The problem with mental illness
Reframing mental health, mental illness and what it is to be human
The problem with mental illness is that there is more misunderstanding than ever surrounding what mental illness actually is.
Confusion and perceptions
Mental health awareness has improved greatly over the last few decades, but unfortunately the focus has been on mental illness issues such as depression, anxiety and PTSD, with little education about what healthy mental health looks like. The result of this is that now any expression of emotional and psychological distress is being seen by the public as a sign of mental illness. Just because someone is feeling depressed doesn’t mean they have depression; just because someone is feeling anxious, doesn’t mean they suffer from anxiety.
Perfectly normal personality traits and temperaments are also being confused as mental illness. Introversion, sensitivity, having a melancholy disposition, being intense – all of these are normal, simply in different positions along one healthy normal spectrum, yet are often labelled as, or mistaken for, mental illness in societies where bold, spontaneous, outgoing behaviour is valued above quiet reserved behaviour.
Mental health and mental illness are being used interchangeably and I often see posts on social media full of good intentions, but that are misleading such as ‘mental health is nothing to be ashamed of’. Health is health. No one talks about physical health as being nothing to be ashamed of. Yet, even though the wording of the statement is flawed, we all know it’s talking about mental illness and this is how the two terms are becoming synonymous. Perhaps I’m quibbling over semantics, but I think the very words we use can impact how we perceive something.
In English, we would say to a friend: I broke my arm and this would mean that I had some kind of misadventure or was the victim of violence that resulted in my arm being broken. However, in languages such as Spanish, this construction would imply that you intentionally broke your arm, that you took a heavy object and smashed it down on your arm to break it. In these languages, the sentence structure to say that you broke your arm accidently would be: my arm broke.
So consider I am depressed versus, I feel depressed. The first implies the mood is a permanent self-inflicted state, an inherent character trait – whereas the second implies that the mood is transitory, a current state of mind rather than a permanent state of being.
Words are powerful and it matters how we use them.
A convenient catchphrase
The second problem with mental illness is that it has become a convenient catch-all phrase used by society to describe any display of emotion or behaviour that deviates from the norm or ideal. It’s used to describe the quiet neighbour who hermits herself at home and rarely goes out: mentally ill. The colourful eccentric who teens at the corner store make jokes about: mentally ill. The difficult friend that overwhelms social gatherings with their nit-picky demands and complaints: mentally ill. The eternally-sad relative who can’t get over the death of their spouse: mentally ill.
It’s easier for people to slap on a label than make the effort to understand, empathise or connect with someone who acts in a way that is outside of their own comfort zone. Believing someone is mentally ill is a convenient way to absolve themselves of their own involvement in that person’s mental and emotional state; excuses them from actions they could take to help that person.
It is a sign of society’s quick-fix mentality. When something breaks down we want it to be fixed immediately. So the assumption is that if you can convince someone that they’re mentally ill, they’ll go get treatment and be fixed.
It’s not that simple. Medication and counselling may help, but they’re not necessarily a solution. Some people are simply given more than their fair share of burdens to deal with in life and to call these people mentally ill because they sometimes struggle to keep fighting is unfair and insensitive. Instead of suggesting a friend needs medication and counselling, people could rather offer them their own time and support. Help with chores around the house, looking after the kids for a while so their friend can get some much-needed rest; just listening and let them vent their frustrations without judging them can be hugely helpful and therapeutic to someone in distress. This kind of support can be far more beneficial than formal therapy because struggling with life’s struggles now and then, is not mental illness – it’s a part of being human.
Another big problem in the term mental illness being used incorrectly and indiscriminately to describe normal and healthy temporary emotional states to difficult and stressful situations, is that this can be extremely damaging. It completely invalidates a person’s experience. It implies that they are inherently deficient and that what they are feeling is somehow self-inflicted.
It dismisses their break-up, loss of a loved one, failure or whatever situation they’re in as irrelevant and suggests that the real reason they are struggling is because they have a predisposition to feeling emotional pain. It suggests that a mentally healthy person would be able to go through the same experience and not be affected at all.
