This summer I met with a group of “peer leaders” in New York City – high school and college students involved in a program called RAPP, the Relationship Abuse Prevention Program. We talked at length about mental illness, and an approach to life the makes room for the experience, awful as it may be. The kids were great: engaged, curious, and critical. I was impressed by their eagerness to tackle some of my more nuanced points. Though it was a relatively small group, there are no small steps to change. Each person is an entire universe (to paraphrase a famous proverb). Thank you all for supporting me and making this possible. I can’t wait to do it again.
I mention this in light of an ongoing debate: what is the best approach to mental illness? This question has plenty of stock answers – too many, perhaps. When we boil down a complex issue to just two sides, it helps us to digest subsequent arguments. Making a simplified choice at the start of a debate (pro or con?) gives us a footing for grey area. But human beings don’t like grey area right off the bat.
Unfortunately, mental illness is grey area. In its most extreme forms it may not be – everyone agrees that John Hinckley was a sick man – but extreme forms of illness are just that; they’re rare. Most of the time, mental disorder expresses itself within a vast spectrum of behaviors that we can and do normalize. Sadness, emptiness, anxiety, fear, compulsion: these aren’t just symptoms.
The inherent “greyness” of illness makes it a difficult topic. We can reduce it to black and white, but that never does justice to our cause. Take, for example, this recent bit of news:
The level of Americans’ prejudice and discrimination toward people with serious mental illness or substance abuse problems didn’t change over 10 years, a new study has found… [Sociologist Bernice Pescosolido] and her colleagues compared the attitudes of people in 1996 and 2006. During this period, there was a major push to make Americans more aware of the genetic and medical explanations for conditions such as depression, schizophrenia and substance abuse… People who believed that mental illness and substance abuse had neurobiological causes were more likely to be in favor of providing treatment. But these people were no less likely to stigmatize patients with mental illness or substance abuse problems. [my emphasis]
First of all, this is progress. If more people support treatment, that’s a huge plus. Nonetheless, these researchers sound disappointed: “It’s time to stand back and rethink our approach,” said Pescosolido.
Really, guys? Obviously doctors are going to take a medical approach. But I’m a bit astonished that doctors, of all people – the ones who have the most direct experience with illness in all its various forms – think that purely medical explanations are going to satisfy us. Yes, it is absolutely crucial for people to understand illness as a medical problem. As I’ve written in the past, classifying something as a “mental illness” is just a way of acknowledging that treatment exists. But reducing these woes to brain chemistry in order to make illness more approachable? It’s almost comic. I’m not suggesting that brain chemistry is too complicated for the average person (the fundamentals are easy to grasp, actually). It’s deeper than that. No one wants to think of their emotional life, no matter how unbalanced, as chemical soup.
First of all, this robs us of agency; it suggests a lack of free will. Second of all, it’s an obvious over-simplification. It’s not a distillation of the issue; it’s reductionist. (From a recent post: “It is time… to wonder deeply in and about our gifts, rather than reduce ourselves to primitive urges and selfish genes.”) Everyone feels in their bones the reach of illness, that illness itself is wrapped up with fundamental things. Even if mental disorder is “just” errant neurons, we know from experience that our psychological development is a feedback loop – that our thoughts, feelings and actions inform our future selves (i.e., our neuronal development). By definition, sufferers can’t control their illness, but invariably they will make decisions that affect its course.
What does this have to do with stigma? Everything. The premise of my efforts here and elsewhere is that stigma makes illness more difficult to bear – and that whatever exacerbates mental illness is actually part of it. Mental illness is simply too amorphous, too expansive and too rich to reduce to molecular biology alone. People may not articulate this in my way, but this argument is at the heart of a lot blowback against a medicalized view of mental suffering. People do believe, and they want to believe, that when it comes to mental illness, everything matters – not just science.
I’m inclined to agree. Part of my discussion with the students this summer included a brief lesson in neurology, showing them how SSRIs actually work in the brain. This is an essential piece of my attack on stigma, but it’s just a piece. I spent much more time talking about the stigma itself: how it arises, why it’s damaging, and how to combat it. I also talked to them about life in general, and in particular feelings of failure and/or hopelessness: how to recognize them, how to address them, and why they’re okay – why they’re essentially, actually, to a life well-lived. This can be abstract stuff. Brain chemistry is more concrete. But if we don’t acknowledge that our attitudes matter, then why change them?
Douglas Faneuil is the founder of Living Proof Productions, a not-for-profit devoted to suicide prevention based in New York City. He also designs database solutions for companies throughout the Northeast.