“Sadness is something we all feel. Unfortunately, it’s all most us have to relate to people with a mental illness dubbed ‘clinical depression’.” This is how Seán Healy began his recent article in The University Times, “The problem with current mental illness terminology”. He argued that stigma around mental health issues stems from a lack of understanding that these conditions are illnesses with physical causes, and that we disrespect people suffering with them when we describe them in emotional terms. He called for conditions such as ‘bipolar’ and ‘schizophrenia’ to be given names that denote their physical causes.
A similar sentiment, albeit usually without the direct call for renaming, is often expressed implicitly in the media and in campaigns about mental illness. Mental health is discussed in increasingly medicalised terms, as more studies make links between neurological factors and psychological conditions. Acknowledging this connection is no doubt positive, as it aids our understanding of and ability to treat mental illnesses. However, I think calling for a general medicalisation of the discussion around mental health is misled. The problem I see with it is summed up quite neatly in the quote I began with. ‘Sadness’, a mere ‘emotion’ is pitted against ‘depression’, an ‘illness’. In this dichotomy, emotion is belittled, while illness, being seen as definitionally a bad thing and something we can all take seriously, is presented as something which the non-sufferer cannot understand but must respect. This is all wrong.
Mental illness is dubbed as such because it is the illness we experience not physically, but emotionally and psychologically. If you believe in science, it is probably not a surprise to you that mental illnesses have physical causes. If mental illnesses have physical causes, emotions do too. What makes mental illnesses important is not the physical processes happening in the brain. That would be like saying what makes emotions and thoughts worth taking seriously is their physical causes. What makes them matter is their experienced content. A mental illness might be something that in the future we can diagnose with physical tests just like we can diagnose physical illnesses now. But their physical cause is not part of their reality for those who suffer from them. I think the largest contributing factor towards stigma and lack of assistance for mentally ill people is not that people do not understand that these conditions have a physical cause, but that they don’t respect the psychological results of these physical causes for their own sake. In short, we are ashamed, embarrassed, and overly judgmental towards our own emotions and the emotions of others. We find physical problems relatively easy to deal with because they seem more objective and can be weighed on a scale that has life on one side and death on the other.
Physiological and medicalised terms are unhelpful
Framing discussion of mental health in physiological, medicalised terms only furthers this bias and discourages people from engaging with the psychological suffering of others for what it is – subjective experience. If people have trouble respecting and believing in mental illnesses, convincing them that mental illnesses really are just physical illnesses by another name is not the way forward. This allows people to be supportive of mental health sufferers in theory, while still telling their miserable friend to buck up and drink a few cans, because that friend hasn’t been diagnosed with a medical label that demands respect. A lot of problems around mental health stem from the fact that people are afraid they will not be taken seriously and do not ask for help, and often their fears are proved true (for some student accounts, see Matthew Mulligan’s “Is anybody listening?” on trinitynews.ie).
Insisting that mental health is important because the way people experience life matters, and that that experience can only be known by the person themselves, is what is important in encouraging people to seek help. According to the HSE, one in four women and one in 10 men will require treatment for depression at some point in their lives. The number that experience the condition but do not seek medical help is likely to be considerably higher. A message needs to be sent to people that they will never be dubbed ‘merely’ emotional if those emotions are having a severely negative impact on their life. People who currently have good mental health need to be able to recognise the situation if their health takes a turn for the worse. Wondering whether or not their suffering is bad enough, or fits the right criteria to be given a clinical name and a physiological solution, is not a path from which people are most likely to seek help and feel justified in doing so.
Physiological discussion of mental health also implies that mental illnesses are understood in a similar way to physical illnesses. They are not. People still don’t really understand brains. You cannot look into a mentally ill person’s brain and find what’s ‘missing’. Mental illnesses are diagnosed purely on a symptomatic basis – there is no test you can do to prove definitively that you ‘have’ some particular mental illness, in the way that you could know you had a tumour, or a gall stone. Medicalised discussion simplifies the picture of mental health to a point that could lead one to talk of cures, as if the person that has a black cloud following her around could instead have a herd of unicorns if the doctor gives her the right pill and she gets a boyfriend. This is unhelpful for a lot of people whose mental health difficulties will persist over long periods, recur, and can only be managed, not eradicated.
