Mental illness, stigma, and the person in the office next door

Recently, I wrote a review for this newspaper of Professor Elyn Saks' memoir

of life as a legal academic who secretly suffers from schizophrenia. My

review did not mention the parallels between my life and Professor Saks'. I

also have a successful career as a law professor. I graduated with highest

distinction from the University of Virginia, finished second in my class at

Duke Law School, clerked for a judge on the U. S. Court of Appeals,

practiced law at a Wall Street firm in New York City and a prominent firm in

Florida, taught for a year at the Top 10-ranked University of Chicago Law

School, and in 1986 joined the faculty of the University of Louisville's

Brandeis School of Law, where I am a professor of law. Over the years, I

have taught a generation of Kentucky attorneys. This happened while I hid

from almost everyone that I have the severe mental illness bipolar disorder

(formerly known as "manic-depressive illness") for which I have been

hospitalized five times and treated constantly for 28 years.

Why did I hide my condition for so long? Mainly, I kept quiet due to the

fear of stigma, which has followed mental illness throughout history. Sadly,

people today stigmatize more than they did 50 years ago. Most no longer use

the racial and ethnic slurs that once were common, but those with

psychiatric disorders still regularly are ridiculed. The Democratic Party

stigmatized when it forced Sen. Thomas Eagleton off its 1972 presidential

ticket after learning he had been hospitalized for depression over a decade

before. Clinton administration official Vincent Foster's concern over stigma

and the possible loss of his White House security clearance if he saw a

psychiatrist, which he did not do, may have led to his suicide. The Kentucky

Board of Bar Examiners stigmatizes when it ignores applicants' "physical"

illnesses but asks such intrusive questions about a counseling history that

law students refuse to seek help they desperately need to avoid having to

answer "yes" to those inquiries. Job applicants hide hospitalizations or

gaps in employment due to mental illness, because they fear disclosure will

keep them from being hired. Families of those with mental illness are so

embarrassed that they are afraid to acknowledge the condition of their loved

ones.

A history of mental illness is not a moral failing, and contrary to popular

belief, many like me have never had problems with alcohol or illegal drugs.

Although most with severe mental illness pose no threat to anyone,

stereotypes, often reinforced by selective media reporting of events like

the Virginia Tech shootings, unduly link violence with mental illness. A

1999 report of the U.S. surgeon general (along with numerous other sources)

emphasizes that the vast majority of those with mental illness are not

violent and that little of the violence in society is due to them.

If the fear of stigma is so great, why have I told my story? I write to show

that people can be effective members of society in high-level and often

stressful jobs despite their psychiatric conditions. I have thrived in the

intellectually challenging realm of legal academics, where I have matched

wits with both students and colleagues who had no idea about my disease.

Even when my disorder temporarily incapacitates me, I gradually regain my

faculties. I cope with many major, unpleasant and potentially dangerous drug

side effects, but still soldier on.

What do I want? I wish to be accepted for who I am, and not have to endure

stigma or doubt that I can perform now that I have gone public with my

condition. If my message to others with severe mental illness encourages

them to reach for everything in life, my "secret" will have been worth

disclosing.

Those who do not have mental diseases can help those who do by demanding

such things as parity for physical and psychiatric disorders in health and

disability insurance coverage and an end to stigma. According to NAMI (the

National Alliance on Mental Illness), mental disease affects one in five

Americans every year. Mental disorders are the leading cause of disability

for people of ages 15 through 44. Mental illness accounts for over 15

percent of the disease burden in the United States, more than the burden of

all cancers. Mental illness is an illness like any chronic physical disease,

and those with it can live happy and productive lives. Society needs to

recognize this, and change its view of those with mental health conditions.

My accomplishments are attributable to things like appropriate medications

prescribed by an excellent psychiatrist, regular psychotherapy, the support

of loved ones and my own hard work. Such a result is possible for many with

severe mental illness.

Society should willingly pay the medical expenses of those with psychiatric

conditions, as it is far cheaper to cover the cost of maintenance

medications for those who cannot afford them than for them to forego such

drugs and end up in expensive hospital beds. The poverty of many with mental

illness helps explain the syndrome that sees individuals bounce in and out

of hospitals.

In light of all this, it is time that society embrace those with psychiatric

conditions. Of particular interest to me, the Kentucky Board of Bar

Examiners should join many other states and stop discriminating against

those with a history of mental health problems. Louisville already has a

highly successful alliance between NAMI and the Louisville Metropolitan

Police Department via the Crisis Intervention Team program, through which

over 500 LMPD officers have been trained to deal with those with psychiatric

disorders. Because of this program, most get medical treatment rather than

ending up in jail as they did in the past. The public should encourage

things like this, as it sees those with an illness receive proper medical

care rather than be warehoused in a correctional facility which is not

equipped to deal with them.

While not all people with mental disorders flourish as I have done, I show

what is possible. Given the one in five, how many other successful

individuals with mental illness are out there? Perhaps each of us should

look at those in the offices next to us, or our friends and neighbors, and

wonder which of these people secretly live with a severe mental condition.

May my journey through life continue to go well despite the occasional bump

in the road and encourage others to create a world free of stigma and

discrimination against those with severe mental illness.

JAMES T. R. JONES

Professor of law

Louis D. Brandeis School of Law

University of Louisville

Louisville 40292