“Mental Illness is Not Biological”

I am a big proponent of being careful with language. I don’t think that we should oversimplify something simply because it sounds better or is better marketing. Especially when it comes to mental illness, we are so sloppy with our language as it is that I think we must be careful. I don’t like the idea that we should describe mental illness as “a chemical imbalance” because it deeply oversimplifies things. So I was fairly dismayed when I sat down to read an article in my local paper about the need to talk more about mental illness and it simply repeated over and over “mental illness is not biological” and that we need to spend more time talking about the pharmaceutical industry.

Many people do not pay enough attention to the biological factors of mental illness. Yes, we recognize that genes can cause a predisposition, but more than that, basic biological systems can deeply affect your mental health. A few examples: sleep deprivation can easily cause symptoms of mental illness. It can deeply affect mood, emotional stability, depression, anxiety, and other brain functions. Continual sleep deprivation can spur a mental illness. I’m not sure what one would call that if not a biological factor.

Similarly, food deprivation is deeply correlated with some serious signs of mental illness. In the hunger studies performed at the University of Minnesota, individuals who willingly deprived themselves of food became depressed, anxious, obsessed, violent, withdrawn…they had diagnosable mental illnesses that were not present before the removal of food. Again, this seems to be a strictly biological change that triggered a mental illness.

Factors like these are often heavily discounted when we talk about mental illness, particularly when we’re attempting to recover from mental illness. Not enough time is spent focusing on the fact that if you don’t have a healthy biological basis with adequate sleep, nutrition, and exercise, it is significantly more difficult to have a stable mood and recover from a mental illness.

In addition, we do know that genes play some role in mental illness. We know from twin studies that many mental illnesses are far more likely to occur in an individual if they have close family members with that mental illness. For some mental illnesses, we have identified specific genes that might be linked to that mental illness. The most likely theory about mental illness right now is that we are genetically pre-disposed to an illness (to varying degrees depending upon the person) and social or environmental factors then can trigger that mental illness. And yes, neurotransmitters and brain chemistry are implicated in that mental illness. Yes, there are physical processes that have been disrupted when we are talking about mental illness. No, it’s not just a chemical imbalance, yes it is more complex than that, but of course it’s biological because our brains are a biological organ.

This is intensely frustrating, because it makes it seem as if the social factors that affect our mental health have no bearing on the physical existence of our brain. In fact studies done on chimps have shown that certain brain chemicals are altered over the course of years by trauma or isolation (if a chimp is isolated at a young age they will have different levels of certain brain chemicals when placed in isolating situations than a chimp not isolated at a young age and these effects last for many years). This is a physical change brought on by an environmental factor.

Of course it’s important to be careful not to oversimplify, but obscuring that there clearly is a biological factor to mental illness is not helpful either. In addition, the fear of labeling mental illness as biological plays directly into the fear of overdiagnosing and overprescribing. When we repeat over and over that mental illness is not a biological illness that revolves around neurotransmitters and brain chemicals, we become even more paranoid about prescribing medication (something that people are already worried about in the case of things like ADHD and Xanax). Speaking as someone who takes medication, this is incredibly damaging. Medication can be a complete life-saver: it made my anxiety manageable and so it gave me a window to actually begin dealing with some of my underlying issues. I was afraid to begin taking medication because I didn’t want to “alter my brain”. Repeating the myth that pharmaceutical companies are out to get us all and that medications are not the proper way to treat mental illness reinforces that stigma.

Of course we should include various kinds of therapy when we’re working on mental illness, but it is actually incredibly difficult to get medication for many mental illnesses and particularly difficult to get insurance to cover it. People are already afraid of medication. People are already afraid of being turned into zombies by pills or having unknown side effects. It is possible to advocate for improved standards for pharmaceutical companies AND accept that medication can be an incredibly important part of treating mental illness.

We need to recognize that mental illness is complex, requires a number of kinds of treatments, and involves a variety of factors including the biological, social, environment, genetic, chemical, and situational. While it is important to move past the “chemical imbalance” trope, that doesn’t mean completely removing any mention of chemistry or biology from our descriptions of mental illness.

