MENTALLY ILL

Advancements in the scientific understanding of the human brain as well improved clinical practices drastically changed the way we view and treat people living severe mental health problems. Those of us who would have once been declared ‘mentally insane’ now could be referred to under a wide possibility of clinical diagnoses. 

As psychiatry grew as a discipline, it became clear that the words we had been using to describe mental illness like ‘insane’ and ‘lunatic’ were not sufficient to describe the variety among mentally ill people. Additionally, those words had developed negative connotations and often involved dehumanizing the people they referred to. It’s almost universally accepted that such terms are offensive and indicative of old and harmful ways of seeing people with mental health disorders.

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This shift in the language used to describe mental illness corresponds to a change in the way we view people living with mental disorders. Rather than being seen as something as an inherent characteristic that describes the nature of a person as insane being the way someone is, mental diagnoses are viewed as something that someone  has (for example, “a person living with anorexia” as opposed to “a person who is anorexic). 

The social construct of the “insane person”, the belief that disordered people were dangerous and to be seen and treated like animals, slowly started to be replaced and/or opposed by a new view more grounded in facts. Organizations like the American Psychiatric Organization (which published the DSM) along with group efforts organized by citizens and individuals took the initiative to promote the spread of public information and awareness regarding mental health. 

The system of diagnosing and classifying mental health problems offers practical benefits in how we understand mental illness and how we treat people who are mentally ill. The consequences that these added benefits have had for the wellbeing of people with them should not be understated. However I think it’s important that we understand the tradeoff and what we lose in exchange for added simplicity. Diagnosing somebody as having a specific disorder, ADHD for instance, makes it possible for doctors and healthcare professionals to make decisions about treatment. The diagnosis ADHD gives a name to the problem and tells the doctor “these medications worked for most patients who have similar problems”. And in that regard, diagnosing is an invaluable tool that improves patient outcomes. However, problems arise when people fail to use this tool without a proper understanding of its limitations. For example, giving a name to something as complicated as a mental disorder makes it hard to resist the temptation to mentally 

Even ignoring the ways in which diagnosing can be misunderstood and abused, the very act of pathologizing somebody as ‘sick’ affects the way we view people with mental health diagnoses. There is a recurring theme in mental health awareness/stigma discourse that I’m sure we’re all familiar with, it goes something like this “mental disorders are just like regular disorders, only they’re in your brain”, “why are we ashamed to call into work when we’re depressed but not when we have a cold”, or “treat people who need psychiatric medications to function the same as you treat people who need glasses to see”. The general sentiment is that we just need to understand that mental illness is just like any other illness and we should treat it as such. However, the assumption underlying this argument is that people view mental disorders more negatively than other illnesses because people see the dysfunction as somehow implicating the fault or character of the person with the mental disorder. After all, we are still dealing with the residual effects of the stigma of the “insane person” view which did attribute the disease to a moral failing, so it seems like maybe the solution is to double down and reinforce the disease view in people’s heads.

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I originally intended to devote this section on supporting the disease view of mental illness (principally because that is the story that the data suggests) and then weaving a logical argument for why that means we should be compassionate towards mentally ill people. I tried ignoring the fact that the disease argument had been circulating almost to the point of being a cliche in mental health discourse and yet had seemingly no effect on negative attitudes toward mental illness. I just had to present it differently. I also tried not to think about the fact that people do still have negative views about other diseases like obesity, physical disabilities, eczema etc. despite them not being psychiatric. I could reconcile that by saying those are only stigmatized because they are inherent to social presentation which we judge as being part of their character. And that argument forced me to reassess the way we judge people negatively from a social standpoint. Stigma of mental illness doesn’t require society to see them as being responsible for it, only that it negatively impacts how they interact with us socially. No matter how many times somebody is reminded that “schizophrenia is just a disease of the brain” we would still make judgements based on how we viewed them as social beings. Judgements like that are made instinctively and cannot be rationalized away.

Its unsettling to think that we tend to judge people negatively simply because we see a problem with how they present no matter what the cause is for that negative perception. Unfortunately, this seems to be supported by researchers who have looked into social psychology of mental health stigma. Its been found that even though neurobiological and genetic explanations reduce the blame placed on the sufferer, they also caused an increase in desire for social distance as well as the perception of dangerousness. Even more disturbing is the finding that disease explanations not only have no effect on social acceptance of the person with the disorder, but might also make participants more likely to treat them with harsher punishment.

As I’m sure many people living with severe mental illness can attest to, the current public perception of a person as mentally ill, having a sickness in the brain, or a damaged mind, is not as progressive or as far away from the “insane person” as we would like to believe. Even though we know it’s not the fault of the person with the disease and even though we know to use technical terms like “person living with PTSD” we still fundamentally suffer from the same social problem that plagued our society a hundred years ago. Only now it’s become medicalized.