A couple of years ago, dissension emerged respecting the use of ‘crazy’ as a pejorative, with some sufferers of mental illness adding that the word’s casual use preserves stigmas, irrespective of the context. “When we use that word the way we have, we perpetuate the dangerous, “separate and unequal” treatment of these illnesses, and continue to pretend that the brain isn’t part of the body.” This comes from political blogger Kevin Drum of Mother Jones.com
While I don’t entirely agree that taking mental health seriously begins or is even meaningfully funded by the parsing of language, Drum is certainly correct in his assessment that we tend to survey psychiatric health with a much cheaper lens than we do when vetting somatic concerns. The tools to address mental wellness are still fairly blunt as the geography remains ill-defined. A rich history of medical barbarism suggests western medicine adopted the appropriate philosophy fairly late in the game. Up until recently, previous generations were taught to confront their electric squishy folds of tissue with a ten-foot pole; being stressed was an inherent part of being a man, sometimes women got hysterical, and kids were provisionally prone to theatrics but they’d grow out of it.
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Terminology and stigmas in 2019
Recently a team of Finnish researchers set out to determine what constitutes the term “disease” as it relates to psychiatric ailments. The results were based on responses from four groups of people: Lay people in the community with no prior training in medicine, members of the Finnish Parliament, nurses, physicians, roughly 10% of which identified as psychiatrists. The respondents were asked to rate how comfortable they felt classifying 20 different mental states as a disease via a five-point scale. The conditions indexed in the massive report are as follows:
- Panic disorder
- Generalized anxiety disorder
- Social anxiety disorder
- Personality disorder
- Gambling addiction
- Drug addiction
- Work exhaustion
- Premature ejaculation
- Absence of sexual desire
A very small portion of respondents queried was unwilling to supply the term “disease” to Autism and schizophrenia, and almost no-one felt comfortable doing so with homosexuality or grief. The remaining entities, however, sourced debate amongst the different groups. Profession seemed to govern classification stipulations the most impactfully: 85% of nurses felt that Transsexualism was most certainly not a disease and the vast majority of medical professionals agreed social anxiety was a disease compared to 25% of members of parliament that felt this way.
From the study: “A majority (at least 50% in each group) considered seven states as diseases (anorexia, attention deficit hyperactivity disorder, bulimia, depression, generalized anxiety disorder, panic disorder and personality disorder) and three not to be diseases (absence of sexual desire, premature ejaculation and transsexualism).”
It’s maybe not all that surprising that people’s appraisal of what is or isn’t a disease survived on the intensity of the external symptoms. ADHD, the boogieman of concentration and hyperactivity, was nearly uniformly agreed to be a disease, as was schizophrenia, the chronic condition famed by its delusory effects and its revered and otherworldy sufferers. Again, we’re often tempted by the tendency to permit classification too much power. The fear of official diagnoses keeps many away from a psychologist’s door a lot longer than it should.
Of course, it can’t be ignored that the stigma is also accompanied by the largely mythologized treatment rollercoaster; the one seen in movies where an otherwise vibrant if not unhinged bearded cardigan actor is severed from their vigor and zombified by a grueling medication regimen. The same internal logic applies to those that leap to decorate their social difficulties with fancy two-cent medical terms. Together these keep mental illness further and further from reasoned eyes.
Mental illness is either trivialized or romanticized, both tacts are toxically counterproductive: One million people commit suicide every year – that’s a person every 40 seconds. Instead of being told to pull up your boots straps, or led to believe that having depression is a shortcut to a personality, a global effort should be made to advertise the incredible success rate of therapy. Anecdotally, I can say that you’re not supposed to like your first couple of therapists, but to quote Chris Gethard, “If you went to a dentist, and you didn’t like the dentist’s personality, you wouldn’t let all your teeth rot out.”
Mental wellness has been benefiting from the wrong kind of attention lately, i.e the urge to lump all the conditions together and demand the same kind of delicacy irrespective of the condition at hand, but the fact that the pendulum is so far on the other side means it has no choice but to settle in the middle, as evidenced by this recent survey.