When I first began my journey towards mental wellness, I did so because I was diagnosed as “ill”. My life had become unmanageable, my self image was so distorted, and the story I’d been told and telling for decades was that I was making other people’s lives for difficult and I should stop existing for the sake of others. I was bound to this world because I knew that my suicide would hurt my family, and I was rejected from this world because they couldn’t handle me as I was. I wanted to die, and the only thing keeping me from dying was this little voice inside that said I had a reason to be here.
My first diagnosis was depression and anxiety, later cPTSD was added to that, but then a few therapists seemed to forget about the cPTSD altogether. My current diagnosis stand at Major Depressive Disorder with recurring episodes. I’ve been denied life insurance, I’ve been misunderstood in the workplace, I’ve been told I am delusional by family members. After finding no help in the research I had done about depression and anxiety, I went back to this cPTSD diagnosis on my own and did the research. What could cause this? What kind of trauma made this occur?
I’ve recently started talking to my current therapist more about rewriting my story and changing my diagnosis. I know more now than I did when I first started therapy five years ago. I know what contributed to my condition. I know that while my sensitivity to certain things made me more susceptible to depression, the thing that exacerbated my depression was my environment. Depression is an illness of doubt–doubting everything around and inside of you–and I had a person who I was supposed to love and trust constantly instilling me with doubt and shame.
If you’ve read my stuff before, you know that I grew up in a dysfunctional home. There was alcoholism, undiagnosed personality disorder, cruel parenting, bigotry, and major codependency. Not to mention, generation upon generation of severe abuse–sexual, physical, mental ,emotional, verbal and financial. There still is. I have been away from my abusive parent for a few months, with little third party contact, and my life and mental state are drastically improving. My depression symptoms are slowly fading. I find it more possible, and more worth it, to take care of myself and seek exercise and good food. I want to hang out with my friends, I don’t feel like they’re all out to get me. My cPTSD is easier to manage, and easier to catch the triggers and redirect them. The choice to change my environment and to keep that change in place has helped me so much, and I was afraid to do it and lacked the motivation to do it before because the diagnosis I had made it seem like I was the problem when actually my environment was the problem.
It took me years to get here though. I have a very low self esteem, so any time I would build myself into an opinion or a decision, someone would disagree (or blatantly attack me for my thought or opinion) as humans often do, and I would be torn back down again–doubting everything I know and believe.
The thing that made healing seem absolutely impossible, over everything else, was the stigma against mental illnesses.
I can’t get away from my past. None of us can. We can heal and move on, but it will always have been what happened. The story can be written with a new perspective, we can see it in a different light, we can ignore it, but it can’t be taken back. The things which mold us into the adult humans we are cannot be changed. We can change, but the facts of our lives to this point are undeniable, even as we deny them. Why then is it so common that victims are shamed for being abused? Why are people are told it is their fault if they have been abused or assaulted? Why do we, as a society, not know how to allow people to tell us their stories without being personally offended by our own inability to understand it?
Stigma.
Quite often, humans look at other humans and assume they function the same as everyone else. They assume that the biological building blocks of their mind are the same as everyone else’s and so if they can live through something in a certain way then others should be able to live through things in that same way. For example, I have met people who have been abused by a parent and have the ability to wake up in the morning and function well and they expect that I should be able to do that. However, when I ask them, “but how do you not react to others as if they are your parent and out to hurt you?” they get frustrated that I even spend time thinking about such things. Sometimes, they get hurtful and abusive toward me, which Jung would say is a shadow projection and a sign that they HAVEN’T dealt with the trauma and have just internalized it to mistreat others as they were mistreated–but that’s another story.
The reality is that we are all different. We all have similar, but slightly different biological makeup, and every individual difference in our environments is going to affect us all differently. Additionally, we all have a different mental function!
Mental function isn’t that hard a concept to prove. You’ve probably heard about the test on the internet about being right or left brain dominant. Well in reality, one half of your brain is not working harder than the other or anything, but rather the paths of communication between the two hemispheres are routed differently by every human and those paths of communication determine how our brain functions in certain situations–whether those situations are learning, defending, coping, processing, etc.
