Until the 19th century, persons who imitated illness—that is, who claimed to be sick without being able to convince their physicians that they suffered from a bona fide illness—were regarded as faking and called malingerers. Not much has changed today and many still see those who say that they are mental ill as deficient morally and (very often) malingering. As the mental health care industry grows are we being more diligent in identifying the sick, enabling those who milking the system or something else?Sigmund Freud wrote that his study of those who suffered from hysteria were creating an imitation of physical illness (i.e. the mind suffering convinces his patients that they are physically ill). In his estimation mental illness was a mistake of confusing what was real with what was imagination. His work explored the power the mind has to influence the body and a real science of psychology was born.
We now know that there are mental conditions that are not created in the psyche but in the body. In those biologically based conditions, we can say for certain that the body is ill. In those cases, the biology of the body affects the ability of the mind and the madness that ensues is profound. If mental illnesses are brain diseases, then they are diseases of the body, not of the mind. In which case psychiatrists would have to conduct themselves like other physicians, that is, inform the patient of their findings and recommendations and then wait until he consents to, or rejects, further diagnostic or therapeutic interventions. (Szasz 1997)
Nevertheless, what about when the traumas and temperaments of the mind are the manifest fountainheads of our distress? The professional challenge of attempting to “heal” illness of the mind is difficult because it is a collaboration a scientific and a socially abstract set of ideas. When we say we are mentally healing, we are no longer only addressing the concrete process of repair for biological and chemical homeostasis like we are bringing a car into the shop and giving it a tune up or replacing a valve to get it into good working order. This would be a repair of the body anatomic. We are also addressing a social concept of behaviors that are artificially created, and a series of internal beliefs and views that sincerely influence each individual’s capacity.
These later two aspects of mental illness fall into the body politic, the socially constructed behaviors of an individual in context to their society and view of themselves. For example those who are depressed, negative, struggling, anxious, etc. We label them with “disorders” because they are struggling with “disruptions of systemic functioning”: however, these are often arbitrary labels given as they relate to social expectations.
Imagine you are at a dinner party. At the table were ten guests who were of average height, similar cultural and spiritual backgrounds, and with full physical capacity. There are also five other guests: one is nearly seven-feet tall, another is just under four feet, one guest is a paraplegic in a wheelchair, one guest is blind, and the last grew up in a far off country of cannibals.
It is natural to start assessing, labeling and judging your new peers. The differences of five of the guests compared to the majority “normal” are socially constructed. What is normal for a cannibal may be immoral and unthinkable in our society. What may be easy activity for the average population may be challenging for the extremely tall or short; or those how are not similarly capable.
WHAT HAPPENED TO PLUTO?
So we see the first issue with the concept of mental illness: that some people suffer from biological and others from psychically internal challenges in functioning. The second issue is that in order to understand the internal mind we start to map it and label what is “normal” and what is “not normal.”
At one time, our solar system had nine planets. This included Pluto. As the astrological community started noting hundreds of other objects in the solar system that were similar to Pluto, they had to make a choice: add more than a hundred new plants on the books or remove Pluto. So one day, Pluto ceased to become a planet.
That does not mean that Pluto no longer existed, or changed in any way. It was just a mental shift in how we categorize the objects in the sky. Yet, people around the world did not see it as moving a name from one column to the next. The planet had gone. It was a perceptual change that had a significant shift in how we thought about a planet, a solar system, our planet and ourselves. Nothing had changed but how we organized nine objects; but everything changed in how we reacted to those objects.
Many who are labeled mentally ill are not “ill,” at least not in the anatomical sense; but they are different in the same way someone may be tall, short or culturally divergent. In America, one in four Americans identifies themselves as suffering from a mental illness (NAMI 2014). Nearly 13.6 million (approximately 4% of the population) report suffering from a significant mental diagnosis that requires significant medical intervention (usually with pharmaceuticals) to manage. Which leaves between 40-50 million Americans struggling to work with mental, emotional and existential issues that are more likely founded in the temperament of the psyche combined with exposure to environment rather than a biological cause? Categorizing those finding themselves in episodes where life seems unmanageable by on their own doesn’t change who these people are, only how we chose to identify and treat them.
BUT ARE THEY ILL?