Will Follow Rules for Rights

“FOLLOW OUR RULES AND YOU WILL HAVE YOUR FREEDOM” IS THE BIGGEST LIE OPPRESSED PEOPLE ARE TOLD IN THIS COUNTRY

 

This morning I was looking at the twitter explosion over the Texas abortion bill and ran across this tweet from @rare_basement. I don’t know how to explain what this tweet means to me or my neuroses. I don’t know how to explain how this sums up all the intersectionality of my gender and mental health. But I’m going to do my best.

 

This is the lie I’ve believed all my life. No, I am hardly the most oppressed person in the world, but I grew up in the 90s, when girls were told that “you can be anything if you believe and work hard!”, despite the fact that sexism is still alive and well and making life incredibly difficult for women. But boy did I fall for that line. I still believe it, despite trying to make myself grow up over and over again. Because you want to know what happens when you buy into a cultural myth that disappoints you repeatedly, one that tells you that you’re responsible for your disappointments? You begin to think you’re the problem.

 

The line that oppressed minorities are fed is that hard work will get them whatever they want, including the rights and freedoms that have been denied to them in the past. This is the myth of meritocracy. Unfortunately, it’s not true, and minorities simply are denied rights and freedoms, as well as opportunities, because of their status as oppressed. But the myth puts all of the responsibility for these problems back on the oppressed: it tells them that they haven’t followed the rules appropriately or they have not worked hard enough.

 

This is the worst form of victim blaming because it can make everything an individual’s fault, and it can obscure from the individual the larger forces that are at work. And in my mind, the most insidious part of it is that it essentially sows the seeds for mental illness. One of the traits of many people with mental illness is personalization: thinking everything is either your fault or aimed at you. This myth directly tells you that everything is your fault. It builds personalization from the ground up and repeats it over and over until it’s been hammered into you. What’s worse is that it doesn’t just wait around until something bad happens and then tells you it’s your fault. It points to structural inequalities that already exist, and when those begin to affect you it tells you that you should have known better and followed the rules so that you didn’t make these problems for yourself. It retroactively blames you for problems that were there before you were born, so you are suddenly responsible for a disturbing amount of things.

 

An additional problem with this is that the “rules” for oppressed populations are contradictory and impossible to follow. No matter what you do, you’re doing something wrong and thus don’t deserve rights and freedoms. An example of rules for women: Be good looking but not shallow, and definitely not overly sexy, and definitely don’t flaunt your body but don’t be a prude either.

 

Is it any surprise that we have a generation of girls who have grown up thinking that they are constantly not doing enough, not right, or need to be perfect? A generation of girls who catastrophize everything? If you were told throughout your whole childhood that you’ll be treated with respect, dignity, and liberty if you follow the rules and then are NOT treated with those things no matter how hard you tried, doesn’t it seem logical that you would conclude that you had done something wrong? What amps up the anxiety of this is that you don’t know what it is you did wrong. You can’t figure out what went differently between the times when you got what you wanted and the times you didn’t (hint: the difference was probably not you, it was the circumstances outside of your control), so you get paranoid that at any point you might be doing something horribly wrong and you don’t know it. You might be messing up the rules which can have disastrous consequences. And if you don’t follow the rules exactly perfectly, if you don’t get straight As and no detention ever and dress modestly and act politely, then it’s your fault if you get raped or harassed or if you get denied a job.

 

This is an enormous amount of responsibility and guilt for any individual to take on. It leads almost directly to a paranoia about one’s actions, to a sense of personalization about everything, to perfectionism and to anxiety. For a while I wondered why nearly every girl my age was a budding anxious perfectionist, but this quote makes it so clear to me: we are because we know we have to be in order to be deemed acceptable and in order to try to keep ourselves safe.

