Sunday, July 8, 2007

But it’s not all in my head

How many ways do you know to say that someone is mentally ill? Crazy. Whacko. Nuts. Nut job. Loony. Bonkers. Batty. Cracked. Cuckoo. Demented. Deranged. Insane. Mental. Unbalanced. Mad. Psycho. Unhinged. To name a few.

How many ways do you say that someone has diabetes? How about to say that someone has epilepsy? Lupus? Arthritis? Cerebral palsy? Psoriasis? Asthma?

I detest the term mental illness. It is filled not only with stigma, but with the implication that no matter what a person’s symptoms, the MI diagnosis immediately negates any credibility of the person having an actual illness. Why have we semantically and culturally separated illness into two classes, one containing conditions of so-called legitimate health and the other being a collection of maladies considered to be shameful, willful, and self-induced?

Most mental illness is very much
biological in nature; a clear genetic link also exists in many cases. Yet, if you say that diabetes runs in your family, you are likely to be met with a response that embodies sympathy and concern. Try the same approach with schizophrenia or bipolar disorder, and the recipient of that news is more likely to be horrified than anything else. It is a type of cultural cooties best kept to ourselves.

If you tell someone you are very sick with a neurological disorder, as I often do, you will probably have the opportunity to answer plenty of questions about brain function and malfunction, medications, lifestyle implications, and more. If you change it up and say you are very ill with a brain malfunction and then continue on and say you have bipolar disorder, get ready for the eye roll and shrug accompanied by, “Oh, is that all? I thought you were actually sick.”

Comedian Richard Jeni died recently. It was no secret that he committed suicide as his family was very frank about releasing this fact to the public. His parents wanted people to know that their son had suffered terribly and that they were not ashamed of his death. Instead, they saw it as the tragic result of treatment that didn’t work—at least, not fast enough. This week, for whatever reason, the
coroner’s report came out. Jeni blew half his head off with a gun. The cause of death seemed pretty obvious. Still, the report was made public, and on CNN’s Website, the headline read simply, “Jeni had severe mental illness.” As if that just explains everything. That’s all you need to know. He was mentally ill, so he killed himself.

What if they had said, “Jeni suffered from chronic illness and could no longer tolerate the symptoms and depression it caused.” No such semantic finesse happened anywhere in the press in this case. There is no drama in illness, but the underlying implications of mental illness are fraught with sordidness. We mentally ill are sordid people.

We are second-class citizens in the health world. Insurance companies don’t feel they need to treat us (lack of mental health care parity is just an extra slap in the face). Employers have no impetus to cut us any slack or make accommodation. Culturally, it is perfectly OK to mock us. Mental illness is the stuff of sitcoms and stand-up routines, shocking news reports, and Law and Order-type dramas.

Why are those of us who have “mental” illness held to a different level of behavioral accountability than someone who, for example, suffers from an insulin reaction that causes erratic behavior? A couple of weeks ago, a man was kicked off of an Amtrak train in a rural area. He was disoriented and talking to himself. The conductors concluded he must be drunk or on drugs, and they removed him from the train. The outcry was swift when the story hit the press. “That poor man! He is diabetic! How could you?”

I wonder if the compassionate reaction would have been the same had the man had bipolar disorder or schizophrenia as his diagnosis instead.

I am not crazy, whacko, nuts, a nut job, loony, bonkers, batty, cracked, cuckoo, demented, deranged, insane, mental, unbalanced, mad, psycho, or unhinged. I am ill and I did nothing to cause my condition.

I can’t control the short circuits and chemical mix-ups in my brain, desperately as I wish I could. I didn’t ask to have BP, and I’ve certainly learned firsthand how awful and insidious an illness it is. It is doubly cruel in that it affects me with both physical limitations and cognitive/behavioral ones, as well.

I propose that we eradicate the term “mental illness” from all languages. I have an illness, plain and simple. It requires medication and lifestyle changes if it is to be managed. It is not a defect of thinking; it is a malfunction of the brain.

I vote for Neurobehavioral Illness.


Miranda said...


One more vote for the term 'neurobehavioral illness.' Actually, what about 'neurological illness,'since many of the medications used to treat neurobehavioral illnesses are also used to treat epilepsy.


May Voirrey said...

You're right--most MI, the biologically based category--is, in fact, neurological illness. For the most part, many of these illnesses "borrow" drugs that were developed to treat other conditions. A brain is a brain is a brain. Or so it should be.