Living with mental illness is not easy, but I’d like to believe we all get wiser with age and experience. Here are five frequently-overlooked inner truths that I’ve discovered while working with people with MI.
1. Mental illness IS physical illness. Distinguishing mental (psychiatric) illness as independent from physical illness is creating a false dichotomy. Psychiatric disorders are biologically and genetically driven. They involve imbalances of neurotransmitters, and physiological abnormalities can be measured with imaging tests. Naturally, they are also influenced by our behaviors and experiences, things that have happened to us over the course of our lives. If mental illness were different substantively from other physical illness, the implication might be that we can control it, whereas we cannot control a more traditional physical illness of the brain, like epilepsy.
Many factors contribute to the etiology of psychiatric disease, including psychological, biological, behavioral, social, and spiritual determinants. As such, treatment for mental illness does not rely solely on behavioral intervention, but also focuses on psychotropic medication and general self-care.
We, as humans, like to think that physical illness cannot be controlled, whereas we have perfect control over our behaviors and emotions. Acknowledging that mental illness has a genetic, biological, and physiological root forces us to acknowledge that it is real and deserving of our intervention.
2. At the core level, there is nothing wrong with who we are. When asked to consider the question, “Who am I?” I find myself inclined to define myself as a mind-spirit combination that inhabits a body. I think many others would endorse a similar belief in the separation between body and mind/spirit. This perceived duality helps define how we see our bodies and our health, and of course that extends to how we go about obtaining and following through on our medical care.
A disease like cancer changes our physical form, but it doesn’t affect who we are at our core. Far too frequently, we consider mental illness to be attacking who we are: our personalities, our emotions, our cognition, and the ways we approach the world. Mental illnesses are brain diseases; do all of these affected factors reside in our brains?
I propose that, despite living with a life-changing condition, a person has nothing intrinsically wrong with them. Mental illness is a physical disease, just like cancer. It does not and cannot harm who we are. Therefore, internalized stigma and self-imposed shame for living with psychiatric disease are unnecessary as we learn to cope and journey toward recovery.
3. Nothing is permanent. Isn’t it a law of physics that, invariably, something that goes up eventually crashes back down? This tenet seems to be true for mood disorders. Likewise, anxiety ebbs and flows (though for some of us it never truly goes away). Every mental illness is a system of offsets and counterbalances. Even the darkest nights are interrupted by the rising sun; conversely, the darkness is always lurking. Living with mental illness is a constant battle, and sometimes simply surviving the day is an enormous victory. Sometimes, in fact, getting through to the next hour takes every ounce of energy we possess. Survival, and even stability, is possible. Nothing lasts forever, and there will be a tomorrow; it is our job to make sure we are part of it. We must keep fighting when things look bleak.
4. “Normalcy” is relative. If we were each to rank how we feel every day for a week using a scale of 0 to 10, where 0 is miserable and 10 is exceptionally well, at the end of the week we would each have a different score. But what does that really mean? Halfway(ish) is 5, but the way I feel at a 5 is different from the way you feel at a 5. I have no idea how you actually feel; I can only know what you tell me. As such, there is no true “normal,” and it is important to remain nonjudgmental toward one another.
Even when we think we are in the same place quantitatively, the qualitative experience may be entirely different. My Defcon 1 could be your Defcon 5. While empathy is critical to our efforts to reduce stigma, it is dangerous and unfair to take it a step further by assuming we know what another person is experiencing.
And we absolutely must establish a standard of tolerance for people who are different because of mental illness or a particular personality quirk. Too many people, both neurodiverse and neurotypical (“normal”), make a habit of referring to people as “normal.” There’s no such thing as a normal person. We all have our quirks and eccentricities. “Normal” is a statistical term describing the average rating of a particular behavior or characteristic. It should never be used to describe a human being.
5. The treatment can seem worse than the disease, but it’s necessary. It’s terrifying to think that the life-saving medications we take may also be killing us. The side effects of these medications are horrible: you may be dizzy all the time. Sometimes people’s skin breaks out easily, and they lose hair in clumps. Often, psych meds preclude alcohol consumption, and you shouldn’t get pregnant on some of them. There are other side effects, too, such as exciting gastrointestinal problems.
Nevertheless, not taking the medicine leads to an increased risk of death from suicide or heightened morbidity. Psych meds often come with an increased risk for cardiovascular problems, like heart attacks. You can decrease your cardiovascular risk factors (reaching a healthy body weight, keeping cholesterol in check, avoiding diabetes, etc.) in hopes of reducing your risk. For some mental illnesses, victims will die at a much younger age than would their counterparts without mental illness, thanks to the medications. Still, you might die within a week from suicide if you do not take the medications. Sometimes living with mental illness is about learning to live with the lesser of two (or several) evils.
–Jaimie Hunter, PhD, MPH