Mental Illness Should Not Be Categorised, But Normalised
Mental illness, at least from a medical standpoint, is a melting pot of contradictions. While an understanding of the human brain, including the reasons for certain functions and an appreciation of the origins of thought, have been elusive to the scientific community, those responsible for the categorisation of mental illness have strode on relentlessly, if not clumsily.
The list of categorisations of various types of anxiety, depression and mental disorders is limitless; from ‘situational depression,’ where a certain circumstance has triggered temporary depression-like symptoms in a patient, to ‘atypical depression,’ where fatigue and lethargy are underpinned by chronic sensitivity. Then there is ‘seasonal affective disorder’ (SAD) which causes people to feel depressed at a specific time during the year — most commonly during winter months — and ‘persistent depressive disorder,’ otherwise known as dysthymia, which is a persistent and mild form of depression that can lead to, severe or chronic depression. Then there are the subcategories within each of the major categories, which mean that a patient can be diagnosed with several types of depression and anxiety.
The problem here is not the attempt to categorise mental illness, but the ungainly work of focusing on mental experience — thoughts and emotions — as a means to put patients in easy to understand boxes. Where other areas of medicine are simple to categorise and therefore treat, the brain is something we still do not understand the workings of. Attempting to extract symptoms and therefore perform a diagnosis using a cross-section of experiences and then offering those findings as categories, leads not only to common misdiagnosis but also confusion — something that sufferers cannot afford.
I should have received psychological treatment years earlier than I did, but I was convinced that I didn’t have depression because I wasn’t sad, angry or upset and I still functioned effectively as a human being. I Googled and Wikipedia’d during my darker moments, read some essays and took some tests and found that the emotional categorisations didn’t fit. Terms like ‘tired,’ ‘depressed,’ and ‘sad,’ didn’t describe me at all. I was living in a constant cloud that stopped me from feeling anything at all, but depressed or sad? Absolutely not.
On YouTube and blogs, sufferers spoke of different symptoms — a sense of hopelessness or perhaps a feeling of dread.
Getting closer.
In the end, it was a complete mental departure from reality that forced me to get help, but had this not happened, the system of categorisation may have meant that I carried on, living a half-life of adherence and fear.
The insistence of the psychiatric and mental health community to feign an understanding of brain function means that problems that need to be solved, aren’t. A perfect example of this is the use of selective serotonin reuptake inhibitors (SSRIs). This group of antidepressants works to artificially prevent the reabsorption (removal) of the neurotransmitter serotonin. Serotonin is a neurotransmitter that works to regulate mood, the theory is that increased levels of serotonin will decrease feelings of anxiety, depression, sadness…you know, moods.
But it doesn’t always work like that, and as with everything else to do with the brain, the reasons for this are speculative. In some cases, SSRIs produce predictable, good results with patients experiencing a decrease in extreme emotions, and — as my psychiatrist described it — a chance to “see the wood for the trees.”
However, in many cases the drug either doesn’t work, or even has a negative effect. There are a number of physical side-effects, but perhaps most disturbingly, there is a certain percentage of the population that will statistically be more likely to consider killing themselves on SSRIs.
Why? Nobody knows. but experts will claim with confidence that there is, “enough evidence,” to form a, “solid hypothesis.” Dig a little deeper, and you will discover that having enough evidence apparently means drawing a logical conclusion, rather than a definite answer. Worse still, experts on the human brain cannot reach consensus on…pretty much anything.
This level of uncertainty has enabled politicians and the media to apportion blame for many of the world’s problems on sufferers of mental illness. The National Rifle Association (NRA) has repeatedly claimed that mental illness is a major contributor to mass shootings, apparently even more so than accessibility to weapons. This is a savvy political move on their part (and they are not the only guilty party) because it’s hard to argue that anyone who chooses to shoot another person has some major psychological issues. Depression perhaps, or anxiety. And it’s here that the clumsy categorisation of mental illness becomes dangerous. The clumsy categories and subcategories mean that everyone essentially falls under one banner — mentally ill.
But if we can’t, and shouldn’t, attempt to categorise mental illness in terms of emotions and feelings, then, what?
We have stumbled into this age of categorisation by accident. This is not the place for the history of categorisation, but if you would like to do some research there are plenty of resources available. In summary, the medical community came up with a number of definitions, which have been expanded on since the early 20th century, resulting in the incarceration and surgical abuse of hundreds of thousands of people. Why? Because society at that stage relied on an educated elite to provide insights and solutions to the world’s problems. It was far easier to shove, “crazy people,” in a mental asylum, than let them roam the streets. What we have now is an extension of that original categorisation methodology — we don’t completely understand what’s going on, but we will trust a bunch of smart people who speak convincingly.
The solution, is the normalisation of mental illness. This means no longer treating those who are afflicted, as people requiring medical intervention. Essentially removing the stigma around issues related to the brain, accepting that everyone is prone to experience a neurological chemical imbalance at some stage in their life.
Post Natal Depression — An Example
For example, a woman has a baby and is forced to confront a lifetime as a mother — something she has never considered before. She feels no connection to her child, and has feelings of extreme guilt as a result. Added to this, she considers her old life, one that she loved, and realises that it will never return, her future is uncertain and she is terrified. Also, she doesn’t feel comfortable talking to anyone about it because she is supposed to be a, “ good mother.” If she doesn’t love her child, then she doesn’t deserve the mantle and by definition she is a bad mother.
All of this goes on in her head with no respite, while she is attempting to learn how to raise a tiny human. Frankly, a sense of depression is a reasonable reaction to this confusing and overwhelming circumstance. She doesn’t need to be diagnosed with a medical condition, she needs to be offered support, and perhaps some medication to, “see the wood for the trees”. She should be told that what she is experiencing is entirely normal based on her own thought patterns. She isn’t a bad mother, and she isn’t just a categorisation. Why does this matter? Because in the midst of overwhelm and fear, the addition of mental illness is the equivalent of pouring gasoline onto a fire. Most importantly, the categorisation itself serves no purpose at all.
Imagine this mother, instead of of being forced to go to a doctor and fill in a questionnaire that deems her to be suffering from some form of postnatal depression, is instead referred to a group of mothers that have been through a similar psychological experience. In a supportive environment, each of the mothers talks about, and laughed about, and cries about, what they went through and are going through. There is no talk of diagnosis or ongoing issues, the focus is on how hard it is to be a mother sometimes, and hints and tips to work through unhelpful feelings.
It has been said that depression is the most over-diagnosed medical condition in the world. I think it is probably under-diagnosed, and with good reason. In our society, it is not okay to be mentally ill, and the stigma and negative connotations are real. People treat you carefully, or with concern or caution and until this stigma is eliminated, the number of people who don’t get the help they need, will continue to rise.
Mental illness is normal. We don’t know how our brain works, or appreciate why certain neurotransmitters are activated at certain times. It’s why one person can ride a rollercoaster and feel exhilarated, and another can ride exactly the same rollercoasters and feel terrified. The terrified person is not abnormal, or in need of any form of medical treatment, they are experiencing life in a way that is different to the other person. Likewise, the exhilarated individual is not immune to fear, nor do they lack any form of sensitivity — it’s just their experience of life, helped (probably) by the way their neurotransmitters are activated.
There is no use anymore for clumsy categorisations, over and above the creation of academic papers and hypotheses that could easily be disproven, resulting in years of mismanaged patients. Antidepressants and other drugs should still serve a purpose — but as tools to clarity, rather than solutions to a medical problem. Let’s allow the next generation to experience mental ups and downs of life, with support and understanding rather than the pain and stress associated with a medical diagnosis.
