Great article… should be reposted often.  Credit to:  http://www.perilouslyprecocious.com/trying-to-understand-mental-illness-whats-up-when-everything-feels-upside-down/

I feel like I’ve jumped head first into a deep sea of mental illness. This is such a sensitive topic, that I hesitate to address it, but know that for my own sake, I have to write about it. Somehow, in some way, if I can help someone else out with my thoughts, then I feel it necessary to post it. So, I will do my best to be sensitive about what I say. It is not my intention to divulge identities, nor is it my intention to spew forth drama or unnecessary stress… I just want to get some things straight in my head so that I can have a more solid stance on what/how I think and feel about this stressful situation.

I’ve studied psychology extensively. I’m at the end of the requirements of getting my bachelors degree in Psychology. I can honestly say that in no way, and by no means, has this education prepared me to understand how it feels to have someone you love be sick with a mental illness. Of course, it is because of the fact that I have several people close to me with mental illnesses that I became interested in the field of psychology, and it is because I have a passion for helping, an innate drive to solve problems, and a geeky fascination with science that I’ve decided to become a doctor, specializing in psychiatry. (Of course this path may evolve as I get deeper and deeper into my education.)

These things being said, I have a personal investment in the topic. Obviously this is something I have a great deal of passion for, otherwise I wouldn’t be putting these goals on the forefront of my plans for life. As much as I feel I have learned, I am still lost, and at a loss for words to understand exactly what it is that a person goes through when afflicted with a sickness that is difficult to diagnose, challenging to treat, and by no means understood by the scientific community– in fact, often scoffed at because it’s just not understood.

There are clinical diagnoses. There are specific criterion that need to be met in order to diagnose someone. Based upon the diagnosis, a person is treated– hopefully by someone who has successfully treated someone with similar symptoms in the past. Of course, the treatment relies upon– demands for– the honesty of the patient describing how they feel– what it’s like to be inside their head. Herein lies an incredible problem. What if the person doesn’t tell their doctor the whole story? The doctor cannot treat their patient for the illness at all– because frequently a patient has learned to say what it is that they think the doctor wants to hear in order to get their own personal desired outcome.

Yes, this is completely counterintuitive. Why on earth would a patient lie to the one doctor who is available to cure them from their ailments?  Fear.   Simply put, the patient is afraid of telling the doctor the whole truth– the magnitude of their symptoms– out of fear of the consequences of being diagnosed as “Crazy.” I’m afraid this probably happens at a much greater frequency than we as a scientific community want to admit. If a person goes in to see their doctor, and tells them the whole truth, then the doctor can hospitalize or instigate institutionalization of the person. Therefore, there is a front held up. Walls… the patient will tell the doctor only enough to be treated for the minute symptoms, leaving out the great big WHOLE picture of their experience. In turn, the patient is not treated for their ailments, and continues to live in misery.

Even if the patient WAS completely honest, there may not be a desirable outcome. Let’s say the patient is completely honest and isn’t at risk of institutionalization. Even in those cases, we don’t know why certain treatments work– or why some work for some people and why they wouldn’t work for another. Psychiatry is such an infant science that we really don’t know. That’s an awfully frightening fact considering the alternative to “being crazy” and “not treatable” is hospitalization.

What is hospitalization like for a sick person? I have no information to even begin to empathize, but I imagine it could be seriously frightening and probably feels to the sick person like taking a significant step backwards. A hospitalized person could lose everything they’ve worked so hard– harder than any “sane” person– to keep. They lose their independence–even if temporarily, can lose their job, have the social stigma of being “officially crazy” and could lose important social supports because of this association of being “crazy.”

If a person is spiraling downwards into the pits of mental illness hell– to the point where they’re not quite sure if they are a risk to themselves or to others, they have a great responsibility on their shoulders– a responsibility that even a mentally well person may not be able to handle. Is it, then, the responsibility of the people around them to know how to fix the situation? Even the doctors, the people who have dedicated their lives to knowing how to handle mental illness, do not necessarily know the answers. How could we possibly expect the family and friends know when to say when with their loved one’s illness? That’s an extremely tough call to make. What if family members do not agree on What Should Happen? Where are the boundaries? Whose responsibility is it? Even in that case, a person who makes that sort of call for their loved one faces the consequences amongst the survivors (so to speak)– the remaining people who also care for this person– who don’t agree that something like hospitalization would be the correct answer.

