The term ‘mental illness’ excites confused passions. The title of this post was expressed by a friend talking about their brother. He was “suffering from mental health.” I knew what she meant, but it was what she said that struck me. I had heard it several times before – but always under circumstances when it was wisest to let it pass, and say nothing.
We can talk easily about a person living with, or experiencing, what is popularly called ‘mental illness’. But when we are referring to somebody with whom we have intimacy or familiarity things change. Suddenly saying they have a ‘mental illness’ is hard to say.
I was recently talking via email to a friend diagnosed with a psychiatric disorder about a person he was interacting with. He observed “Yep. Dude’s got some issues, but haven’t we all?” My friend may have a diagnosable condition, but ill? No.
Personally, I detest the term ‘mental illness’. I worked in psychiatric hospitals back in the early 1970s and I have worked with the operators of what were called ‘licensed boarding houses’ before the NDIS. Many of their residents had long term psychiatric conditions controlled by medication. I don’t like the term because it bundles up a spectrum that covers damaged brains, the victims of trauma, and people who are highly sensitive. The idea that the term ‘mental’ covers all is archaic and cruel.
I am not qualified in psychiatry or psychology, so I want to make it clear that what follows is a philosophical musing on the idea of ‘mental illness’. It mustn’t be mistaken for anything other than a personal opinion offered by a person who has had a lot to do with people diagnosed as having a ‘mental illness’.
What are we talking about?
Three of the smartest people I know would fit the category of having a ‘mental illness’. How does that work? The term implies a cognitive disorder. But these are super smart people. What they have difficulty with is processing emotions. Well, except for one – the one I quoted above. He just has experiences that psychiatry has decided are evidence of a disorder.
I am not going to debate whether such experiences are a disorder to the extent that he is rendered dysfunctional. But certainly, the diagnosis and subsequent treatment achieved that. In the time I have known him [a decade or so] he has been somewhat eccentric. But not once has he indicated disordered thought. Even we if grant his experiences are disordered, there’s a difference between the experience and his reaction – and it’s his reaction to his experiences that got him into bother – and that a long time ago now. These days you wouldn’t know. You might think he’s a bit eccentric, but nothing else. In fact you’d be hard pressed to meet a nicer, kinder, more honest guy – and with a razor sharp intellect.
Trauma can do a potently destructive job on our ability to manage our emotions. The harm done by the trauma is an enduring wound. We are now learning that our response to that wound does not have to be reflexive. We can learn to manage it.
When I was in 6th grade my music teacher insisted that I audition for the school choir. I politely explained that I had no interest in participating in the choir and so declined to audition. She insisted I audition, and I persisted in declining to do so on the obvious logic it would have no consequence – being in the choir was a voluntary after school activity and I had better things to do.
So, I was hauled to the front of the class. We had an escalating scene of her demanding I sing and me declining to do so. Eventually she was screaming, “Sing!” at me, repeatedly. I refused. She finally quit, but the damage was done. I haven’t sung since then, and when people have urged me to sing, they trigger that traumatic memory. It’s a curable condition, of course. I just haven’t felt the motivation to seek the cure.
Not singing does not make me dysfunctional in most aspects of my life. In fact, it’s a fair guess it’s less than 1%. But it’s still an ‘illness’ in the sense that it’s an enduring unhealed wound that continues to impinge on my life experience. The trauma is easy to recall.
I can see that for some my trauma is a ‘mental’ dysfunction that could be overcome by reframing or reprocessing my experience. But it’s my emotional reaction that is the issue, not how I think about it. Intellectually I have tackled the experience – but the wound, the trauma, is emotional, and it persists.
I am of a generation who grew up to dismiss emotions as weak reactions expressed by children and women – irrational essentially – an abdication of mental responsibility. That point of view is, of course, utter nonsense. You will not find it in contemporary psychology. Males expressed emotions only under tightly controlled and approved conditions.
The idea that it is feelings and not thoughts that mess us up is relatively novel. I should here observe that I do think that thoughts can be a problem, but that takes us into the profoundly complex business of the nature of belief – and this is no place for that conversation.
My point is, in essence, that its emotions that trip most of us up. Serious psychiatric conditions like schizophrenia or psychosis are rare in our workplaces. Whether they are ‘mental illnesses’, or brain disorders depends on whether you subscribe to the mind = brain proposition. I don’t. This is important because there’s nothing more futile than arguing at cross purposes because you have failed to agree on terminology.
I suspect that saying a person is “suffering from mental health” is an intuitive disagreement with the mind = brain idea, but without confident awareness. I think what is labelled ‘mental illness’ is mostly some form of emotional trauma – and hence something many of us know to some degree.
The upshot is that we struggle to understand what our terminology means and what the implications of our meanings are. This is made worse by an horrendous history of madness woven into our culture’s worst fears. For us ‘mental illness’ is not a somewhat vague technical term – it is burdened and tainted by movies and scary stories. The reality is deeply different.
Does it matter?
I want to suppose there is a valid thing called ‘mental illness’. I don’t know whether this is true, but I am not committed to saying it’s not. It’s at most a philosophical question. If you believe the mind = brain proposition you will have a philosophical position that differs from those who do not. Let’s allow it is a reasonable position to hold.
There is a considerable difference between a ‘mental illness’ and emotional responses triggered and shaped by trauma and stress. The latter is commonplace.