Another problem with this message is that it tells minorities that their feelings are not valid or right. When your rights are denied, you have every right to be angry and upset, but this myth tells you that feelings of anger are always wrong because you are always at fault. You don’t get to be angry ever, except with yourself, because society can never do you wrong if you play by the rules. This undermines so much of an individual’s identity, confidence, and emotional understanding that you can be left with no conception of what an acceptable feeling is. In DBT when we talk about the circumstances that can trigger a mental illness, an invalidating environment is one of the first things that comes up every single time.

 

It’s no surprise that oppressed populations have some mental health problems different from those of privileged groups: they’ve been put into a situation where perfection is expected of them, everything is personalized, and their feelings are invalidated. It’s the perfect storm, and yet we sit around wondering why women feel so bad about themselves. This is somewhat akin to leaving tripwires everywhere and then asking why people keep falling.

 

We as a society need to start discussing and addressing the mental health effects of these expectations of women and other oppressed individuals because they are creating mindsets that are rife for mental illness. They are creating expectations of perfection in individuals, they are telling individuals to personalize everything, they are heaping guilt and responsibility on individuals who should be looking at the societal discriminations for their difficulties.

Follow Up: Mandatory Mental Health

A couple of notes here: I’ve noticed that I’ve been posting a lot and then having more thoughts come to me immediately afterward I put something up. I think that what this means is that I need to spend more time with each post before I hit the publish button. I probably flood this blog anyway, so I’m going to cut down how much I’m posting so that I can devote more time and energy to editing and putting up quality rather than quantity. I will be posting a fair amount on Teen Skepchick this week, and I should have posts going up at The Fementalists and CFI On Campus as well, so never fear you will have your overdose of my writing. With that explanation, here is my single post for the day.

I recently posted that I thought it could be beneficial to institute mandatory mental health education in schools. In my initial post, I didn’t flesh out some of the serious benefits that we could see from instituting this kind of policy, and I didn’t really explore how we could implement it either, but rather focused on the first flash of an idea. In order for this idea to have any kind of impact, it needs to have some feet under it. I need to identify who it will benefit, how it will show benefits, and what might stand in its way. That’s what I intend to do here.

There are many practical benefits to adding a new . The first chunk of these benefits falls under the heading of “preventative treatments”. As it stands today, it is extremely difficult to get any kind of mental health treatment unless you are already overwhelmed or in a non-functioning state. We don’t hand out diagnoses to people who are showing signs of something and want help to keep those signs under control: we hand them out to people whose symptoms have gotten out of control. Unfortunately, a DSM diagnosis is the only way for many people to get help. By the time they get to this point, they’re often already in a state of crisis.

To take a stark contrast, we spend a great deal of time thinking about preventative measures in our physical health: we tell our children to wash their hands, to stay home if they’re contagious, to eat healthy and exercise, and to get vaccines. For some reason this logic isn’t extended to mental health even though there is a great deal of evidence for the biosocial theory of mental illness: we start with some predisposition that makes us vulnerable to mental illness, but our environment can either tip us into it or help us away from it. The messages that we are sent about our emotions and our worth make a huge difference in determining the severity of our emotional difficulties. Adding education to schools can help send positive messages to kids about accepting their emotions and about how to handle emotions. It reduces the stress level of the environment, or at the very least provides kids with some tools to diminish the stress levels in their personal environments.

There are many people who could benefit from this kind of preventative care. First, those people who are vulnerable to mental illness need all the help they can get to build a healthy and safe environment for themselves. This NEEDS to start as a child. Much of the evidence about mental illness suggests that childhood is one of our most vulnerable times and it’s when we begin to develop our patterns and understandings of emotions. Providing some extra help to children could mean significantly fewer individuals who fall into diagnosable states as they grow older. While we can only do so much to provide kids with safe and happy family environments, schools do provide an ideal location to teach the skills to help handle less than ideal environments. Giving a vulnerable child the skills to not fall into the place of crisis that a diagnosis requires would be a huge improvement in quality of life.

