There’s an entire graveyard of first-drafts of this piece sitting somewhere in the dusty virtual archives of CWR, but after eluding me for so long (and I mean months, people) I finally think I’ve got this complicated and multifaceted post down.
Let’s get right to it.
Mental Disorders Are Partly Your Fault
See this comic?
As much as it’s making a good statement about the way we treat mental illness (and we’ll touch more on that in a second), the simple fact of the matter is that the idea that mental illness is something that just “happens” is wrong. The comic asks us “Would you really tell someone with a broken hand to just ‘get over it’?”. To which I say, “No, but I would yell at him for not wearing cast or for trying to punch through cinder blocks.”
Or anything like this…
Mental illness is a horrific situation which we still don’t know a whole lot about, but that doesn’t mean we can fall into the easy mistake of thinking we’re helpless victims. Just in the same way a person on an all-cheese diet probably shouldn’t be surprised at having constant digestive issues, a person who knowingly and willingly exacerbates his or her own condition or goes into a situation where they’re going to be more vulnerable shouldn’t be too surprised when things start going bad. I’m not saying that a person prone to depressive episodes should constantly avoid any possible trigger, but that person should be aware of his or her own condition, the risks involved, and be actively engaged in their own treatment or recovery.
There’s No Such Thing As Preventative Care
In spite of that, we do need to understand how complicated the situation is. As of yet, we’re severely lacking any kind of preventative mental health care in this country (and indeed, in most countries). The acceptance of the very existence of mental illness is comparatively new, and as far as a comprehensive infrastructure goes, most folks are out of luck.
Whenever flu season rolls around we get flu shots. To fight the spread of major contagions we get vaccines (the sane of us, anyways). To combat against most everything else we practice decent hygiene, proper dieting, and keep ourselves in relatively good shape. All of this, more than anything else, is the cornerstone of of a healthy, functioning society- prevention rather than cures.
We simply do not have an equivalent on the mental health side of things. Our perspective of the situation is either you have a healthy mind or you’re ill- there’s somehow no progression or middle-ground. Obviously there are certain things out of our control here- plenty of mental illnesses are formed over a long time by environmental factors and there’s no easy way of addressing that.
For the most part, though, it seems the closest formalized preventative mental health care comes to us in the form of inspirational and confidence building self-help books.
Not a comforting thought…
Well There Is, But It’s Gotta Be Under The Table
As mentioned above, we really don’t tend to respond to a problem until it’s way too late. Insurance won’t provide basic mental healthcare until there’s an actual disorder present. By then, of course, things are already way out of hand.
The DSM-V, the be-all-end-all diagnostic criteria for mental illness, has become less a guide for doctors and more of a menu for insurance and pharmaceutical companies who influence the language of the text to bend the odds in their favor. While obviously this back-room dealing needs to be addressed in and of itself, perhaps the greatest challenge in modern application is the large number of clinicians out there who are diagnosing folks who don’t meet the criteria for a disorder with one. It’s viewed often as necessity in providing some sort of lifeline to folks while there’s still a chance- think of it like doctors diagnosing people with cancer so they’ll be able to prescribe allergy medication.
As you’d expect, it’s crazy, sloppy, and tends to blur certain legal lines.
All that is just to say that…
We’ve Got No Mental Health System
We really don’t.
There’s no comprehensive system for addressing mental health issues, and certainly not any system for addressing the sheer scale of what we’ve got going today. A huge part of this again seems to be the interference of the insurance industry, meddling (if not out-right dictating) the terms and conditions of mental disorders. Naturally my solution to this would be the overthrow of the whole cancerous Capitalist system, but that’s just me.
Obviously we’re going to have to start making some changes.
We teach first aid. We know CPR. A person on the street can tell you the symptoms of a heart attack or a stroke or even how to set a broken bone. What do we have for mental illness except a bunch of images in movies and on TV of lobotomy patients?
What if we did mental health check-ups on the same regularity that we do physicals? What if we followed the example of some countries and provided sick days not simply for physical issues but for mental stress as well? What if we had a basic understanding of how our own minds work? What if we were taught from our first day of school how to withstand the onslaught of tricks used by advertisers?
No, it ****ing isn’t.
We need to have a society who can see behavior and tell you “Hey man- that doesn’t look right…” or “You don’t sound so good…”.
And we’re getting better, don’t get me wrong, but we still have a long way to go.
