Saturday, March 7, 2020

Mental Health Diversity is Okay: Let's Embrace It

The way we talk about mental health and mental illness is important. We need to aim to avoid stigmatizing language. We need to try to ensure that the way we portray mental illness is helpful to those who may be suffering. There are practical concerns as well. Because physical illnesses are often perceived as being treated more compassionately, there's often a feeling that we need to show the ways in which mental health is "no different than" physical health.

But that doesn't mean we all need to see it the same way all the time. We have to be careful not to stifle open dialogue and diversity for the sake of the one right answer that we feel serves us and whatever practical imperative we are trying to advance.

Is mental illness exactly like physical illness or are there important differences? Is the concept of illness even helpful for all of us? Are physical illnesses even so well-understood that we can readily  use the comparison? Is the medical approach de-stigmatizing and healing, or unhelpfully reductionistic?

For those of us whose mental health conditions were caused by trauma, is it better to see what we suffer from as an injury rather than an illness? Or is the idea of being "damaged" in some way (via injury or illness) unhelpful when we were merely responding normally and naturally (maybe even heroically) to the things that have happened to us?

And there are implications for treatment options. Does medical science have all the answers? Might some of us favor medication options while others reject them and opt for therapy or other methods of healing (spiritual, lifestyle-based, improving social conditions, fighting oppression/violence, etc.), some of which may be frowned upon by the medical establishment, resulting in us being lumped in with and mocked as much as Gwyneth Paltrow for daring to think differently and questioning medical orthodoxy? (Note: I'm not a Paltrow fan--I know almost nothing about Goop and I totally get there are definite problems with celebrity-promoted-wellness-options that need to be pointed out and corrected, but when the response to it descends into mocking those who don't automatically submit to the correctness of doctors saying "Do as I say. I have the answers. I'm a doctor," I grow deeply uncomfortable. I value medical science. It's incredibly important to learn what it has to teach us. But it absolutely doesn't have all the answers and I find a lack of humility and suitable caveats in medicine even more concerning than a lack of caveats and humility from some Hollywood mega-star who obviously doesn't have an MD or the position of authourity it entails).

The questions are endless. For my part, I have definite strongly-held views about many of these questions, some of which would put me out of favour with those leading the charge of certain "mental health awareness" campaigns.
  • The idea of illness is not generally helpful for me, and in some ways has been profoundly damaging. I do meet the criteria for mental illness, and I accept this, but the concept of it doesn't sit easily with me in many ways and I would welcome the opportunity to explore alternate ways of conceiving of my suffering and possible paths to healing. It isn't the stigma of it (although, sadly, there continues to be stigma)--it's just not a fit and doesn't do justice to the nature of what I have suffered and the ways in which I've survived it. In my view, people who have been affected by trauma to the point of developing a trauma-related "mental illness" are not necessarily sick or weak (though there shouldn't be any shame in either of those labels--I just don't feel they fit me). My most helpful way of viewing myself is to see that (1) I'm incredibly strong but (2) the ways in which I've had to be strong have depleted me in many ways and are often not well-matched to the society and conditions in which I have to live, which has resulted in (3) me feeling perfectly normal suffering in response to both the original experiences and the poor way in which it's recognized/handled by the people and social structures around me. So maybe it's the world around me that's sick when it comes to trauma-related suffering, not me. Yet it's a world in which I have to live, so the label of "mental illness" will have to do for now since it's the only way my suffering can currently be meaningfully acknowledged. I've made my peace with it and see no shame in it (I'm proud to stand with those who are mentally ill, whether it's from trauma or some other cause, and will defend others in characterizing their experience in whatever way most does justice to it);
  • I don't think mental illness and physical illness are "the same," at least not always, although I'm confident there is plenty of connection between them, some of which we understand and some of which we don't, but that doesn't mean I don't think they should be cared about the same way. I think we can explore similarities and differences without reducing one to the other. I think we can use metaphors and analogies without getting overly attached to them. I think we can learn more about the mind by comparing it to the body and vice versa, as well as exploring the ways in which they may be inextricably linked.
But those are just my views based on my experience. Maybe these things exist on a continuum. I've made the point before in other contexts: the mind is a very complex diverse thing (or non-thing, or whatever). Mental health conditions are incredibly diverse, and can affect us in very different ways. And the ways in which we are affected may vary even further depending on our history, our degree of privilege, our connection or lack thereof to others, our physical health, the conditions in which we have to live/work, etc.

Maybe you have an illness and I have an injury or something else altogether. Maybe something can be partly understood as an illness  but also have so many other dimensions that need to be addressed that don't readily fit that framework. Maybe for some of us, a focus on one dimension is enough, while others need to be treated more holistically or focus on some other aspect(s) of the way in which their condition affects them.  Maybe your condition is readily treated by medication, while that's not the right option for others (including me) for a variety of reasons. Maybe some people are really helped by therapy while others would rather take medication. Maybe the usual medical treatment options won't do anything for those who continue to be ostracized, oppressed, and harmed by the conditions in which they are forced to live/work. Maybe some mental health conditions are very much like physical illness or injury and some are less well-suited to that comparison....

Maybe we can never know for sure, so we all just need to do the best we can to inform ourselves about the known pros and cons of various options and approaches, reflect on what's important for us, and proceed in a way that feels safe and right to us. Maybe even how we conceive of physical health isn't always perfectly straightforward so the attempt to reduce mental health to physical health blunts our understanding of both in a way that fails to adequately capture their mystery, diversity and complexity. Or maybe there is indeed a beautifully simple"correct" answer out there just waiting to be found, but we'll never get there if we don't allow for real dialogue and diversity: because the "truth" can't be something that erases and ignores the ways in which these things may be experienced differently for many of us.

My view: we need to learn to live with some uncertainty and curiosity as we explore these important issues. We need to talk to and listen to each other, especially those who are differently situated and often silenced. Medical science doesn't automatically have the answer to the mind/body problem, or what it means to have a fulfilling life, although it can certainly contribute to both of those questions. Nor is it free of biases that have long excluded the perspectives and realities of those who have suffered the most.

Until we have all the answers my view is that we need to focus instead on the deeper questions like "Why should we care?" "Why should we help?" "Why should we allocate resources to reduce the suffering of others, whether from mental or physical causes?" Do we really care about mental health only if it's comparable to physical health? Or does the care come first (for those of us who "get it") and then we try to shape our discourse to artificially fit the framework that we think will most motivate others to care?

Why not have a discourse that's transformative rather than reductive? We care not because someone is "sick" as opposed to "weak," or "ill" as opposed to "injured," but because we don't think people should have to suffer needlessly if we can help it. Why don't we focus on that and talk about what it means for us to care in this way, and go from there? That way we won't have to leave anyone out just because they don't "fit" the way we've framed their experience. There will still be difficulty and we won't get around having to characterize these things in some way, but we can at least welcome all voices to the discussion and acknowledge the absence of easy answers rather than silence those whose perspectives differ from the one we've adopted.

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:  



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