What the hell is “mental illness”?: “Hey Siri, why does everyone think I’m going to hurt them?”
So, I didn’t keep my promise.
I spent the three weeks after my first post between New York, Indianapolis, Chicago, and San Francisco working mental health events, buried in lab, and consulting on a project to develop a mental health program in partnership with a major firm that ended up going belly-up.
I also was accepted off the waitlist for counseling at my university, a process that took three months (too long), and started working with a new therapist. Thankfully, I got lucky and found someone I felt comfortable with on the first try.
Not to mention I was trying to juggle my family, friends, relationship, and life in general. I did a pretty poor job.
To be honest, I’ve had most of this post, and the next two posts, written since October of 2016 and I fully intended to publish this on a quick turnaround, but life has a funny way of happening.
To add insult to injury, Donald Trump got elected our next president and I felt too scared to look at anything I had been writing. So, instead, I told you that I was going to take a break from publishing anything on mental illness.
Then, I decided to break that promise and come back to this post because I think thoughts and write words and I need to share them with you. Even if it terrifies me.
(And, I think I have a compelling, digestible, different take on mental health and illness that will help move the field forward.)
So here we go again. Hopefully, there is no more promise breaking. And, hopefully this post is more refined, and less reactionary and guttural than it was at its conception.
Three months ago, I started this post with, “Let’s revisit this, it is no secret that mental healthcare is broken. And finally, people are interested in fixing it.” But, I don’t really believe that statement anymore. Well — I don’t believe the second half of that statement, but let’s run with it anyway.
Before we get to the fixing part, though, let’s start with how mental health and mental illness are viewed in our society, and what the outcomes of these views entail.
If you are not aware, its 2017 and the internet exists. [Print (“Hello World!”)] It also happens to be the place where you cannot avoid social activism, even if you try reallllllyyy hard. From trendy BuzzFeed articles to entire platforms, mental health activism thrives on the internet. There are probably a multitude of explanations for this, but I like to think a large component is due to users’ (i.e. individuals, non-for-profits, universities, governmental organizations) ability to easily create content and share it with a massive audience to inform, educate, and connect with a population without any red tape.
Using the internet as a tool has led to an explosion around the visibility of mental health. Millions of dollars have been pumped into the virtual space in an attempt to join the party in normalizing mental illness and educating viewers about mental health through statistics, hashtags, the promotion of personal experiences and stories, and fundraising campaigns — to name a few approaches. Bring Change 2 Mind, the organization I’ve worked with most closely, has over a few hundred million unique views on their content, and this is just one player in a large and complicated space. Explosion isn’t a hyperbole here, its reality.
Some of these marketers and their campaigns are becoming serious players in creating real action and change, but, unfortunately, many seem to just be hopping on the “mindfulness” bandwagon and throwing around buzzwords they lack an understanding of. It’s a difficult space, and after a failed attempt at developing a social media campaign to decrease stigma, I deeply respect the ones that get it right, and generally advise the rest to quit while they’re ahead.
To be honest, I could write a diatribe with my own pinch of uniqueness on how mental health and mental illness has become more visible and all the fine nuances between different programs and organizations to explain how this happened and what has been effective so far. I’d rather not, though, considering people have already written their dissertation on this topic. So, please read those.
What is important here is that there has been a recent increase in visibility for those affected by mental illness and, in general, about mental health. This was largely made possible by the internet. If you still don’t believe me go ask someone older than you how they viewed mental health in their youth and I will take bets on the answer being, “I didn’t.”
Logically, it seems that the increased clamor about mental health and illness validates the fact that this is a topic that affects everyone in obvious and not so obvious ways. And, as more and more people begin to interact with a topic that was taboo for too long, they will begin to converse about it. This will lead to momentum in the political, economic, and social world, which will inspire a new wave of mental health treatments, companies, and healthcare reforms.
Right? ~fingers crossed emoji~
Unfortunately, while this train of thought seems like a good and rational plan, mental health and illness aren’t playing out in the most logical way.
“Build it and they will come,” they have said. “They” being those people who have pioneered the mental health and illness movement.
But, when you look at the facts, you may be surprised to learn this approach is failing because of public attitudes toward the mentally ill.
It’s been around five years since people popularized using savvy, cute, and emotional hashtags to share their stories about mental health and illness, and much longer since people have been sharing these stories face-to-face. Yet the stigma around mental illness hasn’t had a significant decrease since the 1950s. Interestingly, this is around the same time that society started being “open” about mental illness, due to the deinstitutionalization movement. To be extremely accurate, the General Social Survey (GSS) as well as countless numbers of sociologists note zero change in how our society perceives those with mental illnesses in the last 60 years with the exception that society thinks those with mental illnesses are now 2–3 times more violent than they used to be.
In other words, since we started publicly talking about mental illness, shut down a bunch of asylums that were holding places for the mentally ill until they died, stopped performing icepick lobotomies, and decided that it was a bad idea to put people into insulin-induced comas when they presented with signs of irritability, attitudes towards people with mental illness have actually have gotten worse in the eyes of the public.
The millions of dollars to start and maintain non-profits; the thousands of YouTube videos, blog posts, and Tumblr notes of personal stories; and what some people have called the “mindfulness revolution,” from a macro-view, haven’t helped shift the mean societal view toward people with mental illness or mental health in general to a more positive or understanding place.
