Maybe “mental illness” isn’t what you think it is…

A different version of this post was published by The Good Men Project where it has been shared almost 400 times so far.  Subsequently, this article was republished by Mad in America where it has been viewed over 1100 times.  I recently submitted it to The Mighty.  I received an email from them explaining why they would not be publishing it which included the line below.

Right now, we unfortunately don’t have the capacity to publish every story on our site.

I sincerely doubt “capacity” had anything to do with The Mighty’s editorial decision regarding this piece.

I’ve spent close to twenty years looking for reasons behind why I was compelled to think and act suicidally when I was twenty seven years old.  While my search has yielded more questions than definitive answers thus far, I’m convinced that sharing what I’ve learned so far will help others.

Events happen, and then people think and say things about those events—let’s call those stories.  No matter how accurate or truthful a story is seen to be, events that have occurred and the stories that people tell about those events, are never the same thing.  They can’t be because one is an occurrence in reality while it’s happening, and the other is an after the fact symbolic representation meant to describe a prior real occurrence.  I’m no linguist, but this is the nature of language, right?  We use language and stories to encapsulate and communicate meaning about our reality and our conscious experience of that reality—every word is a story unto itself making sense of existence.  Every diagnosis of every “mental disorder” relies on a translation of stories.  A person tells a psychiatrist a story, and the psychiatrist maps that natural language story onto a “mental disorder” language story from a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM).  Millions of people assigned a “mental disorder” story or a “mental illness” diagnosis end up failing to see the basic event-story distinction I just pointed out.  They confuse their DSM diagnosis or “mental disorder story” with reality itself.  Unfortunately, many patients are also systematically misled to necessarily attribute the issue that prompted them to see a psychiatrist to a supposed specific brain pathology that mysteriously eludes accurate definition and explanation.

I made these mistakes after nearly killing myself nineteen years ago, in part, because of the forces of institutional corruption at work within our mental health care system written about by Robert Whitaker and Lisa Cosgrove in Psychiatry Under the Influence.  I share this true story as an anecdotal example of those corrupting forces in action.  It is my hope to decrease the likelihood that other people won’t be misled like I was.  I also hope to inspire the many well-intentioned but misguided “lived experience” mental health advocates who are confused like I was to think differently.  They are unwitting participants in this harmful confusion’s perpetuation.

A few days after I nearly killed myself a psychiatrist told me that I was suffering from a “mental illness” called Major Depressive Disorder after talking with me for less than fifteen minutes.  That’s all the time it took him to gather enough information to know which “mental illness” was plaguing me and how to treat it.  He prescribed me an antidepressant as he mentioned something vague about the amount of a neurotransmitter in my brain called serotonin and selective reuptake inhibition.  I also began seeing a psychologist for talk therapy twice a week.  In just three or four months I was feeling like my old self again—the same amount of time it had taken me to go from feeling fine to almost killing myself.  I believed the story my psychiatrist told me about the cause of my despair.  He gave me the name of an apparent disorder with my brain, and a pill to fix the problem.  Back then, it seemed to me that the medication I was taking did more to help me than anything the psychologist and I discussed.  That assumption was a costly one for me, and my family.  It led me to make two consequential mistakes that millions of other people diagnosed with a “mental illness” also make.  First, I failed to see my diagnosis as a view of reality, mistaking it for reality itself.  I conflated a series of actual events from my life with a boilerplate story about a “mental disorder” from a big book.  Doctors are trusted authorities.  When you’re unquestionably hurting, it’s comforting when a trusted authority gives you an officially-sanctioned medical reason for why you feel so horrible, and better yet, a remedy to help you.  My mistake was compounded when I came to believe that my diagnosis mapped onto a specific brain pathology necessarily responsible for my problematic thoughts, feelings and behaviors.  My doctor gave no serious consideration to any psychological, social or environmental factors that contributed to the mindset from which my suicidal behavior emerged.  He couldn’t have—he didn’t know enough about any of those factors.  It is no surprise that I blamed my brain for my problems, like millions of other “mental patients” do.  Our collective confusion about a specific brain pathology necessarily being the sole or at least primary causal culpability for our lack of ease is proof of the influence of the forces of institutional corruption within the mental health care system.

