Is a physical problem more important than a mental health problem

06 Aug

I feel compelled to write this and see what others are thinking. Is a physical problem more important than a mental problem?  Why is there such stigma for mental issues when treating individuals should be holistic?

We all have different life experiences and coping strategies come from these experiences. Some people cope better than others, often predetermined by our DNA.  Some people have many horrific life experiences.  Many individuals are able to cope while others perceive these same experiences as insurmountable. What makes it that some people “go with the flow” and bounce back from everything while others “fall apart”?

Issues in Mental Health Nursing

It doesn’t matter what the situation is or who the person is, we are all human and deserve the same respect.  If you have emotions, there must be at least one emotional problem in your life…unless you have a perfect life.  Perfect life does not exist, unless you’re under a cloud of denial.  It’s a shame that people can’t get help when they need it without so much discrimination.  This is an awareness that healthcare has cut mental health drastically over the recent years.

What’s going to happen when one does not get help because of limitations in healthcare .  The actions or inactions of individuals that don’t get proper mental healthcare may have a ripple effect.  Sometimes these actions/inactions affect only a few to several and other times thousands?

Then what happens to the few or thousands of others who may or may not need mental health interventions? The actions of one person can be criminal in nature, but could they be prevented?  It’s always easier to look at situations in retrospect, but we need to learn from them and change or take responsibility for having a system that is failing.

We hear more about gun control in America than we hear about cuts in mental health funding.  Many with traumatic brain injury are misdiagnosed and patients and families suffer immensely.  It’s incomprehensible what these families endure.  I know from experience.  By not getting treatment it becomes a daily torturous life of others who seek treatment and just can’t get it.  What is the real issue here?  Funding cuts for mental health.

Mental Health Awareness Ribbon

Any tragedy that affects others is devastating for all those involved.  The media also involves the world around everyone.  How many people a tragedy effects is directly associated with all those involved.  Lives change forever.  They live with the ramifications for the rest of their lives.  There will be more people dealing with PTSD and other psychological issues because of one event. Some will do well, other’s don’t.  It’s not a character flaw, it human nature!

Mental health is so often overlooked.  America’s funding for mental health has been cut so inpatient stays rarely exist, and office visits are limited to a certain number of visits per year.  How do these and will these people get proper help when the funding is not available?

These are invisible injuries to the mind and brain.  Some of these people will need chemical changes that need continuous monitoring.  Others need ongoing psychological care. All those involved in tragedy bear the burden in different ways.  Many come out unscathed.  Others feel as though they are living a different life.  They are because their lives have been altered.  Altered simply by perception.  Coping occurs in so many different ways and fashions.  There is no one size fits all.

Some people will find that issues that were not problems before, become problems now.  They will be considered pre-existing conditions.  It won’t matter at what level they were functioning prior to the event.  Suddenly, their past history will become an issue. It’s just digging up dirt, and they’ll find it on everyone.  If they can’t find something, they’ll make something up.

Everyone has a history from their life experiences.  To place blame on past history, is unacceptable.  They are innocent, and treatment needs to happen.  How are we expected to help all these individuals with their mental health, when all the funding has been cut?

English: A CT of the head years after a trauma...

Mental health issues are not resolved in a few brief visits.  They are not resolved with a 3 day inpatient stay.  When anyone seeks help from a mental health professional it should be expected that they receive proper care.  This care is based upon what our insurance company guidelines identify.  It takes at least two weeks for chemical changes in the brain to occur.  During these two weeks patients should be monitored closely on inpatient basis or frequent routine visits, but that no longer exists. Neither is cost effective.

Mental health can and is often controlled with chemical changes and should be treated as anyone with a cardiac, respiratory or any other physical ailment.  It’s not, and very frustrating to say the least.  Many of these other physical ailments are treated effectively with medications and so are numerous “mental or brain problems”.

Here is a thought for the day:  Why is it considered a mental problem because if it’s treated with medication and alters chemistry that is very much a physical problem!

Inpatient stays should be mandatory for those with extreme psychiatric issues. Two weeks is just the start of changes within the brain, hence a longer stay or evaluation period should happen.  Thirty days with frequent visits to a mental health professional is definitely appropriate to help any individual regulate their brain chemistry and identify ongoing problems.

