Behind Dr. Oz's Curtain

My son's pictures on the Dr. Oz Show, September 9, 2014

What’s Really “Nuts or Normal?”

“Pay no attention to that man behind the curtain.”—The Wizard of Oz, 1939

I don’t watch much television. In the aftermath of September 11, 2001, when I was shocked to see my then four-year old son crash his toy airplanes into towers built of blocks, I decided we didn’t need cable television and 24-hour news anymore. All the news was bad. And the rapidly expanding reality TV genre was worse. My children were raised on a media diet of PBS (delivered via old-fashioned rabbit ears) and DVD science documentaries we checked out from the library.

That being said, I’ve been on television more than some people, usually to talk about the increasingly desperate need to address the public health crisis of mental illness (one of my children has bipolar disorder). I’ve appeared on national media including the Today Show, Good Morning America, Anderson Cooper 360, Erin Burnett, and Al Jazeera America. I’ve done numerous local broadcast interviews, most recently in Bismarck, North Dakota and Cincinnati, Ohio.  

I was even fortunate to be a guest on the Dr. Oz show last year to talk about my book. Though I don't watch much television, I knew who he was, mostly from his syndicated column that appears on Sundays in my local newspaper. And while I was also vaguely aware of controversy about some of the weight loss methods promoted on his show, I didn’t understand why people wouldn’t just do their own research. There aren’t many times the word “always” is appropriate, but I think it’s fair to say that “Get Rich Quick” and “Lose Weight without Diet or Exercise” promises are almost always too good to be true.

I’m a bit puzzled by the credibility that people attach to television celebrities. The medium’s first duty is clearly to entertain; daytime television never even pretended that it had an obligation to educate.  What are your ethical obligations, then, if you’re a daytime television celebrity physician who calls himself “America’s Doctor”? How do you entertain your audience while also upholding your Hippocratic oath to protect the individual patient’s health and privacy?

In light of this flurry of Dr. Oz criticism, including calls for his resignation from the staff of Columbia University’s medical school, my fearless friend and fellow mental health advocate Janine Francolini of the Flawless Foundation has been quick to remind the public of the Dr. Oz show’s truly terrible 2012 series “Are You Normal or Nuts?” in which a panel of “top psychologists” evaluated audience members’ mental health concerns. 

This truly tasteless show echoed an equally tacky Reader’s Digest annual feature by the same name, which trivializes the tremendous suffering experienced by individuals diagnosed with serious mental illness and their families. For example, the 2013 "Normal or Nuts" article led with this charming introduction: “Calling all neurotics, paranoids, and phobics! Our panel of experts says you might not be as loony as you think in this fan-favorite feature.”

And people wonder why there’s still stigma attached to mental illness.

Like Janine, I want Dr. Oz to use his celebrity status to promote mental health. In my personal experience with him, that’s exactly what Dr. Oz did.

“I’m a dad, and this is important to me,” he told me before we began taping a segment discussing my experience as a parent of a child who has bipolar disorder. His approach to my family’s story was overwhelmingly positive, highlighting the tremendous gains my son has made since his diagnosis in May 2013. The audience applauded when I shared that my son has now written a book of his own, a science fiction novel where the Greek gods all have a mental illness that is actually a super power. This is what the correct diagnosis and treatment can mean to parents and children suffering with mental illness. It means hope.

Dr. Oz has tremendous power to shape public opinion about mental health and mental illness. How can we encourage him to use his power for good, like he did for me and my son? When it comes to mental illness, sadly, too many Americans are still like star-struck Dorothy, believing in the all-powerful image of Oz, not willing to look behind the curtain and acknowledge the truth.

I have an idea for this season’s “Are You Nuts or Normal?” producers. Dr. Oz invites panelists to rate people like Judge Michael Bohren, who refused to authorize medical treatment for 12-year old Morgan Geyser, diagnosed with paranoid schizophrenia and locked up away from her family and denied medical treatment for her brain disease for almost a year.

Nuts or normal?

