A New Perspective on Mental Illness
I read Rose Cartwright’s article in The Guardian a little while ago and it crystallised a sentiment that has been developing for some time. After suffering many years of significant emotional and psychological distress, maladaptive and self-destructive behaviour, and weathering the seriously negative effects that these things had on every aspect of my life, I was finally diagnosed with bipolar disorder type II and emotionally unstable personality disorder (aka BPD) in December 2015. Nearly 10 years later, I no longer agree with this diagnosis - and Cartwright has begun the conversation with a number of the reasons why she, I, and no doubt others like us are starting to question the diagnostic boxes we were once so relieved to be in.
Writing about mental health is hard because it is naturally very intertwined with people’s most private experiences. Cartwright, as she shares in her article, pinpointed that the root of her struggles was wrapped up in her relationship with her mother; this intimacy with strangers makes me uncomfortable with placing a spotlight on my experiences and their effect on my mental health. It also requires me, at least to some extent, to divulge my ‘mental illness credentials’ and explore the circumstances in which I acquired them. As I’ve gotten older privacy has become much more important to me, and I am loathe to willingly make my private struggles a spectacle for public consumption. However, with these reservations noted, some part of me needs to extract something good from everything I went through, and Cartwright’s article suggested to me that maybe just being honest is enough.
In the article, Professor Frances Allen is quoted as saying that psychiatric diagnoses are “bullshit”. This might feel like a very strong statement, but when supported by reasoning it’s obviously true in most cases. Symptoms of mental illness do not tangibly and objectively exist in the way that the symptoms of broken bones and malfunctioning organs do, their existence only observable when the internal psychological process is translated into some sort of external behaviour. Even then, context is vital to assessing whether something is inappropriate/disproportionate (and therefore suggestive of disorder) or appropriate and/or proportionate and therefore completely normal - and the necessity of context is actually the crux of my case against my psychiatric diagnosis. Being mentally unwell implies the psychological state is not normal, or more specifically that it’s not functioning in the manner expected given the circumstances.
This begs the following questions: 1) what is the expected functioning of a mind; 2) how can a mind be accurately and objectively assessed on whether it is reacting appropriately and proportionately, and therefore functioning correctly; and 3) if the mind is functioning normally but is simply reacting to an abnormal environment, why then would someone be condemned as being ‘mentally unwell’ when that is clearly not the case?
The outcome of failing to consider these very important questions is a mental health crisis. At present, the current narrative is paradoxically that there is no possible model for the normal functioning of a mind (because the concept of ‘normal’ is verboten in polite society) but also that everyone who isn’t completely ‘normal’ at all times in every situation must have something fundamentally wrong with them. Which brings us to our second impasse: what does it mean to have something wrong with you, and does the reason why something is wrong actually matter more than what is wrong? My answer to the latter is a resounding yes, and that’s because my answer to the former is that most people don’t actually have something wrong with them. Most people experience mental distress because of something wrong that has happened to them - in other words, they are traumatised and it has quite naturally affected their psychological/emotional function in a negative way. Paradoxically, it is only if something truly was wrong with them that they wouldn’t be affected by malevolent intrusions in their life.
The final thing to consider is that, for most, the origins of their mental distress will be complex. For some the source is easily identifiable - PTSD from military service, for example, or a stress-related breakdown due to multiple significant but current and known stressors - and, whilst this doesn’t mean it is easily resolved, it at least makes finding the first step on the road to recovery support easier. For those of us with complex origin mental distress, even getting to the point where you accept that you’re really not alright can take years - after all, what do you even say to your healthcare professional? “I have a general sense I’m really not okay, but I don’t know why”? This never knowing what to tell them (and them consequently not knowing how exactly to help me) dogged my numerous attempts to engage help as a teenager, and is likely the motivation behind the creation of ever-more specific psychiatric diagnoses; slapping a medically recognised label (even pre-emptively) on a group of symptoms not only gets you through the gateway to being prescribed pills, but also assures the NHS that its duty of care is fulfilled and therefore you can now be left to deal with it alone - and I know this because it’s exactly what happened to me.
This is usually the part where I would delve into my own personal experiences in order to justify my perspective on this topic, but to be honest I don’t really want to condone this expectation that writers owe their audience a pound of flesh in exchange for being taken seriously. What I will say is that I have experienced symptoms of mental distress since I was about 7 years old, peaking between the ages of 12 - 18, and at 31 this is what I have concluded:
Most mental disorders are not disorders at all, they are appropriate and proportionate responses to lives that take place in unnatural and unhealthy environments;
The symptoms of mental distress that most people exhibit follow a cluster pattern, and often the root cause(s) can be identified simply from following the pattern back to source;
Medication will not fix mental distress caused by environmental factors, it will just mask it. Psychotherapy should be prescribed and properly utilised (as an aim to cure, not as weekly navel gazing sessions) in these cases;
Anxiety is responsible for far more symptoms of ‘mental disorder’ than the current diagnostic framework allows for, and this should be rectified in order to facilitate more effective treatment;
Mental disorders should not be being diagnosed in those under 18, especially with a view to prescribing medication;
Diagnostic assignment should only be used as a means to effectively move people down a treatment pathway, and as such the DSM should be simplified and streamlined.
For what it’s worth, I no longer believe that my diagnosis of bipolar disorder II and EUPD/BPD is accurate. I can’t remember the last time I experienced an episode of sustained low mood (or, more colloquially, depression) and the last two 'hypomanic episodes’ I experienced (over a time period of 2.5 years) were both triggered by alcohol. How can someone diagnosed with two mental illnesses (especially as serious as bipolar or as ‘untreatable’ as BPD) just end up being generally fine? Can these things be fixed, do they simply go away on their own? Or is it that I was wrongly diagnosed because the medical system is more concerned with expanding their repertoire of disorders and fobbing people off with pharmaceutical ‘solutions’ than it is utilising whatever is available to them to genuinely help people? Because it actually doesn’t matter, in the end, what your True and Honest mental health diagnosis is - it only matters that you get help and are then able to live your life. If the diagnostic framework isn’t doing that, then it’s worthless.
I want to conclude this essay with a disclaimer: I’m not saying that mental illness or disorder isn’t real, because it clearly is. What I am saying is that it is nowhere near as common as medical professionals, social scientists, and media outlets keep conditioning us to believe it is - and for those amongst us who are genuinely mentally unwell or disordered, the treatment program available should be a hell of a lot more robust. These are the people that medication and institutions are made for, not the emotionally unstable teenage girl struggling with body image and attachment issues or the depressed man weighed down by the impossibilities of supporting his family in the current economy. Even for someone who was as mentally distressed as I was - and it was severe during my teens - the things that finally got me going in the right direction were material, not medical. Going to university gave me a steady income, safe accommodation, and something productive to focus on, and despite not really rating my university experience as a whole (which is an essay for another time) these changes to my circumstances were an invaluable start to my recovery. For full transparency, I did seek psychotherapy and take medication at various points during the last 20 years, but it was only after I went to uni that they provided any benefit: it was my environment shifting that was the catalyst to improved mental health, not happy pills and couch confessionals.
But the NHS can’t prescribe people a brand new life, so instead they’ll keep pretending that people who are quite understandably depressed, stressed, and anxious are insane and are consequently condemned to being lifelong medical patients. Well, I reject this narrative. There is nothing wrong with me.