Magazine article Psychology Today

What the Elite Won't Talk About

Magazine article Psychology Today

What the Elite Won't Talk About

Article excerpt

FOUR DECADES AGO, when my cousin needed treatment for her mental illness, I steered her away from the most prominent and well-established psychiatric facilities of the time, fearing they might only make things worse for her. Today, I wouldn't hesitate to send her to the psychiatric departmen t of any major medical center. As someone who has worked on the front lines of clinical care, I've seen firsthand the sweeping progress that has transformed psychiatry; sadly, not everyone las been able to benefit from it.

Shortly after I became chair of psychiatry at Columbia University, I was asked to consult on a 66-year-old woman named Dr. Kim* She had been admitted to our hospital with a severe skin infection that seemed to have gone untreated for a long time. This was puzzling: Dr. Kim was both educated and affluent. She had graduated from medical school and, as the wife of a prominent industrialist, she had access to the best health care.

I quickly discovered why a psychiatrist had been called to see a patient with a skin infection. When I tried to ask Dr. Kim how she was feeling, she began to shout incoherently and make bizarre, angry gestures. When I remained silent and observed her, she talked to herself-more accurately, she talked to nonexistent people. Because I could not engage her in conversation, I decided to speak with her family. The next day, her husband and adult son and daughter reluctantly came to my office. After much cajoling, they revealed that shortly after Dr. Kim graduated from medical school, she had developed symptoms of schizophrenia.

Her family was ashamed of her condition. Despite their wealth and resources, neither Dr. Kim's parents nor her husband sought any kind of treatment for her illness; instead, they decided to do whatever they could to prevent anyone from discovering her diagnosis. They sectioned off her living quarters in a wing of their spacious home and kept her isolated whenever they had guests. Despite her having received a medical degree, practicing medicine was completely out of the question. Until she developed the skin rash, Dr. Kim rarely left the property. Her family tried over-the-counter remedies, hoping for relief. But when the rash became infected and rapidly began to spread, they were frightened and called in the family doctor. When he saw her torso dotted with abscesses, he implored the family to take her to the hospital, where she was diagnosed with a severe staph infection.

I repeated back to them what they had told me-that for the past 30-some years, they had conspired to keep their wife and mother shut off from the world to avoid public embarrassment. They unabashedly nodded their heads in unison. I told them that their decision to withhold treatment was both cruel and immoral-though, tragically, not illegal-and 1 urged them to let us transfer her to the psychiatric unit when she had been medically cleared so that she could be treated. They refused.

They informed me that even if Dr. Kim could be successfully treated, at this point the resulting changes would be too disruptive to their lives and their position in the community. They would have to explain the reason why she suddenly began to appear in public after such a long absence-and who knows what she herself might say or how she would behave in such circumstances? The Kims perceived the stigma of mental illness as so oppressive that they would have this once intelligent, otherwise physically healthy woman remain untreated and incapacitated, her brain irreversibly deteriorating, rather than face the social consequences of acknowledging her mental illness.

A few short generations ago, the greatest obstacles to the treatment of mental illness were the lack of effective therapies, unreliable diagnostic criteria, and an ossified theory of the basic nature of the conditions. Today, the single greatest hindrance to treatment is not any gap in scientific knowledge or shortcoming in medical capability, but social stigma. …

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