Category Archives: Mental Health

Response to the Response to Libba Bray

 

Theferret.com recently posted a response to Libba Bray’s description of what it’s like to live with depression. You can find Bray’s post here, and the response here.

 

As someone who’s recently started writing about their own depressive issues, the exchange interested me. As people with mental health concerns become more vocal, and more visible, it’s inevitable that they will also become more vocal about their disagreements. TheFerret doesn’t pull any punches in his criticism of Bray’s personal story. He calls out what he considers catering to a “Good Depressive Citizen” trope: the disingenuous tendency to write about depression in a way that distances it from yourself:

write a Very Articulate Post detailing your pain…

…but do it from a distance. Write about it in a sad, somber tone. Do not evince an ounce of self-pity. Hold this odious disease at a distance. End it with a triumphant note that yes, you too can fight back!”

 

The pressure to keep silent about mental health problems is real, and the author of the above statement has every right to be angered by it. The tendency to try and distance oneself from something like mental health is a serious problem, and one of the reasons that so many people with treatable conditions don’t seek out the help they need. But my issue with this response lies mostly with how Libba Bray’s comments are criticized:

 

Now, I’m not kidding, or being in the least sarcastic, when I say that Libba has written a wonderful post. That is part of what it’s like to be depressed, and she expresses it well, and eloquently. It helps, and I am glad she wrote it. But notice how carefully she speaks. She doesn’t say what, if anything, she is depressed about – and she’s a good enough writer that that omission is clearly on purpose.

 

Because she knows how to be a good depressive citizen.”

 

My initial reaction to that statement was a tirade of my own, which I’ll spare you. Not because the public must be protected from my feelings at all cost, but because anger, while valid and cathartic as it can be, is not always the most helpful response. What is helpful for people working through their mental health problems, is keeping the following in mind:

 

 

 

1: People set their own degree of disclosure.

 

Criticizing someone for not stating what’s triggered a specific mental health struggle (setting aside that triggers and episodes aren’t always reducible to one identifiable cause), is like criticizing an amputee for not wearing a sign explaining how they lost a limb. No one is entitled to know the details of your private life or health, and people reaching out for help don’t need to be subjected to some sort of litmus test for expressing their pain correctly.

 

2: Stigma is not the fault of the stigmatized.

 

A lot of the anger in the response to Bray’s post seems to be directed at her for being stigmatized. While the “Good Depressive Citizen” is a very real social pressure, someone who falls into it (and I’m not convinced Bray has), isn’t some sort of traitor to the rest of us; they are someone looking for a way to express something our culture doesn’t give us much practice or forgiveness for. It’s only to be expected that the attempt is awkward. The response to Bray seems to be confusing anger over the state of our culture with anger towards Bray for being caught in it.

 

3: Pain is always individual.

 

Having the same problem, health, personal, social, etc. doesn’t dictate that the experience is the same for everyone that has it; especially with mental health. People with depression may have a lot in common, they may fit the statistical profile, or they may be an outlier. Regardless, depression is always experienced individually. It’s always deeply personal, and it always requires a complex and individualized coping strategy. The idiosyncratic nature of mental health experiences is the reason we need different voices about it. We need to hear the anger and frustration just as much as we need to hear the hope for recovery. There is no “correct” way to express experience with depression, other than honestly; and choosing to be calm and articulate in order to do it isn’t a sign of dishonesty.

 

4: In-fighting never helps.

 

The issues listed in the response to Bray are real; there is little to no forgiveness for someone who publicly demonstrates their mental health problems. There is a lot of pressure to remain silent about them. There is an inexhaustible supply of judgment and ‘advice’ doled out to people dealing with their mental health. There is certainly a tendency to label people as ‘crazy’ or ‘unstable’ when they admit their own struggles. Those of us with mental health have enough trouble with people who expect us to justify our problems; we don’t need to attack each other over how we choose to deal with it. Instead of that, why not focus all that energy on making our culture safer for people to be open about their problems? Simply criticizing how someone chooses to express their own pain only contributes to the heaps of judgment already piled on top of them.

 

How to Not Discuss Mental Illness: part III

#3: “You could kick it if you’d just realize it’s all in your head.”

This is one of the most common responses people with little understanding of mental illness utter, and one of the most destructive.  There is a widespread misconception that mental illnesses are ‘abstract’ issues.  That they are nebulous, poorly defined, unobservable things that people invent for themselves.  Often, people with psychological disorders are blamed for being sick and dismissed as stupid or weak.  This is a leading cause of people who need treatment deciding not to seek it out.  The fact is that mental illnesses are not abstract.  People who struggle with them are in real pain, and in need of real help.

I do believe that a contributing factor to this problem is a lack of understanding of medicine in general.  A background assumption by people without medical knowledge is that a physical illness means something foreign invading the body, or a part of the body being visibly damaged.  It isn’t commonly understood that thoughts and emotions do have observable causes.  A deficiency or excess in a specific neurotransmitter can occur just as easily as an allergy. Only instead of hives, neurotransmitter imbalances can cause mood shifts and obsessive thoughts. There are people who fight this concept, since they misconstrue it as an attack on their freedom of choice. Even people who accept this often have difficulty realizing how specific and predictable the results can be.

I am guilty of this mistake myself.  As a teenager, I believed that a depressive episode was always caused by something I did.  I had begun to understand something wasn’t right, but I saw it as a failure on my part, instead of something that operated according to its own rules.  It took me a long time to get the difference between a cause and an aggravation of a current condition.

