September 2001 Newsletter

Collaboration with NAMI Building Bridges with the Indian Community

The Association for Psychoanalytic Thought (APT) AND National Alliance for the Mentally Ill (NAMI) Collaboration
by David Pincus, DMH

On March 21, 2001, APT (The Association for Psychoanalytic Thought) and NAMI (National Alliance for the Mentally Ill) cosponsored a seminar which has helped to bridge the interests of these two organizations which share many concerns central to mental health and mental illness. The evening’s subject was Altering the Image: The Path to Acceptance - Stigma in Mental Illness. The guest speaker, Suzanne Vogel Scibilia, MD, who operates a clinic in Western Pennsylvania, has the distinction of being both a psychiatrist and a person with bipolar disorder. She is exquisitely qualified to speak about stigma and mental illness, as she has learned a great deal about it from “both sides of the fence.” Drs. Kay McKenzie and Patrick Enders, both psychiatrists and psychoanalysts, provided illuminating and supportive panel presentations, making this an informative and fascinating evening.

Dr. Enders opened the program by defining stigma as “a mark of disgrace, a label that leads to devaluation.” NIMH has stated that being labeled mentally ill “becomes a consumer’s most debilitating handicap.” Partly as a result of mass media coverage, sixty to seventy percent of mentally ill patients are viewed as violent, when in reality less than ten percent are, and they usually are people who are untreated or who have other problems as well.

Dr. Enders then introduced Dr. Vogel Scibilia as a “stigma buster” a practicing clinical psychiatrist who now appreciates that she has had bipolar disorder since the age of 15. She is a highly trained graduate of the residency program at Western Psychiatric Institute, and while there she was distinguished in at least two ways: She was chief resident and she was actively in the throes of her bipolar illness. Dr. Vogel Scibilia is a
remarkable person, though not because she has a significant mental illness and is a professional helping others with mental illnesses. Many of us have been drawn to this field as we have come to work through our own difficulties. No, most remarkable is Dr. Scibilia’s candor and honesty—speaking out about stigma through using her first hand experience.

Dr. Vogel Scibilia spoke eloquently about her family and personal history. Her story was full of humorous anecdotes and clever observations. She spoke rapidly, extensively, with some seemingly tangential details and perhaps a bit too much personal revelation. I was at once swept along with her entertaining manner, and yet began to feel uncomfortable: This woman may be in the midst of a hypomanic episode, and this is going to become embarrassing. She may not be able to stop talking, she may not let the other speakers talk—this could become awkward for the audience and humiliating for her.

But just then Dr. Vogel Scibilia became an in-vivo stigma buster: someone who can be hypomanic and also have great self observational capacity. She explained that she has developed and honed her ability to monitor her states, and can function quite competently, can know when she is getting into trouble, and knows how to ask for help. In describing her patterns of mood and revealing her self awareness, she told us that she is “hypomanic and goofy most of the year, just like I am tonight.” It was a lovely moment that demonstrated a crucial point: Mental difficulties do not necessarily
compromise competency and it is all too easy to stigmatize. Our public and our professions need to be better educated, more at ease, more open.

Dr. Vogel Scibolia described her history first hand. She highlighted the long and elusive process of proper diagnosis in her case, with professionals or herself only partially understanding how psychotherapy or medications alone were not sufficient for her. She helped us to understand how her considerable intellectual abilities and sense of humor made the process of realization more difficult. Her descriptions were personal and
riveting.

At one point she described herself becoming manic during her training at the University of Pittsburgh Western Psychiatric Institute, when she herself was interviewing a manic patient. It was at this point that she ‘realized’ her problem, and in describing her personal terror to us she illustrated the ‘stigma’ of mental illness, and its sometimes-brutal effects. Dr. Vogel Scibilia articulated the “quintessential moment” of
appreciating what she was up against as she identified with the manic patient she was interviewing. “…Everything crystallized…. I am having a psychotic manic episode, and I can’t get out of the E.R…. I am crying like everybody else who finds out that you have a psychiatric diagnosis…oh my God...the shame...my husband is going to leave me, I will fail at everything…life is over…” Accounts like this one brought the audience into
direct contact with Dr. Vogel Scibilia’s experience and the horror of stigma.

