It is wonderful to see that there is an increased awareness of and drive to end the stigma associated with mental illness. Bell did a great job with their “Let’s Talk” Campaign, raising $6, 107, 538, 60 toward mental health initiatives! There is more dialogue happening than in the past, and I think that more than ever people are speaking out about their illness, and that even those without a mental illness are speaking out for those suffering. I think that it will continue to grow and through education and dialogue the stigma will become less of a threat to so many suffering.
If I am totally honest though, I still feel as though I live under the shadow of stigmatization and fear the consequences of sharing my illness with others. I recently wrote a post about a couple of incidents that made it very clear to me that there is a misconception about what mental illness looks like. You can check out the story here.
I have been living with Bipolar 1 for as long as I can remember, although I have only been living with medically treated Bipolar 1 since my diagnosis about 10 years ago. I have come to terms with my illness. Although I have to admit that despite knowing now that my manic and depressive episodes had a medical explanation, and that my condition is stable with proper medical care and medication, I still am not willing to be completely open about my illness. I am very careful about sharing that part of myself.
The illness has caused me an incredible number of challenges, missed opportunities, loss, has lead to self-destructive behaviour and I have hurt many people that I love. Fortunately, I have had the privilege of working with medical professionals to monitor my medications, I have psychiatric treatment/counselling and I’m learning to recognize symptoms and to make positive lifestyle changes. Thanks to this I live a fairly normal and functional life. Proper treatment allows me to maintain balance and some stability, reducing the number and the intensity of episodes I experience.
I have to ask myself though, why are we still differentiating between physical and mental illness? Mental illnesses are a result of brain functioning, and I’m pretty sure the brain is a part of the body. Is it not? Not to mention the fact that symptoms respond to medication, which can in turn allow a person to lead a relatively stable and balanced life.
Maybe we need to rethink the divide. If what is considered to be physical illness is usually diagnosed by definitive tests, is often visible, and is viewed as a legitimate affliction, then mental illness must be something else.
Unfortunately, differentiating between physical and mental illness gives the impression that mental illness is something different, that it is not an illness of the body and therefore must be a problem of the “mind”. The mind is associated with behaviour, personality, and amongst other things, the ability of one to change or choose their disposition. Maybe the very distinction is perpetuating the stigma. Perhaps the decision to no longer label one type of illness physical and one mental is a necessary beginning step in ending the stigma.
Why do we differentiate between mental and physical illness? Where does this come from? Why does it matter?
There is much debate over the definition of Mental Illness. It is generally accepted that it exists and that it can have serious and an often detrimental impact of the lives of those suffering.
While there is debate over how to define mental illness, it is generally accepted that mental illnesses are real and involve disturbances of thought, experience, and emotion serious enough to cause functional impairment in people, making it more difficult for them to sustain interpersonal relationships and carry on their jobs, and sometimes leading to self-destructive behaviour and even suicide. The most serious mental illnesses, such as schizophrenia, bipolar disorder, major depression, and schizo-affective disorder are often chronic and can cause serious disability.~ SEP
The mainstream Western view of mental illness has changed with increased knowledge and conceptual sophistication. We have moved past the less sophisticated, ignorance based view that what we now call mental illness was demon possession, or the result of some other supernatural phenomenon. Could the archaic diagnosis of a spiritual or supernatural cause of mental illness still be lingering in today’s perception? What do we mean when we differentiate mental and physical illness? To me that would imply that a mental illness is somehow an illness or disruption in some part of a person that is external to the physical body wouldn’t it? Which in turn would have to mean that we are more than our physical body, and that our mind is something outside of our physical selves.
At this point some of you reading might be thinking “who cares”? Well, being diagnosed with what is called a mental illness as opposed to a physical illness can have serious, life altering consequences. Including employment, issues with insurance and discrimination, to name a few.