This is essentially a form of gas-lighting – making someone believe they have mental illness when they don’t is no different to an abusive partner who psychologically manipulates the other into thinking they are crazy/worthless/to blame for everything etc.
And as much as we may have been working to make mental illness more socially-acceptable, we have yet to remove the stigma.
Part of this comes from all the confusion surrounding mental illness. By making people aware that depression and anxiety can be very real mental illness in an effort to encourage people to seek help, we’re actually doing the opposite. By giving depression, anxiety and PTSD the same label as psychological disorders such as psychopathy, paranoia and schizophrenia, we have added these conditions to those that people associate with insanity and madness. I believe this is causing people to try to tough things out on their own more than ever rather than talk about what they're going through for fear of being labelled mentally ill and carted off to a mental hospital.
Though we have come a long way from our grandparents’ day when attitudes were that men don’t cry, women don’t make scenes, children were seen and not heard, and displays of emotion or talking about feelings was seen as an undesirable character trait or sign of weakness, this idea is still being perpetuated.
We could learn a lot from Eastern cultures where suffering is seen as a badge of honour. In Western society people who have been through difficult or traumatic life experiences are treated as second-class citizens. They’re seen as undesirable, damaged goods, as carrying too much baggage. In Eastern culture suffering is seen as a path to enlightenment, a means to cleanse the soul, something that is admired and respected. We need to adopt this thinking in our society instead of turning our backs on those in crisis.
We set a double standard, because we admire strength – courage, determination, endurance, bravery – yet we reject vulnerability and suffering. And yet no one is born strong. No one becomes strong by having an easy life. It is only by facing adversity, going through hardship and heartbreaks; by suffering that we become strong.
I believe the solution lies looking at mental health in the same way as we do physical health.
Signs and symptoms
When it comes to physical health, we easily recognise that symptoms are an indication of illness or injury and do not constitute illness in themselves. We don’t classify sneezing, shortness of breath, pain or bleeding as illness – we recognise these as the symptoms of injury or illness. They can also indicate that there is something in the external environment that is causing a reaction. For example, anyone will sneeze in a dusty environment – it doesn’t mean they’re sick or have a dust allergy. Likewise, a person exposed to a toxin is not weak or deficient because they experience the symptoms of poisoning.
However, when it comes to mental health, people often mistake the symptoms for illness. Crying, anger, negative thoughts, feeling sad, social withdrawal – these are all symptoms. They indicate that something is amiss, but do not necessarily point to clinical mental illness. They may be the result of mental, emotional or psychological trauma or illness or, like with physical health, may be a reaction to something in the external environment. Someone who avoids crowds and gets irritable in chaotic situations may not by socially deficient, but may have a very real sensitivity to noise. However, if they don’t understand how noise affects them, they may feel they are shy/unsocial because they think it is people they are avoiding.
Again, with physical health, injury is pretty easy to identify and we also understand that it is always the result of trauma. Bones don’t break spontaneously, bleeding wounds don’t just suddenly appear, limbs don’t just fall off. We also wouldn’t say that someone who accidentally sawn off a hand while cutting wood is suffering from orthopaedic illness.
We understand the importance of having an injury treated as soon as possible to prevent infection or bones setting incorrectly. We also understand that it takes time to recover from an injury. We wouldn’t expect someone with a broken leg to be up and walking around the next day. We also wouldn’t expect the amputee to regrow his hand. Though some might ignore medical advice most of us are mature enough to understand that returning to physical activity too soon after an injury could exacerbate it or delay recovery time.
However, when it comes to mental health, the concept of injury is that it doesn’t exist. Talk about mental injury and people think you mean brain damage. However, mental, emotional and psychological injury are just as real as physical injury, we just haven’t been taught to recognise them. So what is mental injury? Mental injury is anything that causes mental, emotional or psychological symptoms – things like injustice, betrayal, loss, rejection, lack of connection with others, isolation, lack of fulfilment, witnessing or experiencing violence, stress (probably the biggest of all), living with the effects of constant pain and discomfort from chronic physical illness… The list goes on and on.