Dr. Oz interviews the six police officers who tasered 130-pound Natasha McKenna, diagnosed with schizophrenia, and asks them to explain why she died in custody. 

Nuts or normal?

Finally, Dr. Oz presents British parliamentary candidate Chamali Fernando so that experts can discuss her suggestion that people with mental illness should wear color coded wristbands. 

Nuts or normal?

The way we fail to treat children and adults with mental illness in this country is what is really crazy. It’s also expensive, not only in financial terms, but also in lives lost, in dreams shattered. Dr. Oz could rebuild his credibility by focusing his attention on this public health crisis, by providing help—and hope—to millions who are suffering with serious mental illness. 

A Modest Apology

Three suggestions for kinder, gentler, more accurate social media posts

Wise words from a man who never said them.

Did you know James Franco is dead? Or that Idaho Governor Butch Otter thinks poor people are genetically inferior? Or that British author Jonathan Swift thinks the solution to world hunger is to eat babies? None of these stories is true, but the first two fake articles from a satirical content producer called City World News made the Internet rounds in the past few weeks and baited more than a few readers. I was one of them. I made the very public and easily avoidable mistake of believing (and worse, tweeting) the story about Governor Otter.

Satire has a long and colorful history, one that has been particularly prominent in the discussion of the tragic terrorist attack on Charlie Hebdo. While hardly anyone would defend shooting cartoonists, for a surprising number of people, the answer to the question, “Can’t you take a joke?” seems to be “no.” In the case of Governor Otter, I didn’t see the satire, perhaps because I spend a significant portion of my time trying to defend the rights of people that society just doesn’t care about. Many of the real news stories that cross my Twitter feed every day—people with mental illness shot and killed by police, or dying in solitary confinement, or being refused treatment in emergency rooms, or facing the death penalty for actions that were a result of their illness—are true.

Anyway, I screwed up. It was mea culpa, and a few of my friends very kindly pointed out my mistake. But one friend was a little less kind. She wrote: “People who blindly promote satire as truth risk diminishing their own validity.” 

At first, I thought her comment was a little harsh. I mean, I work full time, take care of four kids, and in my so-called “spare” time, I’m buried in dissertation research. You know, too busy to check my sources, right?

Wrong. My friend was right. And the thing is, validity and credibility really matter to me. So here are three suggestions I’ve come up with for myself to ensure that going forward, I tweet more responsibly.

1. Don’t send late night tweets. When I read the Otter story, it was at the end of a long day. Work was intense. The kids were fun—but exhausting. It’s entirely possible that I was unwinding with a glass of cabernet when I read the outrageous “article” I retweeted without checking my source. I should have turned the phone off when I got home and enjoyed a good book instead. Lesson learned: No more late night tweets.
2. Always check your sources. As Abraham Lincoln famously did not say, “The problem with Internet quotes is that you can’t always depend on their accuracy.” www.snopes.com is my favorite source for fact-checking urban legends. Lesson learned: It takes ten seconds to check a story on Snopes. But if you tweet something that isn’t true, you may look like a fool on the Internet forever.
3. Be charitable in correcting people who tweet inaccurate information. The challenge with information these days is that it’s moving so fast. My friend’s comment struck me as harsh—but it reminded me that I’ve made similar “You really should have checked your sources” comments in the past on other friends’ posts.  Lesson learned: You don’t always have to be right. Sometimes it’s okay to be kind—to yourself and to others.

We all make mistakes. And though I regret my inaccurate tweet, I don’t regret standing up for the rights of people who are treated unfairly. I’ll continue to tweet about social justice, while following my own advice about slowing down and checking my sources—and hopefully my followers will not feel that my validity and credibility are too tarnished by one mistake. 

(And with respect to Governor Otter and City World News, props to the person who got me to tweet a false story that points at a larger uglier truth! Jonathan Swift would be proud!).

Knock Knock, Who's There?

Law enforcement officers are first responders
for  mental illness.
Photo by leila haj-hassan, freeimages.com

When your child has a mental illness, too often it’s the police

Last night, I was abruptly awakened at 4:00 a.m. by the sound of my doorbell ringing. Confused with sleep, I struggled to pull on a pair of jeans as the doorbell rang again, followed by an insistent knocking.