Culture War Reporters 
I’m curious as to how you think developing clinical depression, for example, is tantamount to punching a cinder block? Are there things that can be done to help depression or other mental illnesses? Potentially, but nothing is universally applicable. For some people, receiving medication does wonders. For others, it makes the symptoms worse, or replaces them with something worse. Besides, we are talking about MENTAL illness here. Sure, you can criticize a guy with a busted hand for not wearing a cast, but when someone’s mind is ailing, do you really have a leg to stand on in criticizing them for not making “rational” decisions? I don’t think so. So while I think your later points are more or less solid, I’m going to have to strongly disagree with your first point. Mental illness is NOT the fault of the afflicted individual.
I would cite the tendency of some individuals- not all, but some- to exacerbate their own conditions while operating under the belief that they are incapable of doing otherwise. We’re not talking about (as Evan references below) a disease that robs the individual of any sense of reality (such as dementia or schizophrenia), we’re talking about having a basic degree of agency and-
Well, let me offer an illustration here. We’ve got a guy who suffers from clinical depression and is aware of this fact. In spite of this, he involves himself in relationships or activities he knows aren’t going to pan out and will ultimately only exacerbate his condition (i.e., punching cinder blocks). Is he a slave to his condition, stuck in this endless downward spiral? Absolutely not- the dude might not be able to cure himself, but he can choose to actively participate in his recovery. It’s the reason for using Hank from Breaking Bad up above- I draw a parallel to rehabilitative treatment. You can’t change that fact that what has happened to you has happened, but you can (heck, need) to be an active part of coping or if at all possible, recovery, you know? The idea that mental illness “just happens” to people and that there’s nothing you can do to combat it is both untrue and unhelpful.
My point is that many who suffer from depression lack the sense of self-worth necessary to motivate them toward constructive progress. You don’t start down the path to recovery if you A) don’t have a desire to get better and/or B) don’t have any hope that that path will lead anywhere. It’s a very unnatural state of mind to be in, and a very difficult one to understand for those who haven’t experienced it. But you’re still over-simplifying the matter.
That’s kind of my point though- effort and involvement on the part of the individual is essential to combating the pathology in question, without it, there’s really no point.
I mean, plenty of mental disorders- we’ll use depression- aren’t a constant state, they tend to hit in episodes (depending on the nature of psychopathology). There are times of rational thought during which it surely would seem logical for the individual to seek assistance, build a network of support, gain a better understanding of the nature of his own disorder, and take other steps vital to combating the issue.
Under your heading of “Mental Disorders Are Partly Your Fault” you take the comic as a perfect analogy, which is probably the wrong way to go about it in the first place, and offer two solutions to the person with the “broken hand”. The first is to yell at them “for not wearing a cast”, which I’m going to reinterpret as asking them to wear a cast, or to seek help for their condition. That’s all well and good, but then we come to chastising them for “trying to punch through cinder blocks.” What exactly is the parallel here? What wrongheaded action parallels that when it comes to people who suffer from depression or bipolar disorder?
It’s fine to state that people should do their best to get help, but the implication that their current mental state is their own fault strikes me as being patently wrong. There’s a difference between talking to a person who suffers from extreme social anxiety and helping them throw off a mentality of victimhood and telling them “it must have been something you did.” They can worsen their condition but that doesn’t mean they’re to blame for its existence.
Is having schizophrenia run in your family the same thing as eating an all-cheese diet? No illness just “happens”, but what about when their root cause is in genetics? I see what you’re trying to say about people being aware of their mental health and where it’s at, but as far as being responsible for the creation of these issues I think you’re way off base.
Well, I think a lot of what I commented above with Stew will cover the points you bring up down here, but I’ll go ahead and chuck out some more examples which oughta clarify things a bit.
I use an picture up there of a satirical warning sticker on the subject of beauty, and certainly, there’s a host of a mental illnesses centered around that subject. We’re presented with a steady stream of images we’re told are “attractive”,- so called “ideal weights”, “skin tones”, “nose shapes”, the list goes on and on. At some point though, is the individual not responsible for his or her response to these things? If I am investing the whole of my self-esteem in an unattainable image, am I not party responsible for the construction of this fantasy?
Or let’s talk about a different example- let’s say I’ve got an impending death of a loved one. A failure or refusal on my part to accept the reality of the situation is going to be grossly unhealthy (as much as an all-cheese diet). If over the months I staunchly refuse to go through any grieving process, if I maintain a state of denial, is this refusal not partly my fault? If not, it would seem that my *refusal* is in truth an *inability*, which would return us to being just slaves to our environments and our neurology.
Worsening or exacerbating a condition isn’t equivalent to causing it.
