No amount of bootstrapping will “cure” severe mental health diagnosesTwo years ago, I sat in on sessions of a support group for mothers whose grown children had severe mental illness and substance use disorders. Their children suffered from bipolar disorder, schizophrenia and related issues, and these women needed this group because their friends with “normal” children could not understand what they were going through. Their adult children often refused treatment and some were homeless for periods of time. Despite ongoing, gut-wrenching and wallet-emptying effort from these families, their kids slipped out of their care. A mother in this group said to me: “When it’s mental health or drugs, there’s always somebody who wants to tell you, ‘Just solve it.’ And there’s always an implication that you didn’t do that, you didn’t try hard enough.” In a guest essay Opinion published in January, Madeline Till, a psychotherapist, described once wishing that her child with schizophrenia had cancer instead, because there would be real sympathy and support for both of them — a social script for strangers to turn to, for example. “There is no bell for mentally ill individuals marking their survival through another brutal season of homelessness, wandering the streets untreated, unsheltered and utterly vulnerable,” Till wrote. I was thinking of those brokenhearted parents when I saw a clip of Robert F. Kennedy Jr., the secretary of health and human services, claiming that a doctor “up at Harvard has cured schizophrenia using keto diets.” (A ketogenic diet, which has been used to help children with epilepsy, is one that is heavy in fats and low in carbs and protein.) He added that he’s seen studies about how people lose their bipolar diagnosis by changing what they eat. Those assertions are wrong. An exceedingly generous interpretation is that Kennedy’s statements are exaggerations of tiny studies of schizophrenic patients on a ketogenic diet that show some preliminary promise. Other studies show diet (though not necessarily a keto diet) may ease mental health symptoms as one part of treatment for bipolar disorder. But even a charitable nod doesn’t erase the fact that Kennedy’s hyperbole is dangerous advice. Spreading incomplete and misleading information adds to our culture’s widespread misunderstanding of mental illness and the ongoing stigma these families face. Dr. Christopher M. Palmer, the Harvard Medical School assistant professor whose research Kennedy cited, said that while his work shows that a ketogenic diet may be a helpful treatment for patients diagnosed with schizophrenia, using the word “cured” is inappropriate. “In the worst case scenario, a patient might hear, ‘Oh, I can cure my schizophrenia with a keto diet,’ and does that mean I can stop all my meds?” Palmer told The Harvard Crimson, adding, “That would be catastrophic.” Kennedy, and the Department of Health and Human Services under his leadership, have a long-established prejudice against medication to treat mental health diagnoses. In July, I wrote about an H.H.S. panel on antidepressant use during pregnancy that was alarmingly biased and included a clinical psychologist who implied in a (joking?) newsletter that Satan was behind the prescription of psychiatric medication: “Every woman we convince to depend on our chemicals instead of trusting her divine inner guidance is a soul we’ve successfully separated from her creator.” The theme running through much of Kennedy’s unsubstantiated health advice is that a dazzling rainbow of diseases could be cured simply through hard exercise and eating a better diet, the implication being that anybody can bootstrap their way to good health. That was certainly what was suggested by the MAHA Super Bowl ad with Mike Tyson imploring Americans to eat apples instead of ice cream. Kennedy defaults to this kind of thinking, which leads him to underplay the power of many other medical interventions, like vaccines, while he pushes “natural” remedies, like vitamins. He said he embraced a carnivore diet for himself, telling Fox News that he eats only meat and “ferments.” The Make America Healthy Again report that he and the Trump administration published last year decried how compromised government officials were because of the revolving door with corporate pharmaceutical interests. Perhaps he should have thought about that during his recent “fireside chat” with the National Cattlemen’s Beef Association, after which he crowed about how “the war on protein is over,” without quoting a single cardiologist about the downsides of red meat for heart health. While certainly many Americans should eat fewer processed foods and exercise more, which would likely make them healthier in some ways, mental illnesses like schizophrenia are a complex mix of genetics, environment, brain chemistry and sometimes substance use, according to the National Alliance on Mental Illness. There is no quick fix — at least not yet, even if hope springs eternal on scientific progress — and implying that there is one does a disservice to the people who have these profound mental health diagnoses. Furthermore, it is a slap in the face to the families that are going to the ends of the earth to help their sick relatives. The Atavist Magazine just published a long profile by Mary Margaret Alvarado of three Colorado mothers whose children have schizophrenia, and it painfully illustrates the money, time and extraordinary effort they have undertaken to try to save their sons from the grips of this horrible illness. One of the women profiled, Felicia, has a son named Quentin who was a strapping college football player (an example of how physical health does not always correspond to mental health) when he started having hallucinations. Quentin has a family history of schizophrenia, but even so, “there was a deep, family-wide stigma around mental illness,” Alvarado explains, which made treatment harder. Arranging care for Quentin became more than a full-time job for Felicia, who had to quit her job to advocate for her son. Felicia began to drink to ease the pain and ended up needing psychiatric hospitalization herself because the strain of Quentin’s care was so overwhelming. “Quentin wouldn’t consent to be hospitalized, or he would consent, only to sign himself out and leave,” and Felicia couldn’t get him involuntarily committed, even though he physically threatened his stepdad and harmed himself. Theirs is not an uncommon story. I heard variations of this over and over in the support groups I attended. As I wrote two years ago: “Several women reported that even if their children consented to proper treatment and allowed their parents into the process, the treatment they sought could be nearly impossible to obtain. Sometimes insurance wouldn’t cover long-term care, or the availability of care was illusory,” because the facilities wouldn’t take Medicaid or new patients. Blithely telling Americans that a keto diet is going to cure schizophrenia isn’t going to smooth over this patchwork of interconnected problems. But it will definitely hurt society’s understanding of the despair these families feel. End Notes
Read past editions of the newsletter here. If you’re enjoying what you’re reading, please consider recommending it to others. They can sign up here.
|
