I’ve had several discussions with people that I thought would be good to disclose here, as they’re pertinent to earlier posts about our misperceptions of mental health and misuse of language. I want to definitively capture the black and whiteness of our thinking with respect to normalcy and mental illness, proving our conceptions of both to be misinformed.
I will preface this by saying that my knowledge of the topics aren’t close to complete. Most of us consider mental illness and normalcy to have a sharp, dividing line, likely being stunned to learn that such a line simply doesn’t exist. It isn’t us and them, and it isn’t easy for people to just snap out of mental illness, just as it isn’t easy for “normal” people to stop being sad or anxious. I argued elsewhere that mental illness exists on a spectrum, where health and illness are balanced by nuance, the in-between, where each of us fall into. When we think of someone who’s healthy, we think of someone who isn’t clinically diagnosable, someone who doesn’t need therapy; yet, we fail to consider that most symptoms of illness can be found in “healthy” individuals, too. We get sad, we get anxious, we beat ourselves up when we fail, we have moments of dependence, and we get angry, just as the “mentally ill” do.
When we seek out the divider, it’s often difficult, even impossible, to discover it, as the lack of a diagnosis, not meeting the full criteria for a label, doesn’t imply wellness; someone can exhibit just enough symptoms to be considered healthy, barely missing the mark for a diagnosis and still benefit from treatment.
So, it’s often hard to separate health and disorder, the line between the two being a subjective divider, which doesn’t negate the fact that disorders exist, but indicates the problem inherent in attempting to separate them. Now, that we’ve established that there’s continuum, we’ll focus on the similarities between healthy and pathological reactions. Someone undergoing a divorce, who doesn’t struggle with mental illness, will react with heartbreak and sadness, while someone who’s struggling with Major Depression will experience a sense of devastation. Other symptoms include change in sleep and appetite, loss of energy and motivation for basic tasks (like bathing), and social isolation, lasting for a prolonged period of time. Both reactions are similar, yet one is vastly more intense than the other. Thus, both reactions exist on a continuum of sadness, with the dividing line being difficult to detect.
When we discuss the mental health continuum, we should also acknowledge psychosis: auditory or visual hallucinations and/or delusional beliefs. Someone can hear voices and see people, and by learning how to manage them through psychotherapy, can live a life in which they’re able to take care of themselves, sustain gainful employment, and maintain their social support network. In those cases, the disconnection with reality isn’t severe enough to warrant a clinical diagnosis; therefore, by use of the DSM, we would label them as being normal, or rather, not label them at all.
Our black and white thinking gets us into trouble because our simplistic minds search for simple answers. This sort of thinking backfires during critical self-evaluations and positive ones. When a client tells me that they don’t consider themselves to be great or a good this or a good that, I respond by saying, “Yea, I agree; you aren’t.” They laugh, presenting with the expected, and obvious, stunned expression of confusion and discomfort. Here is where the aha moment comes. Then, I ask them to define being a good mother or a great person and it, more often than not, resembles perfection. So, I say, of course you think you’re being lied to when you’re complimented; you definitely aren’t perfect, but nor do you have to be.
Here, again, is a perfect instance of language being misused. Like kids who are presented with trophies for participation, while being told they’re just as good as the winners, most adults are too smart to buy into notions of greatness when they so obviously percieve their flaws. So, I help them decide what it means, for them, to be good enough. And then, our language begins to align with reality, as they acknowledge either being good enough or somewhere close to it.
Whether it’s the black and white thinking of mental illness or normality or the black and white thinking of being a good or bad mother, friend, person, etc… we trap ourselves in a hole from which reason can’t help us escape. Returning to mental illness: my purpose isn’t to degrade its significance but to elucidate its prevalence, as it pervades in one form or another. I don’t believe that someone with depression can’t do the normal things that others can, but it certainly is much, much more difficult, especially because of the strength and force of hopelessness and low self-esteem and self-efficacy.
After years of study, I feel like I’m still in the infancy stage of understanding mental illness and its consequences, including poverty. Every time I think I get it, I’m confounded by more nuance. There are no simple solutions to complex questions; so, hubris, in these areas, should be minimized. And with it, judgment of those whose struggle exceeds what we view as normal.