Here are two dot points from https://www.aihw.gov.au/mental-health/overview/mental-illness
- Over 2 in 5 (44%, or 8.6 million) Australians aged 16–85 are estimated to have experienced a mental disorder at some time in their life, with 1 in 5 (21%, or 4.2 million) having experienced a mental disorder in the previous 12 months.
- Anxiety disorders (such as Social Phobia) are the most common type of disorder, affecting 1 in 6 (17%, or 3.3 million) Australians, followed by Affective disorders (such as Depressive Episode) (8%), and Substance Use disorders (such as Alcohol Dependence) (3.%).
There is an obvious association of ‘mental’ disorders with what seem to me to be essentially emotional responses to life experiences – maybe precipitated by stress or trauma. Substitute ‘emotional’ for ‘mental’ in the above and see how it sits with you.
How we interpret this data matters precisely because we all experience stress, and many experience trauma to varying degrees of intensity. In recent times what is called Complex Post Traumatic Stress Disorder [C-PTSD] has been recognised as something that can be experienced over the long term as the result of abuse [emotional, physical, or sexual] in childhood, or domestic violence. In other words, from ordinary life experience to many.
I don’t want to pathologize our normality, I merely want to make the point many readers will instantly recognise – a lot of bad behaviour by people who have admitted no formal diagnosis may be the result of C-PTSD and just accepted as ‘normal’ because that’s our experience of the world. I think back to that music teacher and wonder why she thought screaming “Sing!” at a child was okay. Why the intimidating powerplay to bully an 11-year-old into doing what she wanted? Why wasn’t she cool and take my disinterest in her stride. Why did she care so much?
I can tell you my side – why I stood up to her. My father was a bully, and violent at times. I stood up to him to survive. My default with the music teacher was to resist. Maybe I should have acquiesced, auditioned and just either sung badly or just not turned up. That would have been better for me, maybe. But I was on survival autopilot. What was her excuse?
We are all in this together
We all have unhealed wounds and sometimes they overwhelm us. If we understand that beyond the awful label of ‘mental illness’ there are people just like us whose ability to manage reactions sometimes needs the help of medication or therapy, we might be more considerate and compassionate – but then we’d need to look at ourselves with kinder eyes – and that isn’t easy to do with deep honesty.
The label of ‘mental illness’ has been burdened with a stigma it does not deserve. Yes, there are extreme manifestations of profound psychological dysfunction that, I grant you, are confronting to engage with – but they are rare, and it is unlikely you’ll ever come across them in a workplace.
To be blunt, the worst accounts of disordered conduct often concern those who declare no diagnosis and are frequently managers. Now, I am not suggesting for a moment that they deserve sanctions. I am merely making the point that from the perspective of staff the most problematic conduct is exhibited by managers who are not only not challenged by their managers but who are the most discriminatory in relation to staff who disclose they have been diagnosed with a ‘mental illness.’
A former colleague told me of a manager who routinely screamed at, and verbally abused, staff. Yet their conduct, of which senior managers were aware, remained unchecked. You’d want to guess there’s an undiagnosed, or unadmitted condition here. Maybe the manager feared that ‘disclosure’, despite the evidence, may have triggered an undesired response.
It is astonishing how often people with a diagnosed condition are discriminated against despite no untoward behaviour or disordered thought when they ‘disclose’ their condition. And yet people whose conduct is erratic or abusive are left alone. Something does seem to happen when there is ‘disclosure’ – the stigma is aroused, and harm is done.
Before I withdrew from fulltime employment, I set up a campaign to ‘Change the Conversation’ about ‘mental illness’. It gained a bit of traction, but it dissolved into the pool of normal. Some folk ‘got’ it but a lot more felt uncomfortable challenging the psychiatric orthodoxy.
The fact is that this is a philosophical question, not a science question. We all make metaphysical guesses about how we imagine reality works. Science does an impressive job on the detail- up to a point, but interpretation on the human level is still free territory. There is a difference between disagreeing and bullying – and there’s too much of the latter, swaddled in a generous covering of bluff.
When you find yourself saying a person is “suffering from mental health” it’s time to wonder what the hell you intended to mean. Clearly its not to suggest that person is ‘mentally ill’, because that’s easy to say. Obviously, something else is going on.
Ill or injured? A fellow traveller carrying a heavier burden of life experiences than many of us, or an alien in our midst? There should be nothing alienating about extreme expressions of the spectrum of being human. For some the injury of trauma is something they must live with and function well in the ‘normal’ world.
I hope this post inspires you to think more deeply about this taint of stigma we allow to be so cruelly imposed. There is, I think, no settled uniform popular position. This is an evolving field of thought and I encourage you to explore it. We must prefer the side of compassion and inclusion over distance and exclusion. The fear is unfounded. It stems from a lack of understanding, and maybe the want of an honest self-reflection on how wounded we are – and yet we behave as well as we can.
Below is a list of resources I have used in recent times. As always, I use Amazon links because of access to ebooks and audiobooks which are more accessible to many. If you are buying hardcopy do support your local bookstore.
The Body Keeps the Score – Bessel van der Kolk – This is a compelling exploration of trauma.
Desperate Remedies – Andrew Scull – This is a look at the history of psychiatry and the problematic place it is now in.
Gabor Maté , Daniel Maté – The title says it all.
In the Realm of Hungry Ghosts: Close Encounters with Addiction – Gabor Maté – An exploration of what triggers addictive behaviours – trauma mostly.