This might be an alternative to inpatient stays, but the funding is just not there.  I’m concerned that our mental health issues are out-of-control simply because of funding. Patients aren’t looking for excuses, they are looking for help.  The same holds true with traumatic brain injury.  It’s an expensive invisible injury.  Families, friends, acquaintances all lose sight what is happening and don’t know how to help these individuals.  They lack the education simply because funding is not available.

We’ve heard repeatedly about gun control, but I see a bigger issue at hand that is rarely spoke about.  What about the Mental Health Issues of all that are involved?  This is not to minimize anything that has transpired, but funding has been cut for mental health that few people ever receive it.

From the most recent incident in July 2012 many more people will need mental health support and treatment.  Will they get the much needed treatment if it relies solely on their healthcare insurance and not on litigation? Are they aware that all their medical records will hold “anxiety” and any additional diagnosis related to this incident and future physical problems can easily be overlooked?


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29 responses to “Is a physical problem more important than a mental health problem

  1. markinidaho

    August 6, 2012 at 1:50 am

    I agree that mental healthcare is severely limited, whether it is by healthcare insurance companies or other impediments such as denial by the patient or provider. The big problem that both mental healthcare and physical healthcare share is the impact of personal behaviors. Chemical dependency, which is relatively easy to diagnose, eats up a huge chunk of mental health care funds. The hidden needs for mental healthcare, depression, and other conditions that have strong behavioral components require serious effort by the patient to be treated successfully. This risk to successful treatment leads fee payers to set limits to contain costs.

    Those of us who struggle with the symptoms of brain injury need a different level of mental healthcare but we still need to be serious participants in our treatment. To make matters worse, the broad consensus is that we are often malingerers. It is not until our condition or behavior becomes extreme that treatment is offered, if at all.

    A big part of the problem is that our culture is so pushy and driven than it is difficult to find the respite needed for improvement. The cultural problem of ‘somebody needs to fix this’ rather than ‘what can I do to fix this’ dumps the problems into the lap of government. And, government is the least able to solve these problems. Government just gets in the way.

    A big hurdle we need to deal with is the pharmaceutical companies. They try to sell the idea that a pill prescribed by a GP or other doctor without much experience in mental health will solve the mental health problem. They want to profit by treating the symptoms, not the cause.
    When the powers that be are allowed to use patient participation as a factor in deciding who receives care and penalizes those who refuse to participate, we may start to move forward. But, the government and other bleeding hearts don’t want anybody to have to feel any negative impact.

    This same problem arises in welfare programs and food stamps. Rather that create a system that uses a bit of humiliation to cause people to learn to take responsibility for themselves, we allow them to get free food by using a debit card that hides the facts that they are receiving public assistance. A sense of pride and self-respect is a powerful motivator for most people. But, in the name of tolerance and ‘promoting self-esteem’, we handicap those who need help learning how to take responsibility for themselves. Those who are incapable of caring for themselves and truly need our help are a small segment.compared to those who are to lazy to make good choices.

    So, we throw those with physical brain injuries that cause mental health issues into the mix with those who refuse to make good choices and develop mental health needs. We need to develop ways to separate the physical injury caused mental health needs from those that are caused by behavior choices and put the resources where they will get long term results.
    If this sounds confusing, blame it on a broken brain. We do the best we can.

    • brain injury self rehabilitation (BISR)

      August 6, 2012 at 1:11 pm

      You’ve made some exceptional points here and I hope everyone takes the time to read your comment. Every thing gets thrown together as “mental health” instead of separating the issues and treating the proper cause. I like how you have broken everything down. It shows that those with a “broken-brain” are intelligent living beings, just having difficulty and need help in a very different way because of physical damage to the brain that is also considered “mental”, because it involves so many aspects of daily living and few people are treated for this ongoing problem that fluctuates with everyday life and through different chapters in our lives. Thank you so much for a fantastic and educational comment. Edie

  2. Three Well Beings

    August 6, 2012 at 4:40 pm

    You make excellent points, Edie. I don’t know why we can’t seem to find the balance in all these areas. It takes time to understand the individual issues and I’m afraid most people don’t want to invest in learning more and asking questions. Very important topic for you, of course, but all of us really! Debra

    • brain injury self rehabilitation (BISR)

      August 6, 2012 at 8:24 pm

      I wish we could find the balance, but our system is fragmented and it’s the patient that suffers. Hence, awareness for the patient and families to take control of their own health and life.

