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Who are the mentally ill? Take a survey


I’ve been a psychiatrist for more than 2 decades, and as such, I treat patients who suffer from mental illnesses. I will be the first to admit that when I heard President Obama say we need to keep guns out of the hands of the mentally ill, I had no idea who he was talking about. I believe we should take guns out of the hands of almost everyone.

The term "mental illness" gets bandied about quite freely, and the designation of mental illness buys both stigma and entitlements. The mentally ill can take their service dogs on planes for free. This is not true for those without a diagnosis; the same dog is just a pet on a plane, and he goes in cargo for a fee. Psychiatric diagnoses sometimes allow access to good things, including extra time to take exams, smaller classes with one-on-one aides for emotionally disturbed children, monthly disability payments and Medicare benefits from the government, as well as admission to day programs and vocational rehabilitation, and sometimes even housing. Those who meet criteria for specific disorders may be able to use their health insurance benefits to pay for psychotherapy. But are all those people the mentally ill?

Dr. Dinah Miller

Mental illness is more frequently a term that is associated with stigma and the assumption of limitations. The designation might restrict a person from owning a gun, driving a car, holding certain jobs, or even – as Andrew Solomon pointed out in a New York Times editorial – passing through the country on the way to a vacation cruise ship. The National Alliance on Mental Illness posts on its website that one in four Americans are affected by these issues and lists the specific disorders that qualify. Do we all agree that everyone with these specific diagnoses are the mentally ill?

I thought I’d ask the question, but I’m not an academic psychiatrist. I hear it takes time and money to conduct surveys through the usual channels; there are grants to be written and submitted, institutional review boards to approach, instruments to validate, a population to identify, and statistics to be analyzed. That process could take months, if not years, and I actually wanted to know this right away, so I decided to ask my questions as a social media experiment. It’s not science, but it’s fast and it’s free.

I designed some questions to look at different aspects of what might constitute the public opinion of mental illness. Is it defined by who delivers the treatment? By the medications a patient takes? By the patient’s diagnosis? By behaviors? By time spent in a hospital? I put the questions together on a free Google form, and posted the survey to my free Shrink Rap blogger site, and began to circulate the survey on Twitter, Facebook, and listservs, and then I asked others to retweet it, which many kindly did. With my budget of $0, the only cost was my uncompensated time, and the weather was kind enough to oblige me; it snowed here in Maryland recently. Many of my patients cancelled and my time was uncompensated, anyway. The question remained, Would someone see a tweet, click through to read a blog post, and then take a survey?

The form went up, and Dr. Steve Daviss, my colleague in our Accessible Psychiatry Project, immediately texted me. The survey is offensive and should come down. It gives credence to those who want to paint the mentally ill with a single brush stroke, and at a minimum, I should ask about "people with mental illness."

I hoped respondents would understand that I was not in favor of such terminology and decided to leave it up for a little while, with the idea that I would take the survey down if commenters complained. Hundreds of people have now taken the survey. No one has yet complained about my use of the term, but several people – among them some psychiatrists – have told me the questions made them uncomfortable. Let’s face it, labeling people as mentally ill is uncomfortable.

With that as a prelude, I invite you to be part of this social media experiment and to add your voice to the question, "Who are the mentally ill?" The survey takes roughly 3 minutes. Click here to take the survey. I’ll also invite you to share the link with your family, followers, friends, circles, and listservs, but I will ask that each person take the survey only once. Thank you for participating, and I welcome your feedback.

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