In addition to those children who may at some point gain a diagnosis, or who need help to not fall into a diagnosis, there are also individuals who have serious struggles with their emotions and mental health but who will never have a DSM diagnosis. They’re hovering in the uncertain place where they’re not destroying themselves, but they’re certainly not healthy or happy. People with subclinical symptoms, or who might have a bad environment but higher tolerance. Oftentimes these individuals can’t afford therapy or simply don’t have very many resources to help them learn about emotional regulation. With some regular education and practice at emotional regulation, these kids could grow into much happier adults. They deserve help to flourish just as much as anyone else.

Finally, the general population of kids (and the adults that they become) could benefit from learning emotional skills. Obviously we all feel better when we can regulate our emotions and tolerate distress. But the most important section in my mind is learning about interpersonal relationships. If the bullying epidemic in this country tells us anything, it’s that we haven’t been stellar at teaching our kids about interpersonal relationships. We’re constantly talking about how to decrease bullying, and asking all children to learn how to get what they want and need in a more appropriate fashion can only help. In addition, as a recent college grad, I can promise you that 99% of the jobs that I’ve been looking at list “work well in a group” as one of their requirements. Our world is very much about connection right now: technology seems to be thriving on the concept of connecting. So giving our kids the skills to navigate the world of constant connection would be extremely helpful, both for their future work lives, and for their current personal lives.

So beyond helping our kids and future citizens be happier and healthier, what else do we get out of adding mental health education to our schools? I know that politics right now is about money, money, money, pragmatics, the economy…we can’t just go throwing money at things without some guarantee of a return on our dollar. But I have news: this will likely save us money. I don’t know if you’ve noticed, but mental healthcare is EXPENSIVE. My experience is primarily with eating disorder treatment, and I know that it’s come near to bankrupting a fair number of families. Most of the money for treatments is coming from insurers, and thus drives up the cost of insurance for everyone. Therapists are damn expensive, and once a mental illness becomes thoroughly entrenched it can take many, many years of therapy and work to get it under control. That’s a huge amount of expense both for individuals and for the community. If we can prevent some mental illnesses from ever occurring, we can save a great deal of money.

In addition to the cost of treatment, mental illness itself can be expensive, both individually and societally: individuals who are struggling can have a harder time getting and keeping work, or may spend money on things they don’t want (BPD can lead to excess shopping, addiction leads to money spend on substance of choice, BED means money on huge quantities of food). If someone is desperately fighting for their own mind, they’re likely not contributing as much to society as they could be (this is in no way meant to shame individuals with mental illness. Your job is to bring yourself back to health, not to contribute to society on a monetary level. If someone had a debilitating physical illness you wouldn’t shame them because they can’t work as many days. This is simply to say that when we’re very ill we’re not at our best). But if society wants its members to be as productive as possible, holding down jobs and putting money back into the economy, preventing mental illness is a really good way to do this.

But maybe money isn’t your thing. Maybe you’re more interested in the people than in the money. Well first of all go back and read the first few paragraphs about how we could make a lot of people happier and healthier. Still not enough? Ok, I’ve got another. The most immediate and concrete would likely be an improve in grades. Now I don’t know of any studies on the relationship between mental health treatment and grades, but I’m gonna go out on a limb here and say that when you’re fighting a mental illness or fighting to stay out of a mental illness, you’re more likely to struggle in school or at work. Now there are absolutely people who can keep up good grades while struggling. Some mental illnesses tend to push people towards perfectionism, and those individuals appear highly competent while in the throes of a mental illness. I myself managed to keep up above average grades through all of college while dealing with an eating disorder, depression, and generalized anxiety. But the worst grades of my life came at the time when my mental health was at its worst. This is not a coincidence. If we want our children to be well-educated and to be as successful as possible, we have to help them to be able to focus on school when they need to, and to have ways to deal with whatever else might be going on in their lives.

In addition, spending time with one’s own emotions can really help to create more empathy for others. Again, I am speaking from my own experience here, but I find that the more I learn about understanding where my own emotions come from, the more I find myself curious about why others are upset or struggling. If even half of the kids in these classes gained something, we would have a significantly more empathetic and supportive community for others who might still have difficulties. And if every child went through something very like therapy at a young age, we might be able to decrease some of the stigma against mental illness and against therapy.