It’s a slippery slope. Even in the less extreme cases, where a mentally ill person can sort of “keep it together” well enough to function– with or without the help of their friends or family, there is extreme stress and vast chasms built upon the tenderfootedness necessary that comes with being part of a family or one of the friends with a loved one suffering from mental illness. Even with the most compassionate love one can conjure up in that situation, there is still stress of not knowing what to say or what to do that could or could not cause a negative reaction from either the person who is sick or the other people who love the person who is sick.

To make matters even more complicated, it’s imperative to understand some simple pieces of mental illness. One of the most significant yet most challenging concepts to grasp is that mental illness is not like cancer. It’s not like a disease that you’re necessarily always sick from. Sometimes one can be perfectly healthy for many years, and then, depending on an infinite variety of factors– most predominantly stress– a person’s mental wellness can drip away. For many, I believe that loss of self is something a person is well aware of, and it must be agonizing to know how one felt “normal” yesterday yet today can’t conjure up the nerve to get out of bed, go to the bathroom, bathe themselves, or feed themselves. How excruciating it is to experience the contrast of wellness versus mental illness in such a brief period of time! There are other cases, though, where the sickness takes a much longer time to rear its head. It could be weeks, months, or years before a person who is getting sick begins to realize just how far off the path they have wandered– until finally, they see that there are no familiar landmarks, and have no idea how they got this sick without realizing it. Lastly, (and probably ideally,) there are also instances when a person with a mental illness is able to monitor their wellness/sickness ratio and are able to maintain that experience so that they’re always teetering closer on the side of wellness than sickness. Again, this responsibility is extreme. how does one maintain such a fine balance, especially when there are so many things about our experience that are stressful? Life in its normal state can be stressful!

Another related article with a ton of merit and kudos from me.  Credit to: http://eliminatethestigma.wordpress.com/2007/12/29/are-explanations-for-depression-contributing-to-stigma/

There are likely a myriad of causes of the stigma against mental illness that so many people hold and it’s also likely that in any individual multiple ideas are at play in fuelling their prejudices. I think that one of those ideas that drive stigma lies in people’s explanations as to what causes mental illness and their perception of the agency of the sufferer in that causation.

(I’m going to write about depression as that’s what I know but I reckon these ideas can apply more or less as well to many other mental illnesses.)

Everyone who has known someone living with depression has ideas about what causes their illness. It’s possible to consider these theories of causation as existing on a spectrum based on the degree of agency attributed to the person suffering. At one extreme (say, zero on the scale) would be the neurobiological explanation: depression is solely caused by an imbalance of neurotransmitters in the brain independent of the events in the person’s life. This positions depression as something that merely happens to a person, something independent of their life and experience, something over which they have no control.

At the other extreme (say, ten on the scale) would be the wholly moral explanation: people are depressed because they choose to be, that they are malingering, that they are self-indulgent and sympathy-seeking. This positions depression not only as something entirely within the person’s control but as a state they are somehow encouraging.

Between these two extremes can be placed all other theories of depression causation such as (in rough order of least to most agency): depression is caused by stressful or traumatic events in a person’s life that result in an imbalance of neurotransmitters in the brain; depression is a pathological but understandable emotional response to stressful or traumatic events in a person’s life; depression results from poor coping skills to stressors/traumas; depression is a weakness of character; etc.

In any individual, differing theories of causation will be attributed to different people they know experiencing depression.

For the person encountering someone with depression, the degree of agency perceived to be involved in causing that depression is likely to be directly proportional to the amount of stigma they may hold to the person living with the illness. The higher on the agency scale the person’s causative theory of depression is in any instance, the more they will perceive the depressed person responsible for their own suffering, the more likely they are to view the person to be inherently morally flawed and the less likely they are to feel sympathy or offer help.

It’s human nature to reason about our lives and experience, particularly to determine the cause of problems in order to discover solutions. In depression it’s often impossible to definitively identify the cause of an episode. In the absence of any clearly identified external cause, sometimes people slide up the scale of agency: “Since I can’t see any reason for your depression, then it must be something wrong with you.”

Looking for causes is not only often futile but frequently pointless. Even in instances where contributing factors can be identified, they may not be able to be removed or modified. Where searching for causes encourages stigma, it’s not only unhelpful but positively harmful.

I think the focus on the cause of someone’s depression diverts attention and energy from the immediate issue: someone is suffering immense pain. If you can’t identify and remedy the cause of the person’s suffering, I’d suggest stop trying, accept what they’re experiencing without judgement, be there for them and give them the love and support they need.

(I’m aware of the irony in arguing for less focus on the cause of events in a blog entry exploring the cause of stigma.)

by auchel