Same Story, Different Country

This article comes from Canada. I agree with most of what they say here. The medicines and treatments have improved for the mentally ill over the years. But it seems like, maybe world-wide, that the mis-understandings and prejudices against the mentally ill are still alive and well. I feel strongly that this is a topic that needs to be understood, not swept under the carpet and forgotten. The mentally ill are our mothers, fathers, brothers, and sisters. You would be very near sighted and self centered to think that you can turn your eyes and ignore this problem in America. It might affect you one day. Education on the subject and understanding with sympathy is the only way to progress.

The branding that devalues

Stigma against the mentally ill is getting both worse and better, as attitudes polarize

MICHAEL KIRBY

Globe and Mail Update

June 27, 2008 at 6:15 PM EDT

'In no other field, except perhaps leprosy," a Canadian report on mental illness said 45 years ago, "has there been as much confusion, misdirection and discrimination against the patient as in mental illness … Down through the ages, [the mentally ill] have been estranged by society and cast out to wander in the wilderness. Mental illness, even today, is all too often considered a crime to be punished, a sin to be expiated, a possessing demon to be exorcised, a disgrace to be hushed up, a personality weakness to be deplored or a welfare problem to be handled as cheaply as possible."

It is unsettling and frustrating that the world has not changed much since then.

Mental health is one of the most pressing problems for us to deal with as a country, as a people and as individual Canadians. There is no health without mental health. One out of five of us is living with a mental illness. But most people are too embarrassed to admit it. That is because of stigma.

Stigma consists of the negative ways in which people living with mental illness are labelled. This labelling is so pernicious that people living with mental illness are often seen as nothing more than the illness itself. In fact, the Greek word stigma means a mark or brand, by which an animal or slave could be identified. When we classify people by their illness, we dehumanize them.

Mental illness still has the taint of leprosy. Many people report that stigma — particularly the ways that they are treated by family, friends and co-workers — often causes them more suffering than their illness itself.

When I was the chair of the Senate standing committee on social affairs, science and technology, which produced in 2006 the first national report on mental illness, Out of the Shadows at Last, we heard heart-wrenching stories about the impact of stigma. We heard about the shame that people living with mental illness suffer. We heard about their losing friends and contact with family. People were wary of telling their friends because of their fear that the friends would react badly and abandon them.

Parents admitted to being too embarrassed to acknowledge that their child was living with a mental illness. In a recent study, 38 per cent of parents said they would not admit to anyone — even their family doctor — that they had a child with a mental illness.

We also heard about humiliation at work — all because of mental illness.

But stigma is not just name-calling. It's also "sticks and stones" that can have concrete consequences. According to a Scottish study, people with mental health problems reported experiencing more than twice as much harassment as the general population. The perpetrators were typically neighbours and teenagers. Almost all those surveyed said that the harassment had made their mental health worse. Almost one in three moved as a result.

People living with mental illness are also less likely to report any offence or crime committed against them, because they report that police are unsupportive. And if they do press charges, they often end up being branded "unreliable" witnesses in court.

British research confirms that 80 per cent of people with longer-term mental health problems are out of work. So poverty and small, fragile social networks add to their problems. In Canada, it is no better. Almost half of us believe that if someone at work was dealing with depression and missing work, they would be more likely to "get into trouble and maybe even fired."

Current research has found that the public is generally better informed about mental illness than it was a few decades ago. Researchers at Columbia University report that there is greater awareness of mental illness and its biological underpinnings, as well as the availability and effectiveness of treatment.

The bad news is that, in lockstep, there has been a corresponding increase in stigma, discrimination and social distancing. Increasingly, the public is attaching stereotypes, such as "dangerous and incompetent," to people with mental illnesses.

The reason for this apparent paradox is that in the past, fewer people thought about mental illness at all. Most people did not give it much consideration. As more people hear about it, many who were neutral are led to take a position, for better or worse. In effect, they divide into two camps: those who are sympathetic and supportive because they understand the issues better, and those people who become more fearful, prejudiced and hostile as they hear more about the subject. Fortunately, a large majority become more sympathetic, while the negative group is considerably smaller.

