By the numbers

Who are the mentally ill? They are our neighbors, friends, family — and us. Put five people in a room and one has suffered from a mental illness in the past year.

One in five adults (46 million Americans) experiences mental illness each year.

One in 17 suffers serious mental illness such as schizophrenia, major depression or bipolar disorder.

One in 10 children lives with a serious mental or emotional disorder.

The rate of mental illness is more than twice as high among those aged 18 to 25 (29.9 percent) than among those 50 and older.

Less than one-third of adults and half of children with a diagnosable mental disorder receives mental health care in a given year.

Half of all lifetime cases of mental illness begins by age 14, three-quarters by 24.

More than 50 percent of students 14 and older with a mental disorder drop out of high school — the highest dropout rate of any disability group.

24 percent of state prisoners and 21 percent of local jail prisoners have a recent history of mental illness.

70 percent of children in juvenile justice systems have at least one mental disorder.

The annual economic, indirect cost of mental illness in the U.S. is about $79 billion, mostly in lost productivity.

Adults living with serious mental illness die 25 years earlier than other Americans, largely due to treatable medical conditions.

An estimated 8.7 million American adults had serious thoughts of suicide in the past year. Of them, 2.5 million made suicide plans, and 1.1 million attempted suicide.

Sources: Substance Abuse and Mental Health Services Administration, National Alliance on Mental Illness, National Institute of Health, U.S. Department of Health and Human Services, National Center for Mental Health and Juvenile Justice

Exhaustion weighs her down until she gets out of bed. Trudging to the shower and going down the grocery store aisles feel like a long slog through dark molasses.

Major mental illnesses

Mental illness refers to a wide range of disorders that affect mood, thinking and behavior. More common ones include:

Attention-deficit/hyperactivity disorder: Characterized by inattention, hyperactivity and impulsivity. Strong scientific evidence indicates ADHD is a biologically based disorder. Research also suggests a strong genetic basis.

Bipolar disorder (formerly known as “manic-depressive disorder”): A major mood disorder in which a person experiences episodes of depression and mania (extreme irritability or euphoria). Likely caused by an imbalance of neurotransmitters or hormones. Trauma and major loss may play roles.

Major depression (known as clinical depression): A combination of depressed mood, poor concentration, insomnia, fatigue, appetite disturbances, excessive guilt and suicidal thoughts. Depression is twice as common in women for reasons not fully understood. Likely caused by biological differences in the brain along with trauma or major loss.

Post-traumatic stress disorder: Severe or repeated exposure to trauma can affect the brain in a way that makes a person feel like the event is happening again and again. Can induce anxiety, sleeplessness, anger or substance abuse. PTSD can affect everyone from survivors of sexual trauma and natural disasters to emergency and rescue personnel and military veterans.

Generalized anxiety disorder: A severe, chronic, exaggerated worrying about everyday events. Likely caused by genetics, brain chemistry and environmental stresses.

Obsessive-compulsive disorder: Obsessions are intrusive, irrational thoughts or impulses that repeatedly well up in a person's mind. Compulsions are repetitive rituals such as handwashing, counting, checking, hoarding or arranging. Evidence suggests that OCD is caused by a chemical imbalance in the brain. People whose brains are injured also can develop OCD.

Panic disorder: Feelings of terror that strike suddenly and repeatedly with no warning. Symptoms include sweating, chest pain and irregular heartbeats. More common in women. Brain abnormalities, family history, major life stress and abuse of drugs and alcohol may play roles.

Schizophrenia: A group of severe brain disorders in which people interpret reality abnormally. May result in hallucinations, delusions and disordered thinking and behavior. Likely caused by differences in the brain, genetic vulnerability and environmental factors that occur during a person's development.

Personality disorders

Borderline personality disorder: Characterized by unstable moods, interpersonal relationships, self-image and behavior.

Antisocial personality disorder: A person's thinking and relating to others are abnormal and destructive, such as disregard for right and wrong, lying and behaving violently.

Narcissistic personality disorder: Characterized by an inflated sense of self-importance and a deep need for admiration.

Personality disorders are thought to be caused by genetic and environmental factors.

Sources: National Alliance on Mental Illness, Mayo Clinic, WebMD

The heaviness caused by major depression has come and gone throughout Lisa Livingston Baker's life. And when her husband died in 2008, she could not even lift her body from her bed.

First in a series

The mentally ill are under pressure and scrutiny like never before. Mental health budgets have been slashed. State inpatient beds are at historic lows. Emergency rooms and jails are the new front lines of care. In the wake of mass shootings — and would-be school shooters such as Alice Boland — some want registration of the severely ill.

But there is promise for change. State funding may increase. Research is showing these illnesses are based in flawed physiology, not character flaws. And many who suffer are challenging the stereotypes that affect them.

The Post and Courier is examining these issues in a series of stories over the next few months. We start with the stigma and its undercurrent of shame.Join the discussion about this story and other mental health issues at Jennifer Berry Hawes' Facebook group.

She blamed herself.

The master's-educated teacher struggled to raise her three girls as she took medications and entered therapy. Books and tapes about coping amassed beneath her bed.

“I've done it all,” the Summerville mom sighed. “And how many more Lisas are out there?”

Millions. One in four adults experiences mental illness in a given year. One in 17 suffers serious mental illness such as schizophrenia, major depression or bipolar disorder, according to the U.S. Department of Health and Human Services.

And at perhaps no other time have they received more public attention than today.

Megachurch Pastor Rick Warren's son committed suicide a week ago after a long battle with major depression.

Lawmakers are debating mental health care funding, gun control and registries of the mentally ill. And last week, 9th Circuit Solicitor Scarlett Wilson voiced doubt that the state can fully rehabilitate the violent mentally ill.

