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Feb 02 2013

Abusing ‘Normal’

Alternately titled: Yes, but isn’t EVERYBODY kinda mentally ill? What is mental illness anyways? Aren’t we just pathologizing being weird?! BUT SO MANY PEOPLE SEEM TO BE MENTALLY ILL NOW!

If you talk about mental health and mental illness long enough someone is going to pull one of these.

 You know, aren’t we all just different?

It seems like everyone has a mental illness. 

I mean, like, isn’t everyone sad/anxious/depressed/a little obsessive-compulsive?

Yes, but mental illness is just a social construct! We just decide what behaviors we don’t like and those are the ones we treat! 

I mean, it’s all just a bell curve!

I’ve always imagined myself shouting BECAUSE REASONS!!11!1, and then promptly brandishing a list at the offending questioner. This post is the internet equivalent to that word waving. Beware of snark.

1) The ‘Useful Heuristic’ Explanation

We, as humans, categorize things, then use shortcuts to understand what’s going on in our world. These can break down and aren’t always helpful (see every racist, sexist, heterosexist stereotype ever) but they do save cognitive time and space and increase processing speed. “Having X mental illness” or even “having a mental illness” is a useful heuristic that conveys specific information. I don’t have to tell you that I am statistically more likely to find food anxiety-provoking, while also having significant distorted bodily perception, obsessive behaviors related to food and drink consumption and discussion of the aforementioned–I can just tell you (or anyone else) that I have an eating disorder.

2) The ‘Special Snowflake’ Explanation

The experiences of those with mental illness are quantifiably different from those without mental illness. In fact, when people respond with “Oh, I get/understand/could imagine [whatever aspect of mental illness I was talking about].” I’m actually faintly uncomfortable. Because no you don’t.

By attempting to cheerfully shoehorn the experiences of the mentally ill into your Just Like Me box, you’re actually ignoring their experience–and also refusing to acknowledge that the ways in which they inhabit the world are fundamentally different from yours. You don’t understand it, and you can’t, and that’s fine. The solution is to get used to it, not to pretend you’re the same people with slightly different idiosyncracies. Mental illness not having a membership to a Special Club for the Quirky. It’s overwhelming, distressing, and the vast, vast majority of people with it spend their time wanting it to go away, now.

And for heaven’s sake, mental illness is not a cute little talent like juggling geese, rearing its head when convenient.

3) Dammit, It’s Hard to Do Research Without Diagnoses

Without some way of quantifying the clusters of symptoms that make up different mental illnesses, we’d have extraordinarily poor research. The anxiety surrounding food in anorexia is different from the anxiety of a phobia or the anxiety of PTSD. The You’re Ostracizing People Who Are Just Different crowd usually fail to consider that research lies almost entirely in developing and learning from divisions of differentness.

4) The Medical Model has Some Uses. 

Before I have a riot on my hands, this is not me throwing my support to the medical model of mental illness. (Medical model redux: Diagnose via a checking boxes on a list of symptoms, find appropriate fix.) I don’t particularly like it for any sort of understanding about actual illnesses. Go biopsychosocial!

But the model is useful for explaining why being neurodivergent is not the same as being neurotypical. By equating mental illness to physical illness, (Another note: I’m not endorsing mind-body dualism here either–or the excessive use of parenthetical notes.) we’ve benefitted greatly. You can say “someone with cancer has physical differences from someone without cancer!” and then substitute ‘depression’ for ‘cancer’, and people wil get it. Not only that, but they’ll understand why treatment is a necessity, why it should be covered under insurance, and why people with depression alter their lives around it. Pretty sure no claims office shelled out for “being a different kind of normal”.

So.
[Dusts off hands.]
Mental illness is A Thing.

14 comments

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  1. 1
    Ma Nonny

    Not only that, but they’ll understand why treatment is a necessity, why it should be covered under insurance, and why people with depression alter their lives around it. Pretty sure no claims office shelled out for “being a different kind of normal.”