  3. katharinetrauger

    August 6, 2012 at 10:49 pm

    I know a woman who had an alergic reaction to MSG, which caused her to have heart palpitations. Because no one knew what was causing it, the medicals assumed she was imagining palpitations; they could not be reproduced in exam and her heart seemed quite healthy. Therefore she spent several weeks in a mental ward, as a hypochondriac. Now she is uninsurable, but no longer has the palpitations since her own research revealed the problem and she now avoids MSG.

    I know another woman who was in a horrible car wreck that left her very brain damaged. This was years ago. She still has a lopsided face and I think it is because the insurance ran out. She walks and still can operate in her profession of speech pathologist, but cannot remember current things well enough to be out alone. She is a bit like an Alzheimer’s sufferer and must have a caretaker with her at all times, for her safety. Emotionally she has much grace, but mentally she has missing parts, if it is okay to say that, since it likely is true.

    There was some research, I think it was a Kinsey report or something, that proved the brain develops or grows most where it is most used, just as the muscles do. Therefore, the person who dwells upon horrible experiences would cause the brain to develop more capability to recall these events, whereas the person who desires to forget it would develop great capability to put it out of the mind.

    Just as a person who needs to relearn walking must practice walking, so also a person who needs to relearn thinking needs to practice right thinking. But a therapist surely could help!

    You asked for our thoughts.
    These are mine.:)
    I think the failure to require the patient to take some responsibility for his thoughts, when possible, leads to a lack of sympathy in the insurance world. A pure lack of understanding about how the mind, will, and emotions work and overlap and cooperate, causes insurers to hesitate.
    Just my thoughts.

    • brain injury self rehabilitation (BISR)

      August 7, 2012 at 9:52 pm

      It’s sad when a physical problem is not clearly identified a patient can spend so much time being misdiagnosed, mismanaged, labeled, and struggle the rest of their lives with such horrific labels. Thank goodness she figured out the problem.

      I also had heart palpitations once and figured out the problem myself. At the time I was clueless, but it was picked up on EKG. I discovered palpitations were related to an over-the-counter vitamin. All medications whether prescribed or not can have adverse effects.

      Your friend with the severe head injury still has significant problems with her short term memory and I was wondering how she is able to coordinate transportation to and from work and who helps her at work and at home? Does she have her own business? What state does she live in? I am trying to figure out if some areas are better at helping those with brain injury. I personally have found that Michigan far surpasses Ohio in brain injury rehabilitation, education, and healthcare needs. Healthcare professionals are much more informed in Michigan and apparently the general population. So, education is key to any success and acceptance by others.

      I am not familiar with the research you have mentioned but I will look it up. I can understand how the research could come to this conclusion. You also have some interesting thoughts. I love thinking through the thoughts others share. It’s all these thoughts that will open the mystery to brain injury and it’s healing process. Thanks so much for all the insight.

      • katharinetrauger

        August 7, 2012 at 9:58 pm

        The friend who was in an accident lives in Arkansas. Her husband has basically abandoned her, although he provided a handicapped accessible house for her and provides the helper, a woman who lives with her and takes care that she remember to turn off the stove, etc. She does not work outside the home at all, that I know of. She still can function, but the appearance of her face is distorted and deeply scarred, and not attractive, i am sure, to clients. Also, probably, she cannot manage much stress, such as having a daily schedule. She wants a child, very badly, but would need her husband’s cooperation for that and far more help from those around her. Imagine forgetting where you put the baby . . .
        It is a sad story. Very sad.

      • brain injury self rehabilitation (BISR)

        August 10, 2012 at 8:32 am

        It’s very sad to hear about your friend. Worse, society doesn’t accept people when it comes to appearance. Rather then embrace these individuals who have been disfigured, they are shunned. I wish everyone would acknowledge every person regardless of appearance. Everyone needs to be seen and loved! While I was working in rehabilitation (as sad as this is), professionals encourage divorce after brain injury for financial reasons among other reasons. I wonder if they ever realize that marriage is a commitment “in sickness and in health”? It’s a difficult road to haul alone, when life will never be the same and that only adds to all the difficulties to one already needs to tow for a lifetime!

      • katharinetrauger

        August 10, 2012 at 11:11 am

        Her friends and acquaintances do accept her, totally. Her husband is the one who is rejecting her.

