What if Mental Illness is Really Just a Conversation?

Fred Moss

Abstract:  This is an exploration into the possibility that the conversation presently in place in the community regarding mental illness is transformable.  A closer look at how and why we declare some people as being mentally ill is reviewed as well as a look at the areas in our life that reinforce the need to classify people with the distinction. 

The use of medications as a first-line treatment for people who are diagnosed with mental illness is also explored here, as we begin to look at what might be possible if medications were used less frequently and instead, human relatedness was used as first line medical treatment perhaps offering the best hope for real efficacy in the mentally disturbed population. 

Discussion:  By shifting the view of how mental illness is defined, there can be new access to the possibility that effective treatment for mental conditions can be fundamentally transformed.  From this new perspective, a world where medications are not used as treatment for mental illness can also be considered, with this modality being replaced by interventions that show an even higher promise for managing the associated mental symptoms, i.e. having them reduce or disappear.  Each and every person’s contribution and point of view could then be respected, regardless of any mental condition they have already been given. 

Do you think that you know somebody who is truly mentally ill?  If so, what is it that separates them from the rest of the population?

1.     Is it that they are sad often and have been told that they are clinically depressed?

2.     Is it that they are nervous beyond their control some times, such that they have now been diagnosed with an anxiety disorder?

3.     Is it that they have had some trauma in their life that they have not satisfactorily recovered from, and now are being labeled Post Traumatic Stress Disorder?

4.     Is it that they hear “voices” or think of things that they cannot control that sometimes frighten them, or maybe have considered doing things that they would not actually want to do, and now they are being labeled Psychotic (e.g. Schizophrenic, Schizoaffective) Disorder?

5.     Maybe they are having trouble focusing in school, such that they cannot perform to the classroom standards, and they are getting bored easily, fidgeting and having trouble completing tasks, so that they are now Attention Deficit Disorder.

6.     Perhaps they have racing thoughts, trouble sleeping, grandiose notions that they can change the world or have access to miraculous powers and/or speak rapidly, now being considered Bipolar Disorder.

7.     Is it that they are using mind-altering substances such as, but not limited to, alcohol, marijuana (even if it is prescribed legally), street drugs, prescription drugs (e.g. narcotics, stimulants, etc.), or designer drugs, and are then thought to be ‘self medicating” to address their otherwise underlying psychiatric condition, whichever one it might be?

8.     Maybe the person you are thinking about has a combination of some or all of these things, and a doctor has declared them to have a hybrid diagnosis of sorts.

9.     Maybe, they are just strange in their ways, in which case doctors may have called them Personality Disorder or Autistic Disorder or Dementia (or variants of any of these). 

The truth is that these days each of us knows at least one person, and often many more than one person, who is declared mentally ill and who owns that diagnosis for themselves as either a burden or a source of their identity.  Some might even use the diagnosis to get special provisions and/or supplemental income. Special living circumstances, jobs, and monetary gifts are often offered to those with these diagnoses that determine them to be mentally ill enough to warrant these specific services.

Are There Benefits to Being Mentally Ill Rather than Healthy?

I recently had somebody approach me stating, “I just found out that I was clinically depressed.  It was maybe the best news I ever heard.”  He was apparently pleased that there was now an explanation for his sense of personal dysfunction. 

Indeed, people come to my psychiatric office actually wanting a mental illness diagnosis, and once they have it, they often promptly let those around them know, so that they can act accordingly around them and alter their expectations they might otherwise have about them.  I have had patients get upset with me when after an examination, I suggested that I did not think that they met clinical criteria for mental illness.   Some even left my office, only to search immediately for a physician who would “properly” diagnose them rather than being appropriately pleased with learning that they did not actually have a diagnosable psychiatric illness. 

What is the inherent benefit of calling one’s self mentally ill?  How could one be upset if they just learned that they were deemed mentally healthy?

By   carrying a mental illness diagnosis,

1.     Patients are less accountable for their actions in the areas of life for which that illness affects them.  When they are ineffective, nonproductive, mean, tired, angry, hopeless, or desperate, they no longer are entirely responsible for their actions, as their mental illness now can be used to explain some of this.

2.     Patients do not have to face themselves so directly when they fail in relationships, work or home as a result of how they acted or what they said.  Again, their mental illness might leave them some leeway to perform less than exemplary in these critical areas of life. 

3.     Patients no longer have to take the risks to assess and alter their lives in areas where they are weak or feel deficient.  They may on these occasions, fall back on their illness as being causative or at least as contributing directly to their failings. 

4.     Patients have the inherent opportunity to remain upset, depressed, anxious and/or ineffective as a baseline rather than to consider alternatives.  If clinically diagnosed, there is a limit to what can now be expected.  In fact, life achievements can often be seen as unexpected rather than simply a celebration to acknowledge.  

Why do Doctors and Mental Health Workers Keep the Diagnoses Alive?