What has occurred is massive failure. These programs while helpful to some have ultimately failed those with mental illness “careers”. (We’ll come back to this idea in a later post)
The promise of social campaigns ability to educate, reduce stigma, and usher in the development of a new wave of effective treatments hasn’t occurred. This is not to say that these programs haven’t been effective in educating, reducing stigma, or inspiring new treatments and start-ups. They have. But, these advances seem to be occurring in silos and specific socio-geographic pockets (i.e. Menlo Park, California). Increases in education aren’t leading to mass changes in societal thoughts. Anti-stigma programing often isn’t reaching larger numbers of unaffected people. Yes, the public is more aware about mental health topics, but we are realizing awareness does not equal progress. Scientists thought these things would work differently in application, and this is where the logic begins to unravel.
To make things worse, people are extremely fucking terrified of the mentally ill. Despite all this progress, public perception is that those with mental illnesses are now more violent and dangerous than ever.
The increased visibility of mental illness negatively correlates with the perceptions of those who are mentally ill. Most of our prevention and education programs are based on being open about and connected to mental illness, but these are difficult to reproduce successfully when the vast majority plays word association between school-shooter and mental illness.
And, while all of this is a shitty situation for society, those who are sufferers of mental illness and mental health problems are affected disproportionately more. As someone who is affected, I can tell you that it’s already an uphill battle. It feels like climbing Mount Everest when the first step is trying to convince someone you’re not going to walk into the nearest elementary school and pull out an AR-15.
Why is an increase in the number of people speaking out about mental illness and validating mental health via the 21st centuries greatest invention creating negative effects?
We really don’t know.
Well, we kind of know.
And, we can make some good guesses.
A major factor is because people with mental illnesses are now way closer to people who don’t have mental illness in society — researchers call this a measure of ‘social distance’. For example, a person living with schizophrenia could now be your child’s 2nd grade teacher instead of being locked in a hospital for life. And, because of this decreased social distance, people have run in fear from mental illness. Research shows that if you ask someone how comfortable they feel dating someone with a mental illness versus having to collaborate with a co-worker who lives with a mental illness, that they’ll be way more comfortable with the co-worker situation than that whole dating situation.
I think that people truly understand that mental health is important and people with mental illnesses aren’t violent or dangerous, but they still make us uncomfortable.
I don’t know if anyone has ever told you this before, but that’s okay.
That’s why I write, amongst other things. It’s why I encourage other people to get involved in mental health advocacy. The only way to become more comfortable with something is to interact with it. It’s why mental health research has moved from psychiatric hospitals to college campuses. Because, when people feel uncomfortable, stressed, and excited in these locations, they form new, diverse networks that change their attitudes and behaviors. And, their understanding of how that change occurs and what it affects are deeply important.
But, it’s not okay when your uncomfortableness turns into unwarranted fear.
And, fear turns into discrimination quickly when we’re talking about mental illness. Mental illness has become the post-modern scapegoat. This phenomenon is driven by a misunderstanding of mental illness, which in turn leads to the dismissal of mental health as a serious topic. Or, if you are a Trustee of Indiana University, you’d call it a “student conduct issue.”
People have become terrified of the discomfort that mental illness brings them. Mix this with a side of decreased social distance and increased avoidance behaviors, and you can begin to understand why people think those that are mentally ill are more dangerous than ever, even when people know their fears aren’t based in fact.
Research that has been replicated over and over clearly shows the mentally ill are less violent than the normal population, yet the public still refuses to uncouple violence and danger from mental illness. Doing so would force society to find a new scapegoat for acts of unthinkable violence, and there isn’t a good one available. Although, immigrants seem to be in the running thanks to President Trump.
But, the public doesn’t want facts. They just want to validate their gut decision, which, in the case of mental illness, is horribly wrong. And, thus, the reaction towards mental health and illness has led policy makers, drug developers, healthcare providers, private companies, venture capitalists, prisons, and educators to ignore, discriminate, divest, prejudice, assault, and isolate those with mental illness.
This is public stigma toward mental health in action. And there’s new research that shows the mentally ill are losing about 20–25 years off their lifespan because of the consequences of these public perceptions.
At the risk of repeating myself, I want to make it perfectly clear that the people who have created this atmosphere around mental illness did it all because they’re fucking terrified of those who are mentally ill in response to increased visibility and decreased social distance. They continue to perpetrate this false narrative even in the face of facts that show there is no reason to be more afraid of the mentally ill than there is to be afraid of any old normal person. And this status quo perpetuates stigma, and unnecessarily destroys the livelihood of those who are affected while road blocking meaningful policies and discussions that could change our climate towards mental health. And last but certainly not least, this is literally is killing people.
So, what do you do when you know people are afraid of you and your movement? What kind of programs do you develop? What do you fund? How do you start the overwhelming task of changing the views of an entire society just so you can build a foundation to start implementing programs and promising laws that help those with mental illness get the help that they need? How do you create parity among physical and mental health?
These are the questions I ask myself, and ones you should be thinking about too. I’ll come back to them in upcoming posts, but I want you to start ideating around what you think would work, what might work, and what would be a colossal waste of time and money to change public attitudes towards mental illness and mental health.
I will leave it here for a couple of weeks. When I come back, I promise to explain what the difference between mental illness and mental health is, why it’s important, and why thinking about trees will make you want to delete your Twitter.