        And her times of lucidity are not dependable enough, yet, to warrant her leaving for the work force, even with a trusted helper. Her strength, also, would not support such a move.

        But the college degree remains, accessible in her memory, in which she rejoices, and uses in a non-structured way, wherever she goes. This is an endearing trait in her, a commitment she has made to make a difference, somehow, in this world, if she can.

        My speech patterns and pronunciation have improved from knowing her. 😉

      • brain injury self rehabilitation (BISR)

        August 10, 2012 at 2:22 pm

        What an amazing woman and friend she finds in you! Education can never be removed from the brain. People look at those with TBI as though they don’t understand. WE DO! It takes longer to process, but everything is clear in the mind. It’s amazing how stupid people think we are! She is just as bright as she was prior to her injury, and no one should ever undermine her intelligence! She is making a difference in this world. All her friends are learning from her. Isn’t it amazing how we learn to speak clear and slowly (not louder) so another can understand. I can’t speak of her spouse, because that’s a shame and I don’t want to go there with my thoughts!

      • katharinetrauger

        August 10, 2012 at 4:19 pm

        Good thing I did not tell you the whole story! 😐
        Yes, she tries to be a blessing to those around her and to Jesus..
        I do know another lady (it’s amazing how many people have had brain trauma!) who did lose her education while in diabetic coma. She had a double doctorate. After she recovered, she decided at age 65, to earn another degree, and did it!
        Hey, maybe I am a magnet for a certain set of people? 😀 Or maybe there are just so many. I am thinking right now of a dear friend who had a huge brain tumor removed. I never think of this usually. You have got me to thinking!

      • brain injury self rehabilitation (BISR)

        August 13, 2012 at 8:59 am

        I believe the population of brain injury is far greater then many realize. I think it’s something like 15 million a year. Everyone is affected differently. Some, recover 100%, and others wish they did but feel blessed for what they have left and spend their life working through everything much differently then they did before injury. Hence, the reason for education and it has only been a focus when a celebrity is injured. Every injury is important, as every person is important. Hope we can all help someone get through this even if it’s in a small way.

      • katharinetrauger

        August 13, 2012 at 9:30 am

        Fifteen million per year. I would never have guessed that huge a number. That is shocking.
        There’ve been several good books, in the last few years, written in an inspiring or even entertaining way, to help the uninjured have less natural fear of the those with brain injuries. We, as rational creatures, ought to be able to rise above natural fear, to reach out to our fellow sufferers. We all have some anomaly, whether we know it or not, whether it shows or not, whether we feel safe admitting it or not.

      • brain injury self rehabilitation (BISR)

        August 14, 2012 at 9:55 am

        Correction! I typed in 15 million and the stats are 1.5-1.7 million a year. Significantly less then I stated, but far too many without treatment! You have so many points that others should help and no one is without problems.

      • katharinetrauger

        August 14, 2012 at 10:22 am

        Well, I feel like I just received very good news! Too bad it still is bad news. 😉 It never hurts to reach out. If you get bitten, so be it. Life is full of biters. We do not hold the “perfect” ones nearly as “at arm’s length” as we do those who appear “off”.
        I suppose there is a fear factor, that someone with his mentality jeopardized might think wrong violent thoughts, and that is sometimes the case, whereas someone in a wheelchair seems too weak to be a danger?

      • brain injury self rehabilitation (BISR)

        August 17, 2012 at 7:48 pm

        Great insight! I enjoy how you put things for all of us to understand.

    • markinidaho

      August 8, 2012 at 12:27 am

      Having researched mental health commitment statutes in a number of states, the system that confined a hypochondriac is far from normal or legitimate. Hypochondriasis is not a valid ” threat to self or others or gravely disabled and unable to care for oneself. ” Even a judicial commitment would not reach this level.
      But, we do have people who know how to abuse the system. A hospital wanting to fill beds could abuse the system, especially if they knew there was a policy and payer willing to pay. Two weeks is often the limit of insurance coverage for psychiatric inpatient care. .

      Actually, Freud was the likely researcher. Kinsey was a professor of entomology and zoology and a sexual pervert with no training in psychiatry.