Three Cups of Tea

This is a book review. Three Cups of Tea is a book written about a remarkable man who while trying to climb a mountain named K2 wandered into a small town in Pakistan. He was touched by the overwhelming need for schools and elementary education in this poverty area. The education that was lacking especially for the young girls. Since 1993 Greg Mortenson has un-selfishly given his whole American life to raise money for the schools in this area. I hope that all Americans join Greg Mortenson by at least giving money to the cause. I am an educator and I can't find the words to say how strongly I agree that education and understanding is probably the only way to peace in the world. Please visit this website and use this sincere opportunity to "give back". Thanks, Liz

www.threecupsoftea.com

Interesting Statistics

It is interesting to read that 2/3 of the homeless have a mental illness and/or have an alcohol problem. I know that some of the mentally ill homeless probably have family that would like to help them, but they are not in a healthy frame of mind to accept their help. Therefore the option the homeless choose in their mental illness fog is to be on the street. It is a shame that they cannot have the presence of mind to accept professional help. It is always good to see that state governments are trying to make the lives of the mentally ill better.

Coverage for All: Inclusion of Mental Illness and Substance use Disorders in State healthcare Reform Initiatives

June 8th, 2008 ·

Frustrated by inaction at the federal level to address the growing number of uninsured Americans, states are increasingly moving forward on healthcare reform. Although state initiatives have been the subject of front page news, no one has examined the impact of their programs on people with mental illnesses and substance use disorders.

“Coverage for All: Inclusion of Mental Illness and Substance use Disorders in State healthcare Reform Initiatives,” a report from the National Alliance on Mental Illness (NAMI) and the National Council for Community Behavioral Healthcare (National Council), examines benefits for mental illness and substance use disorders for adults in state plans that cover the uninsured. The paper, which is based on research on 18 states’ initiatives and proposals, includes important findings on the following topics:

• The scope of the problem

• The history of financing for mental health and substance use treatment

• Analysis of state benefit packages

• Issues for future exploration

• Implications for the future

The Scope of the Problem

People with mental illness and substance use disorders are prevalent in the uninsured population. Data from the 2005 and 2006 National Survey on Drug Use and Health (NSDUH) that were tabulated specifically for this report indicate that more than one in four adults who are uninsured have a mental illness, substance use disorder, or co-occurring disorder. Approximately one-third of people with mental illness, substance use disorders, or both who are under the federal poverty level (FPL) are uninsured.

Not having insurance is a significant roadblock for people with mental illness and/or substance disorders. Almost 80 percent of people with these disorders who needed mental health treatment but did not receive it cited cost as the reason. Underinsurance is also a problem: 34 percent of insured people who had unmet mental health needs indicated that cost was a barrier to seeking treatment.

Data from the World Health Organization show that mental illness is the leading cause of disability in North American adults; substance use is the second leading cause. Neuropsychiatric disorders, which include mental illness and substance use disorders, are more significant contributors to disease burden worldwide than are other noncommunicable diseases, such as heart disease and cancer.

The consequences of untreated or under-treated mental illness, substance use disorders, and co-occurring disorders can be quite severe. Almost one-fourth of all stays in U.S. community hospitals—7.6 million of nearly 32 million stays— involved depression, bipolar disorder, schizophrenia, and other mental health disorders or substance use disorders.

Two-thirds of the U.S. homeless population are adults with chronic alcoholism, drug addiction, mental illness, or some combination of the three. Approximately 16 to 23 percent of jail, state, and federal prison inmates have a serious mental disorder, and adults with serious mental illnesses die 25 years sooner than those who do not have a mental illness.

Given the health and economic consequences of untreated mental illness and substance use disorders, along with the high prevalence of those conditions in people who are uninsured, states that do not include benefits for their residents will fail to address significant treatment needs of a considerable percentage of the uninsured, leaving them to suffer poor health and economic distress.

Over the past 40 years, the evolution in the scientific understanding of the biology of mental illnesses and substance use disorders and the effectiveness of treatments has been dramatic. Policy—aided by recent research showing the high cost of untreated mental illness and substance use disorders and the low to negligible cost of including equal benefits for those disorders and physical health conditions—has begun to reflect those trends. Yet, stigma and concerns about cost persist.