    It frustrates me so much when people do not give mental illness due consideration. My significant other *cannot* find an affordable health insurance/prescription plan that covers medication for “any mental illness” in our city (we just moved and had to get new plans). Instant extra $400 a month costs for someone who only MAKES $600/mo (I mean, who needs to pay rent, am I right?). All I can think is “how is mental illness not an illness worth treating? If it’s not treated, my SO loses their job because they can’t function, and then they lose all hope of ever being a productive member of society (and their ability to keep paying premiums for their stupid plan)!” Considering mental illness is one of the biggest reasons for lost productivity, you would think there is good financial incentive to treat it. How can insurance companies get away with pretending it’s like some cosmetic procedure? /rant over

  2. 2
    erinmcc

    of the 5 individuals in my household, we have 3 autistics, 1 ocpd/ocd, and 1 undiagnosed as of yet who has traits of both ocd and autism. so, a nice cornucopia of weird behavior.

    i avoid use of the term “mental illness” partly because of the negative connotation and partly because none of us here view ourselves as ill. neuroatypical, yes, definitely not “normal”, but not ill. ill implies that there is something wrong to be fixed, or at least attempted to fix. i stick to developmental disorder to describe the autism, and for the ocpd/ocd, ive just called it my own brand of crazy (not politically correct, but absolutely accurate as to what it feels like when i am in the midst of it and cease functioning). perhaps i should be less concerned with the misconceptions but even mental disorder doesnt feel like a fit. and i dont want it to seem as if i am distancing myself from or “othering” people with other disorders, as thats not the case either.

    i wish there was a word for “mentally disordered, not normal, but not ill and not looking for a cure”. i sometimes use neuroatypical, but most people just blink in confusion at that one.

  3. 3
    Megillicuddy

    This is maddening, and has some dangerous implications in terms of barring people from seeking treatment. I have a friend who is schizophrenic but, in part because of the paranoia associated with his illness, is extremely averse to intervention. We’ve talked a number of times about how disruptive his anxiety and fear are in his daily life and I’ve encouraged him to get help if only to alleviate the discomfort of living in a constant state of panic. His response is not unlike the arguments you cite here: “What if my brain is the one that works right and the rest of you are just delusional and complacent about what’s really happening in the world?” It’s a solipsistic argument that’s nearly impossible to effectively counter and the result is that he becomes increasingly symptomatic, slipping away a little more every day.

    When I finally caved on the issue of SSRIs, I had a lengthy discussion with my doctor about my resistance to medication as a treatment for my depression. I suppose I already understood this intellectually, but it made a huge difference in terms of self-acceptance when she said, “If you had diabetes, you might try to control it with diet and exercise, but you wouldn’t be ashamed if you had to take insulin. You don’t feel guilty if you have a headache and you take aspirin. Treating depression isn’t a moral issue or a personal failure any more than treating a physical ailment.”

    Even though we’ve made some progress in understanding and destigmatizing mental illness, it’s much harder to change deeply felt emotional reactions even when we’ve adjusted our conscious thinking, and that goes for those of us suffering mental illness as well as the neurotypical.

  4. 4
    Sassafras

    I’ve seen a lot of #2 with gender dysphoria. Cis folks assume that my dysphoria is the same as them not loving their societal gender roles or their appearance when it’s completely not even in the same world.

  5. 5
    fmcp

    Thank you so much for this. So often I find well meaning friends try to make me feel better about a depressive episode (I have Bipolar II) by reassuring me that everyone has tough times. Aside from all the issues that you’ve addressed, that response has a very dangerous potential outcome; it’s not unusual for a person with a mood disorder to feel “cured” when stable, and it’s incredibly tempting to go off medication. Painting bipolar depression as being on a continuum with a normal reaction to stress increases this temptation. Not cool. It also ignores the incredible amount of strength it sometimes takes for me to get out of bed and go to work; I’m rather proud of myself that I manage to do that, and I’d like a little credit, please!

    Further, I think “we’re all a little bit mentally ill” is close cousins with the profoundly racist claim “I don’t see colour.” The hidden message is “you can feel ok about yourself – you’re more like me than you think.” It implies that I can only feel ok about myself if I’m “normal,” which is pretty damn insulting.

  6. 6
    NoAssume

    @fmcp: Noooooooo. Both of those claims are bad, both are probably wrong, but colorblindness is a cop out that perpetuates racism, not the Seventh Circle of Hell itself.

    I am actually acutely aware of the fact that I do not have mental illness given how commonly you hear people talking about i.e. depression. It mainly comes up with how hard of a time I have being empathetic with people who have much bigger problems that me – instant foot in mouth.