      Regarding requiring the patient to take some responsibility for his/her thoughts is not the cause of the lack of sympathy in the insurance world. It just causes the need to be very circumspect. Why should they spend money trying to teach a patient how to be more responsible for one’s thoughts if they show from the start that they do not want to change? Many in chemical dependency rehab are forced by courts to complete the programs.

      Until recently, I have always had to pay for my and my families health insurance so understanding these policy benefits and issues was important.

      • brain injury self rehabilitation (BISR)

        August 10, 2012 at 9:02 am

        Thank you for clarifying the research. I do see where there is always abuse within the system for numerous reasons and frequently financial.

        I’m thinking that about 20 years ago a stay on inpatient mental health was 30 days paid by insurance. I’m not sure if this is what others are referring to, but I know there has been a drastic change over the years. It could be that healthcare professionals simply abused the system and cuts were based upon that. Of course, their were patients that also figured out the system and abused it!

        While I was in psych-mental health nursing frequently people were transferred from medical to mental-health units because the length of stay was covered by insurance on mental health units.

        I agree that if someone is not willing to change, why offer education to help. That’s simply wasting time and money. When patients are resistant to change, they should be discharged. Stop wasting time and money and save that for those who want and need it.

      • katharinetrauger

        August 10, 2012 at 11:06 am

        You are absolutely right about Kinsey. His research, (unless I missed a memo, here) did show that greater propensity to perversion led to increased growth in that part of the brain, although his interpretations reflected his prejudice. I did not continue following it and probably should have double checked the latest on these findings.

        And I appreciate your re-wording, here. Much clearer. Thanks.

      • katharinetrauger

        August 10, 2012 at 11:32 am

        Oh, regarding the MSG patient, I forgot to say, a lot happens that should not happen when families lean on doctors to do what they should not.
        To think you are dying of heart attack and have a doctor tell you it’s all in your head, when you know you know you know you had chest pain and missing beats, etc., is enough to make a person a bit maniacal, Just a bit. And to have a husband who wants to get to the bottom of this no matter what it takes and is not committed to doing right, just to doing something, ANYTHING, to get some rest from this constant complaining about chest pains he hears every day, is enough to make some doctors say to themselves, well, hmm. Why not? It’s what it’s for, right?
        Truth: there was nothing wrong with her heart and no one could reproduce the pain during exam because few knew, at that time, what caused it.
        Another truth: the makers of MSG fought congress for years to maintian their right to poison our foods. It was not a known allergen for years. (Politically speaking.) Actually is not an allergen as much as a brain poison.
        One more truth: It is very hard to get a mis-diagnosis removed from a health record. And very hard to get health insurance with the diagnosis they gave her.
        Those are facts.

      • brain injury self rehabilitation (BISR)

        August 10, 2012 at 2:11 pm

        I totally agree! There is too much poison in MSG and other things that cause chest pain and other problems including death. Few healthcare professionals will admit to these things. It’s easier to place blame on the patient, then take responsibility and step up and help the patient. Healthcare professionals all stick together and never admit when they make mistakes. It would be better to admit mistakes and help patients and families resolve the issues at hand.

        I totally understand that spouses can be a problem. Many agree with the professionals, rather then take a stand! Do they know how to stand up against healthcare professionals if they don’t know the system or don’t have the knowledge to be an advocate? My husband is living with guilt because he didn’t take a stand when I had a subarachnoid hemorrhage…he went home! He also participated in some sad family situations and laugted and agreed with others along the way. HURTFUL!…but I can’t change that. A proper diagnosis would have alleviated 18 1/2 years of pain and suffering from me and my family. It’s the price we pay, when we can’t advocate for ourselves. But I hope this helps others, millions have died without help.

        It is impossible to remove labels and misdiagnoses from the chart, hence a lifetime of poor care based upon bad diagnosis. Rarely does anyone get a true second opinion. That second opinion is based upon what other professional is saying and covers the professional not the patient. You get a second opinion only if you don’t reveal a first opinion! Sometimes, but rarely does one go against another physician unless it’s blatant. I HATE PEOPLE WHO CAN’T STAND UP FOR THE PATIENT AND BE TRUTHFUL AND HELP THEM TO ACHIEVE THEIR OPTIMAL LEVEL OF FUNCTIONING INSTEAD OF PROTECTING THEIR COLLEAGUES!