“Who is there?” I said as I stumbled to the door.

“The police,” a firm male voice responded. “Open up please, ma’am.”

My heart froze. “Where’s my son?” I thought, panicked.

I slowly opened the door to see two police officers. “Can I help you?” I asked.

“Is that your car, ma’am?” the female officer asked, gesturing toward my grey Suzuki.

“Yes,” I replied.

“The door is open,” the male officer said. “Will you check inside and see if anything is missing?”

My heart started beating again. It wasn’t anything serious; my son had just forgotten to close the car door behind him, like he forgets so many things: dishes on the table, cupboard doors open, sometimes even the refrigerator or freezer gaping wide, sending my electric bill sky high.

My 14-year old son has bipolar disorder. For years, he experienced unpredictable, violent rages. The police have been frequent visitors to our modest suburban townhome. Sometimes they have taken him to the emergency room. Sometimes they have taken him to juvenile detention. Every time, my family has been afraid.

This morning, I read a poignant post on helicopter parenting of adult children with mental illness—one that I am afraid will be my experience in a few years. Karen Easter, a Tennessee mom-advocate, wrote this about  her son:

[O]n bad days, when it is apparent he hasn't been taking his meds, I have no other choice but to put on my helicopter mom hat.
In fact, I have never liked this hat.
Did I mention I really, really despise hats?
Hey, wait just a minute ... I should NOT have to be wearing this hat AT ALL!
But I wear it because right now this very minute, I must hover to keep him safe--only because the system has failed him and our family miserably. I don’t really want to wear this hat.

For so many parents of children with serious mental illness, this last week of August is a nail-biter as we wait to see whether Congress will do the right thing and pass Representative Tim Murphy’s proposed “Helping Families in Mental Health Crisis” Act. Here are some of the critical reforms that Representative Murphy’s bill provides:

Revising HIPAA Laws and Medicaid Reimbursements

Privacy laws in healthcare prevent parents from getting crucial information that they need to help their adult children in crisis. And the Medicaid IMD exclusion has directly caused an acute shortage of inpatient psychiatric beds for patients with mental illness who need treatment. Today, there are only 40,000 psychiatric beds available in the nation. If my son required longer term care, he would have to go hours away from my home. This is true for many families.

Providing Alternatives to Institutionalization through AOT

Assisted Outpatient Treatment (AOT)  is a proven alternative to keep people stable and productive in their communities. The opposition to Rep. Murphy’s bill has labeled this provision as “forced treatment.” It is not. AOT laws are already on the books in 44 of 50 states and “require mental health authorities to provide resources and oversight necessary so that high-risk individuals with serious mental illness may experience fewer incidents and can live in a less restrictive alternative to incarceration or involuntary hospitalization” 

A few weeks ago, I spoke with a young woman who opposed my views on AOT. She had been in a psychiatric hospital for more than a month and felt that the care she received was “horrible.”

“Have you been to jail?” I asked. She admitted that like many people who have mental illness, she had.

“Which did you prefer?” I asked.

“The hospital,” she responded without even hesitating. But she made a good point: our current in-patient hospitalization practices, while not as horrible as the psychiatric institutions of yore, could still use some serious makeovers in terms of both physical facilities and therapeutic practices. One of my friends with bipolar disorder has envisioned a therapeutic hospital that would feel more like a spa, where people could stabilize in safety while also continuing to work remotely or go to school—to do the things that give everyone’s life meaning and purpose. Similarly, AOT aims to keep people in their communities, not force them into institutions.

Restructuring SAMHSA funding

I have already expressed my frustrations with SAMHSA and how they fail to provide assistance to the most critically ill patients and their families.  Representative Murphy’s bill restores accountability by tying funding to evidence-based practices that actually help people with mental illness to manage their conditions and live productive, healthy lives. Far from discouraging innovation, as the opposition warns, this provision will actually encourage organizations to build program evaluation into their practice, providing data about what works—and what doesn’t—so that we can focus on helping people to make their lives better.

