I don’t know how else to title this post, so I offer you this, a reflection on people who advocate for mental health issues, especially their own, on social media or on Twitter by using hashtags. You may have seen the post: I have x, I struggle with y, please understand z, and then a hashtag, such as #mentalhealthstigma, mentalhealthawareness, or pick one of your choosing.
Maybe you’ve seen posts along the line of, “I’m so depressed, I can’t go on…don’t worry, I’m not suicidal, if I were I would go to a hospital. But I just need the world to know that I’m sad, that I can’t cope, and this is what it’s like every day for people with depression/anxiety/insert mental illness here, so please [insert suggestion here].”
I know I see them pretty regularly, and as someone who has used mental health services, I can’t help but cringe.
Obligatory disclaimer: I do not desire, nor do I have the power to, tell you what to post on your Facebook or anywhere else. I do not claim to know who is really sick, who is attention-seeking, what conditions people really have, or what their treatment should look like. If you read this post and think of yourself, please keep in mind it’s not directed at anyone specifically.
Now for the actual substance of the post.
I do, occasionally, talk about mental health on social media. Sometimes I mention my own mental health, with a status like, “Just got out of my psych appointment, trying a new medication and I don’t have to pay for it…yes!” I might share an article, a poem, or something scholarly intended for a large audience, such as “Groundbreaking research suggests connection between strep infection in childhood and OCD in adulthood.” Basically, I try to convey the truth, but not the gory truth, about my life. I try to let people know how I am doing and also give them information, or inspiration, that might help people besides me. I try to convey that mental health is a part of my life, but absolutely not the whole of my life.
That concept seems to be lost in a time when mental health is almost trendy. God, I hate saying that, but I’m forced to think maybe it’s true.
Upside? Mental health is much less taboo, much more recognized, and many people who previously would have gone without recognition, treatment, or accommodation are living full lives. Family and friends no longer hide in shame. Information is everywhere and even people without a mental health diagnosis increasingly find mental health advice useful. The DBT concept of mindfulness (also part of Buddhist teaching) is used as run-of-the-mill self-help. You can get a taste of DBT for free with internet access. I credit mental health awareness for this.
That said, everything has drawbacks, and one of them is the medicalization of human experience and emotions. I know from experience that many people don’t want to struggle through difficult things or feel bad emotions. They run either for medication, a self-help cult, to alcohol and partying, or some other salve for what is a normal experience. It deserves full awareness, analysis, feeling, and it deserves a human response that goes beyond coping with it, dulling, or eliminating it. Existential concerns, grief after a death, and other feelings and experiences are normal and don’t need medicalization. It’s a fallacy of our culture that we must always be happy, productive, grateful, and ticking every minute of every day. John Stuart Mill said, “It is better to be a human being dissatisfied than a pig satisfied.” Being a human isn’t always pleasant, but being aware of unpleasant reality is part of what makes me human, and it fosters growth and change, as opposed to stagnation and simply being content to survive.
For a more everyday application, I am dissatisfied with a lot of things in my life, mostly relating to how I think and spend my time. I feel like I am under-performing, that I could do or be so much more. Most of the people around me accept their realities of working, going home, spending time with family, drinking or having a smoke, occasionally having a party and…that’s it. They are certainly happier than I am right now, but maybe being happy isn’t the goal. Maybe my being unhappy is the gateway to change into the person I want to be and to create the life I really want. How many people really embrace that in their lives, though? They say they agree with my sentiments and with the Mill quote, but their actions and lifestyle tell a totally different story and at the end, they remain unfulfilled. Going back to the issue of mental health, how many people say, “It’s okay because I have a disability and this is who I am” and then don’t make progress? Isn’t it better to say, “I have a disability but this is who I could be?” Being unhappy is lousy, but it’s also crucial to challenging the status quo, whether it’s your status quo or a structural one. Psychoanalyzing or medicating or self-soothing it into nothingness makes that kind of radical change impossible.
Can “normal” experiences cross a line into something that needs treatment? Sure. Grief becomes depression and you may need therapy or an anti-depressant to get over the hump. You may go through a crisis that causes such severe panic that you need a trip to the ER and some Xanax. I believe just as strongly in temporary mental sickness as I do in temporary physical sickness. Just as you can have a short-lived flu or cold, you can also have a short-lived depression or panic episode. The issue that I see is when what should be temporarily illnesses become chronic illnesses, not because of the nature of the illness, but the unwillingness of the patient to give up the diagnosis. Hence the infamous label becomes reality.