Now obviously there would be a cost here. It’s not free to get a therapist into the schools, or to further educate our already over-burdened teachers to handle one more thing. But adding a single additional school therapist who did one hour of work per week with each classroom would not break the budget (possibly two for larger schools. Keeping therapy groups small is REALLY important), and it could lead to some serious improvements. Therapists are expensive, but if we get all of the benefits outlined above it seems that it would be well worthwhile.

The ideal way to do this seems to me to have one therapist who is entirely devoted to education and preventative work, who conducts classes with small groups of students to teach them different skills, check in about their week, and assign them a short piece of homework to practice an emotional skill during the week. This would be a highly demanding position for one therapist to build close relationships with a large number of kids, but if schools were capable they could add more therapists for more students. Even if it didn’t exactly mimic a traditional therapist/patient relationship, it could still be a useful way for kids to simply have a time to check in, learn how to talk about emotions, and get some emotional education. It absolutely seems to be a cost effective measure to improve grades across the board (because this seems to be a measure that would benefit all kinds of students, and engage those with some interest in psychology at an early age) and to prepare kids for jobs and life.

Now I am obviously not a school administrator or policy maker. I have never been in the position to create a budget for a school. So I would love to hear input from those people who might have more experience with these sorts of things: do you think it would be a cost effective measure? Could it help to lighten the load of some of the other school counselors to do some preventative measures? How could we try to push for this change to be made?

Mandatory Mental Health Education

Lately I’ve been spending a lot of time talking to people about concrete ways to deal with stress or improve their mental health. It’s been really interesting and kind of exhilarating as I notice how much I’ve learned in the last year or so and how wonderful it is to be able to share with others. However as I do this, I’ve begun to notice that even those people who are supposedly “normal” often don’t have a whole lot of skills around managing their mental health. Many of them have struggled to regulate emotions, to understand interpersonal effectiveness, or to tolerate distress. While they likely don’t feel emotions as strongly or have as few skills as those with diagnoses or who have been medicated, there is almost no one in this world who is an expert in navigating their emotions and mental health. To use the featured pic as an example, while not everyone is hanging out in the burning basement, few people are on the roof and everyone could enjoy being a few steps higher on the ladder.

 

The odd thing about understanding emotions is that it’s something we’re never taught. We are taught how to interact with other people, we are taught how to learn, we are taught how to budget or do our laundry or care for an animal. We’re particularly taught how to take care of our physical health. But for some reason everyone is expected to just pick up how to manage emotions and mental health. Now many of us have things modeled for us by our parents, but they were often just as clueless as we were and have cobbled something together out of their life experiences to get the best version they can. And rarely do they spend a lot of time consciously helping us sort out our emotions. All of that seems a little bit ridiculous to me. If there are two things that are really really useful to be successful anywhere else in life it’s stable mental health and stable physical health. If you don’t have those two things, everything becomes infinitely more difficult. So why don’t we give our children the tools to succeed?

 

Especially as I’ve been participating in DBT, I’ve been noticing that it really would not be all that hard to include education like that in schools. I only go once a week for two and a half hours. And I’m supposed to figure these skills out in a year. If we began implementing some of the knowledge that we have from psychology in schools from the time children start and teach them skills that will actually help them regulate emotions and deal with interpersonal relationships, we wouldn’t have to devote much time each week to it. Think of how helpful it would be to kids to understand what being judgmental is and how to cut down on judgments without feeling ashamed or bad about it. Or how helpful it would be to give them clear strategies for calming themselves. Or to help them recognize and name their emotions. Or to learn that emotions are acceptable and that they can feel emotions and simply sit with them. Holy cow I would have done so much better in life if I had had some of this basic training.

