Hi, I’m Greg and I am mentally ill

I know that I’m mentally ill because a doctor diagnosed me with a mental illness. And I’m taking medicine for that illness. And the medicine seems to be helping, sometimes at least.

Actually, I’ve been diagnosed with two mental illnesses. Or you might prefer to call them mental disorders. Or syndromes. Whatever they are, I have two of them, although the symptoms overlap considerably with each other. And actually I have other symptoms that don’t fit into either of those diagnoses. They would fit into different diagnoses, but I don’t have enough of the symptoms of those diagnoses, so I don’t have those particular disorders.

I have two mental illnesses, because a doctor told me I have two mental illnesses. I am being treated for those two. Not the other symptoms, because they don’t fit right. I just have to ignore them and pretend they aren’t there. It’s all very inconvenient for everyone concerned.

Illness, disorder, syndrome, treatment, symptoms, diagnoses…all medical terms.

We mostly gave up on the idea of demonic possession a while ago, gave up mostly on asking the priest to come and say prayers and sprinkle us with water and rub oil onto us and command the demons to leave us. It didn’t seem to work very well, not reliably anyway.

So now the doctors do it instead.

The Diagnostic and Statistical Manual (currently DSM-5) defines mental disorder like this:

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behaviour (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”

To paraphrase, mental illness is “a clinically significant disturbance [which is not] a culturally approved response.”

So, whether you’re mentally ill or not depends, in part, on whether your behaviour is culturally approved. DSM says that socially deviant behaviour ISN’T mental illness…oh, but wait, “unless the deviance or conflict results from a dysfunction.”

Got it. So, mental illness is culturally unacceptable behaviour, unless it’s social deviance, unless the deviance is caused by mental illness, which is culturally unacceptable behaviour, unless it’s social deviance, unless…no, wait, I think I got lost again.

The concept of “mental illness” isn’t unhelpful.  Some people CLEARLY have difficulties coping with life in ways that are primarily psychological rather than physical (and where the line lies between those two is a whole other conversation). We should help those people, and make sure they are safe and enjoy their lives. If we can alleviate their difficulties we should.  And there is value in differentiating different types of problem – the issues somebody diagnosed with schizophrenia faces are very different to the ones faced by somebody diagnosed with, say, obsessive-compulsive disorder. Or, rather, they are sometimes. The labels can help us identify treatments, and they can help, but they are just descriptions of a group of symptoms. They are not a real THING that defines the person.

Some argue that this is no different to physical medicine, that the lines are blurred there, too. And that may well be true, but there is a crucial difference socially. Society generally understands that people aren’t defined by their physical illness.

We say, “Auntie Harriet has the ‘flu.” We don’t say “Auntie Harriet is beflued.” Auntie Harriet isn’t defined by the ‘flu, we understand that she’s not well, that it might be serious or mild, that she might have several different symptoms, and that it will probably go away at some point although we also know she may catch it again, sooner or later.

In contrast, we say, or rather we whisper, “Uncle Harry is a schizophrenic,” or “He is bipolar,” or even “He is depressed.” The illness and the person have become one. The illness defines Uncle Harry in a way it didn’t with Auntie Harriet.

And this is where the danger is. By DSM’s own definition; mental illness is culturally defined, and therefore can change according to what is socially acceptable at a particular time. Its attempts to wriggle out of this problem and pin the definition down any further are completely circular, and the psychiatric community knows it.

So arguments, especially in the light of an atrocity or terrible crime, about “Was that person mentally ill?” are always meaningless. A person is mentally ill if society says they are. That’s all it means. It is no more meaningful, or helpful, or explanatory than it would be to say that a person is “evil.” But it gives society an opportunity to absolve itself of responsibility, to pin a label on a person, give us a neat explanation so that we can all move on.

Well, not quite all.

Those of us who have also been pinned with that label of “mentally ill,” realise a bit more clearly that we are, in one way or another, that which society does not want. We’re not to be trusted, we’re dangerous, we’re evil…and all we can do is wait and hope that the secular priests have trust in their incantations, declare us clean of demons and let us back into the fold, to never sin again as the eyes of the congregation will watch us always.

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