If you want to specifically discuss anorexia and bulimia I suggest doing so since they’re clearly what you’re referring to in spite of never outright mentioning them. There are certainly outside factors there [ie. the media, bullying, etc], but your blanket statement covers obsessive-compulsive disorder, phobias, social anxiety and, as I mentioned, depression.
You use a sweeping statement to partially place the blame on the afflicted and it isn’t an accurate one. If someone makes the choice to starve themself to get thinner that doesn’t place them on the same level as a person who wake up completely lacking the motivation to even get out of bed.
I don’t at any point recall having asserted that the individuals suffering from the disorder are the cause of the disorder- my point is rather the individual plays a role in either the perpetuation or the combating of the condition in question. In retrospect “fault” was the wrong word to use, though I don’t think “responsibility” avoids that pitfall either.
If that’s the main point of the section it’s poorly communicated, mostly, as you said, because of the heading. Well, that and the fact that you likened those with mental illness to people who have tried to punch through cinder blocks.
The fact that people can worse their conditions is a good stance to take, and an accurate one. But it’s not entirely what you’re telling us.
Whoever wrote this tangled, traffic accident of an article is objectively clueless in regards to the whole mental health topic. Mental illness in and of itself is not “partially your fault”, namely because the things you mention — hygiene, proper diet, etc. — they should all be in place, but in a lot of cases they can’t be. Quick once-off points I need to get out of the way before I dive in:
1) Consider poverty: (eating cheaper and far less healthy foods high in sugar and salt, which fucks up your blood sugar and makes your mood spike out all over the place; having stress about not being able to get more of said shitty food because you have no money and need to, like, not die; being stressed about life circumstances and supporting family and being sad about feeding them shitty food and not having much else to give to their quality of life (placing that on your shoulders like it’s entirely your fault), being stressed about finding/maintaining/surviving work long enough to make enough money to do the aforementioned things and maybe spend some on yourself so you can have even a smidgen of enjoyment in your life); the part where if you’re already diagnosed with mental illness you’re way less likely to be hired in the first place, exacerbating all those other things
2) The whole “all-cheese diet” which in essence translates to “don’t be surprised if you get sick because your life is shitty” – I can’t even formulate a response to this. come on, are you even real
and finally,
3) “I’m not saying that a person prone to depressive episodes should constantly avoid any possible trigger, but that person should be aware of his or her own condition, the risks involved, and be actively engaged in their own treatment or recovery.” – maybe you’re not saying that specifically but you’re still placing blame on people who are already grappling with enough shit besides another “stay in control” message from some random guy on the internet thinking they’re somehow assisting or ~*weighing in*~ on the conversation when they have no idea which direction is up:
Look. Telling someone to be aware and to just do something about it reeks of stigma and plays into the idea that mental illness is to some degree a choice. You can’t even be “aware of your own condition” because of the level of stigma, lack of education, and pressure on people that exists. I feel like it’s important to note that in many cases, speaking from experience, ~*crazy people don’t usually know they’re crazy*~, hence the whole “this is a legitimate illness” thing. You can usually feel yourself going but if you haven’t made it all the way, so to speak, you don’t really know what it is until after the fact. Usually what happens is a person is (forcibly) made aware they’re exhibiting problematic behaviour, often by another person who is going about it in the entirely wrong and shittiest way possible (if they get told at all), and then they get even worse for a while due to a “now what are you going to do about it” attitude paired with no support or assistance with said “doing something”, along with the unfortunate pattern where half the time when the person telling someone to get help is asked to then, you know, help, and they suddenly backtrack into “just brighten up’ or “it’s not that bad” or “bootstraps” or whatever. THEN you have the part where it takes a really long time to find the correct diagnosis for whatever it is you have, assuming you can find the correct doctor to take on your case – for example, it takes an average of 11 years to be diagnosed with bipolar for most people, assuming you can stick out the treatment and the medication trial and error (and those horrific side-effects) long enough. It only took 9 full years (of life-consuming suffering) for me before my health team (I had a TEAM working to figure it out, and you’re telling individuals to do it somehow? neat), namely because the illness takes a very long time to unwind itself and come out as a fully-cycling disturbance. Also, bipolar is genetic so there’s nothing I or anyone else can actually do to prevent it from coming around, as is the case for many mental illnesses – I do maintain as healthy a lifestyle as I can between episodes, in an attempt to help minimize them when they inevitably happen, but it will never completely nullify what I have had to learn to overcome on a day-to-day basis and it will never entirely impede the episodes that come a few times a year.