Let me give you an example from my own state. In an effort to save money, Idaho contracted with Optum to manage its Medicaid mental health care. Optum looked at one service, psychosocial rehabilitation, or PSR, and decided that it was overused and often not medically necessary, especially in children. 

PSR had historically been used as a “catch-all” for children with serious emotional disturbances or behavioral issues. The result of this abrupt PSR denial was that families suddenly found themselves without a service they felt was necessary to their children’s health.

What did the evidence say? Because there were never any requirements to track outcomes, the state merely logged hours and made reimbursements. It turns out that no one really knows what PSR is in Idaho, let alone whether it is effective. Every agency essentially acted independently, developing their own model in the absence of standards for care. Two researchers did find significant clinical improvements for kids on PSR. But they only looked at one of many models. 

Tying outcomes to funding would have provided much-needed data on whether PSR works in children. If the data had been positive, we might have an additional valuable tool to help children function better in the community, a tool we could share with other communities to improve everyone’s care.

Representative Murphy’s bill was forged after the tragedy of Newtown, which also sparked my own desire to advocate for my son. As I researched the myriad problems that plague our system for my forthcoming book, I repeatedly found the same tragic story: poverty, mental illness, and prison. America’s incarceration rates when compared to other so-called first world countries are quite literally off the charts, with more than 2.4 million people in prison. 

If ever there was a truly bipartisan cause, it’s mental health. Fixing our broken mental healthcare system promises to ameliorate so many of the other social ills that harm children, families, and communities. A new advocacy organization, Treatment Before Tragedy, is sharing stories of families like mine, whose children are suffering.  If you are a family member of someone who has mental illness, I encourage you to join this organization and to share your story on Twitter, using the hashtag #Tb4T.

And if you haven’t, please call your representative personally and ask him or her to cosponsor Representative Murphy’s bill. Right now, if your child is in mental health crisis, your only options are to call the police or to go to the emergency room. We can and must do better for our children and families. No family of a child with mental illness deserves that dreaded knock in the middle of the night.

The Answer

What do you get when you multiply six times nine?

May 11, 2001, the day Douglas Adams died

When I was 12 years old, a Mormon missionary gave me a book that would change my life forever. No, I’m not talking about The Book of Mormon; I’m talking about Douglas Adams’s Hitchhiker’s Guide to the Galaxy. Thanks to this book, I always travel with a towel. I generally don’t panic. And I know that it’s okay that I can never quite get the hang of Thursdays (I really can’t).

I just turned 42 (thank you for asking!), and already I have a feeling it’s going to be a bang-up year. For those of you who haven’t read Adams’s four-book trilogy, 42 is The Answer to the Ultimate Question, the question of Life, the Universe, and Everything. This is my year to be the Answer.

Only it turns out that no one really knows what that pesky question is.

And that’s okay. I don’t know what the question is either, and I don’t want to know. Who am I, why am I here, and where am I going? Not particularly interesting to me anymore. More interesting: where shall we hike? What shall we drink? And where shall we go for lunch?

The day after my birthday, The New Yorker published Andrew Solomon’s intense, compassionate interview with Peter Lanza, Adam Lanza’s father. In light of my viral December 14, 2012 blog post, Time.com asked me to write a response. It seemed like all the major news outlets focused on a few sensational quotes (shocking!), which I feel were taken out of context. Take Yahoo News, for example: "Conn. shooter's dad: 'You can't get any more evil." 

I focused instead on Peter Lanza’s inability to find answers, on how a “normal weird kid” who was loved by both parents became a killer. Because that’s what life is like when you have a child with mental illness. There are no easy answers.

This is the year I’m finally starting to feel comfortable with my ambiguities, in my 15-pounds-too-heavy body. My children aren’t little anymore. We’ve left Thomas the Tank Engine and Dora the Explorer behind, trading them for Sherlock, Dr. Who, and Battlestar Galactica. We still like the Lego movie, but in that “ironic/cool we are way too old for it” sort of way.

