Consumerism for neurobiological disorders. An assessment.

Consumerism is a growing phenomenon in U.S. health care, yet its exercise is still inhibited by powerful forces within the medical community. Despite the neuroscientific framework that stresses the commonalities between mental and physical illness, consumerism is even more problematic and difficult in mental health care than in other areas of health care. People with severe mental illness and their advocates must contend with limited public understanding of neurobiological disorders, poor definitions of effective treatment, and a paucity of outcome data, especially from prospective randomized and long-term studies. The only clear way for consumerism to grow in mental health care is for its advocates to align themselves with the neuroscientific revolution and to demand that effective and equitable treatment programs be created based on the documented evidence of the physical nature of neurobiological disorders.

Donizetti and the music of mental derangement: Anna Bolena, Lucia di Lammermoor, and the composer's neurobiological illness.

The composer Gaetano Donizetti, who died in a state of mental derangement due to neurosyphilis, created some of opera's greatest scenes of psychosis. His letters reveal the clinical progression of his neurobiological illness, which was confirmed by autopsy. One can hypothesize that the composer's brain disease, which led to his psychosis and death, may have had an influence on his ability to create the powerful and unforgettable scenes of psychosis in his operas. In Anna Bolena, he captured in musical and dramatic terms Anne Boleyn's historically corroborated mental disorder during her imprisonment in the Tower of London. Sixteen years after having composed Anna Bolena, Donizetti himself would be locked up, against his will, in a mental institution. In Lucia di Lammermoor, Donizetti portrayed a girl given to hallucinations who, in her unforgettable "mad" scene, comes on stage, a pathetic embodiment of a human being in the throes of psychosis. Thirteen years after Lucia's première, Donizetti would die, psychotic and paralyzed, of untreated neurosyphilis. Studying Donizetti's neurosyphilis and the portrayals of psychosis in his operas can help one to appreciate the pain of human beings trapped in the prison of a brain subjected to the devastation of mental derangement.

The need for specialists in biologically-based brain diseases.

Because neuroscience research has documented that mental illnesses are biologically-based brain diseases, our country should start training programs to create BBBD specialists. The National Alliance for the Mentally Ill has proposed a 2-track training system for psychiatric professionals--(1) A BBBD track and (2) a "mental health" track.

Guilt--in the company of Puccini's doctor.

A physician may feel guilt and sorrow if he contributes, though innocently, to a patient's death. One radiation therapist, whose famous patient died, finds a parallel to his own experience in the case of the opera composer Giacomo Puccini, who died while being treated for cancer by his well-meaning radiotherapist.

"Should I have an affair?" A case study.

Forced to face the possibility of dying of cancer soon, a patient may question previous values and practices. A medical practitioner can learn a lot from such patients about fear, guilt, depression, and hope.

Sisyphus and the triumphs of medicine.

Because they wage a losing battle against death, all physicians resemble Sisyphus, eternally condemned to perform an impossible task. Yet like him, physicians must realize that the small successes they can achieve while contending against destiny are what count.