The first problem is these freely exchanging concepts of mind and illness.
The term “mind” is often referred to the brain, personality, spirit/soul, etc. This collective opens up multiple interpretations as to what the mind is. Mind is also frequently interpreted in context to people around them. When perceptions and thoughts differ from the group, sanity can be brought into question. It is easy to value sickness when the biology of the brain as an organ is not functioning as it should, but how can we evaluate the sickness of the mind as a process doesn’t want to behavior the way other people expect and desire?
Being different is not an illness even when it is a struggle to thrive.
SO WHO IS MENTALLY ILL?
In 1957, Supreme Court Justice Potter Steward said, in a landmark decision on obscenity and pornography that he could not define it “but I know it when I see it.”
We often treat the term illness in the same understanding of obscenity. Most of us use the term with each other with an assumption that we share the exact same understanding of what it means. In the 18th century the work illness meant wicked and immoral. It is a word that derives from the word evil, and harm to the body came from the devil’s work. While the superstition has mostly left our understanding of health, in many modern definitions illness is poorly defined as sickness, and sickness is defined as illness. We think we know what it is, but define it so poorly.
Another synonym would be “disease” and it literally means “absence of ease” (and ease comes from the Old French along with the word aisle: both meaning “space”). So when we are suffering from disease we are impeded from movement, from living our lives. The idea is that you would be likely bed ridden or unable to function.
While this definition is certainly more concise than others, it is still interpretive. Unlike sweating fevers, bleeding limbs or festering skin; it is hard to recognize the debilitating nature of someone struggling with mental and/or emotional distress.
If two men stub their toe on the end of a table there would be two different reactions. Assuming that the pain is equal, one man screams in agony cussing like a sailor while the other cringes and quietly takes deep breaths and walks it off. All things being equal physically the temperaments, experiences, and reactions to the toe stubbing created two totally different experiences. For one it was a temporary unpleasant experience while the other it was a large traumatic event.
So the question become are people mentally ill or are they just dealing with variations in temperament and habituated interpersonal behaviors when dealing with the world? In other words are people sick or are they just who they are?
In the context that we see those struggling with internal challenges as “ill,” I am one that dislikes the labels of the psychological profession. There are many reasons, but the largest is that most people who associate themselves as mentally ill are perfectly normal people who just need some professional help. It is much the same way in which someone may go to their family doctor with a minor condition that is simply remedied, or (if chronic) manageable. We would not look on a friend who went to the doctor for a sniffle, or twisted ankle or pre-hypertension as someone diseased. We would not avoid them with trepidation.
Yet, still today, stigmatize the mental health profession and those who use it as people who are severely deficient and unwell. In many cases there are even moral judgements placed on those who seek mental therapeutic help. There is very little difference to some between struggling and unable to deal with the loss of a loved one and a delusional schizophrenic: they are both broken and unable.
NOT ILLNESS BUT ILL UNDERSTOOD
The medical practice of labelling mental condition (mostly for billing purposes) continues to create stigma. People no longer become someone needing assistance to develop tools to thrive in the world, but a term of an illness of what is “wrong” with an individual.
Certainly, when someone is distressed to the point that they are no longer able to manage their lives that they are at a true sense of dis-ease; we can look at saying that this individual is “ill.” Their condition has manifested in a way significant enough to impede them in their daily lives. However, most people who seek mental wellness are not that debilitated. They are seeking guidance through a moment of their life, coaching on how to build new tools coping and adapting to the world around them, and building greater insight between their maladaptive skills and the skills they need.
Most people seeking mental health assistance are perfectly normal and just needing a little help (as we all do from time to time).
There are some mentally ill people. They truly are suffering at a level that is debilitating and makes it impossible for them to thrive in our society. Nevertheless, it is harmful to keep every person who seeks mental wellness help in the category of ill because most people who are dealing with internal and emotional distress are able to function and adapt with their condition. They are capable individuals and thriving once they have some guidance and assistance. Guidance and assistance that all of us have needed in some form throughout our lives. Labelling them ill, or providing them a label diagnosis of a disorder often risks forgetting that these are arbitrary terms given to an individual who is looking to function at his highest level. That label is little more than a spot on a map to help professionals know which direction to take the client on a journey with towards their best mental self.