When we fall into certain mental functions, we are deemed healthy–when we fall into others we are deemed mentally ill. Furthermore, what one culture sees as illness, another may see as perfectly fine but just different. Some cultures ever revere these people as messengers, shaman, or other holy people. So environment is an aspect of diagnosis I don’t see talked about enough, and in the US the environment is often one of stigma.
By getting a diagnosis of mentally ill, the worst thing that happens is stigma, and internalized stigma.
Stigma is the misunderstanding of others about mental illness, and the judgements that follow that misunderstanding. Those misunderstandings lead mentally typical people to see mental a typical or ill people as incompetent, untrustworthy, inconsistent, or damaged. It is also the assumption that if you understand the condition’s definition you understand how it works within every individual diagnosed with that condition. Much to many people’s surprise, that is not the case. One illness will look and behave very differently from person to person, and so the only real way to understand how one individual suffers is to ask and listen and take them seriously.
When my abusive parent got word that I’d been diagnosed with depression, he began treating me, even more so, as if I didn’t know what I was talking about. He always did that, and gaslit me into thinking my thoughts and beliefs were crazy (things as simple as a difference in political opinion made me crazy to his from a very young age). He began treating me as if everything I had to say about how he treated me was a delusion of my depression, and disregarded most of it. I later got news that he spoke to my mother, grandmother and brothers about how I was a “crazy wack job” who was making a bigger deal out of the abuse than it actually was. My depression, which was primarily caused by his treatment of me and my internalizing that treatment as equal to my self worth, was being used to disregard that he mistreated me at all. This was successful because it was being said to a group of people who hadn’t done any research on mental health themselves, or whose research was outdated and rooted in stigma.
The worst thing about the stigma is the internalization.
When someone doesn’t understand you, and they project their own understanding of how you should by onto you in their words or actions, it hurts. It takes a strong mind and lots of practice not to internalize that as your own perspective on yourself and your own truth, especially when you’ve been told that your mind is ill and can’t be trusted.
My mental illness is actually quite simple–when I am ill it is because I am in resistance with my own mind. We call this “cognitive dissonance”. What it feels like, in a simple explanation, is wanting two opposing things, and the subsequent feelings of knowing that you want these two opposing things, while simultaneously each part of you doesn’t want the other thing so you also don’t want those two things. So it is both wanting and not wanting multiple opposing things, and watching that all happen and having an emotional reaction to it happening. The layers and layers of comprehension are amazing for my intellect, but so horrible when being inflicted upon my own processing.
I think the way we diagnose mental illness actually has the potential to exacerbate the illness.
When we tell people the way their mind functions is wrong we are creating more cognitive dissonance and worsening the illness. That was the case for me, and I’m not the only one.
Eleanor Longden has a TED talk about the diagnosis and treatment of her Schizophrenia. Her’s appeared as an auditory hallucination, a voice narrating her every move. Before she spoke about the voice out loud, it bothered her but it was a neutral voice. It was passive and didn’t attack her. It mostly just acted as a third party narration of her days– “The girl is leaving the classroom”. It occasionally expressed her unexpressed emotions to her, and that became difficult to manage without perspective or guidance, but it didn’t make her act out or distress her in a way that people would think of as stereotypically “crazy” behavior. After she mentioned the voice to a friend, however, the friend expressed that it was a problem, that it was not normal. Having this mirrored to her, Eleanor began to fear the voice. Since the voice was a thing of her own minds creation, and now the mind had a seed of fear and doubt planted in it, the voice began to attack her. It began to make her life impossible, it told her she needed to do things. One time she poured a beaker of liquid onto a fellow student in the middle of class because the voice had convinced her to do so. After seeking help, and going through multiple therapists, she finally found a therapist with a new and different approach. This therapist told her she should listen to the voices, talk back to them, and learn what they were trying to tell her. She found that each voice was linked to a different trauma in her life. This was her brain’s way of dealing with trauma, of categorizing it and giving it a means of expression, which trauma needs in order to heal. The voices were trying to help her, actually! This was the normal function of her brain dealing with the abnormal circumstances of stress and emotional trauma that most of us go through in our lives.