      • katharinetrauger

        August 10, 2012 at 4:12 pm

        Hate is a strong word.
        I know how you must feel, though . . .
        Who was the doctor long ago who realized handwashing among doctors would curtail death in new mothers? Did he not die insane because he could convince no one?

      • brain injury self rehabilitation (BISR)

        August 13, 2012 at 8:54 am

        You are right, “hate” is a strong word! I rarely use it, and I do “despise” or otherwise “hate” situations that individuals and healthcare professionals cannot or do not have independent thinking! I can’t honestly say I “hate” these individuals, but I do hate the situations and circumstances. Thank you for calling me on this!

      • katharinetrauger

        August 13, 2012 at 9:21 am


  4. wendy

    August 8, 2012 at 10:56 am

    Luckily I can be insured through my husband’s work. But at one time I tried to get insurance and since I have Bipolar I, I was denied, even though I had been stable for over 15 years! That is ridiculous.

    I was an inpatient once, and my insurance would only pay for a week. They kept me for almost 2 weeks and did not tell me my insurance was not covering the second week. I had been involuntarily committed (had to be or the insurance wouldn’t have paid at all)…however, I was able to get out of paying for that second week because it showed I was not in the right state of mind to sign anything when I was admitted. when I was admitted I was given a male psychiatrist who made me very uncomfortable. (I was a rape victim, and this man made me feel scared) I told him I was not comfortable with him and why…I also told others there. They would not change my doctor. I insisted that this be documented, and I have a copy of it. When I got out of the hospital this doctor tried to send me a huge bill, I didn’t pay it….and was not forced to because I had requested a new doctor.
    This doctor also changed my medication right before I was released. I’m not sure what it was, but it made me lactate, and then I slept for 3 days. 3 DAYS! My roommate told me I would get up and go to the bathroom and drink some water and go back to sleep. I don’t remember any of that.

    Now I have a good psych team. But our new insurance will only pay for a therapist who is a Phd, or an MD. Mine is a licensed social worker, with a masters. they serve 80 percent of the patients in this country for therapy. This rule made no sense to me. Luckily, our therapist office said we were a hardship case because of our insurance and now we get a lower payment plan…it’s comparable to what we were paying with our old insurance. They really worked with us.
    My psych. doc who writes my prescriptions keeps close tabs on me when he changes my meds. Which isn’t often. I have a number I can call him at any time….(he says I’m his favorite patient….I think he means I’m his longest patient, I’ve been seeing him for over 8 years). But depending on the med change I will see him in a week, 2 weeks, or a month. If no med change, I see him about every 3 months. I’m very lucky I have found such a great group to work with…..but I think of the horrors I went through with other therapist and doctors….it’s very hard to find someone who is knowledgeable and caring. Especially when you aren’t sure of your judgement. I listened to some quacks before, and got worse, because I knew I wasn’t in a good frame of mind and they were professionals so they must know more.

    Know if I had to search for a new psych team, I would interview them, and i would check out more than one to see which one I clicked with.

    You always write about things that get me going!
    I think people want to ignore mental illness, if we ignore it, it’s not a real problem. Like the homeless, who often have mental illness, but people want to blame that on drugs and alcohol. It seems as if people think if you have a mental illness it’s some how your fault. Plus it is invisible. They simply do not want to think about it being real.

    good talk!

    • brain injury self rehabilitation (BISR)

      August 10, 2012 at 8:59 am

      I have seen and know of some dear friends that have been down the road you have been. It’s a harsh reality that healthcare professionals as well as family and friends take advantage of people suffering rather than help. Whatever happens is “always their fault”! No one wakes up in the morning and wants to have an injury, illness or mental illness!

      It’s sad that it takes so much to get the proper help through the system, when it’s already difficult getting through each day. Many people are misdiagnosed and mistreated, but who do they believe? They always believe the healthcare professional over the patient!

      It’s so important to find the proper healthcare professional to help with ongoing support. Thank goodness you are a great advocate, but it’s a difficult road to haul dealing with so many other issues at the same time. It can takes years to find the right chemistry between doctor-patient relationships.

      Getting one’s medical records may save a lifetime of inappropriate labeling and care. It seems like you are so alone, but I would say you are the average person suffering from mental illness. Again, it’s invisible so others don’t want to understand. It’s a state of denial for others. Many never give a family history of “mental illness” in fear of wrong diagnosis. Besides, when people are treated they are permanently labeled.


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