 20 years sooner than her mother's or grandmother's-my mother was in a near-catatonic state, in a depression so severe that she could barely speak. Her health insurance offered little in the way of services. If the family wanted to hospitalize her, we would have had to pay for it ourselves at a cost of thousands of dollars a week. Money our family didn't have. Money only the wealthy can afford.
The tragic case of Miriam Carey-and all those young men before her who shattered so many lives with killing sprees instigated by their illness-will fade into media obscurity until the next tragedy. But for every headline case like Carey's, there are millions more like that of my mother. Carey was suffering for a year and a half before she drove to Washington. If she hadn't, she may have been like my own mother, raising her child in a house full of crazy, where her daughter didn't know from one day to the next who her mother was or what she might do.

Or she might have gotten the help she needed and gone on to live what we call a "normal" life. We'll never know because all the people able to report just how out of her mind Carey was, can't explain why she didn't get treatment.

Nearly 60 million Americans suffer right now from some form of mental illness, be it psychosis like Carey or schizophrenia, depression, anxiety, bi-polar disorder, an eating disorder. Many of those people are compliantly taking medications and others are wandering lost in America, unmedicated, hearing voices, thinking paranoid delusional thoughts and literally going out of their minds.

How many families have to be devastated by the impact of this disease before we make mental illness a priority in this country? One in four is sick. If it were influenza, it would be an epidemic. Let's start acting like mental illness is illness first, mental second. It's a public health crisis in America. And until we address it, there will be more Miriam Careys, more Aaron Alexises, more mothers like mine and so much untreated suffering, we might all go crazy from the pain.

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