An overemphasis on the physical nature and medical treatability of these conditions could impede a holistic approach to their treatment, and make it more difficult for others to accept their fluctuating nature.
For most people, drugs are not a cure but simply a short-term help or something that lets them cope with their illness long-term without ending it or even nullifying its effects. People might find it difficult to explain to people that the bad time they were having two years ago still affects them now, despite their medical treatment, and that ongoing psychological treatment could be needed to help them cope. The fluidity of mental health issues means that many people will be affected on and off throughout their lives by various conditions, to varying degrees. They need understanding and tolerance not only when their condition is deemed bad enough to require specific medical intervention, but before that point, whenever they are finding life difficult to cope with. An overemphasis on the physical nature and medical treatability of these conditions could impede a holistic approach to their treatment, and make it more difficult for others to accept their fluctuating nature.
Couching mental health discussion in medical terms also has a mystifying effect that furthers people’s impressions that mental health sufferers are different to them in some fundamental way. Of course some psychological disorders, such as schizophrenia, can cause significant changes not only in emotional function but also in rational and perceptual function, and these might be difficult or impossible for non-sufferers to understand and empathise with fully. But if you want to understand a mood affective or anxiety disorder, which is what the majority of mental health discussion centres around (another topic for discussion), go and play Depression Quest (www.depressionquest.com), or imagine yourself in a really distressing situation, such as taking an exam you haven’t studied for, and then imagine the resulting feelings of tension, upset and panic won’t go away for weeks, months or even years. Some people think that talking about mental health in this way is reductive, or even insulting, as it undermines the fact that people suffering from mental illnesses are suffering from something the majority of us don’t have to deal with, and that they have no control over. On the contrary,
I think acknowledging that people’s suffering is important not because it can be given a specific label, but just because it feels like suffering to them, is perfectly respectful. It is also important to de-mystify mental health conditions to make them seem less outside the grasp of understanding of the average person – according to a survey carried out by St Patricks’ mental health services, 60% of employers would discriminate against hiring someone with a history of mental health difficulty. This demystification should be easier when keeping discussion at the level of experience than when talking of brains which have specific features that can be labelled as abnormal or dysfunctional.
‘Normal brains’ and ‘sick brains’
Lastly, and importantly, defining mental illnesses by their physical causes suggests that there are ‘normal’ brains and ‘sick’ brains. This is a historical debate within the treatment of mental illness that has largely been won by psychiatry. The consequences of that victory are huge. According to one study (S. N. Visser, Journal of the American Academy of Child & Adolescent Psychiatry), 6% of American children between the age of four and 17 were being given medication for attention deficit disorder in 2011. This happens not only because they are having difficulty physically or psychologically, but because they have something ‘wrong’ with their behaviour that is viewed as inherently problematic.
Whatever your views on psychiatry and the complicated issue of the treatment of people deemed insane or psychotic, the idea of the ‘normal’ brain has consequences for how we deal with more common mental health issues in our universities, families and society as a whole. Something that is obvious from the large numbers of people who report experiencing mental health problems anonymously online is that although psychological difficulty is an undesirable part of the human condition, it’s not an unusual one. What the cause of this ubiquity is remains up for debate, but what seems clear is that the ideal of a normal, happy brain is not one which is consistently attainable for most people. When people almost certainly will experience mental health difficulties, unrealistically equating the ‘normal brain’ and the ‘happy brain’, creates the impression that people are failing to live up to an achievable standard, which may only increase their own negative feelings towards themselves and their lives.
In short, although mental health needs to be taken seriously, I don’t think that discussing it in physiological terms is the way forward. This is because it encourages a rigid understanding of things which are not yet understood, and delegitimises the subjective character of those illnesses, the lack of respect for which is possibly the biggest hurdle people with mental health issues face at the moment.