As much as the former phenomenon distresses me, it does not bother me nearly as much as what I am about to describe to you. People who get diagnosed, or who diagnose themselves, with a certain mental illness and then order their whole personalities, their whole lives, and all their relationships to that diagnosis. And more often than not, they are insufferable and attention-seeking about it.
I am talking about my own friends, people I know well, and whose thoughts and behavior I have some insight into, who talk on Facebook constantly about their struggles. Not struggles that are faced by the mentally ill as a whole. Their struggles. And the struggles are not always directly related to their illness, but the normal human struggles that they contorted beyond recognition to resemble one of their mental health symptoms. Their whole life has become a testament to their snowflake specialness and their personal rendition of a train wreck. Some of these diagnoses aren’t even real. They diagnosed themselves with these illnesses a lot of times. Being shy became an anxiety disorder, and instead of trying, with or without help, to overcome it by ordinary means, they rush to reduce themselves to fit their dysfunction. Being intellectual and being an outsider automatically becomes Asperger’s syndrome, which is a real condition with distinctive symptoms and notable impairment in daily function and abnormalities in childhood development.
Nothing irritates me more than when someone who can barely read or spell butchers the English language in a professional (work or school setting) and they use “dyslexia” as an excuse. Never diagnosed with dyslexia. Never experienced the school failure associated with dyslexia. Never experienced the non-academic challenges of dyslexia. Never had to get accommodations for dyslexia. Dyslexia is simply their convenient excuse for being too lazy to learn to read and write in their own language.
Dyslexia is a word and a diagnosis that means something. It’s not whatever you want it to be, and it’s not whatever you identify with. If you do actually have dyslexia, you seek help for it so you can make actual progress, which most people with real dyslexia do without issue. Not use it as an excuse to be unprofessional or illiterate.
Likewise with OCD. This is the one where I’m really tempted to tell everyone that claims OCD to fuck off. OCD is relatively rare compared to other mental illnesses and it, too, has distinctive symptoms that actually mean something. It’s not a preference. It’s not a personality trait. It’s a disorder than can and does destroy lives.
Here’s the clue: If someone says they “are” OCD or “have a little bit of OCD,” I can almost guarantee you they don’t really have it. OCD can be mild or severe, but it’s a condition that you either have or you don’t. If you don’t require treatment or accommodations for it, it’s not OCD. If you use OCD as your excuse to take control of everyone else’s environment and organize it to your preferences, that’s unacceptable. If you have plans with other people to go on an outing, and you hold everyone else hostage because you need to pack and re-pack your bags, or leave on your own time, or wash your hands a million times…you’re, plain and simple, being a jackass.
Note that I specifically referred to those who use OCD as an excuse. People who acknowledge OCD, who are trying to treat it and who still struggle, will sometimes have their plans interrupted and sometimes do things that are illogical or bothersome to others. Any good friend or family member will understand this. However, part of treatment for OCD includes a family, community, and employment piece. People who are supporting an individual with OCD are explicitly instructed and trained NOT to enable OCD. We are NOT to change our plans to accommodate their rituals. We are NOT to arrange our work space or household to their liking. We are NOT to spend household money when they run out of soap through excessive hand washing. We are to guide them through to the best of our ability and keep living our own lives. And people with OCD are supposed to use CBT/DBT/ERP to challenge their obsessions and compulsions and adapt to normal life. Anyone that just expects people to cater to the OCD as a personality trait is both a) being a jackass and b) probably doesn’t even have OCD to begin with.
Aside from annoying the ever living hell out of me, this mental health trend-setting has real-life destructive consequences. The original mental health movement did not fight for the right of the mentally ill to stay sick and stay stuck in their current state. The whole purpose of mental health awareness is not just for people to gaze at their navels, or show off their social justice credentials. The practical point was to do research, expand resources, and to actually cure, or at least treat, the mentally ill, to make them able to participate in life and to give them legal protections. It doesn’t exist so people can brag about their dysfunction and adorn their profiles. It doesn’t exist to protect the lazy, the unmotivated, or the just plain dysfunctional. If your idea of raising mental health awareness is to publicly kvetch about your screw-ups and put a hashtag next to it…and then refuse actual help to fix it… you’re doing it wrong.
