The Hard Reality of Mental Illnesses
As mental health professional I recognize the damage that mental illness stigma has on our society. There is still a lot of work to be done to reduce negative stereotypes of people who struggle with something that they didn't ask for. There needs to be more resources for those who are ill and those sucked in the wake of illness. However, in our attempts to progress the awareness of mental illness I believe we have inadvertently sent some erroneous and dangerous messages that have done us more harm than good. Here are a few hard truths about mental illness that are not popular to talk about.
Here's a few tips for discernment.
- Has the person been diagnosed by a mental health professional? If not they likely don't have a disorder, they just have one or a few of the symptoms for the moment. ie. Major Depressive Disorder is vastly different from being sad a lot. OR they do have it and are avoiding getting properly diagnosed and treated which means they wouldn't be telling you about it anyway unless there was a benefit to maintaining their illness as is. This sounds callous but what I mean is, changing is often one of the scariest prospects and some people would rather suffer with their illness than attempt to change it. Regardless, call them on their bluff and help them see their doctor to get diagnosed so that proper steps can be made to help them. Sometimes it takes one trip to the professional to realize that they don't in fact have the disorder they thought they had.
- Does the individual have something to gain by a disclosure of mental illness? In my line of work, kids use mental health labels to get out of class constantly which mocks those who actually struggle. Once again, being anxious is normal, having an anxiety disorder is not and it is serious. You should not be suspicious of everyone who is vulnerable to you, you do not need to be the mental health police. But don't be naive enough to think that malingering is not a thing.. ering.
- Do they talk about their illness a little too much? When people are ultra eager to share their vulnerabilities it comes off suspicious. The people with whom I've worked who were struggling the most wanted to talk about it the least. Unless the individual has unhealthy boundaries (which is possible but then would also need to be treated) it is likely that if they are talking about their illness a lot there exist motives beyond a genuine search for help. Most people who are suffering tend to keep their circles pretty tight, for good reason. It's not usually a good idea to be ultra vulnerable to the a world as cruel as ours. Being too open leads a person open to attack. Most hurting people do not want to do this.
- Do they accept any sort of evidence based help? What's that you say? You have bipolar disorder but you've never talked about it with your doctor, never seen a counsellor, and never taken medication? Is it possible that there is some kind of payoff to telling people you have it? What would it hurt to go see if you could get treatment outside of your self administered essential oil therapy?
It's not as easy as saying, we just need to be nicer to people. People being mean to each other causes a lot of problems but it does not cause mental illness. It will aggravate, incite, and maybe activate someone's illness but everyone in this entire world has been mistreated before, yet only some of us have mental illness. There's more to it than just how people have treated you. There is biologically something abnormal about you that makes it harder for you to cope with difficult situations but it is not the difficult situations that have caused your illness.
We can fight stigma of mental illness without ignoring the fact that people in the depths of a major depressive episode are often going to be terribly cruel to others. We don't use their illness to excuse their behaviour it just helps us not to take it too personally. You should not feel ashamed of your mental illness because you did not choose it. But you should not be proud of it either, in the same way that you should not be proud of having kidney stones. It sucks. You suffer and the people around you suffer and people being nicer to you is not going cure you, and even if it did, you make it very difficult for people to be continually nice to you anyway. So get the help you need!
You will make decisions and think that you are rationally in control and that your decisions are in your best interest. You will often be wrong. By a long shot. Your neurochemistry sends signals to your brain causing you to feel a certain way and your executive control centre comes up with a rational reason for that feeling. In other words, the feeling arises and your thoughts, after the fact, construct a reason for that feeling, and it seems like the thought came first. That you conscientiously chose a certain action. This is how all of our brains work. We are far more emotionally driven than rationally driven than we would like to admit.
Jon Haidt famously uses the metaphor of the elephant and the rider. Sometimes our rider (rationality) can get the elephant (emotional motivation) to move in a certain direction but mostly, if the elephant wants to, it goes where it pleases. Then the rider, trying to maintain his perception as the one in charge, makes up an excuse as to why he actually wanted the elephant to do that in the first place.
So what? If you have a mental illness, your elephant does things that most of society doesn't want you to do. So what I'm saying is, sometimes, and perhaps a lot of the time, you are not going to be able to trust what your elephant wants to do. You will need to rely on safe people to help you see things straight. I'm not saying that you should forfeit all free-will to others but now is the time that you need to trust other people's honest opinions. You're going to need to be able to hear their honest opinions, and they might not be pleasant to hear but for the sake of making decisions that are in your best interest you will often need to outsource some decision making, or at least some opinion forming.
