In the last few weeks, talk of illnesses like depression and medicines like Zoloft have become almost routine on the Senate floor, as Congress debates a bill intended to make insurers cover mental illness the same way they do traditional ““physical’’ illnesses like heart disease and cancer (page 23). Senators from across the political spectrum have told the stories of suffering that have prompted them to support the legislation: Sen. Alan Simpson about a niece who killed herself, Sen. Paul Wellstone about visiting his brother in a psychiatric ward.
Whether or not the bill becomes law, it is a landmark in the history of this stubborn, centuries-old stigma. Elected officials now feel safe discussing mental illness in the family – though seldom their own problems. Even more powerful are the first-person accounts of patients themselves who have been there – and back. While cheap confessions have become a staple of afternoon talk shows, many prominent Americans have now taken to telling their stories in the hopes that ordinary citizens can face their families, friends and, finally, the boss. In the last few years, Wallace and Styron have been joined by a growing list of those who’ve not only ““come out’’ about their illness but have gone on the hustings. Since 1994, Academy Award winner Rod Steiger has traveled across the country, speaking about his eight years of depression, about pain ““so brutal, it flays you. It skins you alive.’’ Singer Naomi Judd, Heisman winner Earl Campbell and ““Baywatch’’ star Vince Van Patten have described panic disorders that trapped them inside their homes. Ted Turner has talked about his manic-depressive illness.
The message: mental illness is a disease, not a failure of character. And a disease that, in many forms, has proven to be a tractable enemy. From chronic, low-grade depression that can quietly steal a life to the terrifying hallucinations of schizophrenia, there are answers. Life can become not only possible but pleasurable. The hope, says Bob Boorstin, a former Clinton staffer who has talked about being hospitalized for manic-depressive illness, is that the 1990s could be for mental illness ““what the 1980s were for alcoholism. That people will realize that it is a disease … that, in fact, seeking treatment would almost become chic. [In the ’80s,] Betty Ford was the place to be seen.''
That day may still be far off. But the climate is certainly changing. In 1972 Sen. Thomas Eagleton was knocked off the Democratic presidential ticket when he acknowledged that he’d been depressed, and treated with electroshock therapy. But when Newsweek, among others, reported last fall that Alma Powell, wife of a could-be presidential candidate, suffered from depression, she and her husband appeared at a nationally televised press conference and casually said it was so. ““My wife has depression. It is not a family secret,’’ said Colin Powell. ““It is very easily controlled with proper medication, just as my blood pressure is.''
The new candor about mental illness is not just a product of our increasingly confessional society. As scientists have found ways to photograph the brain’s activity and have developed more effective pharmacology, they have convinced much of the public – and patients themselves – that brain disorders are more a matter of genetics and biochemistry than of willpower or child rearing. In addition to Prozac, which treats depression and panic disorder and is now a household name, there is Anafranil for obsessive-compulsive disorder, clozapine for schizophrenia and, most recently, Depakote for mania. The National Institute of Mental Health says, for example, that 60 percent of people medicated for schizophrenia improve, compared with only 41 percent of patients given angioplasty for heart disease. Therapy has changed, too, from the daunting idea of endless years on a couch to a variety of treatments, often short-term, and as accessible as your friendly, talk-show shrink.
Still, going public is a complicated business. The support of family and friends is critical, says Boorstin, now a top aide at the State Department, as is successful treatment. Then ““you can say, ‘I have this illness; watch me function.’ You’re sitting there in a suit and tie, looking normal.’’ It also helps to be in the right field. The arts and Hollywood are probably the most tolerant. When Rod Steiger decided to go public two years ago at 69, he says, ““my agents went berserk. In this town, if people are unsure of you, your career is over. Everybody thinks, ‘He won’t be salable; he won’t be marketable’.’’ But Steiger wasn’t blacklisted. His next feature is Tim Burton’s ““Mars Attacks!’’
Hollywood is cake compared with more traditional territory. Corporate America may be the least forgiving. ““Men go so far as to drive their secretary’s car’’ to an appointment ““and pay with cash for fear of being detected,’’ says Steven Berglas, a Boston psychologist whose patients are high-powered business types. In the macho cultures of law and investment banking, he says, ““if you admit vulnerability, you’re a pariah.’’ For politicians, ““it’s very realistic not to come out,’’ says Kay Jamison, a psychologist and leading authority on manic-depressive illness, who spoke out for the first time about her own mania and depression in her memoir, ““An Unquiet Mind.’’ Florida Gov. Lawton Chiles revealed that he was taking Prozac during his 1990 campaign only because his opponent insisted he release his medical records.