 

I don’t know if there’s any way to make this happen, but if we could adjust education in any way, I would suggest that we should add in a basic curriculum of emotional regulation. Most schools have a school therapist: it could be something they do once a week or once a month, or it could be something that teachers start getting trained on in school. It would include skills like how to make requests, set boundaries, validate, or be generous to and with others as part of interpersonal effectiveness. It would include techniques like breathing, distraction, or self-soothing for tolerating bad situations. And it would include some measure of work on identifying emotions, accepting emotions, fighting judgments, and using mindfulness to accept situations. Does anyone have a suggestion of how to make this into a petition or move it into the broader dialogue? I never hear a question of emotional education being brought up when we talk about improving mental health, but this could be a huge step towards decreasing stigma and increasing access.

Mental Health: Speaking Openly

I’m in the process of applying for jobs (yippee!) and lately I’ve been finding some helpful sounding people asking me if I want to be so open about certain aspects of myself where a future employer could see it. Particularly whether I want to talk about my mental health status on a blog which is easily found through both my facebook and my twitter accounts. And as much as I hate to admit it, they may be right: being open about my depression, anxiety, self-harm, and eating disorder could harm my job prospects. There is stigma against these conditions. They can make doing a job well difficult. However I also know that they have never made me incapable of completing the work I need to do, and that I am qualified for the jobs I’m applying for.

So why do I continue to write openly about my mental health when I know that it could harm my chances of getting the jobs I really want? Well first and foremost, this is my small way of fighting against the stigmas against mental illness. I would really like to be a mental health advocate in the future. I would like to do things with my life that help others understand their mental health and that make it easier for everyone in our country to have easy access to good mental healthcare. Right now I can’t do those things. I’m not qualified, I’m trying to take care of my own mental health, and I just don’t know if I’d even enjoy them. And so I’m doing the one thing I AM capable of, the one thing I DO enjoy, and the one thing that I LIKE doing: writing.

The best way to decrease stigma against mental illness is to illustrate its normality. Most people view me as a fairly regular person. Some people even think I’m intelligent or successful for someone my age. I’m not violent, I’m not out of control, I’m not angry. I’ve got some problems but I’m basically a regular joe. And by telling my friends and family and acquaintances that I struggle with mental illness, I see therapists on a regular basis, and that’s ok, I can let them know that it’s NORMAL and ACCEPTABLE to have a mental illness, and that going to a therapist is no different from going to a doctor: you’re keeping tabs on your health and making sure you’re taking care of yourself. For me at this moment, that is the best form of  activism I can do.

Beyond that, I feel that because I like to write (and am good at it???) I can give people a window into what mental illness is like. I want to provide a voice for myself and others, because we’re often spoken over: rarely do you hear those WITH mental illness speaking about mental health and mental health treatment. We need to be part of the conversation. I hope that by speaking up I can illustrate to others that they can as well.

But perhaps more than anything, I don’t have fear about speaking up about my mental health because I don’t want to work somewhere that would discriminate against me based on my mental health status. Eventually I hope to work somewhere where I can be completely open about my mental illness. As it is, it’s difficult for me to work in my appointments and groups without going to some of them during the day. It would greatly decrease my stress if I could simply tell my bosses openly where I was going, if I had some understanding from my colleagues and supervisors that sometimes I will need to take my PTO for a mental health day, or that sometimes I might ask for minimal human contact during the day. If I want to take care of my mental health in the long run, it would be SO much easier to ask for what I need if I could be OPEN about why I need it. And if I feel that people have a stigma against mental illness or wouldn’t want me around if they knew, I will not be happy and I will not be mentally healthy. I don’t want to work in an environment like that. And I will not be the one losing out. The company will.

I want the freedom to say NO to places that will discriminate against me, and so I am open. If individuals with mental illness are forced to keep their conditions in the closet so that they can get employment and schooling and so on, we will not move forward. I would prefer to limit my choices in work to those places that want me. And so I’m not afraid of openly admitting that I struggle. This may lead to some unpleasant emails and phone calls denying me jobs in the near future. But I’ll find something. And I will be happier there than I would have been in a situation that denied me because of mental illness.