As the nation moves to cover more of the uninsured, the debate on the scope of benefits for mental illness and substance use disorders will continue. Policymakers will also seek better healthcare outcomes and lower costs for all conditions, including mental illness and substance use disorders. Lessons from the states indicate the need for further innovation as well as sharing of current practices to fully address mental healthcare and substance use treatment in state plans to cover uninsured populations.

Another idea

This is another idea that I never have understood. We can talk about and advertise everything that would seem to be private, i.e. erectile dysfunction, female products, and birth control choices. These items are advertised on prime time television. And to be fair I do see the drug Abilify advertised for Bipolar Disorder as well. But why can't we openly discuss any mental illness without embarrassment or shame?It is just an illness just like cancer. We have so many fund raising opportunities for Breast Cancer. The pink ribbon is known world wide as being the symbol for breast cancer. Where is the symbol for mental illness? Do we have as many research fund raisers nationally for mental illness? I would like to see them as prominently advertised and discussed as any cancer known to man.

Officials call for change in how mental illness is treated

Anne Kyle, Leader-Post

Published: Thursday, June 12, 2008

REGINA -- Mental health needs a champion, someone with a public profile, to come forward to advocate on behalf of persons struggling with mental-health issues, say the people who work in the field.

"They need to have someone brave enough with a mental illness, who has maybe some celebrity status, who steps forward and says, 'I have schizophrenia and I am doing pretty good.' Being able to have a role model to look up to will give others hope and help to remove the stigma attached to mental illness,'' said Anita Hopfauf, executive director of the Schizophrenia Society of Saskatchewan.

Stigma is really just a nice way of window dressing the discrimination people with mental-health problems face during their illness and their recovery, according to Hopfauf.

Friday and Saturday consumers and mental-health workers and advocates will gather at the Travelodge Hotel in south Regina to hear leading national and international experts discuss how to transform the current medical model of treatment of mental-health problems to one where services are recovery-oriented.

"The concept of recovery is essentially a very personal one. A recovery-oriented system is one in which consumers have more control to define for themselves what the issues are, but also have a part in the solutions to those issues,'' said Michael Seiferling, a psychosocial rehabilitation worker who works with persons with acquired brain injuries.

"The recovery plan touches every aspect of service from care in acute hospital settings to the supports provided in the community. At its core the recovery-oriented model must offer the individual the promise of hope, healing and recovery at every intervention.''

When people in the field talk about recovery they are not talking about a cure but are talking about people doing well at where they are at in their recovery process, Hopfauf said.

"They are able to live a productive and satisfactory life whether they have symptoms or don't have symptoms,'' she said. "It definitely doesn't mean the person is cured or completely recovered.''

The central focus to the concept of recovery is one's quality of life with or without symptoms, Seiferling said. "Recovery means finding meaning in life and healing from the trauma or the effects of the illness. Central to one's recovery is the hope that things will get better and improve. This provides a drive to move forward,'' he said.

The recovery model, he said, demands an increased involvement by the individual and their family at all levels, who bring with them the experiential knowledge of the unique challenges and successes of living in recovery.

There are four internal conditions that are to be facilitated in recovery -- hope, healing, connectedness (and connecting with community) and empowerment, Seiferling said.

"It is the hope, healing and empowerment -- the ability to manage these symptoms when they flare up and to take control over some of the things that are causing intrusions in your life -- that enable you to manage their long-term impact,'' Seiferling said.

Hopfauf said it is time for the federal and provincial governments to step forward and implement a much-needed and long-overdue mental health and addictions recovery plan in Saskatchewan.

Statistically one in four Canadians will experience some mental health issue in their lifetime, she said.

"This is huge and it needs to start getting the proper attention that it should have got years ago,'' she added.

Hopfauf and Seiferling said that in this time of economic prosperity in Saskatchewan they are hopeful that the provincial government will inject some much-needed funds into the mental health system.

That'swhatI'vebeenTalkingAbout

Here I am a grown fifty two year old woman. This article is exactly what I have been talking about and what I wrote about in my book,"Who are the Victims? A Bipolar Quandary". I don't want the sympathy, I am past that now. But I am still angry that I was not given the time and consideration as a young woman growing up in the shadow of my mother's bipolar disorder. I hope that the Mental Health Organizations of America are doing a better job with the families of mentally ill people. I feel like my brothers and I were adversely effected by our mother's disorder. But we were not encouraged to express any personal emotions because our mother's emotional roller coaster was all the family could manage to think about every minute of each day. I don't have any ill feelings toward my mother, but I am still upset with the disorder and the help and care that should be given to the young, impressionable sons and daughters of bipolar parents. These children see and witness situations that their young years are not able to process. The emotional support is not there either. Here's hoping that America is doing a better job now than in the past.