This story is not so far off from my own. I don’t hear voice as auditory hallucinations, but I have distinct perspectives in my head. Sometimes a perspective takes control and I express outwardly what it is feeling inwardly, sometimes it takes over in words or actions or feelings. It is impossible to decipher at times because the same perspective will express itself through different means all the time. All of the perspectives are me, and they all have access to every part of my brain. I had the ability to rewrite my experiences as positive ones until I mentioned it out loud and someone told me that was an insane thing to do. Then I started internally attacking myself whenever I saw I was coping in that manner. My new coping was attacking myself for who I was naturally, and my illness got worse the longer I did that. I had the ability to cope without seeing my past until I was told my coping was not appropriate. Even as a child, I had my own way of feeling my way through life and interpersonal relationships until I was told that was inappropriate (even though it was not, it just bothered the person who told me it was wrong).
I had my own means of functioning, and it worked well until I was told that function was bad and wrong–then my mind began to attack itself. My new coping became self-attack, and not only did my mental state decline, but I started mistreating others.
My point in this correlation is to express a criticism toward the mental health industry itself. I’ve been told, as the patient, that I need cognitive behavior therapy. I have had amazing success with CBT– but what if the cognitive behavior therapy that would help us most needs to be performed on the DSM, and psychological studies at large? What if the way mental health practitioners are taught to look at patients is making us worse off? What if the reason that most major mental illnesses get worse with age is because we are treating them incorrectly and the longer they go treated the worse they get?
What if the perspective doctors have on mental health cases could be changed to help more people seek and find health and wellness?
What if by simply changing the perspective of the medicine, the therapy became more effective?
Stigma is one thing that hurts us, and it is made worse by the education about us. So we need to change how we educate!
When a patient has certain insurance, they must be diagnosed within the first session or the insurance will not pay for their treatment. For a psychiatrist, they pretty much have to see the issue as purely biological to prescribe medicine, and again there must be a diagnosis to give those meds. This is an interesting contradiction to the proven science of neuro-plasticity. So the first thing hurting us is the NEED for diagnosis, and the inevitable stigma that follows being diagnosed with a major mental health condition. The insurance companies are making this horrible condition worse, and in their need for diagnosis they are perhaps condemning people who are just going through hard times. Furthermore, a person who is grieving and needs to talk to a therapist might be diagnosed with depression, and when they learn to cope and their grief subsides, they might say they’ve had their depression cured! This stigmatizes those of us with a long-term diagnosis. People like Nichole Arbour think they can give medical advice to people who’ve gone through traumas she couldn’t possibly fathom with a different brain function than hers. This is creating stigma!
To end stigma, we have to educate people. We have to re-think how we are treating people, and that means educating our doctors. The education of our doctors actually begins with the education of our society, and that begins with our youth.
Last month, New York became the first state in the USA to make mental health education a part of the public school curriculum. In the reading I have done, they will be focusing on mental illnesses, indicators of mental illness, and de-stigmatizing. While this is a good start, I don’t think it will end stigma, and I don’t think it is a good perspective to teach.
My own abuser knew a thing or two about the symptoms and signs of mental illness. When I started to show symptoms of depression, he used them to threaten me back into submission–making sure I didn’t act out, threatening me with therapy instead of recognizing I might actually need it. I have friends who have been thrown in mental institutions as high schoolers, basically because their parents couldn’t handle their emotional outbursts. This is unacceptable and what happens internally when you tell people indicators of mental illness, but don’t normalize the treatment.
I propose something else entirely.
I am a teacher. I work one on one with students, teaching them music. But primarily what I am doing is teaching them how to use their brains to learn an instrument that requires a multitude of other skills–multitasking, linear and conceptual comprehension, motor skills, hand eye coordination, reading, writing, mathematics, and creative expression, emotional awareness, muscle tension and relaxation–honestly the list goes on and on. I have to be on my toes all the time, I have to change my teaching style from one student to the next. My mother is a teacher also, and she has a masters in curriculum. She writes lesson plans like nobody’s business–a true master of her craft. I say this to let you know that I may not be an expert, but I’m also not lacking in experience or knowledge.
