“Come on Max, if you’d just go for a walk you’d feel heaps better.”
Behind this comment is a loving parent: what makes the comment so alarming is that they show how serious mental health issues continue to be dangerously misunderstood. When I was diagnosed with Bipolar Disorder Type II, I sat my parents down to explain how the condition had affected me in the past and meant for the future. They retorted, “Oh, we thought you were just being a difficult little shit.”
These comments highlight a critical fault in the way we don’t understand the limits in the agency people with mental illnesses have over their moods and behaviours. To an extent, people are right to think that the same things that help them when they’re feeling a bit sad or stressed, for example, might help someone with a mood disorder that throws them into the extreme depths of depression and anxiety. However, what characterises a mood disorder is precisely that they are severe enough to cause “difficult”, undesired behaviours and that they don’t respond well to interventions that might help less severe moods.
In recent years, much has been done to improve understanding of depression and anxiety. Yet, in their more extreme forms, these (and other mood disorders) are still shamefully misunderstood.
Perhaps this is an issue with the language in ‘mental illness’ as a term: it has more in common with a long-term disease such as diabetes – needing long-term treatment and restricting the lives of sufferers – than with an illness such as the flu, which has a negative impact but goes away after a relatively short period of care. Mood disorders have resulted in me feeling, at various points, depressed – unable to move, tired, with aches and pains, lacking in appetite and motivation, confused, and suicidal. Or at other points manic – with racing and incoherent thoughts, inflated self-esteem, excessively talkative and distractible, sexually driven, spending excessive amounts, and sometimes experiencing delusions and hallucinations. What’s more, there’s also a significant likelihood that people with bipolar disorder develop an anxiety disorder (about three quarters do), or an addiction problem (like about half of people with bipolar), and the rate of suicide is fifteen times higher than in the general population. Only about 20% of people with bipolar disorder are considered “high-functioning”, with the other four in five struggling to stay employed long-term or keep in touch with their social peers.
It’s a heavy set of statistics, one that illustrates quite how heavily the odds are stacked against people with bipolar disorder – and mood disorders more widely – being able to live balanced lives. Above all, diagnoses of mood disorders are lifelong: this means that, according to psychologists, they can be managed, but never cured, and that people experiencing them will have to stay alert their whole lives or risk spiralling into the grip of a severe mood episode.
Considering the agency of people with mental illnesses and the time frames of their conditions, it seems that referring to disease or disability is more adequate: appropriately, Oxford University provides support for people with mental illness through the Disability Advisory Service. However, the connotations of mental disease (associated with neurological degeneracy) or of mental disability (typically referring to intellectual disability such as Down syndrome) mean that the language of mental illness will have to suffice for this article. I hope that the meaning of illness can be questioned, and understood through a wider, less discriminatory lens.
Sadly, the unfortunate effects of a condition that one cannot opt out of are frequently compounded by issues arising from people’s perception of such conditions. Far too often, people carry a misconception that those with mental illness are in some way failing to do enough to control it. This wrongly and damagingly assumes agency in people with mental illness where there is little to none. It’s easy to see how it comes about – perhaps the neuro-typical observer witnesses behaviours that exceed their own reaction (such as a screaming or sobbing fit) in the sufferer. “I might have done that,” they think, “but I pulled myself together so that I wouldn’t. Why can’t they do the same?”
We’re not all equally good at pulling ourselves together, whether mentally ill or not. However, to look at the behaviour of someone with a mood disorder and think it to result from incompetence in dealing with tough situations is misguided and can lead to counter-productive attitudes and interventions. The options for someone with a mental illness in such a situation might range from sobbing (at best), to darker, suicidal moods. The behaviour they exhibit having strived their hardest to resist their mental illness’ negative pull might match up with the behaviour a neurotypical person could foresee themselves having if they ‘allowed’ themselves to feel worse.
If the standard of agency that neuro-typical people have is used to judge those with mental illness, we end up with a very skewed perception of how well someone with a disorder is managing their mood. They might have been fighting their hardest to reach what, to others, looks like a low point. When we assume in such ways that the behaviours of those with a mental illness are in some sense an indulgence or a failure on their part, we drastically underestimate the great forces at work on them and the great strength required to face up to such forces.
What’s more, this flawed thinking actually undermines how we think of the actual capabilities of someone with a mental illness, disempowering them in the process. Confusing the limitation in choices available to them with the variety of ways they can react to these, those with mental health problems are often thought of as reckless, unhinged, or lazy.
Surely it only takes looking at the great lengths they go to in order to live less affected lives to dispel such an impression: consider the time needed to regularly go to appointments with doctors, psychiatrists, therapists and support groups; consider, too, the alarming side effects that they put up with because of medications or medical interventions (a far from exhaustive list could include such things as nausea, memory loss, skin problems like psoriasis, hyper- or insomnia, potential kidney failure and – with a dark irony – suicidal thoughts). Consider quite how terrifying treatments like electroshock therapy and deep brain stimulation are, both involving having electrical shocks administered to the brain, the organ that constitutes your identity as a person. If those with mental health issues are subjecting themselves to such things in the name of being healthier, the toll that not intervening takes on them surely is remarkable, and their strength, assiduity and bravery in trying to manage their condition is commendable.
Of course, not everyone who experiences a mental health problem will seek the sorts of treatments outlined here, and many are right not to do so and to manage their condition in another way. There is no best solution to the problem of mental health: different treatments are effective in varying degrees and they are likely to affect each of us differently. Some of us will struggle with therapy, others will find it really helps them understand and address issues. Some will do better without medication, others will find it essential in allowing them to be in control of their lives.
