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The Scourge of Societal Anosognosia About the Mentally Ill

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The Scourge of Societal Anosognosia About the Mentally Ill From the Editor The scourge of societal anosognosia about the mentally ill The Centers for Disease Control and the timely intervention that might save Prevention (CDC) released an alarm- their life. ing statistic last month: The suicide Our national blind spot Henry A. Nasrallah, MD rate in the United States increased Editor-in-Chief It is poignant that the CDC report was 1 by 24% between 1999 and 2014. released in spring: The rate of suicide The report got the usual casual men- is highest in April and May, when tion on the daily news and was side- the light-dark cycle is reversed. This lined by other news the next day. springtime peak runs contrary to the common belief that the rate of sui- A society that fails to What if this increase had occurred in cide is highest during winter months. attend to the mental cardiovascular disease or cancer (both The Annual Meeting of the American on the decline, in fact, thanks to the Psychiatric Association convenes in illness of its citizens intense attention they receive)? I think May, such that, ironically, thousands of endangers their overall there would have been a public outcry, psychiatrists are away from their office followed by demands by Congress that exactly when their patients might need health and welfare the National Institutes of Health and them most! the CDC address this catastrophic rise Lack of attention to the high risk of immediately. And billions of dollars suicide among all ages and both sexes would then be earmarked to prevent is emblematic of society’s inexplicable these 2 diseases. neglect of the needs of the mentally ill. How sad that society has “forgot- That neglect is fueled, and exacerbated, ten” that mental illness has deadly by the destructive stigma attached to consequences, often leading to suicide brain disorders that display psychiat- (42,773 deaths in 2014 alone2—the ric symptoms. As a neuropsychiatrist, I second most common cause among label this neglect societal anosognosia— people age 15 to 253)! Hundreds of the same as the lack of insight seen in thousands of people attempt suicide patients with acute schizophrenia, who every year, and those who do not are unaware of how impaired they lose their life often end up injured or are and insist that they are not sick. To comment on this editorial maimed. Millions who suffer depres- (Anosognosia also occurs in stroke or other topics of interest, sion, bipolar disorder, schizophrenia, patients who deny that their limb is visit www.facebook.com/ anxiety, posttraumatic stress disorder, paralyzed and insist that all is well.) CurrentPsychiatry, or go to CurrentPsychiatry.com and click on or a substance use disorder are at high Loss of insight can have serious con- the “Contact us” link. risk of suicide, and many never receive sequences for patients who lose the continued on page 23 Current Psychiatry Vol. 15, No. 6 19 From the Editor continued from page 19 ability to monitor and evaluate their medical care they need. The trans- Editorial Staff physical and mental health. Just as institutionalization of the mentally EDITOR John Baranowski patients with anosognosia think they ill—from state hospitals to prisons—is MANAGING EDITOR Erica Vonderheid ASSOCIATE EDITOR Patrice Kubik do not need help, a society that fails one of the most shameful consequences WEB ASSISTANTS to attend to the mental illness of its of societal anosognosia, burdening our Tyler Mundhenk, Kathryn Wighton citizens endangers their overall health patients with the dual stigma of being a Art & Production Staff and welfare. criminal and mentally ill. CREATIVE DIRECTOR Mary Ellen Niatas ART DIRECTOR Pat Fopma • Turning a blind eye to abuses by DIRECTOR, JOURNAL MANUFACTURING From neglect of mental illness insurance companies. More appalling Michael Wendt PRODUCTION MANAGER Donna Pituras many hazards arise is the perpetuation of restricted health Tens of millions of Americans suffer coverage despite the passage of parity Publishing Staff PUBLISHER Sharon J. Spector from mental illness, according to the laws! Why are sensory and motor dis- ASSOCIATE DIRECTOR, eBUSINESS National Institute of Mental Health- orders of brain lesions covered fully, DEVELOPMENT Joshua Norton MARKETPLACE ACCOUNT MANAGER sponsored Epidemiologic Catchment while the thought, emotional, and Linda Wilson To come Area Study.4 The last thing these peo- behavior disorders of the brain covered CONFERENCE MARKETING MANAGER Kathy Wenzler ple can afford is societal anosognosia, only partially? which deprives them of necessary and • Consent laws that restrict psychia- Editor-in-Chief Emeritus James Randolph Hillard, MD timely access to psychiatric care. trists from medicating acutely