If you're quick to admit that you have a mental illness you also then need to admit that you need help perceiving the world in an accurate and helpful way. You can't simultaneously use mental illness as a shield while refusing help with your perceptions. It's healthy for all of us to seek consultation on decisions that involve complicated nuances (most life decisions), it's NECESSARY for those with mental illness to do so.
This graph from Our World in Data illustrates world suicide rates. Notice the trend? Here's a link to the Canadian statistics. The media loves reporting on how terrible the world is and how rates of mental illness and suicide are at all time highs. The data just does not support this. Why would they report such bad, and false news? Because if it bleeds it leads. It catches the eye, it alerts us. How do they get away with it? They're usually sneaky. They'll report that rates are at a 7 year high, which in some cases are true but the difference between this year and 7 years ago is statistically irrelevant.
Now I should say that until these numbers are at ZERO then we should always be worried about mental illness and keeping vulnerable people safe. But do not cave to what chicken little is reporting.
As polarized and visibly nasty we have become online; as disconnected as we seem to be; we are still doing just fine, relative to how we've always been doing.
Think about it. Do you honestly think we are more anxious now than we were 100 years ago when we were still in the thralls of World War I? Does anyone else find that almost sacrilegious? To think that we have it worse than our grandparents did during the holocaust or even our parents who lived under the constant fear of nuclear war?
There is a lot of suffering in our world, in our homes, on our streets. And we constantly need to be evaluating how to alleviate that suffering. We have some pretty good ideas that work a lot of the time but the problem is that often those who can help spend too much time with people who either don't need THAT kind of help or who aren't truly interested in getting better.
We've got to be able to reduce stigma without glorifying the suffering that comes with mental illness.
1) Mental illnesses are not noble diseases.
In today's society we are obsessed with the oppressor vs oppressed narrative and in an attempt to subvert the power of those at the top of our hierarchies we have unintentionally (or intentionally) maintained that hierarchy only in reverse, where you gain more social credit and power by being oppressed. I applaud people who are brave enough to discuss their own struggles with vulnerability and honesty in the hopes that they can be a voice for others with similar struggles. We should encourage this. But we should not reward those who use mental illness to signal their oppression to the twitter saviors. Telling the difference between the two is often difficult which is why I am so adamantly against people using mental illness labels to elicit sympathy. It takes away resources from those who need it most.Here's a few tips for discernment.
- Has the person been diagnosed by a mental health professional? If not they likely don't have a disorder, they just have one or a few of the symptoms for the moment. ie. Major Depressive Disorder is vastly different from being sad a lot. OR they do have it and are avoiding getting properly diagnosed and treated which means they wouldn't be telling you about it anyway unless there was a benefit to maintaining their illness as is. This sounds callous but what I mean is, changing is often one of the scariest prospects and some people would rather suffer with their illness than attempt to change it. Regardless, call them on their bluff and help them see their doctor to get diagnosed so that proper steps can be made to help them. Sometimes it takes one trip to the professional to realize that they don't in fact have the disorder they thought they had.
- Does the individual have something to gain by a disclosure of mental illness? In my line of work, kids use mental health labels to get out of class constantly which mocks those who actually struggle. Once again, being anxious is normal, having an anxiety disorder is not and it is serious. You should not be suspicious of everyone who is vulnerable to you, you do not need to be the mental health police. But don't be naive enough to think that malingering is not a thing.. ering.
- Do they talk about their illness a little too much? When people are ultra eager to share their vulnerabilities it comes off suspicious. The people with whom I've worked who were struggling the most wanted to talk about it the least. Unless the individual has unhealthy boundaries (which is possible but then would also need to be treated) it is likely that if they are talking about their illness a lot there exist motives beyond a genuine search for help. Most people who are suffering tend to keep their circles pretty tight, for good reason. It's not usually a good idea to be ultra vulnerable to the a world as cruel as ours. Being too open leads a person open to attack. Most hurting people do not want to do this.
- Do they accept any sort of evidence based help? What's that you say? You have bipolar disorder but you've never talked about it with your doctor, never seen a counsellor, and never taken medication? Is it possible that there is some kind of payoff to telling people you have it? What would it hurt to go see if you could get treatment outside of your self administered essential oil therapy?
2) Mental illnesses often make it difficult to get a long with you.
