Will we ever ‘cure’ Mental Illness?

Jonathan Cooke

People do not wake up one day realising that they have a mental illness; that their view of the world is clouded by a poorly defined alteration of their brain chemistry. It can take days, months or even years before a person comes to terms with that what they are experiencing is not ‘normal’. Even at that time, they may not immediately seek medical advice, to some seeking such advice is an admission of weakness; an inability to deal with what everyone else is dealing with.

That is not to say that people cannot recover from mental illness. The flood in the pharmaceutical industry of different pills and tablets that are prescribed to people to help their conditions would lend credibility to the theory that these conditions can be coped with. However medication doesn’t work for some, and for others it can make the situation even worse than before. Pills are not a one-stop solution, they do not suddenly fix your brain chemistry overnight. Even SSRIs (selective serotonin uptake inhibitors) only help to limit the amount of serotonin your body absorbs, it doesn’t alter the amount your body produces.

The negative reactions to these tablets betrays a much more important point: the debate over the cause of mental illness is still hotly debated. There is undeniably a natural-genetic component to their disorder. However does this make the development of mental illness inevitable? Or does it merely increase the chance of mental illness arising in a person and its environment that provides the trigger?

In addition, there are other ‘cures’ that over the years have been used to try and treat ‘mental illness’ over the years. It was not that long ago that electro-convulsive therapy (ECT) was prescribed as the most efficient therapy when trying to treat anything that was considered a mental illness. Whilst its efficiency at treating some conditions has been noted in the literature, very few therapies have generated such a heated debate, perhaps due to how the treatment is perceived. After all, no-one is likely to warmly receive the idea of having an electric current shot through their brain.

The evolving definition of what and what isn’t a mental illness should give pause to the idea of a cure. It wasn’t until 1987 that homosexuality was removed from textbooks which listed psychiatric disorders and being transgender is soon to be removed as well, replaced with the more accurate but no less weighted term ‘gender dysphoria’. Societies needing a cure for conditions which it doesn’t understand is perhaps its greatest failing. If we don’t understand or accept something, it is that something which is regarded as being in the wrong and having to change rather than our attitude towards it. It is therefore the reaction that these marginalized minorities receive that is probably the root cause of their higher than average rates of depression and suicide, rather than who they are themselves.

What use is a cure if it does not cure the stigma that comes with a mental illness. A book by Nunally J (1981) looked at the semantics that people typically associate with people that have a mental illness. Respondents, when describing a mentally ill man, were most likely to use semantics like “dangerous, dirty, unpredictable and worthless”.

That may have been several decades ago and times have changed; there are more public advocates of mental health awareness and the advent of the internet has allowed people to find others experiencing similar symptoms, helping them to forge support networks. However, to those unaware of those advocates or support networks, what are they greeted with? Most shows on ‘mainstream’ media that try to portray mental illness inevitably demonize characters on TV shows with mental health illnesses as either violent or unlikeable.

Full disclosure, I have not watched either 13 Reasons Why or To the bone, arguably the two biggest attempts to portray characters with mental illnesses recently. However, both were widely criticized, by the depression and anorexic communities respectively, for their inadequate portrayal of the issues that they raised. It would be naïve to suggest that a people are not heavily influenced by what they watch on television. In a paper in 1978, it was shown that people who watch a lot of crime-related television and police dramas are more likely to vastly overestimate their chances of being a victim of crime, as well as overestimate how many police officers and judges there are. (Gerloner et al. 1978)

These criticisms are not based on wild speculation either; Granello & Pauley (2000) demonstrated that portrayals of mentally ill characters on TV and film are typically made out to be “violent and unpredictable”. This is not just negative for those who wish to identify with a character on TV that represents them, but also for the general public. With the ever emerging evidence that genetics play a part in the development of mental illness, such demonization of the mentally ill allow the rest of the public to separate the mentally ill into a ‘other’ group of people, different and unique to them.

This separation of the population into ‘normal’ and ‘other’ leads to a disassociation and an inability to understand that mental illness is a sliding scale of grey with no two conditions exactly alike. My depression and anxiety do affect me, but they affect others differently to me. There are similarities, but also differences. It is this nuance that is missing in our discourse when we discuss mental illness in the media and with the public.

Some people get better without a recognized ‘cure’. They open up, discuss their problems and find they are not quite as alone as they thought they were. There is power in the ability to talk with your fellows about how you are feeling. But how can they hope to ever feel they are better if society refuses to acknowledge that someone can recover from mental illness without the need for a specially crafted ‘happy pill’ that solves all their problems? Curing mental illness is a lofty and admirable goal; but my training is not in that area and so it would be unwarranted of me to posit that such a cure is achievable.

Cures begin by having an accurate picture of what we are trying to cure. We could not cure the plague by ‘bleeding’ the badness away. To help those with mental illness, we have to understand that many of the common mental illnesses, depression/anxiety, are exacerbated by the society in which we live. Therefore, should not the conversation be about curing society and not those that live within it?

#JonathanCooke #MentalHealth