There are limitations and difficulty surrounding medical insurance, being qualified to receive care and benefits that someone with a physical illness would receive even though the mental illness is causing comparable limitations. There is fear of informing employers because of concern about jeopardizing a career, even though it would be beneficial for an employer to understand the illness so that he would understand that the employee might need a to step out for a moments or whatever the case may be, rather than not understanding and chalking it up to laziness or incompetence. For example it might be important for a diabetic to inform his or her employer so that there is an understanding and accommodation for certain behaviours and needs related to the illness. It does not feel safe, however, in the case of mental illness.
The reason that the parity debate exists at all is because our institutions (governmental, legal, medical, insurance/financial, etc.) are and have been (for hundreds of years!) invested in the idea that mental disorders (such as depression, psychosis, and anorexia) are somehow fundamentally different (less real, more the fault of the victim/patient, and less deserving of support) than physical disorders. Though we know today that this view (that mental disorders are different and/or inferior to physical disorders) is false, the legacy of these older prejudiced beliefs still rules:
~Within any given health insurance plan, the coverage for mental disorders is inferior to that provided for physical health concerns.
~Many health insurance providers don’t even underwrite their own mental health coverage, but rather ‘carve it out’ (sub-contract it) to other specialized companies.
~Mental and physical disorders are actually diagnosed using separate diagnostic books. In no other field of medicine (that I’m aware of) is this done! Mental disorders are diagnosed using the “Diagnostic and Statistical Manual of Mental Disorders (the DSM)”, and physical disorders are diagnosed using the “International Statistical Classification of Diseases and Related Health Problems (the ICD)”. Last I understood, the DSM is also considered a ‘carve-out’ of the ICD in that the DSM (published separately) is considered a code-compatible sub-section of the larger ICD which covers physical disorders.
~While there is stigma involved with all illness, you get stigmatized (discriminated against) by employers and society at large more when you have a mental illness as compared to when you have a physical illness. No one thinks less of you for consulting a physician for diabetes, but they generally will if you consult a psychiatrist for depression.
~ Mark Dombeck, PhDBlurring The Boundary Between Mental and Physical.
Clearly there are serious consequences in differentiating between physical and mental illness. Sure, there are differences, but there are also differences between illnesses that are both considered physical. Could it be possible that the distinction itself between physical and mental illness is adding to the problem of stigma?
I have been wondering about this for a while, so I thought I would ask the question. I have no training in medicine or psychology but I think it would be safe to say that most medical professionals treat patients based on the assumption that they are physical beings. Where would a “mental illness” originate if not in the brain? The brain is an organ. Why then, is an illness that is the result of improper brain functioning not physical? Hypothyroidism has been associated with Bipolar like symptoms, behavioural symptoms. The malfunction is in the thyroid gland, but is causing “mental/emotional” symptoms. Why is it not a mental illness? How about damage to the brain causing behavioural changes, or any other disorder that is considered a physical illness (like epilepsy, stroke, etc.) that is a result of activity in the brain? Why are those physical illnesses and not mental illnesses?
In my opinion, I don’t see how any illness that causes symptoms that are shared by millions of people, responds to some variation of the same category of treatments, and that originates in an organ in the body can be anything other than a certain type of physical illness. Illness is illness, and illness occurs in the body. Unless we want to get into arguments about the mind being something outside of or separate from the body, something supernatural, I’m pretty sure most of us would agree that what we call our mind is our brain in action. The mind is the state when the brain is alive and at work. A living functioning brain produces the mind, so mental illness by that definition of mind would be caused by a malfunctioning of the brain, causing symptoms in the mind.
It is a big question to ask, but I do think that the stigma surrounding mental illness is perpetuated by our continuing to treat mental illness as something different from physical illness. It is all physical illness. They may represent symptomatically different, but they all originate in a part of the (physical) body.
Bell Canada (Bell “Let’s talk” campaign)
Seven Counties Services Inc., Blurring The Boundary Between Mental and Physical. By: Mark Dombeck, Ph.D.
American Psychological Association: The roots of mental illness: How much of mental illness can the biology of the brain explain? By Kirsten Weir
Stanford Encyclopaedia of Philosophy: Mental Illness.