What does all this attention mean for the average person with a mental illness, suffering amid a public that stigmatizes them?

Baker can't count how often she's heard:

Buck up. Get over it. Just cheer up!

“People make you feel bad about yourself — and you make you feel bad about yourself,” Baker said. “I'm not a bad person. I'm not lazy or weak. I'm a good person. I'm trying.”

She recently joined a clinical trial at the Medical University of South Carolina that administers a brain stimulation treatment based on researchers' improving knowledge of the brain as a highly complex electro-chemical organ, one that can malfunction just like any body part.

After receiving most of her treatments, Baker can laugh again. She even tackled her taxes.

And it's not just the relief. The boost proves to her that the depression is caused not by personal failure, as stigma insinuates, but rather by malfunctioning brain circuitry.

It's proof that the illness isn't her fault.

Biology trumps

Dr. Mark George trained in psychiatry and neurology. He doesn't see a distinction between the two.

Both deal with disorders caused by dysfunctional brain circuitry. So why are neurological disorders — Parkinson's disease, for instance — viewed without the stigma that clouds others like depression and bipolar disorder?

“Stigma is really hard for me to deal with. I've trained across these disciplines, and to me it's all the same,” said George, director of MUSC's Center for Advanced Imaging Research and its Brain Stimulation Laboratory.

Stigma stems from historical misunderstandings, such as when people thought the mentally ill were inherently weak-minded or evil, or when George's medical school professors taught that the brain was a fixed organ, incapable of changing and repairing itself.

Not true.

Modern imaging technology is allowing researchers to track the brain's activity and to examine its wiring, structures and tissue micro-architecture to see exactly what is going on inside a living, thinking organ.

It has revolutionized knowledge of psychiatric disorders.

“The brain is really the last frontier in medicine,” George said.

What is now clear to researchers is that malfunctioning brain circuitry, and its interplay with genetics, trauma and environmental stress, plays a major role in many illnesses, including depression, anxiety and addictions. A new mantra rising among medical professionals calls mental illnesses “brain disorders.”

“We have these powerful imaging tools so we can see all of these things,” George said. “This new understanding should make people wake up to stigma.”

For instance, when imaging showed differences in the brains of people with attention deficit hyperactivity disorder, it indicated that the problem wasn't bad parenting or a lack of discipline. It was based in physiology.

“That was huge. Imaging can add that legitimacy,” said Joseph A. Helpern, professor and vice chairman for research in radiology and endowed chair in brain imaging at MUSC.

Today, MUSC psychiatry is the largest research department in its College of Medicine, and is especially known for research of addictions and imaging techniques. And just this month President Barack Obama announced his BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative to map the brain's activity in unprecedented detail.

So much research promises better understanding of this final frontier, and new treatments for when its circuits malfunction.

“In mental illness and addiction, the brain is different,” said Rhonda Faughender, clinical director for adult services at Palmetto Behavioral Health System. “But we can retrain our brains.”

Which means there is hope for people like Baker.

Biology of change

Baker sits in a small room in the Institute of Psychiatry lying on what resembles a dentist's chair.

Dr. Baron Short, clinical director of MUSC's Brain Stimulation Services, positions a plastic block containing an electromagnetic coil onto the upper left area of Baker's forehead. She wears neon yellow earplugs to block out the rapid and fairly loud tapping of electrical pulses that penetrate her scalp and skull.

Brain tissue lacks pain receptors, so she can't feel where the pulses penetrate into her prefrontal cortex, the upper front area of the brain.

Coils pulse for four seconds, then quiet for 20. The sensation on her skin is irritating but not painful, Baker said, like getting snapped by a rubber band.

Transcranial Magnetic Stimulation, recently approved by the FDA for the treatment of depression, aims to rouse the prefrontal cortex. It is considered the brain's CEO, responsible for abstract thinking and regulating behavior and emotions, and it tends to be underactive in people with depression.

This underactivity, in turn, appears to affect the brain's limbic system, a primitive area often called the “feeling and reacting brain” that is important in memory formation. This area tends to be overly active in people with depression.

“We're helping the brain re-regulate itself,” Short explained.

Brain stimulation may hold promise in treating other illnesses, including addiction, which imaging indicates is another form of brain disorder. This also could change societal views of addiction — after all, when it comes to stigma, few disorders carry more shame than drug addiction, George said.

Yet it appears that some people are predisposed to addiction due to overly active brain regions that control craving and desire, while impulse-control areas are not as active. Researchers are testing ways to correct this circuitry just as they are with depression and other illnesses.

On Monday, George and a team of researchers will publish a study in the journal Biological Psychiatry that showed high-frequency TMS significantly reduced nicotine craving even in heavy smokers.

“People still think it's about bad behavior and not an illness,” George said. “But it's not you. It is a part of the brain that needs to exercise differently.”

Surviving stigma

Today, when someone is released from a psychiatric hospital, there are no sympathy cards in the mail, no meals provided by friends, no flowers or well-wishers eager to visit.

Often, there is only the suffocating silence of fear and rejection.

“We as a people don't look at mental illness as an illness. If we just pull up our bootstraps and go, we can go. And it's so untrue. It's an illness just like heart disease or cancer,” said Wanda Brockmeyer, emergency services director for Roper St. Francis Healthcare.

When Baker turned 50 recently, she cried.

“This isn't where I wanted to be,” she said. Then she reminded herself: I'm not a loser.

She wonders if others see her that way.

“Imagine if you said to a person, 'If you had only been stronger, you wouldn't have gotten cancer,'” Baker said.

She agreed to share her story here to challenge the stigma, to remind people that those with mental illness are parents, children, neighbors. And that their illnesses aren't their fault.