But for someone who has told lies and kept secrets for years, going public can give a stunning sense of freedom. ““I can say what I’m thinking. It’s exhilarating,’’ says Jamison. It can be almost as momentous for those who feel they can’t afford the truth. Every celebrity who comes out is the instant confidant of thousands of strangers who write or call. After Naomi Judd appeared on ““Larry King Live’’ recently, the reaction was ““unbelievable,’’ she says. Locals gathered at her Nashville restaurant, Trilogy, even though she was out of town, her husband told her. ““He said you could see it in their eyes, the desperation. I’ve had people come up to me on the streets, in the airports, even one of the security guards backstage,’’ all want- ing to share their stories.
Many of those stories will remain untold. Yes, the ““stigma’’ is fading, says Styron, likening it to the once unmentionable cancer. But slowly. One best-selling author in his 40s with obsessive-compulsive disorder told News- week about losing years of his life, of leaving his apartment 20 times in an evening to go down and check the locks and lights on his car, prompting the curiosity of police. Now much improved, he has come out to family and friends. But, he notes, the only public figures who have revealed that they have OCD are Howard Stern and Rose- anne, ““not the ideal poster children.’’ The problem: ““OCD looks weird. [The image of] a depressed person is just someone sitting around, looking sad. It’s not like anyone wants to picture [their hero] standing in a shower for 16 hours’’ because he feels contaminated. The best-selling author is an expert at what some in the mental-illness underground call ““passing.’’ He plans to do it for the rest of his life.
A landmark federally funded study reported that about one in five Americans suffered from some form of mental illness during the course of a year.
NUMBER PERCENT OF MENTAL DISORDER (IN MILLIONS) POPULATION Anxiety: phobia, panic disorder, 23.0 12.6 obsessive-compulsive disorder Depression: manic-depression, 17.4 9.5 major depression, dysthymia Severe cognitive impairment 4.9 2.7 Antisocial personality 2.7 1.5 Schizophrenia 0.4 0.2 Somatization (hypochondria) 0.4 0.2 TOTAL: 40.4 22.1
title: “Breaking The Silence” ShowToc: true date: “2023-01-26” author: “Joseph George”
Ifoli may be extreme behavior, practiced by a minority. But the casual manner in which South African teens discuss coercive relationships and unprotected sex is staggering, and reflects a crisis within a crisis. Adolescents everywhere are occasionally oblivious to their own mortality, and the youth of southern Africa are no exception. But what is abhorrent or risky behavior elsewhere can be suicidal–or homicidal–here. Sub-Saharan Africa faces the worst AIDS plague on the planet, and South Africa is one of the worst-hit countries. Some 4.2 million South Africans are living with AIDS, and the overall HIV-infection rate has jumped to nearly 20 percent, from 13 percent in 1998.
Appalling new statistics on the AIDS crisis will be a special focus of this week’s 13th Annual International AIDS Conference in Durban, South Africa. The theme is “Break the Silence.” UNICEF will make news by announcing results of a recent study on the spread of HIV among young people. Those figures will underscore mortality projections announced two weeks ago by UNAIDS, the Geneva-based umbrella organization. Among the findings: HIV infection rates are far higher among African teenage girls than among boys, in part because of physiology and also because the girls often have sex with older men; and about half of all 15-year-olds in the worst-hit countries will die of the disease. AIDS already has left more than 12 million orphans. Other studies are equally alarming. In Luanshya, Zambia, missionary Robert Bona recently tested 200 teenage schoolgirls for HIV. All but four were HIV-positive.
That makes 196 more teenage girls among millions of walking dead. There is no vaccine for AIDS, and severe poverty and grossly inadequate health services put the most effective treatments for prolonging the lives of people with HIV beyond reach for the overwhelming majority of Africans. In the absence of a cure, prevention is far and away the best way to combat the disease. And prevention can mean only one thing: changing sexual behavior and attitudes.
