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Thursday, December 17, 2009


The difference between a mental illness sufferer and a jackass

When I get into online conversations, something happens about once a month. Either in an attempt to be compassionate or to condemn, somebody will declare that this corrupt politician, that creep, this annoying person or that wrong-headed one, is probably suffering from a mental illness. Inevitably the person making the comparison doesn't actually have much experience of mental illness, and consequently knows as much about it as anyone who hasn't studied it as a professional or encountered it in their personal lives does - which, in this society so appallingly under-educated when it comes to mental illnesses, is to say: very little.

Their understanding of terms like 'psychotic', 'paranoid', 'schizophrenic' or 'mentally ill', therefore, tends to be colloquial, and they're usually doing what everyone does, which is assume a word means pretty much what you were told it means. In cases where a word has two meanings, though, a colloquial and a clinical one, there are two distinct meanings, and it's not uncommon for someone to conflate the two.

I always end up saying the same thing, so I think I'll write a blog post explaining why you shouldn't do this. It's important.

Mental illness is not a behaviour or a character trait. It's an illness. People who suffer from a mental illness are physically ill. Depression involves damage to the hippocampus, for example, which is to say organic brain damage not unlike with Alzheimer's. Many mental illnesses involve some kind of chemical imbalance. Much treatment is currently what a doctor friend of mine refers to as a 'black box': you go in the black box, something happens, you come out the other side feeling better and no one's sure exactly what went on in the box. Which is to say that even doctors are still just chipping away at the edges of mental illness: while great strides are being made, it's still poorly understood. What's not in dispute is that mental illness is like diabetes or AIDS, an actual illness that the sufferer is not undergoing voluntarily. In many cases they're in agony and seriously considering killing themselves to get away from it.

One of the worst things about mental illness in this society is that it's deeply stigmatised. People sneer at the 'happy pills' that help people in anguish struggle back to health. No one wants to hire the schizophrenia sufferer. Admit you have a mental illness and you run the serious risk that the person you tell may decide you're weird and creepy or weak and self-indulgent and they want nothing more to do with you, even if you're bravely fighting every day and successfully beating it back and holding down a job, a family and a social life just like everyone else.

The stigma comes from the fact that we're ignorant. And I want to stress this: saying that someone's ignorant about mental illness isn't insulting them. Everybody's ignorant about it until their son or their best friend or they themselves go under. Personally I believe schools ought to put classes on mental illness at the same high priority that they should put sex education, because your chances of encountering mental illness are roughly equal to your chances of having sex, and both can be killers if you don't know what's what. But till that day, we none of us necessarily know very much about it.

But these are our brothers and sisters suffering from it, this is us. I've heard it estimated that three out of four people will get a mental illness at some point. We may start out not knowing enough about it, but we need to inform ourselves. People are dying, people are weeping in pain, people are losing their homes and their families and their friends. And they're good, normal, decent, ordinary people, no different from anyone else. They just got sick. It can happen to the best of us.

The problem with calling someone mentally ill because they're acting unreasonably is that it perpetuates false ideas about mental illness, and false ideas are what keeps the stigma going.

Often when I see someone call this person or that mentally ill, they're trying to be charitable. Saying that maybe this or that hateful demagogue is suffering from paranoid schizophrenia, for instance, sounds kinder than saying that they're either a liar or a fantasist. But it isn't, not when you remember that we're all connected. Calling someone clinically paranoid because they're hateful is conflating hatefulness with clinical paranoia. Calling a fantasist clinically paranoid is trivialising genuine involuntary delusions by implying they're mere daydreams. Calling someone wilfully ignorant clinically paranoid increases the stigma against sufferers by suggesting it's mere laziness or self-indulgence rather than real sickness that's troubling them - and the world is plenty full of people who are already saying that. It's a tremendous implied insult to the people struggling to keep paranoid schizophrenia from ruining their lives and the lives of everyone they love, and the people too sick to know how sick they are who are sleeping rough for fear their neighbours will kill them in the night, and the people who've been through that hell and fought their way out.

And that's just an example, but it holds true in other cases. There is a difference between a stupid belief and a clinical delusion, an unreasonable attitude or a nasty personality or a wilful disregard for the truth and a mental illness. People are prone to imply someone's mentally ill (however they vaguely understand the term) when that someone is actually just being a jackass. And if you conflate 'jackass' with 'mentally ill', you're insulting millions of people in pain. You are also factually incorrect.

Yes, a lot of us don't actually know what the words precisely mean. So if you want to use the word, go away and look it up. There is plenty of information out there. If you don't know what a word means you have no business using it, especially when it refers to a real medical problem. Mental illness is often depicted in fiction, often inaccurately, but it's not a fictional condition. It's a common, ordinary kind of disease that destroys people every year, every month, every day.

Saying that someone's mentally ill because they're being stupid or weird perpetuates the stereotypes that ostracise and isolate and hurt all the good people who happened to be unlucky enough to have a disease. It isn't charitable, it isn't funny, it isn't accurate. It kicks people who are down.

We all of us need to be better informed about mental illness, because one way or another it's going to affect all of us. Using such words casually and ignorantly spreads misinformation and makes things worse. Please don't do it.

Yes yes yes!

I have been fortunate enough not to suffer from any mental illnesses myself, but my husband has been clinically depressed for most of his life. It is amazing to me how difficult it is to discuss his depression with people who haven't had any direct experience with mental illness. There are so many damaging and false ideas floating around out there about how "depression is just laziness" or how "he should just have more willpower or get more exercise" that any conversation bogs down before it can even get started.

