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By Margaret Gillis
While I was surfing the web one day, I read an interesting piece that changed my understanding of clinical depression. The blogger described her struggle with clinical depression as difficulties getting through mundane tasks. She illustrated this idea by walking through an average day in her life, when her mental to-do list for the day would read: wake up, get ready, go to school, come home, do homework, and go to bed. However, on a day when her depression was severe, she would list tasks to complete in her head: wake up, get out of bed, brush my teeth, get dressed, make breakfast, eat breakfast, walk to the bus stop, catch the bus, get to class, etc. When depressed, every chore felt like many chores, making getting through the day very hard. She would have to rally herself and summon up energy to do tasks that she would not even have to think about otherwise.
About 1 out of 5 American adults each year suffer from some type of mental illness. This statistic might be shocking. You might think, “Well that must be wrong, there are five people in my family, and none of us suffer from mental illness!” This could be perfectly true, or you might have to adjust your understanding of mental illness. According to the American Psychiatric Association, mental illnesses are defined as “health conditions involving changes in thinking, emotion or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.”1 There are two categories of mental illness: Any Mental Illness (AMI), which encompasses all mental illnesses, and Serious Mental Illness (SMI), which includes the most severe.2 AMI includes common disorders such as substance abuse, depression, anxiety, and panic disorders.
Sometimes, people suffer from mental illnesses and they are not even aware of it. They are told that what they are feeling is “all in their head.” Such was the case for fictional character, Dorothy, on the hit show of the late 1980’s, Golden Girls. In a series of episodes titled “Sick And Tired,” Dorothy was feeling very lethargic for long periods of time. She went to doctor after doctor, and each told her that her illness was all in her head, that she was imagining it. Some even told her that it was just a symptom of her old age, or that she would feel better if she got a new haircut or a new boyfriend. After hearing this from doctor after doctor, she began to despair, fearing that she would never get the help that she needed. Finally, she met a doctor who had heard of her symptoms before, and reassured her that her disease was not imaginary, and that she would receive the care she needed. He diagnosed her with chronic fatigue syndrome, which is a long-term condition characterized by exhaustion that can sometimes leave its sufferers confined to their beds from extreme tiredness. I feel like this storyline illustrates the difficulties of having a mental illness that is not well known, and the difficulty of having doctors who are uneducated about your condition.
Mental illness has existed since humans have existed, and references to it can be seen in books, writings, and pictures throughout history. Its causes were speculated to be either supernatural, or originating from the body, or originating from the soul.
In 400 BC, Hippocrates, referred to as the “Father of Medicine,” tried to separate superstition from medicine, and hypothesized that an excess or deficiency of bodily fluids caused disease. He proposed that mental illness was like any other illness, and that it is caused by a bodily imbalance.4 Despite wide acceptance, hundred of years later in the Middle Ages, supernatural beliefs in the causes of mental illness reappeared. It was commonly believed that any illness was a reflection of a person’s flawed soul, and that they needed to atone for their sins to get better. Fast-forward to the 1200’s, where women with mental disorders were being burned at the stake, believed to be “witches.” This continued for several centuries.
Starting in the 1500’s, mental illness was thought to originate from the body again, and the mentally ill were confined to facilities where they could be taken care of. They were treated using the techniques of bloodletting and purging. These patients were very often mistreated: chained to walls, malnourished, and physically abused. Today, we still have institutions such as these, although they run more like hospitals where the patients, suffering from serious mental illnesses, receive modern medical care. This includes accurate diagnoses of mental illnesses. Those that are known can be found in the American Psychiatric Association’s Diagnostic and Statistical Manual. This manual, which is constantly updated and corrected for errors, serves as an encyclopedia of known mental illnesses, meant to guide doctors in their diagnoses. But as Dorothy’s story illustrates, even modern doctors are not immune to prejudice, ignorance of mental illnesses, and proper mental health treatment.
So why are people with mental illnesses so often mistreated? What about diseases of the brain makes them different from other diseases? The brain is an organ in the body, just like the heart or the liver. If someone has a chemical imbalance in their brain that causes them to hear voices (like with schizophrenia, where there is an imbalance of the neurotransmitters dopamine and serotonin5), why are they isolated and demeaned more than someone with a chemical imbalance in their thyroid gland (such as with hyperthyroidism, where the thyroid hormone is overproduced6)? Does the difference in organ constitute such a drastic difference in social treatment? Maybe mental illness is more stigmatized than other illnesses because the brain is where think, where we believe, and where we decide how to act. Our personalities come from our brains. So, when someone exhibits symptoms of mental illness, it is easy to believe that their actions are a part of their personalities, and that they are at fault for their behavior. But the negative symptoms of mental illness are the result of a health issue. Therefore, I believe that those with mental illness should be helped more often than punished.
