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Hoag Health – Brain Matters: When the Joker is Wild

?Obsessed with a comic book character? You may be courting tragedy. When voices compel you to act like a villain, your tragedy may visit others.
With each new mass murder, grief grips yet another large group: We rightfully think first of the lives lost needlessly. The media vilifies the killer: His photo shows what could be a friendly smile, transformed by the horror perpetrated into a maniacal grin. Whether it’s the shootings in Arizona, including Senator Gifford’s, or the current carnage in a Colorado cinema, we think, “He must be insane!”

Riddle me this: How common is mental illness? Nearly one-third of U.S. adults and one-fifth of children had a diagnosable substance or mental health problem last year. A 2011 study of insurance claims by Medco Health Solutions showed that more than one in five Americans take prescribed medication for a psychological disorder. Perhaps even more should. Estimates show that only 4.1 million of the 9.8 million Americans who needed treatment for a serious mental illness received it.
Mental health disorders rarely produce psychopathic killers. Predicting who will actually kill others is extremely difficult (though some fascinating research suggests a brain focus found hyperactive on scans in some, may increase the risk).
Prior violence, substance abuse and paranoia are red flags. Schizophrenics hurt themselves much more often than others, with a 50-fold higher suicide rate.
Flying like Superman may only cause one loss of life. Voices commanding you to harm others may lead to the loss of many. Psychotic breaks often develop in late teen-age or early adult life, and may be heralded by some early warning signs including social isolation, obsession with mind control, or grossly inappropriate interpersonal behavior. What combination of genetics, environmental or family issues leads to a psychotic break is still unknown, and not the subject here. The recognition that, as a society, we need to treat mental health equally with physical health, is.
For every one psychotic killer, millions of our brethren suffer a variety of mental “dis-ease.” Depression is the single largest cause of disability worldwide, according to the World Health Organization, ahead of heart disease, cancer and stroke.Mood disorders such as bipolar (manic-depressive) illness, anxiety, post-traumatic stress, obsessive-compulsive disorder, and their associated dysfunctions such as compulsive gambling, anorexia, substance abuse (often subconscious self-medication), etc. maim human beings and damage relationships. Indeed, these conditions affect our physical well being.
A significant percentage of those with substance abuse or mental health problems die prematurely. Their health care costs are substantially higher. One of every eight emergency department visits are related to a mental health disorder.
It doesn’t take a brainiac to see that it’s way past time to treat mental health with equal zeal and dedication of resources as we treat physical disease. Indeed, the Affordable Care Act includes such a provision. To do so, however, we must de-stigmatize mental illness.
Given the statistics above, every family likely has someone affected. Hiding the “shame” worsens the condition, delaying care. Most mental health conditions are treatable with a combination of medication and various psychological support strategies. Emerging targeted treatments for depression not responding to drugs, like transcranial magnetic stimulation, may replace more aggressive electroshock therapy sensationalized by movies like “One Flew Over the Cuckoo’s Nest.” Finding the appropriate team of mental health professionals is key.
Going to drug rehab, yet ignoring the underlying disorder causing the substance abuse in the first place, typically one requiring true mental health expertise, is a prescription for failure. It often takes months, if not years, to treat some of these conditions. It’s a process, not unlike maintaining one’s physical health. Indeed exercise helps, but don’t try running through a brick wall like the Hulk. And don’t be the Invisible Man. Ask for help when you feel you need it.
It may avoid many dark nights.
Dr. Michael Brant-Zawadzki is executive medical director of the Hoag Hospital Neurosciences Institute.