Mental illness wreaks havoc with individuals, their families and friends. Most of us, unfortunately, will know someone who has suffered or is suffering from severe depression, schizophrenia, bipolar disorder or the like. And these are serious disorders.
In recent decades, society rightly, (at least on my opinion) has sought to destigmatise mental illness. But this well-meaning trend has had other unintended consequences. It has caught up in the wash many more minor behavioural disorders that have been given the same legitimacy as schizophrenia, severe psychoses and so on.
In our efforts to be compassionate and helpful to those suffering from anxiety and mild depression, for example, we have equated them with physical illnesses requiring medication. The downside to the medical approach is that it results in a state where the sufferer is relieved of any responsibility for their behaviour. They are given a passive role in the healing process. “Just take your medicine and rest,” seems to be the mantra. It is thus implied that the sufferers, through no fault of their own, have temporarily lost control of their lives. They just need to give medical science the chance to do its job.
Often this seems to work – at least in the short term. There is no doubt that many of the modern psychotropic drugs can be quite effective in ameliorating some of the symptoms of the sufferers. Because of this medical practitioners become complicit in the process. After all for many of them when a person presents with such symptoms, the only weapons they have in their armoury are drugs.
(Although some researchers dispute the effectiveness of some of the modern medications. For example Professor Irving Kirsch, a prominent researcher in this field from the University of Hull, had this to say about antidepressants at a conference I attended last year:
“The companies claim that the effectiveness of antidepressants has been proven in published clinical trials showing that the drugs are significantly better than placebos. But a close look at the data tells a different story. Although many depressed patients improve when given medications, so do many who are given a placebo, and the difference between the drug response and the placebo response is not that great. Most of the effects of antidepressant treatment seem to be due to the placebo effect. Furthermore the published trials are only the tip of the iceberg of material that doesn’t see the light of day. There are also clinical trials that have been withheld from publication. These are studies that have failed to show a significant benefit from taking the actual drug. When all the data are combined – published and unpublished – the inescapable conclusion is that antidepressants may be little more than active placebos, drugs with very little specific therapeutic benefit, but with serious side effects.”)
There are always some arbitrary lines to be drawn between what is “normal” and “abnormal” behaviour. Some of those around us whose behaviours deviate somewhat from the norm we might describe as quaint, individualistic or somewhat eccentric.
[Thomas Szasz has had some controversial opinions about this issue. “Mental illness” is an expression, a metaphor that describes an offending, disturbing, shocking, or vexing conduct, action, or pattern of behaviour, such as schizophrenia, as an “illness” or “disease”. Szasz wrote: “If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic.” While people behave and think in ways that are very disturbing, and that may resemble a disease process (pain, deterioration, response to various interventions), this does not mean they actually have a disease.”]
However, once these behaviours become a little more extreme, we tend to label them as mental illnesses. One of the more graphic illustrations of this phenomenon is Attention Deficit Disorder (ADD) in adults or Attention Deficit Hyperactive Disorder (ADHD) in children. So let’s look briefly at ADHD, according to the Australian Psychological Society if a child demonstrates the following symptoms for six months, then they should be diagnosed with ADHD:
• fidgeting with hands or feet, squirming in seat
• leaving seat when remaining sitting is expected
• running about or climbing excessively
• difficulty playing or engaging in leisure activities and often ‘on the go’
• talking excessively and blurting out answers before a question is completed
• interrupting others
At this stage, via this rather arbitrary classification process, the child passes from someone who has a behavioural problem that they should be encouraged to correct to a helpless victim of a disease which must under the medical paradigm of mental illness be treated by drugs. They and their parents are now relieved of any responsibility to “own” the problem and are encouraged to believe that the condition is a medical one and they can rely on their doctor to prescribe the right drugs which through addressing some supposed chemical imbalance will then lead them to adopt more acceptable behaviours! So now disorganised, compulsive people are caught up in the medical model and relieved of any personal responsibility for their behaviour.
Psychologist Rogers H Wright when writing about ADHD rightly points out:
“Certainly there are deficiencies of attention and hyperactivity, but such behavioural aberrancies are most often indicative of a transitory state or condition within the organism. They are not in and of themselves indicative of a ‘disorder’. Every parent has noticed, particularly younger children, that toward the end of a particularly exciting and fatiguing day children are literally ‘ricocheting off the walls’. Although this behaviour may in the broadest sense be classified as hyperactivity, it is generally pathognomic of nothing more than excessive fatigue for which the treatment of choice is a good night’s sleep. Distractibility (attention deficit) is a frequent concomitant of excessive fatigue, particularly with children under five years of age, and can even be seen in adults if fatigue levels are extreme or if stress is prolonged. However such ‘symptoms in these contexts do not rise to the level of treatable disorder.”
The point I am trying to make is that in an effort to destigmatise mental illness, we have created a plethora of diagnoses that are really just a description of aberrant behavioural patterns. The problem is exacerbated when some of these behaviours are somewhat ameliorated by psychotropic drugs.