What is the first image that comes to your mind when you think of mental illness? Maybe you think of that man on the train last week who repeatedly screamed at the top of his lungs for no other reason. Maybe you think of Nixon’s would-be assassin, who committed his crime to impress actress Jodie Foster, and eventually received a lesser charge for pleading mentally ill. Or maybe you think of the school shooters, portrayed as mentally ill individuals who got their hands on weapons. Frequently, when people think of mental illness, they think of violent individuals. In reality, those who suffer from mental illness are more often nonviolent. Although some mental illnesses, combined with job loss and substance abuse, increases a person’s risk of committing a violent crime, usually those who suffer from mental illnesses are more likely to be victims of violent crime than perpetrators.8
Think of the language that we use in every day. Even I, like many of us, say that I’m “depressed” to mean that I am feeling sad, or that my week has been “crazy” when I mean it has been busy; these words originated from descriptions of complex medical symptoms. What about words like “insane,” “wacky,” “loony,” “crazy,” or “nuts?” These words are spoken daily, often used out of the context of mental illness, or worse, to demean someone with mental health problems. This is not reserved to the public.
Hearing these words used all the time in culture, someone with medical health issues would understandably feel humiliated. This type of social interaction is at the heart of mental health stigma, in which those with mental health disorders are alienated. Not only does mental health stigma shame those with mental disorders, but it also acts as a barrier to comprehensive medical care.
Other barriers include inefficient rehabilitation programs for mentally ill individuals who have lost their jobs. Many people who suffer from mental illness live in poverty. This often occurs because they lose their jobs, are estranged from their families, and with no one left to care for them and the inability to properly care for themselves, they end up on the streets. From there, with no capital or support system, it is much more difficult to receive adequate care, and the condition of mental health for those who are poor and mentally ill does not improve; it gets worse.
In the U.S., 80 percent of people who are mentally ill are unemployed. About 60 percent of these people want to work, but do not have the proper support to find a job. Programs called “supported employment,” designed to rehabilitate those with mental illness back into the workforce, only help the 2 percent of those with mental illness who do this. Ineffectiveness is due to the rarity of these programs, “partly because of the difficulty of cobbling together sufficient funding,” stated Dartmouth Psychiatric Research Center Professor, Robert Drake.7 The U.S. should really increase funding to programs designed to help the rehabilitated mentally ill return to work, as two thirds of the $444 billion cost of U.S. mental illness is due to unemployment.7
The World Health Organization found that among high income countries like the U.S., less than 1 percent of the health budget is spent on mental illness.11 Further analysis shows that other countries handle mental illness far better than the U.S. Although mental illness in prevalent across the globe, countries like Luxembourg have better methods of dealing with it.10 According to Business Insider, they are able to do this through their “Positive Education” model. Luxembourg teaches students to connect skills of well-being and of achievement to promote happiness and productivity, and to destigmatize mental health issues.10 Australia focuses most of its national and state policies for mental health on recovery. In 2013, their Health Minister’s Advisory Council created a framework that outlines five practice domains of care for recovery from mental health issues. These range from promoting hope to encouraging social inclusion. Additionally, the Australian government funded a review on the mental health recovery strategies, to find what method would benefit its people the most.12 While the U.S. does not have as much success as these countries in terms of education models and recovery systems, we are developing similar tools to help those with mental illnesses reintegrate into society, such as the Substance Abuse and Mental Health Services Administration’s “Recovery Support Strategic Initiative”.12
So how can we, in our daily lives, support and aid those with mental health issues? For one, we should spread a message of awareness, so that others can be informed about mental illness as a disease and not as a personality trait. Secondly, we can be a little more understanding of the actions of those in our daily lives who suffer from mental illness. I recently found out that those suffering from anxiety have a tendency to ask many questions after being given a command, verifying exactly what they needed to do as a tactic for feeling a little more in control of a chaotic world. To a neurotypical person, unaware of the reasons behind this behavior, it might seem very annoying. I know someone who suffers from anxiety, and whenever they used to do this, I would wonder why, and tell them to “just do it” and “stop thinking about it so much.” I did not understand that repeating a question about a task was a mechanism of reassurance. After learning this, I stopped thinking about how much the repeated questions irritated me, and instead thought about how I could make my friend feel more secure.
People are not naturally intolerant of those with mental health issues, they are taught to be so from society. But once you peel back the stigma and begin to understand the “annoying” behaviors of mental health, you can help people who are suffering feel less ashamed and isolated. Removing mental health stigma allows people to freely seek help for their issues, and leads to a healthier, better-functioning society.
References:
https://www.psychiatry.org/patients-families/what-is-mental-illness
https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
http://nobaproject.com/modules/history-of-mental-illness#content
https://www.usatoday.com/story/news/nation/2014/07/10/high-unemployment-mentally-ill/12186049/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5131415/#Sec14title