Plea for children of mentally ill

Hospital visits can be traumatic for children

More needs to be done to support the children of parents with mental illness, says the charity Barnardo's.

In a report, it says children do not get enough information on their parent's condition, and says mental hospital visits can be traumatic.

The charity says children go "unnoticed", and it wants specialist services to help families cope.

A mental health charity said counselling should be available to all family members.

Children rely on their parents for emotional and practical support but when parents are affected by mental illness, their role can become a struggle Alison Webster Barnardo's

Studies suggest that a fifth of all women referred for mental health treatment have a child under the age of five, and Barnardo's interviewed children of all ages, and their parents, to find out more about their experiences.

These included the 11 and 12-year-old son and daughter of a woman with severe depression, who were placed in separate foster homes every time she had to be treated as an inpatient, and the eldest of five children, who, at 16, said that he felt that he had to look after the entire family after his mother suffered from mental illness.

Barnardo's chief executive Martin Narey said: "Our experience is that, at times, children go unnoticed when a parent needs mental health treatment. "Promoting collaborative work between adults' mental health services and children's services is critical.

"Every needs to remember the patient's crucial importance as a parent."

Advocate

The report recommends that every family which has a parent with mental illness has a named professional who can provide information and act on their behalf.

Barnardo's also wants mental health trusts to make their inpatient visiting facilities more "child-friendly", and for schools to be given the means to support children.

The charity's lead researcher on mental health, Alison Webster, said: "Children rely on their parents for emotional and practical support but when parents are affected by mental illness, their role can become a struggle.

"Our proposals would mean that the whole family would get more of the support they need."

Government policy appears to be moving towards this approach. A review of the 1999 English National Service Framework on Mental Health, which helps set NHS policy and practice, found "little to report" on the support offered to family carers.

However, the Code of Practice linked to the 2006 Mental Health Bill does include advice on dealing with the families of those affected by mental health problems.

Government documents, such as the "Children's Plan", published in England in 2007, and similar documents in Scotland and Northern Ireland, now acknowledge the need to deliver health services with the effects on the entire family in mind.

Dr Andrew McCulloch, Chief Executive of the Mental Health Foundation, said that the present situation was "scandalous".

He said: "The family is the place where children learn to be happy and healthy so it's scandalous that at the moment the system is completely failing families where a parent has a serious mental illness.

"Children who are not given help to cope with their parent's mental illness are vulnerable to long-term emotional and behavioural problems.

"A range of services including talking therapies and practical social support need to be made available to everyone in the family - we must stop leaving families to struggle on their own to cope with mental illness."

Amen to this in Indonesia!!

All I can say is America needs to continue to work toward the open dialogue like this one in Indonesia.

Need to address mental illness

MENTAL health issues at the workplace should be given due attention as the productivity of the staff of any organisation depends on their mental health.

Employers must be aware that the neglect of mental health and psychosocial factors at the workplace is not only detrimental to the individual worker but also directly affects productivity, efficiency and output of any organisation.

Employee performance, frequent illness, absenteeism, accidents and staff turnover are all related to the employees’ mental health.

Issues related to mental health at the workplace can also have a direct impact on all stakeholders of the workplace, including the employers, customers and the community in which the organisation is located.

No workplace is immune to mental disorders, and the impact in psychological, social and economic terms is high. Mental health should no longer be ignored. On the contrary it should be given adequate attention in relation to other businesses in any organisation.

Mental health problems, especially stress-related, among Malaysians are a matter of serious concern and need to be addressed urgently at the workplace so that problems like depression, mental illness and psychiatric disorders can be avoided.

NIOSH is of the view that urgent steps need to be taken to address mental and health issues at workplaces.

In this connection the Government should introduce guidelines for promoting mental health at workplaces in order to contribute towards a healthier and productive workforce both mentally and physically.