I propose that we stop seeing mental illness as the only reason one may need therapy. I propose that we stop seeing mental illness as “Ill” unless something has gone wrong in the function itself. I’ll explain.
Everybody has a mind.
All minds have similar components, but different function and communication between those components.
Therefore, we should not be teaching people mental illness, but mental wellness.
Comparing mental health to physical health can be helpful, and I will do so now.
When children are little, part of their public school curriculum is physical fitness, and physical wellness. They are taught what a human body needs in terms of food (fuel) and exercise. They are taught, eventually, about the possible things that can go wrong in the body, some of which are preventable through healthy habits and some of which are unavoidable or out of our control. While I think we could do better to educate our kids on the different indicators of health, and what different healthy bodies look like, this is a decent way to go.
This should be the same curriculum we follow for mental health and wellness. The first thing we should teach kids is that all of us have a mind! That mind needs certain fuel (food, but also information, logical thought process, coping for emotions) and certain exercise. Some actions are healthy for the mind, and some can be seen as harmful.
The other thing I think we need to teach kids, which would begin with a major change in the DSM, is that mental illness is different from mental function–and both need a space to exist as themselves in this world.
Currently, we diagnose personality and mood disorders based on an set of symptoms, most of which are seen from the outside looking in, and some of which overlap. Some are very severe, and its clear that they fit the symptoms of a particular diagnosis, but others kind of have a way of melting into one another. For example, it’s not uncommon for someone to first be diagnosed with anxiety, then Generalized Anxiety Disorder, then with Borderline Personality, then with Bipolar Disorder. I have a friend who went through that exact thing. Another common string of diagnosis is anxiety eventually being re-diagnosed at Obsessive Compulsive Disorder.
When we look from the outside in, instead of giving the therapist enough time to know how the brain functions and giving diagnosis based on brain function, we fail to give a proper diagnosis. We waste years of people’s lives battling one issue when another is actually more accurate and more helpful to their finding wellness within that functionality. For example, I have been told that because I sleep strange hours of the day, don’t have an appetite sometimes, and have dark, existential thoughts I have signs of depression and they need to be fixed for me to live my life happily. I have been told that my ability to think things through to their end and come to amazing conclusions is “over-thinking” that is causing me problems. I was told to STOP doing that, not to figure out how and when it is useful and when it is hurtful. I have found that I can have a life, and a career within that function though. If I had found out sooner, I may have gone into a field where that was celebrated, like mathematics or physics.
Now, I cope and live my life as an artist. I don’t sleep normal hours, but I sleep when I need to. I don’t work at an office full time, but I probably work more than 40 hours a week–it’s just not stuff I get paid for. I live my life happier now, embracing the lifestyle that has been diagnosed as symptoms of my depression, than I ever did trying to fit into the function society has deemed as “normal”. I propose that while my depression may be a function of my brain (and one that offers a lot of beautiful insight to the people who know me best, and brilliant inspiration to my creative expression), my illness is when I am in resistance to that function and actively hating myself for who I am. The spirals of self loathing, the loops, the confusion, the outbursts, the fear–it only comes around when I am in resistance to what is natural for me.
Now, I’m sure some of you may think that sounds like madness. Perhaps it is–but if it makes me happy and I am able to live without the guilt and weight of my diagnosis, if I am not hurting myself or others, why is it bad? Why is it bad to rethink how we see patients in order to help them heal or cope more efficiently?