You’re right about the part where there’s no such thing as preventative care, except that there is and it’s just not treated as medically-sound by the community at large. As someone with over a decade of experience with manic depression, or Type 2 Bipolar (Bipolar II), I use it a lot – it’s just self-care. I do things like go to the gym on the regular (boosts endorphins and burns away the bad shit in my system like my excesses of adrenaline and cortisol), I eat less in favour of affording the healthier alternatives (because I don’t have enough money to afford enormous meals’ worth nice things), I live in a house full of windows to let in as much light as possible, and I leave lists and self-encouragements EVERYWHERE because I know I can’t rely on anyone else to give me the constant support I need to keep functioning. That being said, I am incredibly privileged with a family that offers me financial support and after several years of battle am finally on ODSP, meaning I have around $1000 a month I can live on, something most people in my situation don’t and won’t have (they tried to turn me down for ODSP multiple times, citing “insufficient evidence” of impaired life despite the fact I no longer talked or left the house, had dropped an incredible amount of weight, and cycled in and out of acute suicidal tendencies). As for that self-care stuff, I can only do those things without help when I’m in-between episodes like I am now; see, the thing with mental illness is that _you literally can’t do most normal everyday activities when you’re in the throes of an episode_, and it’s really, really fucking difficult to do them when you’re on the road to one. Getting out of bed becomes next to impossible, the house turns into a garbage heap, you can’t eat, you can’t sleep or sleep too much, and you’re exhausting to yourself and everyone else. It’s not a matter of “just do x and deal with it”. And by the way, that dig at self-help books is shit too because they are one of the only places to get taught how to be kind to yourself right now, and the little tips and tricks they usually offer can really help some people; reading is where I got most of the information that has kept me alive today, because no one has a comprehensive list they can just hand to you and figuring it out when you can’t think of anything besides sadness is next to impossible.
You go from saying that mental illness is kind of your fault to, “we have no mental health system” and “doctors aren’t doing it right and are diagnosing people who don’t even have anything [says the guy who is not a doctor, and by the way, if you can’t see it, it either means that a) the doctor is doing it right because the person is treated and as healthy as possible given their condition and b) most people with mental illnesses give it their all to actively hide said illness at all times, which is why you can’t look at me and go “that chick has something funny going on upstairs”. The idea that disability has to be visible to others to be real but invisible if acceptably handled is toxic and ridiculous.
I suggest you do a lot more learning before attempting to enter the discussion again
Well, there’s a lot to respond to here, but I’ll try to cut right down to the heart of the matter.
You assert that “As someone with over a decade of experience with manic depression, or Type 2 Bipolar (Bipolar II), I use it a lot – it’s just self-care.”
See, that’s exactly that I’m talking about up above- you’re aware of what you’ve got going on and you’ve taken steps to understand it, its effects on you, and how best to handle the situation. You could, alternatively, let all that slide and wind up exacerbating your condition but (I assume) you don’t. In short, your own choices are linked inextricably (though of course, not exclusively) to the issue. “Responsibility” I admit, would have been a way better word to use than “fault”, but hindsight’s 20/20, eh?
You say we have to “Consider poverty”, citing it and all that goes along with it as being part and parcel of the issue. And hey- I hear ya. I work with a largely impoverished community and I absolutely agree that there’s plenty of stuff that WOULD be helpful simply out of reach. Nevertheless, folks aren’t stripped entirely of their own agency- we can’t control as much as we want, and certainly not as much as we should, but there are still things we can do to improve the situation as much as possible. That again, is ultimately my point, that we’re not helpless, that we’ve got a role in this as well.
My comments on diagnoses from doctors comes from both my own experience in the field as well as the statements I’ve heard from some doctors themselves, asserting that they have chosen to provide a more severe diagnosis than is actually present in the hopes of being able to provide the client with help before the issue gets too far out of hand. Though that’s more to point out how convoluted the field can get.
Look, at no point do I say “just deal with it”. There are people out there who have that mentality, I am not among them. Dealing with all of this, from the disease itself to the stigma to the chaos of the mental health system is a nightmare, but one that still needs to be dealt with. We have to change what we can, be it the culture surrounding mental illness or the way we diagnose it or anything else.
“See, that’s exactly that I’m talking about up above- you’re aware of what you’ve got going on and you’ve taken steps to understand it, its effects on you, and how best to handle the situation. You could, alternatively, let all that slide and wind up exacerbating your condition but (I assume) you don’t. In short, your own choices are linked inextricably (though of course, not exclusively) to the issue. “Responsibility” I admit, would have been a way better word to use than “fault”, but hindsight’s 20/20, eh?”