Employers should use safety and health committees at the workplace to examine and identify the problems relating to the promotion of mental healthcare at workplaces and formulate a fundamental programme to address these problems.

An employee assistance programme (EAP) which can provide both prevention and early intervention for employees affected by stress, emotional and mental health issues should be introduced at workplaces.

Funds expended on EAPs have documented investment returns in such areas as productivity and work performance. Companies are finding that investing in employee’ emotional well-being can mean a healthier bottom line.

Mental Health education and promotion, which aims to address the rise of psychosocial problems in our society, is most essential in view of our aspiration to achieve developed nation status, which obviously will exert tremendous pressure to deal with our daily responsibilities, which could lead to stressful predicaments.

The impact of mental illness on the family and society is enormous in terms of loss of productivity, legal problems and economic costs. Direct costs of mental disorders are high but indirect costs are estimated to be much higher than the direct costs to society.

We need to do more for those who suffer from mental illness. On the welfare services front, the Government should include the mentally ill as disabled persons and brought under the category of disabled persons and they should be accorded opportunities in employment to help them return to the mainstream and not be a burden to society.

TAN SRI LEE LAM THYE,
NIOSH chairman.

Aptly Written

This article is very aptly written. This author, in my opinion, very correctly points the finger at all the average "Joes" in America who do not want to acknowledge that humans can be so mentally ill. This is like Dr. Jekyl and Mr. Hyde. Some of us love to read about the manic episodes that people can be in. The other half of us do not want to be responsible for knowing that such madness does exist in our daily lives. The mentally ill are wonderful people. But they need specialized care and constant supervision. The liberal laws in America allow all mentally ill persons to be as crazy as they want to be in their everyday life. What the general population does not grasp is that a mentally ill person must actually harm themselves or someone else before corrective action can be taken to ensure their safety and the safety of the people they harm. Most mentally ill people are harmless, but the few who are hearing God and voices in their head need proper medication. They cannot be forced to take their prescribed medication. Hence, that is why we get the unfortunate circumstances such as we have seen on recent college campuses. Also the sad stories like Andrea Yates in Texas who did drown her five young children. Those children along with Andrea were and are victims of mental illness. Victims of a disorder that can be controlled with proper medical care. But this medical care cannot be forced or imposed upon someone who refuses the care or is in a manic frame of mind that will not allow them to think rationally for themselves. All the misplaced power is definitely in the hands of the individually mentally ill persons. That is the insane part of the law that needs to be modified. I don't want to return to the dark ages when the patient was held down against their will and had medicine forced down their throat. But if I was the mother of a child who was gunned down sitting in a college classroom, I would vote for the mentally ill person who killed my child to be forced to take his/her medicine no matter what. Just My Opinion.

We're all to blame for staying mum on mental illness

ANDRE PICARD

June 5, 2008 at 9:22 AM EDT

There is something we need to cry out long and loud: Joshua Lall was mentally ill.

Before the murderous rampage that left two of his children, his wife and a tenant dead, the 34-year-old Calgary man reportedly was hearing voices and feared he was possessed by the devil.

Mr. Lall's family said he had told them he was having a "mental breakdown," and according to an e-mail written by his wife he had been stressed out and unable to sleep for a long period of time - all classic signs of severe untreated mental illness and the psychosis that can grip those with depression, bipolar disorder or schizophrenia.

There are those who do not want to say Mr. Lall was mentally ill for fear of besmirching his memory. Apparently, there is one thing more shameful than being a mass murderer, and that is being crazy.

There are those who fear that openly discussing the role of mental illness in these killings will perpetuate negative stereotypes about those with mental illness.

Yet by tiptoeing around Mr. Lall's apparent sickness, by not daring to speak aloud the words "mentally ill," we are perpetuating the stigma that was likely a driving force in this tragedy.

Mr. Lall was sick. He was exhausted. He was hearing voices. He was probably frightened half to death.

And what did he do? He called his parents. He booked time off work. He hid.

By all accounts, Mr. Lall did not go to his employer and say, "I need help." He didn't reach out to friends. And he apparently did not seek medical help.

If, instead of hearing voices, Mr. Lall had been suffering heart palpitations, laboured breathing or other physical symptoms, do you think he would have hesitated for an instant before going to the emergency room or to a doctor?

