I was at a Twelve Step meeting recently and heard several references to the “mentally ill.” One was a woman who said she had a mentally ill sister and that was one reason she didn’t like to have friends over as a kid. Another was a man who said on his block growing up there was alcoholism, mental illness and incest (just like that, in that order) in the families of his friends, so he didn’t want them at his house but didn’t want to go to their houses either. The last was a woman struggling with having grown up in an alcoholic home and having an alcoholic boyfriend and she listed taking anti-depressant meds and going to therapy as things she was doing to try to improve her situation. For her, it seemed, nothing was helping her feel good enough to get out of bed or do the things she cared about, including the meds and therapy, but she was doing the things society had prescribed for “people like her.” Psychiatric drugs and therapy are protocol even though they haven’t proven to have better results than, say, cooking and eating a meal with friends, playing tennis, or singing in a choir. Well, I doubt they’ve ever been statistically compared.
When people call someone in their family “mentally ill,” what does it mean? The term mental illness has gotten out of control vague. There is no way to prove someone does or doesn’t have a mental illness in the way it is referred to, so why don’t we hear people say, “There’s someone in my family who’s extremely challenging for me (and others perhaps)”? Why don’t we hear descriptions of the behavior, how people feel in response to it, and what concerns it brings up in an honest way where the speaker owns their own experience?
Using the term mental illness might seem like a quick and easy way to reach common ground with other people, for some, but it doesn’t give accurate detail, so people don’t know what is being referred to. Since things like nail biting, leg shaking and restlessness are now becoming mental illnesses, it’s more important than ever to be specific in speech or writing about what we are referring to. Not long ago, homosexuality was a mental illness and currently premenstrual cramps and moodiness, gender non-conformity, and children or teens not obeying authority are all mental illnesses. When someone describes a mentally ill sister, all we know about her is that her behavior has been stigmatized. She is probably taking the label for the family (and society).
The other reason it’s problematic to use the term mental illness is that most people by now have been labeled with one (or more). So those listening or reading are likely to feel alienated by the term. People are questioning what it means more and more and it’s starting to sound old-fashioned to those with more multicultural awareness and understanding of mental diversity. People are starting to see the political and socioeconomic factors that go into who gets that label, and who doesn’t. In order to get insurance coverage for therapy, one needs a diagnosis of a mental illness. Some may say, “But I’m talking about MAJOR mental illness. My sister is schizophrenic/psychotic.” For one thing, “anti-psychotic” drugs have been some of the top selling of ANY pharmaceuticals in this country, so it’s important not to underestimate how many people have MAJOR mental illness labels. Most importantly, though, even in cases of extreme diagnoses, and extreme behaviors and situations, people will not know what you mean unless you describe it. Using a label is stigmatizing, so it is more powerful and clear to say what is actually going on; then others can understand, connect and empathize with a unique situation.
When I hear labels used, I have to talk myself down, remind myself that not everyone has been studying mental diversity for the past 15 years and not everyone investigates the language they use. This talking myself down takes time and during that time there is a disconnect between me and the one using a label. It’s similar to if you are listening to a white person make racist comments or use the word “nigger” or a heterosexual use the word “faggot” or a man “bitch.”
A close family member has struggled with substance addictions and extreme mood swings for as long as I can remember. Another family member once said to me, “I think your (family member) is bipolar.” I was in my mid-20’s and it had never occurred to me to label this family member. This could be because she was high on the social totem pole: she owned a nice house, made plenty of money, was very active in life and had an extroverted, yang personality. Perhaps I had never thought to label her since she had labeled me and I was the one in the family to be stigmatized for awhile. The term bipolar would have served to stigmatize her but not clarify, heal or deeply explain any of her behavior, its roots or how it affected me (or others). Since I experienced and still experience a lot of agony, pain and fear (as well as joy, love, nurturance and comfort) in response to her behavior, labeling her might feel like retaliation, or it might give me a chance to put the stigmatizing lens on her after she’d (unfairly I’d say) put it on me. But it wouldn’t be honest. She could get that diagnosis as readily as most people who’ve gotten it, but it’s a low blow. It’s dehumanizing and lacking love and empathy to resort to a label.
I recently asked a friend who hears voices (and has gone through quite a bit in the mental health system, gotten diagnoses and taken psychiatric drugs in the past) if her parents label her. She replied, “They love me too much to label me.” Enough said.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.