Many of these so-called disorders, if they are to be properly addressed, require conscious effort by the sufferer to understand how their behaviours can be beneficially modified by coming to see the world in a more functional way. We don’t need a diagnosis of “illness” to destigmatise the condition. Once we understand how much of our behaviour is driven by our genetics and our early socialisation there is no “blame” to be allocated to such aberrant behaviour.
But to infantilise such people and deprive them of their need (and the right) to have a sense of responsibility for overcoming one’s problems, damages the self-respect that comes from self-responsibility and the importance of being confirmed as an autonomous entity.
Whilst those so anointed might get a sense of temporary relief, there is no enduring joy from victimhood. The role of the victim is generally accompanied by a sense of shame and powerlessness. That is why we must be careful in expressing our sympathy for those so afflicted to ensure we do not create a passive dependency.
In an essay titled “The Psychology of Victimhood”, the psychologist Ofer Zur concluded:
“Understanding types, origins and mode of operations of victims will allow therapists and non-therapists alike to recognise, prevent, and intervene in violent systems, enabling all participants to live better lives. For this to occur, victims must be helped to overcome their feelings of helplessness and low self-esteem. They must not focus on blame, and they must avoid moral self-righteousness. Victims have to believe that they have a say in what happens to them and learn to overcome their victim patterns. The healing process should empower them to become conscious contributors to the unfolding of their lives which can become dignified and meaningful.”
The famous American Psychiatrist Dr William Glasser, the founder of Reality Therapy, referring to the many patients he has dealt with that have no indication of brain pathology writes, “The most accurate way to describe these unhappy people is that, although they are not mentally ill, they are not nearly as mentally healthy as they would like to be.”. Whilst conceding that they may be benefited by counselling he continues, “I believe unhappy people can be taught to improve their own mental health…..”
Glasser believes that we fall into a trap when we try to draw parallels with physical and mental health. The problem is that we have been led to believe that only two states of health exist. We have come to believe we are either healthy or unhealthy. But this is demonstrably not true. The best way to describe physical health of the whole population, he suggests, he suggests is along a continuum:
Physically Ill——————-Out of Shape———————-Physically Healthy
Similarly, he suggests there is a mental health continuum:
Mentally Ill——————–Unhappy—————————Mentally Healthy
He asserts that, “The ‘mental illnesses’ that establishment psychiatrists diagnose, treat and list in DSM-IV (the Diagnostic and Statistical Manual of the American Psychiatric Association) should not be labeled illnesses because none of them is associated with any brain pathology.” He maintains that these “illnesses” are the many ways in which unhappy people express there unhappiness. Comparing the two continuums above, the mental equivalent of being “out of shape” physically, is being unhappy. Most times when we become aware of being out of shape physically, we know what to do – most likely to pay attention to our diet and to exercise. When we become aware we are out of shape mentally we present to a doctor steeped in the medical model who will take over responsibility for our unhappiness and probably prescribe drugs.
If for example, such an unhappy person were to present to a psychologist with any five of the following symptoms having been present for more than two weeks,
1. Depressed mood
2. Loss of interest in usual activities
3. Loss of appetite
5. Psychomotor retardation (slow thought or movement)
6. Loss of energy
7. Feelings of worthlessness or guilt
8. Diminished ability to think and poor concentration
9. Suicidal thought or action
then under the guidelines of DSM-IV they should be diagnosed as clinically depressed.
The Mental Health Foundation of Australia in 2007 reported:
• 3.8 million Australians have suffered depression at some stage in their lives
• 6.2 million Australians have either a personal or family history of depression
• More days are lost to depression, than those to industrial action
It is difficult to know how many of these unfortunate people are merely “unhappy” as per Glasser’s categorisation above and need some assistance in finding more constructive ways of dealing with the world or have conditions that are severe enough to need treatment by drugs. The only thing we can be assured of is which ever category they might fit into, they are more than likely to be co-opted into the medical model and more than likely rendered passive victims under the paternalistic purview of a doctor whose only perceived option is the administration of drugs.
As we have seen from previous blogs drawing on the work of Martin Seligman, Matthieu Ricard and others there are positive strategies available to individuals to improve their sense of well-being without resort to drugs.
Some of the issues relating to mental illness outlined in the above are further explored in my new book, “Yu, The Dragon Tamer” which should be available in book stores next month.
After writing the above I came across an article in The Weekend Australian September 18-19 titled “Disorder in the classroom on the rise.” This article outlined how in Queensland there is an “epidemic of autism”. This is caused by the pressure on paediatricians and childhood psychologists to diagnose this disorder because of the funding schools can access for children so diagnosed. The scheme that has created this dilemma was created by former politician Dean Wells who now regrets the scheme’s unintended impacts. In an interview for the piece developmental paediatrician Catherine Skellern is quoted as saying, “I don’t think anyone appreciates the downstream effects on children labelled with something they probably don’t have and how people will treat them as a result.”