If he had broken a leg, would he have booked a few days off work in hopes that it would heal before anybody noticed?

Why are physical wounds treated and mental wounds hidden?

In modern society, and the business world in particular (Mr. Lall toiled in a firm of architects), nobody wants to admit to mental health problems because to do so is a sign of weakness and a surefire career killer.

That's why most mental health problems - two-thirds by some estimates - go undiagnosed and untreated. That's why most people muddle through depression or ignore the strange voices rather than reach out for help. (And make no mistake, hearing voices and other forms of psychosis are a lot more common than most people realize.)

As the media dissected his life, Mr. Lall was portrayed as a loving father, a wonderful employee, a brilliant student and an all-round good guy.

But guess what? So are most people with mental illness. It is the most intelligent and educated who are best able to rationalize their symptoms and who most fear being exposed.

One in five Canadians will experience a bout of severe mental illness during their lifetime. The mentally ill are not only among us, they are us.

Yet we continue to view mental illness very differently from physical illness, as a type of moral failing and an affliction of losers.

There is no evidence that people with mental illness are more violent.

But there is clearly a subset of people with untreated mental illness who are a danger to themselves and others. Most of this violence is turned inward - as evidenced by the 3,500 or so suicides that occur in Canada annually.

But in the rare instances when people with untreated mental illness kill others, they disproportionately commit certain kinds of homicide - the murder of mothers and children tops the list.

Untreated mental illness destroys families in the most horrific ways imaginable.

In his psychotic state, the voices in Mr. Lall's head no doubt told him to kill those he loved most, perhaps because they were possessed by the devil, or to free them from some hallucinatory danger.

But when he was not in a psychotic state, when he could rationally consider what was happening inside his brain, Mr. Lall undoubtedly heard other voices - the judgmental voices that are so commonplace in our society.

Stigma is what keeps most people from seeking the help they need. Stigma is what leads those with mental illness to put on a smile to hide the searing pain inside. Stigma is what leads to isolation and to dangerous spirals downward.

Mr. Lall stabbed to death his wife, Alison, two of their children, five-year-old Kristen and three-year-old Rochelle, and tenant Amber Bowerman. (He spared one-year-old Anna.)

He did so because he was sick and untreated. But Mr. Lall did not act alone.

We are all complicit in those murders. Complicit because we turn away rather than reach out to those suffering from mental illness. Complicit in allowing so many barriers to care to exist. Complicit because we pretend this could never happen to us.

Complicit because we refuse to say aloud that mental illness kills.

Complicit in our silence.

Interesting idea, where was this thirty years ago?

This article brings a fabulous concept to the table for the help and management of a family members bipolar disorder. Years ago, most of my mother's doctors thought family therapy was not productive because the disorder is a chemical imbalance therefore not really reachable by verbal therapy sessions. One of the large problems we had with our bipolar loved one was the fact that she herself did not want to embrace or admit that she was as severely ill as she actually was. She tried to blame her manic episodes on each of her close family members. I think one of the positive steps a bipolar person can take is to acknowledge the fact that they are sick and need important medical help. Otherwise the family spends a lot of frustrating time just working with and around the paranoia of mania. Very, very tiring and un-necessary.

Clinic Treats Mental Illness by Enlisting the Family

It was hard to tell just who was the patient, as the Cunanan siblings — Jennifer, Adrian and Anthony — sat in a row on three chairs in a sparsely decorated therapist’s office at Beth Israel Medical Center in Manhattan.

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Marilynn K. Yee/The New York Times

Adrian Cunanan, 30, was flanked by his brother Anthony and his sister, Jennifer, as he discussed a recent manic-depressive episode at a clinic at Beth Israel Medical Center.

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Marilynn K. Yee/The New York Times

Helen Kraljic Fama, 50, was supported by her husband, Anthony P. Fama.

It was Jennifer Cunanan, 27, who did most of the talking, describing life with Adrian, 30, a computer consultant who has bipolar disorder and who went through a severe manic episode in March. He would go two days without sleeping, she said, then become so frazzled that he depended on his family to carry out life’s daily chores, like shopping and cleaning.

