What can we possibly understand about mental illness?
Only one thing’s for sure: there are no definitive answers.
What is meaning, how is it stored, where does it exist, what does it look like in the brain? We really don’t have a sense of how the brain works, and if we’re going to be able to make the progress that we need against those disorders that we want during this century we’re going to have to get a deeper understanding of this problem.
Dr. Thomas Insel, the Director of the National Institute of Mental Health, 2015
There’s not a credible psychiatrist or neuroscientist on the planet who would claim we know unequivocally how mental illness manifests in the brain, or how to treat it — let alone how to cure it.
That’s not to say we know nothing at all.
We know something about the risk and causal factors that lead to propensity — like childhood trauma, abuse of psychoactive drugs, stressful life events and potentially exacerbating genetic factors. We know something about the efficacy of medications for psychiatric disorders — at least, we have stats from thousands of studies — though the picture is far from clear or unequivocal (and without the context of the participants’ circumstances, I’d argue that not much of individual use can really be extrapolated from the studies). We know something about how these medications work in the brain — but not enough to be able to dispense them on anything much more sophisticated than a trial and error basis. And we certainly don’t know how to judge with certainty when someone may no longer need to take them.
With every experience being so individual, and the science being so uncomprehensive, where does that leave the sufferer?
Everyone who’s suffered from some sort of mental illness has their own understanding of its nature, its origins and its trajectory. In this way they’re no different from physical illnesses. From when we begin to suffer symptoms to when we’re diagnosed, we ask ourselves — and our doctors — where the problem has come from, what kind of treatment is available, and what outcome we can hope to expect. Of course, even when we hear the answers we don’t necessarily believe them, no matter how authoritatively they are delivered. Even if diagnosed with advanced cancer, we might cling on to the hope that we can beat it against the odds — or that a new remedy, medical or alternative, might provide a miracle cure. Sometimes we do defy the odds. Often we don’t.
Where mental illness is concerned, the odds are a lot less clear. As with physical illnesses, we have plenty of stats to go off, of the form “X% of the number of people who develop these symptoms by age X go on to relapse if they’re untreated by medication”. But those stats don’t tell us anything about the qualitative situation of those who beat the odds. This is one issue with the non-recovery model of psychiatry that I’ve written about elsewhere.
When it comes to mental illness, treatment plans and outcomes are strictly individual. Often (though not always) patients will have a say in the medication they take, and the dosage: I’ve often been asked by psychiatrists whether I want to strengthen the dose of an antidepressant, or try another drug if it doesn’t appear to be working. With these invisible illnesses, the patient’s word and behaviours play more of a role in treatment than physiological symptoms.
Of course this opens up the system to problematic biases of the kind exposed in the Rosenhan experiment, when eight psychologists feigned symptoms, got themselves admitted to psychiatric hospitals, then resumed normal behaviour — but were still considered ill and not allowed to leave.
More critically, the individualistic nature of invisible illnesses means that patients can never fully connect with each other on a comparative level.
No matter what your experience or understanding of your illness is, someone else will have a different experience or understanding that counters it. Of course, that doesn’t mean that it’s not possible to connect with fellow sufferers, and derive plenty of benefit from mutual support — even if your experiences or perspectives are vastly different. The challenge comes when trying to extrapolate from one’s own individual experience or perspective to articulate them in a way that may be more widely helpful or relevant.
I discovered this when I posted a blog setting out my personal understanding of depression, and tips for getting through it. Whilst the response was mainly positive, some of the comments were downright hostile at my pretensions to know what I was talking about — typically on the basis that they’d had it so much worse than me.
From this response, two things became clear for me.
Firstly, the importance of solidarity and respect amongst the sufferer community, against a backdrop of humility (and, for me, sadness) about the fact that until we have a clear understanding of the brain, we are going to have to continue muddling through adversity in the face of uncertainty.
And secondly, it reinforced to me that ultimately this is a journey everyone has to navigate by themselves.
When faced with the symptoms or diagnosis of a mental illness, all we can do is come up with the narrative or understanding that best works for us, as individuals. We have to make sense of it in a way that helps us, as much as possible, to move forward, to fight it, and to live the best quality of life that we’re able. In the face of an illness characterised by disempowerment, that’s the only way we can take some power back.
