Who defines “mental illness?”

 

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2018 can be looked at as a year the glass ceiling on stigmatizing “mental illness” was shattered. It will also be looked at as the year the term mental illness ran amok. Athletes from Kevin Love to actors like Ryan Reynolds have shed light on what roughly 40% of the population deals with, generalized anxiety. But, using the term mental illness suggests that anxiety is an illness, which for most people, it is not. And, since the term has been used to define heinous acts, like school shootings, it is time to formally provide a working definition that does not lump school shooters with the lay person.

This past week, two prominent celebrities, Kate Spade and Anthony Bourdain, both took their own lives. We were reminded, as the saying goes, that everyone fights his or her own demons. The talking heads on cable television were quick to label both individuals as struggling with “mental illness.” While they both might have had struggles, it is not fair to assume their deaths were the result of being mentally ill. Suicide is a complicated act, one that this society tiptoes around. As the CDC reported after the wake of both suicides,  the majority of those who killed themselves had relationship problems, not mental health conditions. This does not mean mental health issues are not major factors in suicide. But, to conclude that a psychiatric condition is the culprit for most self-inflicted deaths is irresponsible.  Suicide can often be the result of impulsivity, financial ruin, substance abuse and physical illness. In fact, it is a myth that truly depressive people commit suicide, as those who struggle usually do not have the energy to engage in such an action.

Too often, we are quick to throw such a loaded term (mental illness) on anyone and everyone who experiences difficulty. As we move closer to a fragmented society, with increased rates of loneliness, the dismantling of social norms and the ever-increasing demand of the illusion of happiness via social media, the world around us will continue to feel “off.” Routine feelings, such as sadness, hyperactivity, joy and subtle boredom have been and will be labeled as “mental illness.” Psychosocial factors, like friendships, family, employment and religious affiliation have been cast aside for psycho-stimulants (ADHD meds), misdiagnoses and gross entitlement (“You can be whatever you want to be!”) . This is not to dismiss or suggest that mental illness is not real, because it is. There are those who struggle with crippling psychotic conditions, devastating mood and personality disorders and anxieties that appear indefinite. What needs to be challenged is the course of treatment we currently provide: medication, behavioral modification and meditation.

If mental illness is as common as we believe it to be, why do we treat mental health conditions as second-rate disorders compared to other medical conditions? Why do we subject the “mentally ill” to jails, instead of invest in infrastructure to support real psychiatric and psychological treatment? Why has the the suicide rate increased 24% between 1999-2014, and as a nation, we have yet to address this as a major societal epidemic (suicide is now the 10th leading cause of death in the United States). Our answer cannot be more medication (antidepressants continue to have modest effects), more marijuana and brief behavioral psychotherapy.

A good start would be to be invest in families and children at an early age. Schools need full-time social workers/therapists and nurses. Schools need to increase socialization through group play, team-building and recess. Doctors need to stop (!!!) labeling children as having ADHD without assessing family dynamics, anxiety, culture and the like. Psychologists, psychiatrists and clinical social workers should not have their care dictated by insurance companies. Normal, everyday emotions should not be pathologized into mental illnesses.

We will not be able to prevent every suicide. We sometimes will never see the warning signs or the cries for help. Talking about suicide openly is a start, but let’s start understanding the person who is struggling, and not resort to relying on a misused term that has no real meaning.

 

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