Basically, we need to de-stigmatize how we see patients. We need to trust that how they experience things is real for them, and compassionately reword the way we think of them in our treatment. Patients aren’t dumb. Many do a lot of their own research. When I researched depression and read that it was a delusion, a morphed reality, it hurt me more than the perspective of living in depression. We aren’t avoiding the information our therapists have, and when we read it, some of it is hurtful. It puts us at odds with our own minds. It’s like being in a room of people who are all talking about you as if you are a specimen, as if you lack the perspective or intellect to talk about it yourself, as if you can’t be trusted to know the whole truth about your own experience. This isn’t the case for all of us. In fact, for those of us living with a chronic diagnosis of mental illness, this isn’t the case at all. We have learned to live a life in spite of and outside of and around our mental illness, to categorize and compartmentalize it in our own minds, to cope and thrive sometimes even. After a certain level of treatment we learn to talk about the experience of our mind from inside of our mind. Can we not be trusted to talk about our own experience, to be a part of the conversation of how mental wellness is treated as a whole?
To include us in this conversation, we need the language to be de-stigmatized.
The DSM needs some serious CBT.
You can talk about, empathize with and educate yourself on an experience as much as you want but unless you’ve lived it you don’t know what it is to be inside that experience every second of every day that it is happening. Let those who are affected be the ones to educate practitioners on the things we need to heal! Empower us to take control of our own healing by giving us the information we need to heal ourselves. If you’re ashamed to give us the information because it is hurtful on an emotional level to our identities, then CHANGE THE WORDS YOU USE! This is CBT–cognitive behavior therapy. We have to do it as patients all the time. If we can do it, the industry that diagnoses and treats us can do it.
Another, final point I want to touch on is the thing that happens when you begin to study personality and mood disorders. It is a phenomenon that occurs in students of psychology that when you begin studying these things, you begin to see the minor traces of them all around you. You start to see the behaviors of your friends, family and even yourself as similar to those which fall into extremes and become diagnosable. This, to me, is another point of proof that we need to see these disorders as functions and put them on a spectrum of severity. If we can draw a line from the person functioning with a few minor behaviors of Narcissist Personality Disorder and the person functioning with ONLY NPD behaviors and pitfalls, we can begin to see what makes the difference. Is it environment, is it chemistry, is it how they cope internally or what they’re coping with? Seeing the patient with the most severe on an equal playing field as the person who is not seeing a therapist but acts out similarly and is seen as “totally fine” could make all the difference for the person who is suffering. This is a spectrum, and putting the behaviors on a spectrum would be helpful to ALL people seeking mental wellness, not just those with unmanageable symptoms.
All this to say, the current way we see and treat mental illness still lacks a level of equality and compassion. We do not treat patients as sane, and humans have a way of following suite. We don’t just need to educate people on the symptoms of major mental illnesses, we need to make a space for those people to healthily and happily exist within their diagnosis, within the natural function of their own mind. We need to allow parenting, and society at large to be changed so there can be a space for people who are different.
People who are deaf and hard of hearing have a culture all their own that is molded by the different ways they need to live their lives, and its is not only beautiful–but something we can ALL learn from. People with Autism Spectrum Disorder definitely face some major stigma still, but they too have a culture all their own which gives them a space to exist and gives everyone outside of that culture more understanding about humanity. People with a different mental function, be it depression, bipolar, anxiety, obsessive compulsive, schizophrenic, or any other functionality have their own cultures. Depression culture is its own thing, for sure! We need to create an understanding and acceptance for those differences! In doing so, we will learn more about ourselves and humanity as a whole.
The guidelines for “insanity” should not be fitting a set of listed symptoms. It should be based strictly on the will or impulse to hurt one’s self or others–and even then a person is not INSANE, they are simply dangerous to themselves or others and should be rehabilitated. Everything else is function. With knowledge, education and exploration of one’s natural function, they can learn to live healthily within that function–possibly to the point of that function changing all on its own to more healthy resolves. Teaching this to children from a young age will not only help those with resistance to that function find acceptance and coping early on, it will also help the average person learn how their brain works so they can use it as the tool it is and achieve the things they want to achieve in this world. It makes more possible for even the “typical” mind when a person knows the quirks and functions of their own mind and can use those things to their own advantage. This could literally help every person on the planet to be more compassionate, empathetic, and efficient in their own lives and relationships.
Thanks for coming to my TED talk–lol.