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Posted by Philip on 29 September 2010, 9:18 pm in , ,

“I’m not sick but I’m not well…”


Guest blogger: Barbara Pike

I loathe the term mental illness. It’s unhelpful, it’s incorrect and it’s terribly stigmatising. And worst of all: no one actually has one. Now, before you think I really have lost the plot – everyone knows the statistics for mental illness, right? The numbers are increasing every year. – let me tell you why I think this is so.

Mental illness is not an illness; it’s a normal reaction to stressful life events. It’s a coping mechanism for situations in which you have no other cognitive mechanism to cope and it’s a normal experience, not an abnormal one. You get depressed when depressing things happen to you. If you have extremely horrible or continuing stressful events happening in your life, such as poverty or abuse, then you may even develop psychosis or a “personality disorder”. Sometimes, to alter your mental state is the only escape or defence mechanism that you have available in a given situation. This isn’t a theory; this is what current research indicates. If you’re interested, feel free to email me and I’ll send you a few dozen articles from academic journals where the link between stressful life events and mental illness is made clear.

Everyone knows what it’s like to experience mental distress. Who hasn’t felt depressed at the loss of a job, a relationship breakdown, or the death of a loved one? Or even had a period in their life – a few days, weeks, or years – when things were just not going the way you wanted them to, that left you feeling pretty down and out. Now, it is very true that some people can become “stuck” in this area and depression, which I’ll use as an example since I can speak from experience, is a very real mental state. Once you are there it is almost impossible to “snap out of it” on your own. Being stuck in a depressed state changes your thought patterns; it changes your brain chemistry, structure, and your cognitive processes. At it’s worst it can be one of the most extraordinarily horrible experiences to endure and the longer you spend there, the harder it can be to find your way out again.

This is why we have a mental health system. This is why people are offered medical and therapeutic help and this is why there are current high profile campaigns to promote acceptance and provide information. It’s a common experience. The Mental Health Foundation website states that one in five New Zealanders will be diagnosed with a mental illness in their lifetime. Do one in five New Zealanders have something fundamentally wrong with their brain? Or are we pathologizing a normal, universal, human experience?

So why is it such a bad thing to label people having an experience of serious mental distress as ill? Why does it matter if that’s what we call them in order to get them the treatments that they need? Because they’re bloody well not, that’s why, and diagnosis does more harm than good.

In medicine, misdiagnosis leads to the prescription of the wrong treatment, with potentially disastrous results. In the mental health system, labelling something as a mental illness can be equally disastrous with useless or potentially damaging treatments deemed to be helpful. The system says, take this, do this, and you will be cured. When you are not, your only alternative is to either seriously act out and get committed, or give up on treatment altogether. Soldiering on, as so many do, hating life, in and out of the fog for eternity; possibly figuring out what makes you happy and what doesn’t along the way but most likely identifying with the illness and accepting that is just how life feels. Or get frustrated enough to successfully leave this mortal coil for good – suicide being one of the greatest tragedies in our supposedly enlightened age. The options are not that hot.

The one good thing about diagnosis is that is can be overwhelmingly relieving to hear that you “have something” rather than that you are as crazy as you feel in that moment. Something medical and treatable, that you can recover from. However, I would argue that diagnosis only provides relief because our society is so intolerant of any state other than excessive happiness. You can finally give people a legitimate reason for why you find it so hard to get out of bed in the morning. Unfortunately, when you do the things and take the drugs that are prescribed, and nothing changes because the underlying problem has not been resolved, you get told that you are not doing it right, and to try harder. Ultimately, you get blamed for perpetuating your own condition and people lose patience with you. This in turn makes you feel worse, and the failure to get well reinforces the belief that there is something fundamentally wrong with you – and so on and so forth down the spiral.

Despite ongoing campaigns by the Mental Health Foundation in New Zealand to change attitudes towards mental illness, there is still a huge amount of implicit discrimination towards people who identify themselves as mentally ill. Being labelled as having a mental illness is totally marginalizing and acts as a disincentive to seek help in many cases. When you give someone a label, you give them all the connotations that label holds, and all the assumptions that go with it, whether or not they may apply. Want to end a conversation with a stranger? Tell them you have a mental illness and watch that information go down like a lead balloon. Whereas, if you said, “So I’ve got this situation, it sucks and it’s making me feeling pretty bad…” the response would be quite different.

Illness is suggestive of something that cannot be helped; something that you have to treat in a certain way and that way is the same for everyone. In particular, it removes responsibility from the person who is experiencing the distress to change their own life. Now, I know that it sounds harsh to relegate total responsibility to get well to a person who currently can’t think straight. I understand exactly how hard it is to see the changes that need to be made when your brain is in a black fog, I’ve been there, but all the therapists in the world can’t change your life for you. Therapy can help you see the viable solutions, talking to friends and family can also be helpful, as can taking time out to recover. People can help you, and you should get help if you need it. But ultimately, change is up to you.

I absolutely don’t have the answer to this dilemma. We do need to label people with something in order to get them the support that they need for their particular situation. Personally, I would prefer to be referred to as “having experiencing a period of distress” or a “period of depression”, rather than to identify as “having a mental illness”. I am happy to refer to times when I have “been mentally unwell” – but in no way do I have a permanent illness.

It would also aid us to change the way in which we think about mental health, stop pathologizing normal experiences and start talking about them in real terms, as much as we can. Talk about them like the reality they are, without catastrophizing, without discriminating, and treat mental health as a spectrum on which all of us travel around.

To be open and honest about issues of mental health is our only hope to achieve these goals. I’m talking about it. Are you?

Title quote from Flagpole Sitta by Harvey Danger (I’m showing my age…)

I’m passionate and opinionated, but I will happily admit to not always being right. Please feel free to let me in on your own perspectives and experiences, or link me to any new information that I may not be aware of, because in sharing we may both learn something useful.

You can comment below, or contact me at barbara@diversitynz.com