At the most basic level, those who are attempting to destigmatize mental illness have a simple goal: Make it easier to talk about these issues openly, to stop forcing people who are struggling with mental-health issues, or who have loved ones who are, to feel like they have to suffer in the shadows. This can be a truly lifesaving endeavor — all else being equal, people who feel they can speak openly about their mental-health problems have better outcomes.
But destigmatization can sometimes be a bit more complicated than it might seem, and sometimes there are unintended consequences to goodhearted efforts at making the world a more just and kinder place. That’s the main argument of a really thoughtful and powerful post on the blog Troubles, which is written by “Purplepersuasion,” a woman in her 40s with bipolar disorder.
Her post is in part a response to this tweet from Kensington Palace, which is in turn about Prince Harry’s recent frank, open talk about his mental-health issues:
Purplepersuasion sees this as part of a broader, ongoing shift in the mental-health conversation that she’s skeptical of:
I keep hearing this lately – especially I think from psychologists, and especially I think from the academic variety. The idea that “we all struggle”. We all have “troubles”. We all have “difficulties” and we all experience “distress”. Let’s not use diagnostic language, because that increases stigma. Let’s not use words like “condition” or “disorder” or “illness” because that creates a them and us, the unlabelled and the labelled, again fuelling stigma. Let’s focus on the commonalities between us all. Where’s the harm in that?
I can’t believe that I have to point out the harm, but clearly I do.
She uses a dermatology analogy to explain what she’s getting at: There’s an important difference between having a skin condition that causes annoying but minor blemishes and one that seriously restricts someone’s ability to live their life: “Some people are stared at all day, every day because they have facial scarring. Some people experience potentially life-threatening rashes all over their body.” These two categories of people aren’t really in the same boat — there are skin problems, and then there are skin problems.
Purplepersuasion then cycles back to mental-health issues:
Yes, “we all have struggles/troubles/demons/distress” but just like with skin, some struggles are more overwhelming. A good number of mental health difficulties are transient, and many are mild. Some, such as bereavement, are part of the normal course of life – the pain is very real, but it is not necessarily pathological. Some people end up having time off work because their stress levels have built up to the point where they cannot carry on effectively, but often the situation can be resolved by changes in the workplace. Some people get very anxious about things they know don’t merit it but they are able to push on through and live their lives. || Yet some people don’t have custody of their children due to their mental health problems. Some lose close personal relationships or are never able to form them. Some people bankrupt themselves when unwell. Some people are never able to work. Some are detained against their will. Some people have permanent physical effects from self injury, malnutrition, suicide attempts. Some people live in terror because of unfounded fears that people are trying to catch and kill them. Some people are mentally or actively working on ways to kill themselves. Many people do die.
Again, the overall goal of destigmatization is, of course, vital: People with mental-health problems need to be treated with respect and granted the full human dignity they and everyone else are entitled to, and shouldn’t have to fear harsh judgment when they go to friends or mental-health professionals for support. But Purplepersuasion is reacting to a very real trend in some circles to, intentionally or not, play down what it really means to have severe mental illness. Sometimes this manifests itself as the insistence that the entire mental-health Establishment, with its DSM criteria and so on, is just a scam to oppress people or make money, or an attempt to sandpaper the interesting corners off of people who think or see the world differently. Other times it’s the denial that anyone should be on medication, or that such treatment can be helpful, or an overly restrictive language-policing that insists we never use terms like mentally ill.
This rubric from the American Psychiatric Association, designed to help journalists write more sensitively about mental health, is a good example of this tendency (though I should be clear that Purplepersuasion doesn’t mention it in her post). Mixed in with common-sense suggestions — don’t call people “psychos,” of course — are ones like “avoid words like ‘suffering’ or ‘victim’ when discussing those who have mental health challenges.” This comes from a good place, but if people are suffering, or are victimized by a mental-health problem they in no way chose to experience, isn’t it really important we be able to describe these facts plainly? “Please don’t try to normalise severe suffering,” writes Purplepersuasion in her post, and that’s what it feels like this type of language might do.
There are very real critiques to be leveled at the psychological and psychiatric Establishment, of course, and their long history of treating mentally ill people as not quite human. Much of the broader destigmatization effort, occasional overreach and all, is a response to this sad history. But at the end of the day some people, Purplepersuasion among them, really are robbed of normal lives by their mental illness, really do suffer as a result, and they aren’t well-served by euphemisms or platitudes, or by the idea that we’re all just on some continuum that needs to be better understood. “Please do not tell me that the personal relationships I have lost, the overdoses I have taken, the end of two professional careers, the inability to parent my children full time, my endless cocktails of drugs with their endless parade of side effects, my hospitalisations, my community suicide watches are just a normal part of life,” she writes. In other words: None of this is normal, and it doesn’t help me, the person suffering, for you to claim it is in an attempt to feel like you’re being more sensitive and inclusive.