“All of us would like someone to sweep up after us,” Ms. Cunanan said, half understanding, half resentful, as her brother listened, his eyelids drooping from exhaustion.

Adrian’s brother and sister, as well as the woman he is dating, are critical components of his therapy at Beth Israel, where a fledgling clinic aggressively treats people with bipolar disorder by involving their family members. The clinic, the Family Center for Bipolar Disorder, was set to be formally dedicated on Wednesday, though it has evaluated some 60 families since 2006, in a program that doctors say is unique in the city and based on a model developed at the University of Colorado.

Family-focused therapy, as it is called, breaks the image of the psychiatrist sitting in his chair, alone in a room with the patient, as well as the traditional wisdom that patient confidentiality is sacrosanct. In family therapy, the family might be treated as part of the problem; in contrast, in family-focused therapy the point is not to treat relatives, but to enlist their help in managing the patient’s illness.

“We’ve tested it in a number of different trials against different types of therapy, and consistently find that if you combine medication and family-focused therapy, you get quicker recoveries from episodes and longer intervals of wellness,” said David J. Miklowitz, a professor of psychology and psychiatry at the University of Colorado, whose pioneering research on the topic inspired the Beth Israel clinic. “So the relapses are less common, and their functioning improves, including relationship and family functioning.”

For many years, Dr. Miklowitz said, the extreme mood swings of bipolar disorder had been thought of “as sort of an exclusively genetic, biologically treated illness,” to be managed primarily with medication. But his most recent study, reported a year ago in the Archives of General Psychiatry, showed that long-term therapy of 30 50-minute sessions over nine months, with medication, cut median recovery time to 169 days, compared to 279 days for those receiving short-term therapy of three sessions over six weeks.

The study also showed that family therapy had slightly better results than other types of psychotherapy, Dr. Miklowitz said, though the difference was found to be statistically insignificant.

Nonetheless, he and the founder of Beth Israel’s clinic, Dr. Igor Galynker, said their experiences with patients showed that families are in the best position to catch early warning signs of a manic or depressive episode.

“It can be something as subtle as a change in lipstick shade,” Dr. Galynker said. “Only a person who knows them very, very well would know.”

Patients often do not recognize the symptoms. “Because the mania feels so good, there’s no way for me to know that I’m doing it,” Mr. Cunanan explained. “That’s why it’s so important to have the family involved.”

Dr. Galynker and his patients agreed to open therapy sessions to a reporter with the hope of dispelling the stigma that surrounds mental illness, which can sometimes make patients ashamed to confide in those close to them.

Because there is data that shows bipolar illness to be hereditary, Dr. Galynker said that being open about the disease could help the children of people with bipolar disorder to understand the risks of inheriting it. People with bipolar disorder can cycle between depression and mania. The manic highs, with attendant feelings of excitement, elation, grandiosity and obsession, can be so gratifying that patients fail to realize they are part of an illness and prelude to a breakdown.

It was a depressive swing that brought Helen Kraljic Fama and her husband to Beth Israel’s clinic, on 17th Street near First Avenue, nearly 30 years after Ms. Fama suffered her first bout with the disease.

Ms. Fama, 50, who was once a bookkeeper and a cashier, said her manic episodes include an obsession with numbers, which she feels are friendly to her. (“I always brag that she scored a perfect 800 on her math SAT,” said her husband, Anthony P. Fama, 60.) In her last bout, in March, she was watching a John Travolta movie, “Swordfish,” when her fingers began working an imaginary keyboard as she communicated with the numbered codes on the screen.

The subsequent depression, coupled with the guilt she feels about her inability to work, or even to make dinner, has left her sometimes feeling like “ending it all,” she said.

Ms. Fama recently walked from her home in Queens to the 59th Street Bridge, thinking of jumping off, but changed her mind when she saw a lot of construction workers on the bridge. So she had breakfast at a restaurant, then called her brother to take her home.

In a therapy session on Monday, Dr. Galynker suggested enlisting Ms. Fama’s brother to keep her company at home while Mr. Fama was at his job as a supermarket manager in Manhattan.

“Can I rely on your brother?” Dr. Galynker asked Ms. Fama.

“Oh, yes,” she replied, clutching her purse as if it were her anchor in a storm. “He’s telling me to look in the mirror, see how pretty I am.”