psy- Frontline Medical Communications Societal anosognosia is associated chotic or depressed patients unless they CHAIRMAN Stephen Stoneburn with numerous hazards for persons consent—but no laws that restrict a car- EVP DIGITAL BUSINESS DEVELOPMENT/CFO Douglas E. Grose with mental illness, including: diologist from immediately treating an PRESIDENT/CEO Alan J. Imhoff • Lack of compassion, which is read- unconscious heart attack patient who PRESIDENT, CUSTOM SOLUTIONS JoAnn Wahl ily available for people with a medical cannot consent, or an obtunded stroke VICE PRESIDENT, FINANCE Dennis Quirk Jim Chicca ailment (broken bones, cardiovascular patient who cannot communicate? The VICE PRESIDENT, OPERATIONS VICE PRESIDENT, AUDIENCE DEVELOPMENT disease, cancer). duration of untreated psychosis or Donna Sickles Lack of adequate, affordable health VICE PRESIDENT, CUSTOM PROGRAMS • depression has been shown repeatedly Carol Nathan insurance and financial support, com- to have deleterious effects on brain VICE PRESIDENT, CUSTOM SOLUTIONS pared with what is available for non- tissue and functional outcomes, yet Wendy Raupers VICE PRESIDENT, eBUSINESS DEVELOPMENT psychiatric disorders. treatment of an acutely ill psychiatric Lee Schweizer • Shortage of publicly funded pro- patient is often delayed until a court VICE PRESIDENT, HUMAN RESOURCES & FACILITY OPERATIONS Carolyn Caccavelli grams and mental health practitioners order is obtained. When was the last VICE PRESIDENT, MARKETING & CUSTOMER to provide prevention and intervention time a court order was needed to treat ADVOCACY Jim McDonough VICE PRESIDENT, SALES Phil Soufleris for those who consider ending their life an acute myocardial infarction? VICE PRESIDENT, SOCIETY PARTNERS during an episode of depression, psy- • Failure to recognize that pre- Mark Branca chosis, stress, or a panic attack. mature mortality (by approximately CORPORATE DIRECTOR, RESEARCH & COMMUNICATIONS Lori Raskin • Allowing the stigma to continue 25 years) is a devastating consequence of EDITORIAL DIRECTOR Karen J. Clemments unabated. Why are there strict laws mental illness, whether from suicide or Subscription Services: (800) 480-4851 about hate crimes, but not about cardiometabolic risk factors due to smok- In affiliation with Global Academy for Medical Education, LLC stigma? Why does society continue ing, substance use (often used to self- VICE PRESIDENT, MEDICAL EDUCATION to portray depression and anxiety as medicate because proper treatment is & CONFERENCES Sylvia H. Reitman, MBA VICE PRESIDENT, EVENTS David J. Small, MBA a personal weakness or failure, while lacking), poor diet, and sedentary living. patients with Parkinson’s disease or • Failure to provide basic primary care multiple sclerosis who have motor to people with severe mental illness, weakness are not stigmatized for their and the much lower use of life-saving 7 Century Drive, Suite 302 Parsippany, NJ 07054 physical deficits? diagnostic and treatment procedures Tel: (973) 206-3434 • Transforming the seriously mentally offered to these patients, compared Fax: (973) 206-9378 www.frontlinemedcom.com ill into felons by arresting and jailing with non-psychiatric patients. Inadequate funding for research Published through an them because of erratic behavior— • on educational partnership instead of hospitalizing them for the psychiatric disorders, compared with with Saint Louis University Current Psychiatry Vol. 15, No. 6 23 From the Editor other medical disorders—even though be selective: We have comprehensive direct and indirect costs of mental ill- insight about diseases of the body but ness to society (hundreds of billions of not diseases of the mind. dollars a year) far exceed costs of most The essence and soul of a society are medical disorders. the collective minds of its citizens, not • Severe shortage of rehabilitation their bodies. Societal anosognosia is a programs for the mentally ill, com- serious dysfunction of its mind, and a pared with many other medical disor- rising suicide rate is a symptom of that ders. Why does paralysis of the mind pathological dysfunction. receive far less support than paralysis of the legs or arms? The rising suicide rate reflects Henry A. Nasrallah, MD How sad that poorly on us Editor-in-Chief society has ‘forgotten’ Societal anosognosia is a global scourge, affecting many underdevel- References 1. Curtin SC, Warner M, Hedegaard H, et al. Increase that mental illness oped countries. Why do developed in suicide in the United States, 1999-2014. National nations, like ours, have the same blind Center for Health Statistics Data Brief No. 241. has deadly Atlanta, GA: National Center for Health Statistics, spot for mental illness? Might igno- U.S. Department of Health and Human Services; consequences, often 2016. rance and discrimination be universal? 2. Ten leading causes of death by age
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