5 Frequently-Overlooked Truths about Mental Illness

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Living with mental illness is not easy, but I’d like to believe we all get wiser with age and experience. Here are five frequently-overlooked inner truths that I’ve discovered while working with people with MI.

1. Mental illness IS physical illness. Distinguishing mental (psychiatric) illness as independent from physical illness is creating a false dichotomy. Psychiatric disorders are biologically and genetically driven. They involve imbalances of neurotransmitters, and physiological abnormalities can be measured with imaging tests. Naturally, they are also influenced by our behaviors and experiences, things that have happened to us over the course of our lives. If mental illness were different substantively from other physical illness, the implication might be that we can control it, whereas we cannot control a more traditional physical illness of the brain, like epilepsy.

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Many factors contribute to the etiology of psychiatric disease, including psychological, biological, behavioral, social, and spiritual determinants. As such, treatment for mental illness does not rely solely on behavioral intervention, but also focuses on psychotropic medication and general self-care.

We, as humans, like to think that physical illness cannot be controlled, whereas we have perfect control over our behaviors and emotions. Acknowledging that mental illness has a genetic, biological, and physiological root forces us to acknowledge that it is real and deserving of our intervention.

2. At the core level, there is nothing wrong with who we are. When asked to consider the question, “Who am I?” I find myself inclined to define myself as a mind-spirit combination that inhabits a body. I think many others would endorse a similar belief in the separation between body and mind/spirit. This perceived duality helps define how we see our bodies and our health, and of course that extends to how we go about obtaining and following through on our medical care.

A disease like cancer changes our physical form, but it doesn’t affect who we are at our core. Far too frequently, we consider mental illness to be attacking who we are: our personalities, our emotions, our cognition, and the ways we approach the world. Mental illnesses are brain diseases; do all of these affected factors reside in our brains?

I propose that, despite living with a life-changing condition, a person has nothing intrinsically wrong with them. Mental illness is a physical disease, just like cancer. It does not and cannot harm who we are. Therefore, internalized stigma and self-imposed shame for living with psychiatric disease are unnecessary as we learn to cope and journey toward recovery.

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3. Nothing is permanent. Isn’t it a law of physics that, invariably, something that goes up eventually crashes back down? This tenet seems to be true for mood disorders. Likewise, anxiety ebbs and flows (though for some of us it never truly goes away). Every mental illness is a system of offsets and counterbalances. Even the darkest nights are interrupted by the rising sun; conversely, the darkness is always lurking. Living with mental illness is a constant battle, and sometimes simply surviving the day is an enormous victory. Sometimes, in fact, getting through to the next hour takes every ounce of energy we possess. Survival, and even stability, is possible. Nothing lasts forever, and there will be a tomorrow; it is our job to make sure we are part of it. We must keep fighting when things look bleak.

4. “Normalcy” is relative. If we were each to rank how we feel every day for a week using a scale of 0 to 10, where 0 is miserable and 10 is exceptionally well, at the end of the week we would each have a different score. But what does that really mean? Halfway(ish) is 5, but the way I feel at a 5 is different from the way you feel at a 5. I have no idea how you actually feel; I can only know what you tell me. As such, there is no true “normal,” and it is important to remain nonjudgmental toward one another.

Even when we think we are in the same place quantitatively, the qualitative experience may be entirely different. My Defcon 1 could be your Defcon 5. While empathy is critical to our efforts to reduce stigma, it is dangerous and unfair to take it a step further by assuming we know what another person is experiencing.

And we absolutely must establish a standard of tolerance for people who are different because of mental illness or a particular personality quirk. Too many people, both neurodiverse and neurotypical (“normal”), make a habit of referring to people as “normal.” There’s no such thing as a normal person. We all have our quirks and eccentricities. “Normal” is a statistical term describing the average rating of a particular behavior or characteristic. It should never be used to describe a human being.

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5. The treatment can seem worse than the disease, but it’s necessary. It’s terrifying to think that the life-saving medications we take may also be killing us. The side effects of these medications are horrible: you may be dizzy all the time. Sometimes people’s skin breaks out easily, and they lose hair in clumps. Often, psych meds preclude alcohol consumption, and you shouldn’t get pregnant on some of them. There are other side effects, too, such as exciting gastrointestinal problems.

Nevertheless, not taking the medicine leads to an increased risk of death from suicide or heightened morbidity. Psych meds often come with an increased risk for cardiovascular problems, like heart attacks. You can decrease your cardiovascular risk factors (reaching a healthy body weight, keeping cholesterol in check, avoiding diabetes, etc.) in hopes of reducing your risk. For some mental illnesses, victims will die at a much younger age than would their counterparts without mental illness, thanks to the medications. Still, you might die within a week from suicide if you do not take the medications. Sometimes living with mental illness is about learning to live with the lesser of two (or several) evils.