You seem to have missed the part where I mentioned it took *nine years* to arrive at a diagnosis – before that I was told I had an anxiety disorder (GAD), panic disorder, clinical depression, mood disorder NOS, and before that even, I just got “we don’t know”. And because we didn’t know all through that period of time, I was given the wrong medication, the wrong treatments, and therefore rotated between constant nosedive and extremely/dangerously (I feel the need to specify only to myself) unstable for those nine years. I also had to put up with the constant shaming and “try harder” attitude of everyone I knew, despite the fact I was doing literally everything there was for me personally to do (aside from off myself, which came up as an option to me more times than I can count). And then there are people like you, who seem to think that because I’m now finally under a remote amount of control after that excessively long period of figuring what was even going on and another number of years since learning how to manage and get by (and miraculously remaining consistent in being managed) I’m one of the ~good ones~ somehow. Although a certain level of responsibility is involved, saying it’s the sick’s responsibility alone to get un-sick is extremely harmful and pins them — us — in a corner and further exacerbates the issue of harmful thoughts and “why can’t you just do it” and “you should be able to do just fix it” attitudes that we hear in our own heads endlessly anyway. You should not feel pride to be a mouthpiece for toxic thoughts. Mental health is a community issue and will always be a community issue, and that responsibility you seem so interested in pressing extends to the healthcare team, friends, and loved ones of the sick just as much as the unwell themselves for this type of illness.
Although I’m on the correct medication (for now – they only ever last for six months to a year before I need to switch again, on average) and have a decent sort of therapeutic approach to go with it (again, because I’m privileged and can actually afford it thanks to my family helping me out [PS: finding a therapist that works and actually makes a different is a crucial part of treatment even for those who can afford to experiment-away $200 per 50 minutes at a time, but since you seem heavily uninterested in listening to what anyone else says about your extremely unfortunate and damaging stance on how easy it is to manage mental health, I won’t bother getting into it]), I still have awful days/weeks/months and I still get triggered left and right; it is only through an excess of willpower and support that I’m still alive today. Because of things outside of myself.
“You say we have to “Consider poverty”, citing it and all that goes along with it as being part and parcel of the issue. And hey- I hear ya. I work with a largely impoverished community and I absolutely agree that there’s plenty of stuff that WOULD be helpful simply out of reach. Nevertheless, folks aren’t stripped entirely of their own agency- we can’t control as much as we want, and certainly not as much as we should, but there are still things we can do to improve the situation as much as possible. That again, is ultimately my point, that we’re not helpless, that we’ve got a role in this as well.”
Huh. So… being poor and literally not having access or options, but hey, you still have agency, so… I guess… just… be less poor?
All I can think of right now is, firstly, this GIF:
Then this: http://blogs.sfweekly.com/thesnitch/romney-poor-buy-more-money-thumb-250×204-thumb-250×204.jpg
Your absolute refusal to listen to the feedback you’re receiving is exhausting and objectively awful to try and bother to get interested in dealing with any further. Assuming you respond, I will not be doing so back. I hope you eventually learn how wrong you are and refrain from adding to the cesspool of misinformation and harmful online articles regarding this topic, because the mentally-ill need support, not to get kicked down one more time.
You state that you’re not going to respond back, which I think is disappointing, but I’ll nevertheless respond and hope that you do.
We’ll start off with the issue of poverty, since I think we can knock that one out of the way pretty quickly.
At no point do I say “be less poor” as a response to poverty, I’m simply saying that there’s a difference between being impoverished and being completely and wholly without any control over one’s own life. Being poor is not the same as not having access or options; while they’re certainly diminished for the poor, they do still exist.
Let me throw out an example here. I used to work as a PSR provider (psychosocial rehabilitation). It was my client’s choice to seek out services for his condition, his choice to attend sessions, and his choice to either respond to or ignore his rehabilitation. This is what I’m talking about when I talk about agency- in spite of disorders, people are not (usually) stripped wholly of their ability to make conscious decisions. We tend to portray mental illness not as an illness but as an irrevocable curse (in no small part due to the way mental illness is typically portrayed in culture and media at large). As a result, we seem to neglect the role of the individual in worsening or in improving his or her condition.
I am not advocating any of the simplistic responses to mental illness portrayed in the comic, and I do not deny the role of friends, family, or the healthcare industry at large. It is my intention to return focus, which I do not believe is being given, to the role of the individual. As you yourself state “it is only through an excess of willpower and support that I’m still alive today.”
Look, I think we’re in agreement, we’re just talking past each other here. I’m not here to “kick” anyone, I want to see individuals with mental illness viewed as equal participants in treatment, not as the lost and damned.