by Sylvain Comeau
"It wasn't the system that didn't know John wasn't well. It was John who didn't know he wasn't well. That's what we had to deal with."
That video testimonial, from the mother of a young man diagnosed with schizophrenia, underscored the urgency of Lili C. Kopala's message on September 24. Kopala, a professor and director of research at Dalhousie University's Department of Psychiatry, spoke in the D.B. Clarke Theatre on "The Importance of Early Recognition and Treatment of Mental Illness."
Commenting on John's case, Kopala noted that John's parents were forced to ask police to pick him up off the street in order to get him admitted to hospital.
"Patients tend to show improvement in six months or less [after hospitalization], but someone like John, who was ill for years, takes much longer. Often people like him won't recognize their own illness, which makes it tragically hard to treat them."
Kopala explained that people suffering from mental illness learn to adapt to the unusual ways that their brains are processing information. In an effort to cope, they begin to see their thought processes as normal. As a result, they frequently refuse to believe that there is anything wrong with them.
To make matters worse, diagnosis is a tricky business. "We don't have a blood test, like we do with diabetes, that will give us an instant diagnosis. With mental illness, we can only get that by carefully examining a patient's history."
In addition, early detection is
difficult because many of the warning signs are mundane or even commonplace.
"Symptoms such as lack of motivation and ambition, moodiness, and an inability to find words to express yourself are just as common as delusions and hallucinations. In fact, most of these symptoms are experienced, at some time or another, by people who are not mentally ill." Only clusters of symptoms are considered reliable for diagnosis.
Society pays a high price for allowing mental illness to go undetected for years, Kopala said. "The dollar costs associated with treatment and hospitalization are just part of the problem. These people are also more likely to take their own lives. The suicide rate among people with a psychotic disorder is 45 times that of the general population."
On the other hand, Kopala pointed to independent studies by an early detection program under her direction in Halifax, and by a similar program in the U.S. Both found "no successful suicide attempts" by people in their programs.
Kopala called for more programs that do not exclude people on the basis of age. She says that a lot of teenagers, in particular, are at risk of suffering without treatment because some do not fit within the carefully defined criteria of current treatment programs.
"If you're 17 and mentally ill in Canada, heaven help you, because you fall between the cracks. You don't qualify for child programs or for adult programs. We need youth programs, not programs which will exclude you if you're not exactly the right age."
She also called for increased research on side-effects of common psychiatric drugs.
"Psychotic patients are not the only ones who often don't want to take their pills. Side-effects are a legitimate concern, and we need to learn more about how pills are affecting people. If we don't help reduce side-effects, then adherence [to treatment programs] will be a growing concern. The consequences of non-adherence can be enormous."
Kopala's speech was the John Hans Low-Beer Memorial Lecture for 1998. The annual lecture series, which covers mental health issues, is co-sponsored by Ami-Quebec Alliance for the Mentally Ill and
the Concordia Department of