–Jaimie Hunter, PhD, MPH


An Open Letter to Parents of Children with a Mental Health Diagnosis

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I am not a parent.

I can’t identify with you on that level. I don’t know what it’s like to receive word that your child (even adult child) has been diagnosed with a mental health condition. I can only imagine what the shock, anger, anxiety, and fear associated with this diagnosis feel like for you. You want the best for your child.

Upon receiving a mental health diagnosis, some people feel an enormous sense of relief that they finally know what is wrong. This feeling may be juxtaposed joltingly with the realization that you’ll be fighting this thing for the rest of your natural life. And people often have so many questions: Why do I have this disease? What would treatment be like? What would people think of me?

But the biggest question of all, far too frequently, is, “You’re kidding, right?”

(It’s always okay–encouraged, even–to get a second opinion.)

So, I wrote this article to provide some insight into what your child may be experiencing, with the hope that these insights can provide some guidance, or at least some comfort.

It’s no one’s fault.

Your child probably thinks he or she did something wrong to “deserve” this condition. Or, perhaps they blame you for problems they perceive arose from childhood. Both are bogus; mental illness is no one’s fault.

OK, sure, some mental illnesses have a high heritability quotient (they get passed on readily through genes). But that doesn’t make it your fault.

Assuaging the sense of guilt by helping your child learn that he or she is not to blame for this condition is really important for recovery.

Mental illness belongs to the family, not just the child.

While your child is the one who carries the mental health diagnosis, it will take the entire household to help him or her recover from or live with the condition. Your child needs your support. She needs you to take your frustration with her down a notch. He needs you to acknowledge that he’s still there and still himself, regardless of what he is going through.

Support means actively seeking to understand what your child feels and how you can best help meet some of their needs. It means asking questions and being open to hearing the answers.

Support also means being open to your child’s questions and helping her find answers if you don’t already have them. You should be your child’s most staunch advocate and biggest cheerleader. He CAN survive this. Sometimes you just have to take it one day at a time.

Don’t blame the illness for things that are under your child’s control.

Support does NOT mean allowing your child to be irresponsible—i.e., using the illness as an excuse for not going to school or work when he is not experiencing symptoms (and should have no problem going). Responsibility is critical for people living with mental illness, as people might already assume that they are lazy or unmotivated.

It really bothers me when people use mental illness as a crutch for their actions. Most of the time, those with mental illness have the dominion over their behavior. They can still make choices and roll with the outcomes. Sometimes, blaming mental illness is legitimate—for example, my roommate once was so ill that she couldn’t get out of bed to go to a medical school interview. She lived and breathed medical school, so that was a huge setback. But when your child has the ability but not the desire to be responsible, it is inappropriate to blame the mental illness.

On the other hand, it can be incredibly difficult to discern whether your child is having genuine symptoms. You know your child better than I do. I would advise being gentle and nonjudgmental in assessing “where he’s at,” all the while encouraging him to do what he is able.

Most people will give your child some leeway upon learning of his condition; this goodwill can easily be eroded by abusing the privilege. My advice? Use what you need. Use it liberally; that’s why it’s there. But when you are better, stand on your own again.

What can I do?

I know parents often feel helpless to relieve their child’s symptoms and deliver peace. Rest assured: you are your child’s greatest ally in this lifelong battle. Here are some important actions you can take to be the best partner for your child.

  1. Learn everything you can about the condition. 
  2. Don’t be afraid to ask questions of your child. Research shows asking questions does not drive someone into self-harmful behaviors.
  3. If your child is under 18 and/or your adult child gives you permission, ask questions of his or her doctor.
  4. Learn patience. Whether you have to count to 10 or learn some yoga moves, you’re the one who is going to have to remain calm and centered when your child cannot.
  5. Learn the warning signs of crisis. These may include things like withdrawal, illicit drug use, and talk of suicide.
  6. In partnership with your child, identify a key word or phrase for use exclusively when your child is in crisis and needs immediate help. Alternatively, perhaps a rating system would work better for you. (For example, with bipolar disorder, you might use 0 to 10, where 0 is the lowest/most depressed you can imagine, 5 is average/having no symptoms, and 10 is the highest/most manic you can imagine.)
  7. Encourage your adult child to obtain care and stick with it. It can take months to get an appointment, so start early and make sure your child doesn’t miss the appointment. Ultimately, the responsibility for keeping appointments is your adult child’s, not yours, but your support helps.
  8. Don’t treat your child like he is somehow deficient. Eliminate words like “crazy,” “nuts,” and “retarded” from the household language.
  9. Remember there will be good days and bad days, ups and downs. Don’t let the bad days be devastating, and don’t let the good days give you a false sense of security. 
  10. Assure your child that you still love them and will always do so, no matter what. Never let go.

Jaimie Hunter, PhD, MPH