This is the year I’m finally not afraid to say what I think. Guns on Idaho college campuses? It’s an expensive, moronic example of unwarranted government intrusion. Gay marriage? Though I pride myself on trying to see all sides of an issue, I really cannot understand a single argument against it. Mental illness? Sometimes we have to talk about violence, even when we don’t want to.

Douglas Adams died in 2001 at the age of 49 while working out in a Santa Barbara gym. The day he died, I took my two boys, then ages two and four, to the Santa Barbara zoo where I took the picture above.  That picture, my boy and a gorilla, still brings me to tears. I don’t know what it means, or what questions it answers. But I do know that I never want to feel like Peter Lanza did. I never want to wish my children had never been born. I never want these pictures to disappear, or this narrative we've shared so far to lose its meaning.

For a writer, 42 is young. When I was 22, I thought I was a great writer, but what can a 22 year old know? The truth is that I know so much less now, but I am so much more compassionate and accepting. So if you need a towel, let me know. Mine’s big enough for two.

Lent by Proxy

What if I want to give up everybody else’s annoying habits for Lent?

‘Tis the season when I start thinking about what Father Len likes to call “weeding the garden.” Yes, it’s officially the Lenten Season, and as a relatively new Catholic, I still look forward to these 40 days of fish on Fridays, culminating in a glorious celebration of renewal and rebirth that is Easter. Like a lot of my Facebook friends, I’ve spent the past few weeks thinking about what to give up for Lent, with the full knowledge that whatever I choose may end up leaving my life permanently, and that might be a good thing.

Some of my friends are giving up Facebook. Not me. I don’t need that kind of personal growth (though I think I should negotiate full credit with God for all 40 days if I agree to give up my smartphone for a weekend).  

There’s the obvious stuff: sugar/wine/coffee/refined carbohydrates or whatever else is keeping a few extra pounds on my waistline while also greasing the wheels of my incredibly “intense” (my fiance’s carefully thought out word choice, not mine) lifestyle.  If I take the results of this Buzzfeed quiz as valid, I should give up caffeine. Really? I’m a mother of four children, in graduate school, working full time, and on the planning committee for Idaho’s Children’s Mental Health Week in May. I think there’s a scripture somewhere, probably the Book of Esther, that says, “Thou shalt not give up caffeine for Lent, lest thou drive thy coworkers crazy.”

In fact, I’m going with Father Len on this one. In one of my favorite homilies of all time, he said not to give up chocolate or wine or things that make you happy, because that’s not what Lent is about. Lent is actually a celebration. We are celebrating the death of our sins, the weeding of the soul’s garden, a new simplicity in our relationship with ourselves and with God.

When my kids asked me about what I planned to give up for Lent, I said, “I’m giving up your Xbox. I’ve decided on Lent by proxy.” Hey, I was raised as a Mormon, and we used to baptize people who were dead—why not outsource Lent?

This year, I can think of plenty of things other people ought to give up, starting with fear, hate, and bigotry that has characterized this year’s session of the Idaho Legislature.

But that’s not the point. Neither is telling everybody what you’re giving up. The point is the journey. The point is simplicity, reflexivity, self-awareness.

In that spirit, I recall some of the more meaningful Lenten journeys I have taken. One year I decided to give up dating, after a string of unhappy and unfulfilling relationships with men who could definitely be described as invasive species. Three years later, I looked at a kind, joy-filled friend and realized I was hopefully (not hopelessly) in love. And now we are planning a wedding. If by planning, you mean, which lake should we hike into?

I will freely admit that I am kind of God-challenged, meaning I just can’t quite buy in to the idea of a big man in the sky telling me what to do. But I can totally understand the statement, “God is love.” If God is love, then Lent is an act of love, of self-abnegation, not glorification. I’m not going to give up caffeine. I’m not going to give up my kids’ Xbox. I’m going to pull some weeds, to work on things I need to work on. And what those things are is none of your business. In the words of Voltaire, "Let us cultivate our gardens."