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Express Yourself, Part II

For the previous article to this, click here for Express Yourself, Part I

Last month, I related a story of a recent study from Dr. Kevin J. Petrie at the University of Auckland (New Zealand) of how 37 people living with HIV were studied in two groups: one group who expressively wrote about their feelings for 30 minutes a day on 4 consecutive days, and a comparison group who wrote objectively about how they occupied their time. It was found that the CD4 count of the “emotionally expressive” writers increased gradually and continually in the 6 months after the writing sessions, but there was no CD4 change in the comparison group. Dr. Petrie concluded that his study’s findings were consistent with others that found that people “who don’t get to discuss their feelings have a faster decline in their health” (Journal of Psychosomatic Medicine, March/April 2004, 66:272-275).

This month, John James reported in his wonderful newsletter, AIDS Treatment News (#403, July, 2004) about another story where “Chronically Depressed Women with HIV Almost Twice As Likely As Others to Die from AIDS-Related Causes; Those with Mental Health Services Had Half the Death Rate Those Without.” The study of 1,716 volunteer HIV-positive women from six U.S. clinics “statistically controlled for all the other variables like CD4 count, viral load, AIDS-related symptoms, HAART or other antiretroviral use, cocaine/heroin use, income level, age, and race and other factors, those were chronically depressed still were 1.7 times as likely as those who were not depressed to die of AIDS-related causes.” This underscores yet again the importance of mental health services for those living with HIV. James’ article goes on to comment that treating mental illness or distress can improve survival by possibly triggering an immune response in humans that we do not yet fully understand, that may have treatment implications for perhaps new classes of medications in the future.

Despite the evidence from these two studies, in my experience working as a mental health program director in HIV-related clinics, I have seen significant resistance to people accepting mental health services despite having symptoms of depression, anxiety, or other disorders that impact their quality of life. Why is that? My colleagues and I have surmised that it is possibly related to the regrettably continuing stigma around receiving mental health services. “No Estoy Loco!” (“I’m Not Crazy!”) is the name a brochure promoting mental health services at a local agency in Los Angeles. The brochure explains that, contrary to some common belief, you don’t have to be “crazy” to seek mental health counseling, and conversely, those who do are not “crazy” but are the same as everyone else, with the exception of suffering from the symptoms of anxiety or depression.

I’ve also seen a stigma around the use of psychiatric medication, especially among people in recovery from street drugs who claim they don’t want to “get hooked” on antidepressants. While I understand their concern, the proper use of a medication prescribed and monitored on an ongoing basis by a psychiatrist (who is a medical doctor trained in the specialty of mental disorders, just like a dermatologist is a medical doctor trained in the specialty of skin disorders) is not the same thing as self-medicating with a possible impure, unpredictable, illegal and unregulated, addicting street drug. I have always said that antidepressant medications do not give someone a “high” above normal like a street drug; instead, they simply help a person compensate and balance brain neurotransmitter chemicals that Mother Nature has somehow taken away. In this age of increasingly sophisticated medications with fewer side-effects, there is no reason a person should have to suffer needlessly from untreated depression or anxiety.

Another stigma that I have seen against mental health services is among some of the very religious, who believe that receiving mental health counseling is somehow a betrayal of their faith. “I don’t need therapy,” I heard one exclaim, “I just need Jesus.” While a rich and active spiritual life can also be enormously supportive of people living with HIV (and I had heard of other studies long in the past that showed increased survival associated with this), mental health services and spirituality are not mutually exclusive. This schism has been promoted by the Church of Scientology, who disparages the entire field of psychiatry apparently because it “competes” with their brand of cult-like, unscientific self-help, but this is rare.

My bias, of course, is in favor of people seeking mental health treatment because that is how I make my living and that is how many programs survive, by being patronized by the community. However, doing this work has allowed me to see, first-hand with hundreds of clients, the kind of improvements in people’s lives that are described in the above studies. This means real people, getting real help, to alleviate real suffering. Beyond a livelihood, doing this work is an honor and a privilege. My hope is that increased awareness gets help to the people who need it most.

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