As destructive as the above attitude is, it’s one of the easiest to understand.  It comes from a confusion regarding the relationship between thought, emotion, and behavior; a confusion that usually takes diligent study to straighten out.  So, similar to last week, the advice I would give healthy people is this:  If you have doubts about the validity of someone’s condition, hold off on voicing them until you’ve researched the issue yourself, from reputable sources.  Ask a medical professional for advice if you’re having trouble understanding. In the meantime, listen.  Do what you can to help someone who’s reached out to you; let them know they aren’t alone.  Also, it’s okay to admit you don’t have answers.  A statement like: “I don’t understand this situation, but I love you and want to help.”  Is a much better way of dealing with an uncomfortable topic than insisting it doesn’t exist.

How to Not Discuss Mental Illness: part II

As part of my series about mental illness, here is conversation-stopper # two:

 

2: But, you seem so normal!

Never, I repeat, never, say this to someone who has told you they have a mental disorder. Apart from being a terrible way of responding to just about anything, it’s offensive and harmful on several levels.

First: There are plenty of “normal” people who struggle with mental illness. This statement makes about as much sense as classifying someone with pneumonia as not normal. Furthermore, it tells the person you’re speaking to that you now see them as “other” because they have health problems; problems they never asked for in the first place. It’s isolating enough dealing with psychological disorders without being stigmatized for it, so don’t make it worse.

Second: It ignores the principal issue. If someone has revealed to you that they have a mental health problem, it’s very likely that they’re looking for help, or at least social support; especially if no one else knows about it. It can be very difficult to make that step, and it’s crucial that anyone struggling to deal with their psychological disorder gets treatment. Reacting this way can undermine the work they’ve done to come to terms with their issues, and prevent them from seeking needed treatment for fear of being viewed as a freak.

Third: The above sentence shows a complete lack of understanding about what mental illness actually is. It suggests that the speaker assumes it consists of erratic, irrational behavior; that you can look at someone and “just know”. Are their psychological conditions that cause (or contribute to) negative behaviors? Yes. Are their healthy people who behave erratically? Of course. There is a very wide range of mental illnesses, and each illness has its own spectrum of type and severity. There are many cases where symptoms are not obvious.

I can use myself as an example here. I have Major Depressive Disorder. However, unless I’m in an especially bad episode, you probably couldn’t tell unless you either lived with me or I told you. Often, my classmates, co-workers, and acquaintances describe me as “quiet” or “reserved”. It isn’t obvious to a casual observer that I have this internal battle with myself. There are plenty of others who face similar issues, and all to often, they face them alone because of the stigma about mental illness.

Not everyone can be an expert in psychology. Which means that most of us have erroneous ideas about general or specific mental illness, and what it looks like. So if someone confides in you about their struggles, and it takes you off-guard, here is a better way of expressing it than the above statement: “I had no idea you were dealing with that. I’m sorry. Is there anything I can do?” I don’t recommend that you try to be someone’s therapist but at least listen. If this person is a family member, or other permanent feature in your life, then take the time to learn what you can about their disorder; not for the purpose of diagnosing them, but to prepare yourself for helping when it’s needed. It’s amazing what a little bit of knowledge and sympathy can do, but they aren’t always useful without each other.

How to Not Discuss Mental Illness

With the current discussion about gun control laws, the subject of mental illness is also gaining a lot of attention. This is a good thing, on the whole. Mental illness is a subject that makes many people uncomfortable, and as a consequence, we tend to shy away from talking about it. This often leads to widespread misinformation about the mentally ill, and negative stereotypes about them. For those who don’t believe that this is an issue, I’d ask two questions: How many movie villains can you name who have a stated or implied mental disorder? How many heroes?

In both cases, it’s rare to see an accurate portrayal of mental illness*, but many people walk away from fictional portrayals believing they know something about abnormal psychology, which in turn leads to people living with disorders being discriminated against and stigmatized. It is necessary to combat this with better dissemination of information about mental illness, and more open societal conversation. However, it’s important to bear in mind that a good conversation actually goes somewhere. It consists of people listening as well as talking, and not simply re-stating their own views over and over again. To that end, over the next couple of weeks, I’ll be posting a series of conversation-stoppers everyone should avoid, especially when talking one-on-one with someone struggling with a psychological disorder. Here is today’s:

 

1: You’re not really sick; you’re just unique and society doesn’t understand you.

This is insidious, mostly because the speaker believes that they’re being tolerant. Instead, what this tells someone with a mental illness is that their conversational partner dismisses their suffering. It also says that the speaker is defining them in terms of their pathology. I myself have been on the receiving end of this. I’ve struggled with depression from an unusually young age, and often encountered people who believed that my symptoms were merely personality quirks. In one particular conversation, after admitting some of my struggles to a classmate, they responded: “But who’s to say that means there’s something wrong with you? It’s okay if that’s who you are. I don’t think there’s such a thing as mental illness.” I never spoke to this classmate again, and it was years before I confided in anyone else. It strengthened the fear that my problems were the result of personal weakness, and that they were inseparable from my personality. It also made me feel that I needed permission to be sick.

Often, people need to discuss their problems in order to increase their own understanding of them, and they’re putting themselves in a vulnerable place to do so. If someone confides in you that they are mentally ill, you should take it as a sign of great trust. If they tell you about their struggles with their disorder, listen. Also, never argue with someone about whether or not they’re sick. Even if you believe they aren’t, get them to a doctor immediately, and let a professional make that assessment.

Mental Illness will exist whether we believe it’s there or not; it will affect people whether we give them permission to be sick or not. We as a society have the means of diminishing the problem, or exacerbating the suffering of millions. That makes it just as much an ethical issue as a medical and cultural one; it’s an issue that needs to be addressed, because it certainly isn’t going anywhere.

 

* the book “Movies and Mental Illness” is an excellent resource for this issue.