Considering that there are far more things that can cause mental injury than physical injury it is shameful that mental injury is dismissed as inconsequential. While we treat someone with physical injury with sympathy, patience and understanding we do the opposite for someone with mental injury. We expect them to keep their injury to themselves, to recover quickly and just get on with life as if nothing happened – ‘just suck it up’, ‘stop whining’, ‘get a grip’…
When it comes to physical health, there are many things that cause illness. Infection caused by viruses, bacteria, fungi and other pathogens, disease caused by faulty genes, disease caused by malnutrition or deficiencies, autoimmune diseases, cancers, exposure to toxins and more.
The spectrum is just as broad when it comes to mental illness. These days we’ve come to see mental illness as meaning conditions like depression, anxiety and PTSD, but there is a lot more that this umbrella term covers. It is used to describe all manner of disorders of the mind from mental/intellectual deficits, psychological issues such as schizophrenia, OCD and phobias, psychopathy, personality disorders, eating disorders and emotional problems.
While it is uncommon for a mental illness to be caused by a virus or other infection, it does happen, as well as mental illness caused by exposure to toxins such as lead and mercury. As far as deficiencies go, mental health is no different. Deficiencies in belonging, connection with others, purpose and love can cause loneliness and depression, deficiencies in stability and trust can cause anxiety.
Where a physical injury is not treated properly infection can set in with very serious consequences. It’s the same with mental health. Chronic clinical depression, debilitating anxiety and PTSD are the gangrene of not addressing mental injury and allowing it to fester.
There is a misconception that stress-related illness occurs at the same time as the stress. This is not true – it very often occurs much later, once the stress has passed and the body starts to relax and lowers its defenses. In the last decade or so we have been seeing a dramatic increase in chronic diseases that are difficult to diagnose and often seem to have no pathological cause. Diseases like functional neurological disorders, hypersensitivities and autoimmune disorders. Interestingly, often in these cases there is a traumatic event(s) in the past that caused significant stress and emotional distress. Though at the time, the patient may have thought they were coping, it would suggest the damage was already being done and for some reason, which we have yet to understand, manifested years later as mysterious seemingly unexplainable illness, in a similar way that a person may develop asbestosis decades after exposure to asbestos.
Mental Health and Happiness
It is important to note that mental illness is not the opposite of happiness. People make the assumption that if someone has anxiety or depression then they must automatically be unhappy.
I see so much advice for self-care to promote mental health and while this is useful and necessary there is a hidden message – that good mental health is the same as happy mental health. Good mental health doesn’t guarantee happiness any more than physical health. It certainly helps, but it’s no guarantee.
This is because happiness is a state of mind and being not a mood or emotion. Someone can be struggling with mental and physical illness and yet be happy in life; while another can have no mental health issues and perfect physical health and fitness and yet be completely unhappy.
In an episode of the fictional TV show Instinct, psychologist Dr Dylan Reinhart proposes to his students during a lecture that happiness should be classed as a mental illness, because it is so statistically rare as to make it abnormal. I love this idea! If we’re going to label those who struggle with sadness, nerves and low mood as being mentally ill and suffering from depression and anxiety, then why don’t we also label those annoyingly cheerful and incessantly optimistic types as being mentally ill and suffering from mania and delusions?
I think much of our problem with mental health issues is that people have an idealised view of how life should be – that pain, unhappiness, struggle are bad and should not be tolerated. Yes, we all have the right to happiness, health, love and a comfortable life, but that doesn’t mean we’re entitled to those things.
In closing, I am not trying to diminish the reality of mental illness, rather what I’m trying to say is that we need to shift our focus from mental health and mental illness, to what it is to be human. Life is hard, life is messy, at times life will try to break you and we need to normalise the unpleasant feelings and emotions that we all go through from time to time. If we can do this, then we will achieve far more in the effort to combat mental illness.
Note: I am not a psychologist or counsellor and wrote this article from the point of view of how society views mental illness and as one who struggles at times with the effects of emotional injury.