We all want to cure the world with kindness and I'm on board with that philosophy but anyone who has worked with or lived with people who actually have a mental disorder, discover quickly that it is often incredibly difficult to socialize with someone who thinks, speaks, and behaves in ways that are abnormal (because that is what mental illness is: a chronic abnormal behaviour). As much as we need to stop judging people unfairly we have to realize that if you have a mental illness you are highly likely to hurt other people's feelings, most likely the people who care about you the most. It's not fun and it's not something to brag about.It's not as easy as saying, we just need to be nicer to people. People being mean to each other causes a lot of problems but it does not cause mental illness. It will aggravate, incite, and maybe activate someone's illness but everyone in this entire world has been mistreated before, yet only some of us have mental illness. There's more to it than just how people have treated you. There is biologically something abnormal about you that makes it harder for you to cope with difficult situations but it is not the difficult situations that have caused your illness.
We can fight stigma of mental illness without ignoring the fact that people in the depths of a major depressive episode are often going to be terribly cruel to others. We don't use their illness to excuse their behaviour it just helps us not to take it too personally. You should not feel ashamed of your mental illness because you did not choose it. But you should not be proud of it either, in the same way that you should not be proud of having kidney stones. It sucks. You suffer and the people around you suffer and people being nicer to you is not going cure you, and even if it did, you make it very difficult for people to be continually nice to you anyway. So get the help you need!
3) If you have a mental illness you are not seeing the world as it is.
We live in a world in which we are encouraged to trust our gut, be true to ourselves, be independent, and self-determined. It's wonderful. But if you have a mental illness, it is most likely true, that by definition you are not in a position where you can trust your gut or be true to yourself. Your gut is wrong a lot of the time. Everyone's is. Yours is more often.You will make decisions and think that you are rationally in control and that your decisions are in your best interest. You will often be wrong. By a long shot. Your neurochemistry sends signals to your brain causing you to feel a certain way and your executive control centre comes up with a rational reason for that feeling. In other words, the feeling arises and your thoughts, after the fact, construct a reason for that feeling, and it seems like the thought came first. That you conscientiously chose a certain action. This is how all of our brains work. We are far more emotionally driven than rationally driven than we would like to admit.
Jon Haidt famously uses the metaphor of the elephant and the rider. Sometimes our rider (rationality) can get the elephant (emotional motivation) to move in a certain direction but mostly, if the elephant wants to, it goes where it pleases. Then the rider, trying to maintain his perception as the one in charge, makes up an excuse as to why he actually wanted the elephant to do that in the first place.
So what? If you have a mental illness, your elephant does things that most of society doesn't want you to do. So what I'm saying is, sometimes, and perhaps a lot of the time, you are not going to be able to trust what your elephant wants to do. You will need to rely on safe people to help you see things straight. I'm not saying that you should forfeit all free-will to others but now is the time that you need to trust other people's honest opinions. You're going to need to be able to hear their honest opinions, and they might not be pleasant to hear but for the sake of making decisions that are in your best interest you will often need to outsource some decision making, or at least some opinion forming.
If you're quick to admit that you have a mental illness you also then need to admit that you need help perceiving the world in an accurate and helpful way. You can't simultaneously use mental illness as a shield while refusing help with your perceptions. It's healthy for all of us to seek consultation on decisions that involve complicated nuances (most life decisions), it's NECESSARY for those with mental illness to do so.
4) Suicide rates are not skyrocketing.
This graph from Our World in Data illustrates world suicide rates. Notice the trend? Here's a link to the Canadian statistics. The media loves reporting on how terrible the world is and how rates of mental illness and suicide are at all time highs. The data just does not support this. Why would they report such bad, and false news? Because if it bleeds it leads. It catches the eye, it alerts us. How do they get away with it? They're usually sneaky. They'll report that rates are at a 7 year high, which in some cases are true but the difference between this year and 7 years ago is statistically irrelevant.
Now I should say that until these numbers are at ZERO then we should always be worried about mental illness and keeping vulnerable people safe. But do not cave to what chicken little is reporting.
As polarized and visibly nasty we have become online; as disconnected as we seem to be; we are still doing just fine, relative to how we've always been doing.
Think about it. Do you honestly think we are more anxious now than we were 100 years ago when we were still in the thralls of World War I? Does anyone else find that almost sacrilegious? To think that we have it worse than our grandparents did during the holocaust or even our parents who lived under the constant fear of nuclear war?
There is a lot of suffering in our world, in our homes, on our streets. And we constantly need to be evaluating how to alleviate that suffering. We have some pretty good ideas that work a lot of the time but the problem is that often those who can help spend too much time with people who either don't need THAT kind of help or who aren't truly interested in getting better.
We've got to be able to reduce stigma without glorifying the suffering that comes with mental illness.
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