Bipolar: Crazy Mermaid's Blog

Which Medical Condition Is the Worst? July 15, 2010

If you had to guess which medical condition was the worst, which one would you pick?

Most people’s thoughts would go immediately to the most widely publicized, the disease advertised as the most painful and deadliest of all diseases: cancer.  With pancreatic cancer, the victim suffers prolonged agony, relieved only by colossal injections of pain medication, until finally he expires, leaving his cancer-ridden body once and for all.  The worst possible disease, some would say.

Many would choose Alzheimer’s disease as the worst disease.  Your mind slowly loses memory, forgetting things and people and places. Eventually, your heart “forgets” to beat, and you pass on, leaving a wake of pain and suffering by your loved ones.  Because you generally become less aware of your surroundings as time goes by, and because the deterioration happens over years or even decades, the pain and suffering are felt more by your family and friends than you.

Some would say that Lou Gherig’s Disease, also known as ALS, is the worst. Like Alzheimer’s, your body slowly forgets to function, but unlike Alzheimer’s, your mind works perfectly.  The result is a little like waking up in the middle of a surgery, and being unable to communicate to the staff that you are awake. Your body is paralyzed, but your brain is wide awake. Thankfully (or not), death is generally relatively quickly.

Others would say that a stroke is the worst, for reasons similar to ALS. Your mind is generally awake, but your body is unable to communicate that awareness to the world at large. Thinking that your brain has turned to mush because you undergo the humility of wearing diapers and eating baby food,  your family may treat you like you’re a piece of furniture, or as if you’re an infant. Unable to communicate your complete awareness to them, you suffer for years or even decades in silence.

As the worst possible disease, mental illness isn’t even on most people’s radar. But consider, for a moment, the facts.

One of the problems is that unlike cancer, mental illness has a lousy public relations campaign. It doesn’t have a public personality attached to it- at least nobody positive. There’s no Lou Gherig or Lance Armstrong or Stephen Hawking to bring a sense of empathy to the masses. Unlike breast cancer, hundreds of millions of dollars aren’t spent on events to publicize mental illness- events like the Susan G. Komen Walk for the Cure – where the color pink has come to symbolize breast cancer in everything from headbands to hand mixers. Unlike Lance Armstrong’s Livestrong cancer campaign, where yellow bracelets signify triumph over cancer, there is no public campaign for the little plastic bracelet color for mental illness awareness (silver). In fact, because of its enormous stigma, you would be hard-pressed to find many victims and family members willing to take the spotlight for mental illness.

Everyone recognizes that the term “cancer” is a blanket term for a multitude of illnesses all sharing the same basic characteristic: improper cell division. Unlike cancer, the general public doesn’t perceive mental illness as a blanket name for illnesses caused by improper brain chemistry. Both are breakdowns of normal bodily functions, yet cancer doesn’t have the reputation of being a character flaw or a sign of moral bankruptcy that mental illness does.

Patients with cancer are not embarrassed to tell their friends and family their diagnosis. They aren’t afraid of being thought less of as a person for that diagnosis, that somehow they fell short. But with mental illness, the stigma is so great that the fear of rejection and isolation is a legitimate concern.  You just don’t tell anyone.

Because their loved one’s illness isn’t associated with moral bankruptcy and character flaws, friends and relatives of cancer victims don’t have the same incentives to keep anyone from knowing their loved one has cancer. Protecting themselves from the unspoken charge of moral bankruptcy by association isn’t a top concern of the families of cancer patients.

Other diseases, like cancer or ALS or a stroke, don’t cause its victims to commit heinous crimes.  You don’t see a breast cancer victim as the lead-in story on the nightly news because she murdered a bunch of school children. You don’t hear about a stroke victim trying to assassinate the President. A lung cancer victim doesn’t jump off a bridge to get away from the voices in his head. And yet the connection between these types of actions and mental illness, if the news media even bothers to make one, is voyeuristic rather than sympathetic.

People with cancer or ALS or all of the other diseases are aware that they are ill and need treatment for that illness.  In many mental illness cases, this is not true. The mentally ill patient, in many cases, has no insight into the fact that he is mentally ill and need treatment.

No legitimate insurance company would dare decline to authorize or pay  for mainstream treatment of a cancer victim, but most insurance companies have little or no such coverage for mainstream treatment of mental illness, reasoning that it isn’t, after all, a real physical illness. If they do cover it, it’s under a separate policy from “physical” health, called “Behavioral Mental Health”, and the payment for treatment and disability from the disease is very limited.  We don’t see major insurance companies splitting off cancer from a list of diseases, calling it “Cell Divisional Health”, severely restricting its access, and farming out its administration to an entirely separate company.

When it comes time for hospitalization, there isn’t a question of whether a cancer victim or stroke victim even needs to go to a hospital. If they’re seriously ill, a cancer patient doesn’t have to be at death’s door before he’s admitted to the hospital. But a mentally ill victim has to either be about to hurt or kill himself or others (as determined by a third party) or needs to have tried (and failed) to kill himself before a mental hospital will consider admitting him.

If they’re hemorrhaging, but not near death, a cancer patient isn’t turned away for lack of space. Cancer patients don’t have to wait until there’s room for them at a hospital. Unlike hospital space for the mentally ill, hospital space for cancer victims hasn’t decreased over the past 20 years.

Alzheimer’s patients aren’t routinely discharged from hospitals onto the streets, left to fend for themselves. Cancer patients aren’t routinely discharged before they are stabilized. And yet the mentally ill are routinely discharged out onto the streets while they are still unwell all of the time. Who do you think the homeless people are?

The cancer patient doesn’t have to give up his civil rights in order to be treated. He can leave the hospital whenever he wants to. But in order for a mentally ill patient to be treated, he has to give up his civil rights. Mental patients are locked in, physically unable to leave the hospital until someone else- the attending psychiatrist- says they can go- however long that takes.

Once in a hospital, a cancer patient has the option to discontinue medication at any time. Again, a cancer patient doesn’t have to give up his civil rights in order to be treated.  Mentally ill patients, on the other hand, must leave their civil rights at the door when they enter a mental hospital. Whether they want to or not, they are forced to continue medication while they are hospitalized. That is the treatment.

Comparing the physical pain of the cancer or the effects of cancer treatment with the effects of mental illness is in some ways like comparing apples to oranges.  Whereas the cancer victim fights for her life, the severely depressed victim fights to kill herself.  Is the physical pain of cancer worse than the emotional pain of continually hearing voices in your head nonstop? Is radiation sickness worse than lithium side effects?  Is prostate cancer preferable to schizophrenia?

I’m not trying in any way to minimize the pain and suffering that these diseases engender. My point is that each of these diseases -all of them- including mental illness-engenders tremendous pain and suffering. None of them- including mental illness- is any less severe than any other.

For too long, mental illness has been a quiet disease. Quietly terrible, but still quiet.  This is a disease- or a family of diseases- on par with cancer and ALS and strokes, and yet there is a huge vacuum out there. Nobody even thinks about mental illness as a true physical disease. It’s not even on the radar. This needs to change. We need to raise people’s consciousness about mental illness, and give it the parity it deserves.  We’ll know we’ve done our job when “mental illness” takes its rightful place on the list of Terrible Diseases in the public consciousness.