And it's not just people trying to be hateful. The misconceptions are so widespread, everyone's heard them; and I have to address them before I can have an actual conversation about our experience of his depression or what-have-you. It's infuriating--and that's just for ME. Now imagine facing those hurdles while also trying to deal with the effects of a mental illness. It's no wonder people have trouble asking for help!

Thanks for putting this message out there.
A friend who has bipolar pointed me to this website where you can link to an article on "the spoon theory." The writer is talking about lupus, but my friend noted that it works as well for her situation, particularly as she's aware people might think of her as a drama queen, when in fact difficulty in maintaining an emotional even keel is an effect of the bipolar illness.

The spoon theory idea is an interesting way to think about how mental illness (or physical illness for that matter) can be understood by those of us fortunate enough to be without it. (For the present.)
"depression is just laziness"

Man, I hate that one. Carry a twenty-stone demon on your back and see how much energy you have, why don't you?

The 'spoons theory' does seem to apply there: when you're depressed you have to use so much of your energy just hanging on to your reason that you very probably don't have much left for other stuff.

One of the difficult things to explain is that depression isn't laziness even though exercise often does help and CBT uses the slogan 'motivation follows action' - ie you have to stay active if you want any energy. Activity is usually better for depression than just lying down crushed under the weight, but that doesn't mean it's laziness if you do lie down. It just means it's exhaustion.

As a result, sometimes the best thing you can do for a depressed person actually is gently push them into doing something. But it has to be from a position of understanding; if you go on the 'depression is laziness' assumption you're going to make things so, so much worse.
A friend pointed me to your blog and I am so very glad.I am currently working on my doctorate in Clinical Psychology. I also have a mental illness. Stigma against mental illness is my specialty. I am always so glad to find others who have taken up the cause. Thank you.
Hello and welcome! If you have any thoughts to share on the subject of stigma I, for one, would be very interested; it's always good to hear from an expert. And I hope your illness isn't chewing on you too badly. Nice to cyber-meet you.
Oh, and good luck with the doctorate! I know people who've done them and they're a long old haul...

If you're interested, I've written a couple of other posts about mental illness, largely talking about how they're portrayed in art:

http://www.kitwhitfield.com/2009/01/exorcism-isnt-game.html - which criticises the film The Exorcism of Emily Rose for its irresponsible take on mental illness.

http://www.kitwhitfield.com/2008/09/depression-and-childrens-fiction.html - which talks about how depression can be portrayed in children's fiction and compares it with some adult stuff.
I wish I'd found this blog earlier; this is a subject so close to my heart. My mum suffered post-natal depression after my brother was born; my dad had a full-on nervous breakdown about fifteen years ago. I have suffered depression on and off since my early teens.

I thought I understood all I needed to about mental illness until I got with my boyfriend, who is being assessed for psychosis in a couple of weeks, and has been pushed out of his job because of his depression. Now I'm re-learning everything because I want to be able to support him as fully as possible, and my own experiences have been very, very mild compared with his.

Thank you for addressing this, Kit - I can't tell you how much I struggled with people's reactions when I turned to them for help with my own depression. Close friends distanced themselves from me, or told me snap out of it, that I'd talked myself into depression, etc. I even got told by a friend that I was probably just doing it all "for the image." I still get angry when I remember that!

It's always reassuring to me to see people challenge the perceptions of mental illness, and as usual you've done it with real eloquence. Thank you.
Yikes. Good luck to you and your boyfriend, Naomi - it sounds awful. I hope you're taking care of yourself, too, and have some people to back you up: being a major support to someone sick can be extremely tough, even if you aren't struggling with an illness yourself. You're one brave person to take all that on.

And yes, I'm pretty angry with your friend for the 'image' remark too, and I wasn't even there. That's a rotten thing to say. I really wish there was better knowledge in the world so people realised how silly they sound making that kind of remark.

Hang in there. You'll both be in my thoughts.
Thank you, that means a lot :)

And I'm well looked-after myself; my boss has been amazing and my friends are endlessly supportive, so I'm confident about the future.
That's good news, I'm glad to hear it; coping with a sick loved one without support is something you wouldn't wish on your worst enemy. Do let me know how it goes. :-)
I'm 52 yrs old, depressed, have tried suicide 9 times and survived, been in and out of hospital, been called paranoid, schizophrenic, bipolar, schizoaffective (different doctors, different diagnosis). I've been in mental hospitals 19 times. However, I have something wonderful to say about the cure for depression, with no pills. What it took was: I'd been out of hospital for some few years. I went into a panic, and ended up in hospital again. My family came up with the cure: visit, telephone call, let myself know I'm loved, I'm cared about, and every day without fail, either a visit or a telephone call, from at least one family member. My family visited, a few at a time. They forgave myself. They listened, really listened, instead of getting angry and calling myself silly names like selfish. They listened, they visited, they made myself smile. They bought myself a whole lot of Not Tested on Animals cosmetics, so I started bathing and enjoying that, better than before. They smiled. My depression goes away, as soon as I remember what my family did for myself. Once out of hospital, my elder sister and I travelled to another city just to visit my twin sister. There is the only cure for depression I know of, regardless of pills that made things worse. Smile. And, even though the stigma is there, my family, so precious, have chosen to ignore the ignorance of stigma, the stigma that does not only affect myself, it affects my family too, since others say things about myself that are not nice. Smile. My advice to others is: while sick, and not wanting to do anything, if you can write a letter, write a letter, and write about what you and they LIKE, not about what you hate. Love counts. My family have proven their love, in the most wonderful way.
Peace be with you all
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