Saturday, September 13, 2014

A Light in the Brain

"You won't feel anything", they assure you the first time you head in to the radiation machine.  "It's just like a CAT scan".

That's almost true.  But, every time, for the first few cycles, I see a series of bright flashes at the periphery of my vision.  Though not everyone has this experience, it is fairly common among patients receiving radiation to the head.  The flashes are there just the same whether my eyes are open or shut.  They don't correspond to any actual light in the world outside.  Instead, they arise directly from stimulation of the brain (or the optic nerve) by the gamma-ray beam - tampering with the perceptual process and making me see things that aren't really there.

There's something a bit disquieting about this experience.  It disrupts our common way of thinking that the mental and the physical aspects of our existence are two quite separate realms, interpreted in different ways, with traffic between them permitted only at a few well-understood border posts.

Consider: I have cancer.  A frightening physical illness.  Since 'going public' with the news, I've experienced an outpouring of love and support that has left me awestruck and deeply moved.  Thank you all - you know who you are - for your prayers, your messages, your gifts of your time and patience.  May the blessing that you have shared return to you.

We have plenty of language available to talk about my relationship to cancer.  It's a "struggle", a "war" - though it is physically made of my own cells, cancer is an external force, needing to be defeated.  Chemotherapy is like saturation bombing, more modern targeted therapies (available for some kinds of cancer, though not mine) are like precision-guided munitions.

And like all modern warfare, the war on cancer has its cutting-edge technology, its shock and awe.  The radiation rooms, with their lead-lined doors sliding slowly closed like the defenses of a nuclear bunker.  The venomous colors of the different chemotherapy solutions, handled by nurses in protective outfits which say right away that this is serious business.  The five billion dollar research budget of the National Cancer Institute.

I am grateful for all of it.

But once again, consider: In our schools, thousands of teens struggle in silence with feelings of worthlessness and desperation.  They tell themselves - and we adults sometimes tell them too - to "just snap out of it", "push on through", "live strong".  These concepts maybe fit with our common way of thinking about the mental world, but they are pretty useless in dealing with major depression - with mental illness. 

And in contrast to the cancer patient who can count on the "outpouring of love and support", the young adult needs to be careful about sharing a psychiatric diagnosis.  Too often, he or she may experience shaming rather than support.  Too often, a church which is fully supportive of cancer medicine will construe mental illness as a symptom of flawed character or spiritual failure.

Mental illness is a strange light in the brain, like my gamma flashes, shining through from a complex and unknown physical cause.  Treatments have greatly improved over the years, but the best medications modern psychiatry can offer still have the wholesale aspect of chemotherapy.  We can alter the levels of neurotransmitters across the whole brain, but we can't target a specific structure (nor do we know which ones we would target if we could).

And medication has often been used as a cheap substitute for actual care.  In the 1980s, with the development of new antipsychotic agents, a movement gained traction to close the huge and horrifying state mental hospitals.  The cutting-edge idea was that antipsychotics would make it possible for most of their patients to be cared for in the community.  But guess what?  The asylums were closed, but the "care in the community" never materialized.  Today the largest mental health institutions in the USA are prisons - the asylums of last resort.

The number of Americans who are cancer survivors is almost exactly equal to the number who live with major mental illness - about 13.5 million in each case.  But while cancer tends to arrive later in life (more than 75% of diagnoses are at age 55 or older), major mental illness strikes young (over 75% of diagnoses by age 24).  Those it afflicts are those whose life is still before them.

Breast cancer was once an unmentionable affliction in America.  Women suffered in silence.  Thanks to Betty Ford and others, that stigma is past.  As a result, millions of lives are better.

It is past time for the "stigma" of mental illness to join the "stigma" of breast cancer on the garbage heap of history.  And for research into its treatment to command the same prestige and support as cancer research.

As you pray for the cancer patient who you know, will you also pray for the sufferer from mental illness who you do not know?

If you want to learn more about mental illness, I recommend reading The Center Cannot Hold by Elyn R. Saks

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