A deeper examination of my suicidal crisis subsequent to receiving my “mental illness” diagnosis revealed how childish, fearful, egocentric thinking and bad luck led me down a path towards self-destruction.  To clarify “egocentric” I’m not talking about arrogance, narcissism or even self-preoccupation.  At the heart of my egocentrism in my younger years was the failure to readily recognize that my view of reality, was a point of view at all.  Growing up I prided myself on being right.  I prided myself on objective, quantitative measures of just how right I was.  I was especially proud when I was deemed 100% right.  Egocentric people become attached to being right, and they often are.  I became so accustomed to being right, that I confused my view of reality with reality itself.  I almost killed myself, in part, because of this confusion, this conflation of what I thought was happening with what was actually happening.  There were four other types of childish and/or fearful thinking that led me from being involved in an awkward exchange during a routine business meeting in Toronto to genuinely believing that I was an unintelligent, overcompensated fraud of a human being destined to disappoint my father and myself.  Those types of thinking are called catastrophizing, overgeneralizing, black and white thinking and past counter-example blocking.  Cognitive behavioral therapy is an effective way to address these often disempowering ways of thinking.  This other narrative that describes the conditions and events that led to my psychological and emotional struggle is patently more accurate and more practically useful than anything my psychiatrist told me about my ostensibly malfunctioning brain.  Nineteen years later, it’s evident that me believing that my suicidal behavior necessarily resulted from a “mental illness” was more beneficial to the psychiatrist who told me that than it was for me.  I’m not claiming that this was a fault of my doctor or a sign of bad faith or ill-intent on his part.  His profession trained him to look for different nails to hit with different hammers, and I was a perfect fit for a hit from an antidepressant.  He was just doing his job—playing his role in a system.  Unfortunately, like millions of other people who are given a “mental illness” diagnosis, I came to see my diagnosis as a defining part of my identity because of my respect for my doctor’s authority, and my belief that my problem was necessarily in my brain.  This belief led me to seriously entertain the fallacy that I was biologically destined to suffer from despair over and over again.

My stay at the private mental hospital subsequent to nearly dying by suicide was five days long. I spoke with my psychiatrist on three separate occasions during my five day stay. We spoke briefly on the day I was admitted. We bumped into each other once, and spoke for less than five minutes. And we spoke for about ten minutes on the day I was discharged.  While reviewing my bill, after being released, I noticed that I was billed for “Individual psychotherapy” five times, one charge for each day of my stay. When I called the mental hospital to inform them of the obvious billing error, I was informed that every patient in the facility was charged in this manner. I explained how this seemed patently fraudulent and unethical to me given the literal definition of the word psychotherapy. The person I spoke with apologized but said there was nothing she could do, remarking something like, “That’s just how it works.” The first time I thought and behaved in a way that matched the diagnostic criteria for a “manic episode” found in the DSM occurred after taking an antidepressant. I’m aware this fact doesn’t prove that the antidepressant was the proximate cause of this development in my life, but given the wealth of evidence supporting the hypothesis that antidepressants often have iatrogenic effects on the people who take them, like inducing mania, for example, it’s reasonable to consider that my treatment for Major Depressive Disorder was a causal factor in me exhibiting behavior that led a different psychiatrist to diagnose me with Bipolar Disorder I.

I’m so grateful that someone was willing and able to inspire me to question the stories psychiatrists told me about the cause of my suffering.  Powerful authority figures implying that brain pathology is necessarily to blame for the suffering behind “mental illnesses” increases the chances of people believing that they need to buy pharmaceutical remedies to be well.  How else are psychiatrists who only prescribe psych meds going to their pay bills?  Ironically and probably unbeknownst to the vast majority of people diagnosed with a “mental illness” the National Institute of Mental Health ceased funding research based on the categories listed in the DSM in 2013.  When announcing that no more federal dollars would be spent on research based on the DSM going forward, Dr. Thomas Insel said that diagnosing a “mental illness” by asking a patient about her feelings was analogous to diagnosing a heart patient by asking her about her chest pain.  I’m not arguing that people don’t experience emotional distress.  I’m arguing that the words used to describe the causes of feeling a lack of ease or distress can perpetuate a person’s lack or ease, or worse, compound it.  I am committed to changing the world by changing the words that people use when they talk about “mental illness.”

Here’s an example:

You have a “mental illness” or a “mental defect” resulting from a specific, yet somehow unidentifiable, brain pathology that is causing you psychological and emotional distress.  You can treat your “mental disorder” with a chemical made in a lab that will hopefully mysteriously correct your brain pathology for as long as you can bear the undesirable effects of that chemical.

Learning more about yourself, the human condition and the many different approaches proven to help other people maximize their own well-being will help you to grow into a person who experiences less and less psychological and emotional distress over time.

Which is more empowering?

If I still haven’t convinced you, please consider this final example from history that hopefully more clearly illustrates my point that a “mental disorder” or a “mental illness” diagnosis is necessarily a subjective story about events, and not an objective description of a constellation of thoughts and behaviors that are necessarily caused by a specific brain pathology.

Imagine it’s 1972 and a man visits a psychiatrist because despite having a great relationship with his lover and a job he loves, he’s miserable.  He’s been estranged from his entire family, and he is suffering a great deal as a result.  He can’t sleep.  He’s constantly anxious, and he’s feeling quite hopeless about things ever getting better.  He explains that all of his problems arose when he admitted to his family, a few weeks ago, that his lover was a man.  Shocked by the revelation, his family said they never wanted to see or speak with him again.  The doctor tells the man that the source of his problem is a “mental disorder” in the DSM called Homosexuality.  The man is the son of a southern Baptist minister, and he has been ashamed of his attraction to men his whole life.  He respects his doctor, and his father too.  In fact, he thinks they’re both right.  He sees his love and sexual desire for men as sinful urges that he is supposed to resist, but he is incapable of doing so.  He sees his homosexual acts as mortal sins, and evidence of brain pathology. Feeling utterly hopeless, lost and beyond redemption, a month after being diagnosed with the Homosexuality “mental disorder” the man kills himself.

Please consider helping me spread the idea that “mental illness” is a harmfully misleading phrase that causes suffering by design.