Depression, Addiction & Mental Health Policy

The last time I remember feeling as badly about a celebrity passing has to be December 8, 1980. I remember exactly where I was and what I was doing when a radio disk jockey (people that used to play and broadcast what were known as records on electronic turntables) broke the news over a song that John Lennon had been shot. About two minutes later, the music was stopped – and the sad news announced that he had been shot – and killed.

Queue up round the clock Beatles music and millions of tears across the world.  The next day in the Rock n Roll capital was damp and dreary. A cold mist just seemed to hang in the air. One of those days where ironically it would feel warmer if it would have just snowed. There are a lot of days like that in early December in Cleveland, Ohio. But this one so fit the mood.

Nobody saw that one coming. Whereas we all know now what only a few knew all to well before Monday: that Robin Willams’ mental demons were probably always only a few steps behind. Shadowing him like the inescapable darkness of a night in the forest, depression is a disease that lurks, pounces, retreats and then stalks – taking in turn at random how it chooses to haunt its victims.

Addiction, on the other hand, despite the cultural shift in attitudes over the past few decades, is not a disease. Writing in the Psychology Today blog a couple of years back, Dr. Lance Dodes explains how addiction has little in common with other diseases and cannot be explained by any disease process. But as he also astutely points out, neither is it the purview of individuals lacking in discipline and morality,  just being selfish and self-centered.

But to understand addiction is to understand the mental state of an individual leading up to and perpetuating its hold on that person.  Dr. Lance writes, “addictive behavior is a readily understandable symptom, not a disease.” In Williams’ case the connection between depression and resulting behavior leading to addiction is something that should continue to build awareness and understanding.

I realize it’s a sensitive line here because the last thing we want to do is roll back the progress made fighting stigmatization and the barrier and obstacles that has created in affecting treatment access. On the other hand, from a public policy perspective it is crucial that we continue to dig deeper: to understand mental health – and mental illness – as a critically holistic element impacting all varieties of personal well being, not just as a precept to alcoholism and addiction.

Robin Williams’ wife has asked that we remember her husband by not focusing on his death, “but on the countless moments of joy and laughter he gave to millions.” As the emotional pain subsides I am certain we will be able to do that. Before we get to that place, however, it is natural to question and seek answers on how this tragedy might have been avoided.

For millions of Americans suffering from, or affected by a loved one suffering from, a mental illness, alcoholism or addiction, Robin Williams’ death is a painful reminder of the fear and vulnerability they live with every day. And they are right to be questioning what might be done to help address that suffering. Yesterday, Rep. Tim Murphy (R-Pa) noted that, “Williams’ greatest gift to us, if we choose to accept it, is a focused determination to help those with brain illness and finally take real action to stop the loss of one more precious life.”

In December of last year, in response to the 2012 elementary school shooting in Connecticut, Murphy – a clinical psychologist – introduced H.R. 3717, The Helping Families in Mental Health Crisis Act. One of the most important initiatives in the bill is to address the Institutions for Mental Disease (IMD) Exclusion, which limits Medicaid coverage for inpatient mental health and addiction treatment.

The bill is complex, comprehensive and has faced a significant amount of criticism. Good coverage of this can be found in a blog post from Gary Earles, LICSW, writing last year for the Morning Zen on the Children’s Mental Health Network. Very doubtful that even with this latest tragedy the bill will move anywhere before the next Congress is installed. But what might now happen is the debate will move from the purview of policy wonks, trade groups and special interests into the real world where those aforementioned suffering can have a voice. We can only hope.

Cheers,
  Sparky