However, the obvious stakes at play in the treatments above demonstrate the severity of people’s conditions regardless of the treatment chosen and the strength of character so many of them have in facing up to them. The pursuit of mental health is anything but reckless or lazy. The sooner this can be acknowledged, the sooner we can give those who experience it credit for their defiance of the complex neural mechanisms which attempt to sabotage their lives in every way.
Rather than a “pull yourself together” comment delivered at a time of crisis, praise for the steps they are already taking and offers of help where useful would go a long way to help the situation. This will help them receive more accurate feedback as to their character so as to construct a self-image that is less negative and less skewed. Given the unfortunate effect that mental illness has on self-esteem, this may well be a good way to empower those who experience it in fighting the unfairly negative feedback their brains are constantly providing them with. If you know someone with a serious mental illness, consider quite how many victories they have had: as morbid as it sounds, if they are still alive then they’ve already got one thing to be proud of. If they are managing to keep in touch, that’s another. Feeding themselves daily is too.
Though I have, until this point, made much of the seriousness of mental illnesses, it should also be stressed that increasing awareness of their severity shouldn’t come at the cost of downplaying mental suffering on the less severe end of the spectrum. Demanding more realistic attitudes and better treatments for those with chronic mental issues doesn’t mean abandoning those whose distress is less permanent. Unfortunately, there seems to be a line drawn in the sand which changes as often as the tide comes in and which separates “significant” conditions from fleeting discomfort, and, more problematically, considers the latter kind as something not worthy of treatment or help.
Any degree of undue suffering is undesirable, and worthy of being addressed. I continue to be shocked by the number of people I know that suffer from mental illness to a large extent but, for a long time, don’t consider themselves worthy of treatment. Part of this is the illness itself: if your self-esteem is low, then your ability to feel you’re deserving of services that people with serious difficulties use is greatly diminished. It’s easy for people with mental illness to admonish themselves for using others’ time and money to get better when there must be someone suffering more than them (this, of course, is wrong on many levels). However, the way mental illness is understood by society at large also feeds into these damaging perceptions, and can troublingly reinforce the distortions they might believe because of low self-esteem.
Oxford University’s counselling system does seem to approach this issue relatively successfully. Anyone going to the service is set up with two-to-three sessions to begin with. For many, a few hours of frankly reviewing the issues they face and the factors at play will be a good way of taking account of how they are doing and how they should address issues going forward. For some, though, this won’t prove sufficient, and they are given the option to have more sessions if they wish.
Options like this are crucial for bridging the gap between neurotypical and mentally ill populations, and for intervening before suffering escalates to a chronic level. The counselling service is unfortunately under-appreciated for its ability to help out in this realm, with many thinking of it as being “reserved” for those with serious conditions. In fact, almost the opposite is true: the counselling service is probably best placed to help precisely those who are going through a rough patch, before their mental health deteriorates to the point of needing psychiatric intervention.
Oxford has the second highest budget of any British university for mental health services, so, though the counselling service can be quite busy, they do have the resources to deal with students wanting help. Furthermore, the Disability Advisory Service can help make arrangements from exam scheduling to housing for those with more chronic forms of mental illness, and peer supporters and Nightline are on hand to listen to your issues and struggles. Raising awareness of both the University’s many services and others such as the Samaritans, Mind, and Warneford Mood Clinic is a worthwhile pursuit, as it will help people with any degree of mental suffering understand that they need not face their struggles alone, as well as informing their friends on the best ways to support them.
Above all, the guilt and stigma around both needing help and seeking help must be fought. This takes many forms, and means bringing an end to “pull yourself together!” comments and the mentalities behind them, not shying away from discussions about mental health, and, where possible, “coming out” about your own mental struggles. When it’s safe to do so, starting conversations about your experience of mental illness will help alleviate the shame of being affected by it, much of which simply results from such topics being taboo.
Mental illness permeates humanity. Not only do you personally know several people who are affected, you also constantly engage in the creations of people with mental illness: you have read some Edgar Allen Poe or perhaps some Virginia Woolf. You have heard the music of Tchaikovsky or Joy Division’s Ian Curtis. You have seen the art of Michelangelo or Van Gogh. You have watched the performances of Carrie Fisher or Catherine Zeta Jones. You are reading this article.
Mental illness is a major part of normal society, and it’s time it be treated as such. Mental health is just another factor that affects our abilities to go about our lives day-by-day, and as such is nothing to be ashamed of. I feel lucky that, when seeing friends, it’s become fairly normal to ask each other how our mental health is, much like asking if someone slept well or if their ankle is recovering after a sprain.
This acknowledges that mental health is like any other form of health: just as consulting a friend on a toothache might lead to them giving you valuable advice to go to a doctor if it seems severe from their perspective, asking about each other’s mental health means you’re more likely to spot issues before they get too severe. We can provide each other with somewhat educated help rather than just wondering why someone looks glum and not knowing what to do. Not only does opening up like this lead to deeper, more meaningful friendships, it also chips away just a little at the stigma around mental illness in encouraging those in your entourage to see it as an acceptable thing to be affected by, struggle with, and talk about. We’ll start to accept the important basic facts about mental illness: it affects millions of people in the UK to differing degrees, it permeates your social groups, it often can’t be cured, but it can be managed, and those affected by it can live fulfilled lives. Those fulfilled lives start with this acceptance and the wider the acceptance, the better for us all.