Do you know what mental health awareness was supposed to achieve? It was supposed to educate the world all the ways in which we are normal, healthy, and successful. We highlight the accomplishments of people like Dr. Temple Grandin and John Nash. We talk about the people who go to school and work, who get married, who raise children, who educate, who live and who, with the right assistance, lead full lives. We highlight all the things mental illness isn’t. It’s not laziness, it’s not mental retardation, it’s not psychopathy or sociopathy, and it’s not a death sentence, nor is it a life sentence in solitary confinement. We highlight the ways even those living with their parents, in group homes, and in hospitals can still make progress and integrate. We highlight the hope and the opportunities for the homeless and welfare recipients. We don’t want to draw attention to the fact that we are sick, but that our sickness doesn’t have to destroy lives. For some reason, I don’t see a whole lot of that anymore. I see a lot more people advertising not their achievements, their goals, or their strengths…but their addictions, failed marriages, emotional outbursts, and all the wrong things. We are now fighting to be seen as everything the original mental health movement tried to NOT be seen as, and to fix. It’s perverse.
I know someone who likely does have mental health issues, but I’m unsure if she actually has the conditions she claims she has, or she went doctor shopping. Regardless, she claims to have constant trouble in relationships, on the job, and in her mind. I have tried, on a number of occasions, to give her advice and direct her to resources. Others have as well. There is always an excuse why she can’t. She outright refuses to take a break from relationships, to stop binge drinking, to stop doing whatever it is that she’s doing that holds her back. That’s a pretty good indicator that someone doesn’t actually want to get well. They want the attention and sympathy that comes from being seen as sick. And that’s a shame, and it does an extreme disservice to themselves and to others who want to be seen as something other than sick.
When you claim to have a mental illness or learning disability that you don’t have, you create a false public perception of people who actually have the condition. This affects how we are treated by the public, by healthcare providers, by employers, by schools and legal authorities. It affects our legal protections and our funding.
Not too long ago, people with learning disabilities were “diagnosed” as stupid or lazy and either sent to institutions, publicly humiliated by teachers, or punished by their parents. Knowing that learning disabilities were real and treatable changed this. People pretending to have learning disabilities and NOT changing the so-called symptoms leads to people thinking the disability itself is pretend and that symptoms are just personal failures dressed up. Ever wonder why people are still saying mental illness and learning disabilities are over-diagnosed, and that what kids really need is good old-fashioned discipline? I have your answer, folks. Stop it.
This mental-health-awareness-that-isn’t has caused untold grief to the mentally ill in terms of how they perceive themselves. When a highly successful and socially acceptable person diagnoses themselves with autism because they’re introverts and they “feel different,” people with legitimate autism who are actually disabled start to wonder what’s wrong with them that they can’t be that successful, or that they need accommodations when this other person doesn’t. Family members and teachers have unrealistic expectations and push the autistic person beyond her capabilities and start to think maybe she’s just not trying hard enough. Conversely, they may lose hope for their autistic loved one and give up because the individual still needs extra help and isn’t progressing as fast as, or in the way that, they expected. These are problems that are exacerbated, in large part, because our perception of what disability looks like has been ironically dismembered by the very movement and awareness that was supposed to clarify it.
Obsessive compulsive disorder is yet another, classic, tragic example. OCD has nothing to do with being neat, clean, tidy, organized, or having type A personality traits. Some of the thoughts and behaviors may revolve around those ideas, but that’s not what OCD is, and many forms of OCD look nothing like the picture you often see in the media. When people with OCD and their carers are socialized to think of OCD as compulsive Martha-Stewarting, they fail to recognize the symptoms in themselves when symptoms don’t conform to stereotypes. I know someone who had severe OCD that had existed since childhood. Serious OCD can involve lurid visions and bizarre behavior that resembles schizophrenia. She was diagnosed with schizophrenia because she and those around her were unable to accurately recognize OCD symptoms. When she described lurid visions, disorganized thinking, social impairment, physical self-neglect, bizarre rituals and fixations, people were thinking about delusions, hallucinations and negative symptoms. No one thought OCD, role playing, reassurance seeking, and rituals to lessen obsessive thinking. The end result is that the true illness was missed, the treatment prescribed wasn’t helpful, and she was encouraged to take anti-psychotic medications she didn’t need that have dangerous, permanent side effects that are, flatly, unacceptable for people who aren’t truly psychotic.
Mental health awareness, past and present, has done immeasurable good. Mental health awareness in the present, as leveraged by people with privilege, has done immeasurable harm. At the very least, it’s not benefiting the right people and it all but ignores those who need it most.