Dr. Kay McKenzie spoke next, dovetailing Dr. Vogel Scibilia’s presentation with a historical, social, and psychoanalytical context for understanding stigma. Dr. McKenzie spoke about universal psychological fears of contamination. Nonconformity to the social norm leads to strong emotions in a group, with actions that often isolate and attack the stigmatized person. And it certainly has not helped that mental illness has historically, and all too often these days, been associated with the demonic,
or with some form of moral weakness.

Dr. Patrick Enders spoke of how there is much better monitoring of professionals for chemical dependency issues than for general mental health issues. Mental health professionals are taking on complex and often unclear problems in their work, often requiring that we tolerate great discomfort and uncertainty as we attempt to understand our patients. Dr. Enders stated, “it is important to be able to have doubts—the ones we worry about are the doctors who do not have any doubts.”

All the speakers discussed the special responsibilities that a practitioner has if he or she is acting in the capacity of a professional while being in treatment. The “consumer provider” should have ongoing monitoring by another trusted professional. It is helpful to be able to develop effective methods of self observation, to have an ongoing group of
colleagues who have similar difficulties can be enormously effective. Dr. McKenzie stated that there are senior psychiatrists available for any therapist to consult with if they are having problems. Dr. Vogel Scibilia added that she found that professionals who know she is a psychiatrist tend to view her as having more insight than she might otherwise possess during her most difficult moments, and she wants to be viewed accurately.

Each panelist stressed the complexity involved in diagnosis and treatment, and that it is crucial to approach every clinical situation with the ability to entertain multiple hypotheses, not reducing symptoms to a single biological or psychological container. Dr. McKenzie conveyed her enthusiasm that our understanding of mind and brain are converging with increasingly sophisticated and integrated models. These will be of great help to patients and practitioners alike. Dr. Vogel Scibilia explained that
in her situation “one to three times per week psychotherapy along with medications has been the best combination for her.”

This was a very well attended and successful event. There were many questions and comments from the audience, and the presenters responded with openness, humor, and wisdom. This collaboration between NAMI and APT was an effective stigma-buster. Everyone left with a sense of enthusiasm and enrichment.

BUILDING BRIDGES by Rachel M. Baker

The Friends of The Cleveland Psychoanalytic Society and The Cleveland Psychoanalytic Society are embarking on an outreach program to the Indian community in connection with Dr. Salman Akhtar’s visit to Cleveland on September 28 and 29, 2001.

Keeping in mind that a bridge is a two way street, The Friends with the help of Professor Verghese Chirayath of the John Carroll University Sociology Department will introduce the psychoanalytic community to Indian culture with a film by famed Indian film director Satayajit Ray, The Stranger. The film will be shown on Sunday, September 9, 2001, in the Murphy Room at the D.J. Lombardo Student Union at John Carroll University at 6:45 p.m. Discussion will follow the film presentation. Watch your mail for flyers. Members of the Indian community are invited to join us.

Friday, September 28, 2001, at 8:15 p.m. at the RB&C amphitheater Dr. Akhtar will talk about The Immigrant’s Bi-Cultural World: Conflict Between Metaphors and Generations. A panel consisting of Professor Chirayath, Norma Cofresi, Ph.D. of Cleveland State University Psychology Department and Candidate at the Cleveland Psychoanalytic Institute, and Jaehak Yu, M.D., Fellow in Addiction Medicine at University Hospitals and Candidate at The Cleveland Psychoanalytic Institute, will respond to Dr. Akhtar’s presentation. Members of the Indian community, including their adolescent children are invited to this event and to contribute to the discussion.

A Saturday fund-raiser luncheon is planned for September 29, 2001 at the Racquet Club in Pepper Pike. A program of Indian music, a reading of short stories from A.K. Ramanjam’s Folktales From India and Dr. Akhtar’s poetry will be offered. Watch your mail or call Debbie Morse (216) 229-2111 for more details.