  7. 7
    Nothing

    I think this post illustrates something important. People with no mental illness or even ones who have mental illnesses but are unaware of them often have these simplistic misconceptions that a given person is not really mentally ill or that mental illness implies total insanity.

    Maybe this problem is made worse because of the rare elements that muddle the line separating mental illness.

    A personal example:

    I do not have a mental illness. Maybe someone would confuse me for a person with mental illness due to my suicidal tendencies, wretchedness, self loathing, incompetence and so forth when not one of these things means necessarily that I’m depressed, but merely that I’m a useless bum.
    On the other hand, there might be people who feel just like I do, but they cannot help themselves because they really are depressive.

    A mix-up between us in any direction is harmful because: a person who is genuinely depressed shouldn’t be expected to mend their life on their own. They do need help very much. On the other hand, mistaking someone like me for a depressive person would just take away this person’s accountability for their failures and blame it on a disease.

    Now, I’m not entirely sure how to tell apart people with genuine grievances like mental illnesses from wretches like myself, but that’s all the more reason to research deeper into this matter. It’s important.

  8. 8
    dianne

    Untreated major depression has a 20% mortality. Isn’t that enough of a reason to treat it as a “real” illness?

  9. 9
    karmacat

    If the insurance is not covering mental health or certain medications, then it is violating mental health parity. Try calling the state’s medical insurance administration or even the state’s attorney general. Mental health parity is a law based on the Paul Wellstone act (there is another name attached to it but I can’t remember it) There is an exception for employers who have fewer than 50 employees. Starting in 2014, they can’t deny insurance for a pre-existing condition. However, they can charge you a higher premium, unfortunately

  10. 10
    karmacat

    This is a good summary of how to define mental illness. Basically, mental illness is a disease of the brain (which, of course, scares people). Since the brain is so complex it is hard to determine the pathophysiology of different diseases like bipolar, depression, schizophrenia, etc. In addition, there are lots of bipolar disorders and schizophrenia and depression. Sometimes, it is difficult to know if certain conditions are “biological” and will respond to meds or not, especially when it comes to depression and anxiety

  11. 11
    Ma Nonny

    Thanks, I will definitely look this up. It’s a huge, well-known insurance company, so I figure they must have some legal loophole for it (or else they would have been caught by now), but my S.O. was told that “any medication we define as a mental illness medication will be the sole financial responsibility of the patient. None of our plans help pay for any of these medications.”

    Also, although they aren’t denying “coverage” for the pre-existing condition, the insurance company was able to stipulate that there be a 3-12 month waiting period (depending on which company we talked to) before they have to pay for anything related to the pre-existing condition. This eventual coverage, of course, covers doctor visits but not prescriptions.

  12. 12
    Ma Nonny

    Looking through the Wellstone Act info, I think the answer lies in the fact that we are looking at individual health insurance plans (which are not under the Act) instead of group health insurance plans. Unfortunately, if you don’t have a generous employer that offers insurance, these parity rules seem irrelevant. If there are laws out there governing mental illness parity in a broader sense, I would be very interested in hearing it.

    Kate, maybe a really interesting blog post (for us in the U.S. at least) could be on how mental illness insurance coverage and/or treatment access for low-income people will change in each implementation stage of Obamacare.

  13. 13
    Kate Donovan

    So! I would love to do this blog post. But I’ve never gotten treatment *or* medication via insurance. My school covers my treatment. So I don’t have the foggiest idea, and I think I’d be offering awful information.

  14. 14
    Karrie

    Do you think it’s more useful to call it CNS disease or CNS disorder (CNS being central nervous system)? I worked in discovery/early R&D for drugs to treat anxiety, depression, addiction, and pain, and we always called it “CNS diseases and pain.” To me at least, the inclusion of pain, which is actually related to the neurotransmitter systems that govern anxiety, depression, bipolar, schizophrenia, etc. makes it obvious that we were looking at physical/chemical differences between a state of health and a disease/disorder state. Calling my research topic “mental illness” in grants would seem to imply that I was researching imaginary things in people’s minds, so…why should a funding agency pay me for something silly that people can just be talked away from? Thus, I called it CNS disease, because we want to cure or at least help people with diseases. And this terminology is not just semantics; there are measurable, observable differences in brain chemistry.

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