That’s a battle many African governments have been hesitant to wage. In South Africa, politicians have been slow to treat AIDS with the urgency it deserves–and President Thabo Mbeki has recently come under fire for flirting with controversial theories about the causes of AIDS. But leaders have publicized the dangers of unsafe sex. In the early 1990s the new black-led government was preoccupied with making a peaceful transition from white-minority rule. Nonetheless it put a nationwide AIDS-awareness program in place. Information was delivered via “life skills” classes in public high schools. Posters went up that mimicked liberation slogans: viva condoms! Nearly every public official in South Africa, from Mbeki down, has worn a red AIDS ribbon.
Yet those and other efforts to break through to teenagers about the dangers the young face–and about the right of a woman to refuse sex–have so far proved no match for custom, cultural confusion and peer pressure. “They say, ‘We are going to die anyway, so what’s the use of using a condom’,” says Sheila Mathemba, 20, of the Viros, a township rap group. “They say, ‘Unless it’s flesh on flesh, it’s not real sex.’ They don’t want to take responsibility.” The group’s latest song declares: “AIDS is going to kill you–you vibe [party] and vibe all these weekends, but you don’t care about yourself.”
Why has the safe-sex effort failed so abjectly? The best answer may be that changing the way people act during their most private moments isn’t easy under the best of circumstances. “I don’t think we know about what influences behavior and how to change behavior,” says Dr. Dave Pinchuck, a psychologist who heads a clinic serving schools in the impoverished Cape Flats. “There is so much coercion. For a lot of girls there is no choice.”
Deeply ingrained customs and modern upheavals have both fed the crisis. In many precolonial African societies, it was common for successful men to take multiple brides, sometimes by paying a dowry–usually cows–to members of the bride’s family. In some cultures, widows were expected to become the wives of a brother-in-law or other relative. Many such practices now survive alongside imported beliefs, which can also be controversial: Roman Catholicism, for instance, forbids the use of condoms. The problem of reaching South African teenagers, in particular, may be exacerbated because of the recent political past. The country suffered what Mbeki has called a “moral collapse” during the apar-theid years, when the government insti-tutionalized racism. Black children were encouraged to reject authority, and adults have had a hard time restoring control.
Violence against women has become all too common–and accepted–by young people of both sexes. According to a three-year study released last month by Johannesburg’s Southern Metropolitan Local Council, eight out of 10 young men think women are responsible or partly responsible for causing sexual violence. Twelve percent of young women believe they have no right to avoid sexual abuse, and more than half of the young people interviewed–both male and female–believe that forcing sex with someone you know does not constitute sexual violence. There is often a double standard at work: men are frequently proud to have mistresses, yet they also consider it shameful to a family when a person dies of AIDS. For that reason physicians often falsify death certificates of their patients, obliquely marking the cause as “heart failure” or “stopped breathing.” The teenagers most at risk think they don’t know anyone who has died of AIDS. “People choose not to look into the face of the monster,” says Roland Jethro, a history teacher at Guguletu Comprehensive High School near Cape Town.
Frank talk with students at Guguletu Comprehensive is eye-opening. Many boys want to have a “bestie”–No. 1 girlfriend–and secondary girlfriends, known as the “bread.” Girls want one boyfriend for love, one to “stun”–or look good with–and others for backup in case their boyfriends leave them. Girls complain that their boyfriends won’t use condoms, especially if they’ve been partying. “Sex with a condom,” says one young man, “is like eating a sweet with the wrapper on.” A new national survey of people 15 to 30 found only half said they had used protection the last time they had sex–a figure that may be high.
South African officials insist they’re finally seizing the nettle of sex education. The new strategy focuses on talking the kids’ language, and using deejays and others with credibility among teenagers to spread the word. Straight talk–and street talk–may not be enough, however. South Africa’s best-known singer, Miriam Makeba, plans to invite pop stars to an AIDS-awareness concert this fall in Pretoria, where the singers will also tape public-service announcements to be aired around the continent. But what teenagers really need, Makeba says, is to be terrified. “We have to have people see someone who is about to die from AIDS, and that person must tell the story,” she told NEWSWEEK. “We have to shake them and show them that this thing exists and it kills, by showing them someone talking… from their deathbed.” In the best-case scenario, South African kids will eventually think it’s cool to look the monster square in the face, and live to tell the tale.
