Not blame, but responsibility for mental illness

I just read your column in The View (Sept. 2 and blogged here Aug. 23.) I have been diagnosed with bipolar for 8 years and have lived in Las Vegas for 4 1/2 years. With respect to your answer to 'j,' yes that's exactly what we want to hear. Pull your self up by your own boot straps. Believe me if we could do it we would! There is still a negative stigma regarding mental illness. With your comments it only shows your lack of knowledge of the disease and only goes to reinforce the communities thinking that mental illness can be cured by saying just snap out of it.
You and other so called mental heath professionals in this city are totally out of touch with the problem. My heath plan gives me a new psychiatrist every 3 months. All he/she or it wants to do is change my medication. This is no way to treat a disease. If it was any thing else other than mental illness you so called professionals would treat it and us with respect. If you clowns had to go through in one day what we go through in our lives every day you would change your tune and start treating us instead of blaming us. J., Las Vegas
J., for the average American, modern health insurance plans have mostly bailed on meaningful mental health coverage. Most Americans, if they have coverage at all, have mental health benefits limited to psychiatric hospitalization and medication. If they do have coverage for therapy, it tends to be limited to Brief Therapy Models, more 4-8 session interventions than depth therapy. The 'best' plans might pay for 20 sessions per year, after $500-5,000 deductibles and still including co-pays.

It stinks, J. It stinks for the middle and lower economic classes who really, really need marital, family, or individual therapy, and it especially stinks for people with mental illness. 'The System,' on its best days, often manages these people; it doesn't treat them.

It's easy to imagine that many people feel like you do: a disrespected, stigmatized number, rather than a patient.

You should know that there is a steady flow of gifted therapists, psychologists and psychiatrists minimizing or even opting out of the 'second party payment' system precisely because the system itself sometimes makes it difficult to deliver competent, ethical treatment. And, to be completely honest, it is increasingly difficult to recover a reasonable fee.

Now, let me speak specifically to bipolar disorder ...

The good news is that bipolar disorder can so often be managed successfully with modern medications. By 'managed,' I mean that many bipolar patients lead thriving, meaningful lives - successful vocations, marriages, family - with well-managed medication, sometimes coupled with the support of talk therapy.

J, I challenge you to read my column again. You won't find one word or one sentence that "blames you." Quite the opposite. In the column, I go to great pains to describe the VERY REAL burden of depressive illness, including bipolar disorder.

The column says NOTHING at all about "pulling yourself up by your boot straps" or "snap out of it." Quite the opposite. It affirms that people with mental illness need the support of competent professionals and understanding loved ones. Sometimes medicine. Sometimes therapy. Sometimes both.

What I said, J., is what I will continue to say, and that without apology: Your bipolar disorder is not your 'fault,' but IT IS your responsibility. The same way it is the responsibility of a diabetic to stay on top of his blood sugar and diet, the same way it is the responsibility of someone with high blood pressure to take his meds and to eat right.

Seriously. Read it again. I'm your advocate. One part of advocacy is compassion. But another part of advocacy is high expectations. Just because someone is ill doesn't mean we stop having expectations.
Disrespect? One of my favorite ways to respect my patients, J., is by having high expectations of them.