The mental health professional has a stake in the matter.  By declaring somebody mentally ill, that person can become a patient to be seen.  If things go as designed, a long-term arrangement is made that becomes a source of personal gratification for the treating clinician as well as a direct source of income.  

This inherent conflict of interest in no way suggests that the mental health industry is self-serving above care and concern for patients.  However, it does imply that the redefinition of mental illness would threaten their livelihood to the core.  This is a venture that nobody could or would take lightly.  It then is easy to understand that this notion would be inherently unacceptable from the vantage point of the average treating mental health caretaker. 

I submit that there are at least two major contributing factors associated with the phenomena of sustaining mental illness as a reality.  As mental illness now has reached nearly epidemic proportions, attention to this matter is warranted. 

First, there is no set of reasons that would make pursuing the removal of an already existent diagnosis worth seriously considering, from a patient’s standpoint.  A great deal of time and energy led to that point of diagnosis, and the benefits, perverse as some of them have now become, are now part of their everyday life.  The reversal of mental illness is thought to be nothing short of a miracle (or often a delusion of the afflicted party, likely resulting in increased treatment as a response), and is therefore not worth exploring further realistically.

Secondly, it is my controversial opinion that the first-line treatments currently being used for the mentally ill, namely psychotropic medications, may actually be reliably causing the symptoms that they are marketed to treat.   In other words, if a person takes medications meant to treat depression, it is quite possible that they eventually will become depressed as a direct result, whether or not they have had depression beforehand.  Similarly, if a person takes an anti-anxiety agent, even without a previous anxiety-based diagnosis, they have a high likelihood of becoming anxious shortly thereafter, with a gradual worsening over time.   The same pattern might also hold true for medications given for psychosis, mood instability, attention concerns, sleep disturbance, eating disturbance, trauma management, etc.  (Breggin, 2013), (Whitaker, 2014)  

Furthermore, and even more alarming, when the patient comes off medication, it may unfortunately be inherent in the drug’s formulation that a surge of the symptoms that the drug was supposedly treating will reoccur, such that the patient (and the doctor) would naturally think that the now-untreated condition had returned.  It would, they might concur, require retreating with more, different or higher dose of drugs.  This time, however, there would probably be no consideration of ever coming off the medications again, for fear of this worsening of symptoms and return of the “condition.”  Of course, this really did not occur in the first place, as the symptoms arising is this fashion are relatively short lived in nature if left alone, and do not represent true long-standing disease.  (Whitaker, 2010)

We have a great deal of anecdotal data suggesting that drugs can cause or exacerbate all of the symptoms listed above if taken carelessly.  That drugs can remove symptoms and return someone to a state of normalcy is a more difficult assumption, given how little we know about the source of the symptoms and the biological actions of the medications used.   (Breggin, 2013) (Moncrief, 2006) (Whitaker, 2010)

If all or most of this is true, the great illusion here would be that when the patient is taking the medications, he/she becomes relatively certain that when the symptoms resurface, that the medications are not working as well as hoped.  He/she is also certain that during those times that the symptoms are controlled, that the medications are working just as they are intended. 

If we really look at the above phenomena, we can easily see that the subjective experience of the treated patient is not sufficient to make this determination.  What is causing or not causing symptoms at any given time cannot reliably be attributed to the effects or lack of effects of medications, by the patient actually taking the medications.   There are simply too many other confounding factors to consider.   

Mass media and drug companies create the belief that medicines cause more benefit than harm.  The research scientific community also supports this belief by offering tenure and job retention for positive results when drugs are tested for efficacy. 

Perhaps, the patient’s diminishment of symptoms is a result of the patient’s “healthy self” winning over the detrimental effects of the medications.  Perhaps, in turn, the return of symptoms then represents the common untoward response, is actually correlated to using the medications as prescribed. 

When looked at closer, each of us has had some or all of the symptoms that are characteristic to varying degrees of mental illness at different times in our life.  When we are sophisticated however, we call our voices “chatter” or “thinking.”  Sadness, anxiety, worry, fear, insomnia, racing thoughts, and wild hopes for the future are all simply part of the human condition, parts that are to be celebrated as indicators for the need to make appropriate adaptive adjustments in our lifestyles as an intentional response.  Even if these experiences are at times emotionally uncomfortable, they remain something each and every one of us endures periodically. 

Clearly, with all of this taken into consideration, there is something to learn from the people we call mentally ill.   With an available shifting of our perspective, one that acknowledges the patient as an equal, we might consider altering the pervasive conversation of mental illness, maybe even toward eliminating it altogether.   What if we, as a team of human beings, created the best possible living environment for each other, with our differences celebrated and not negatively evaluated?   Providing assistance in removing and minimizing toxic intake at all levels of life, including in the physical, emotional and spiritual realms, could be what we did for each other without serious consideration of the impact of mental diagnoses. 

What if we all appreciated each other for everything that we are and everything that we are not? We could then all begin to hold each other accountable for all we did, including the mistakes and pain we inadvertently generate and the responses to general uncertainties that we each experience on a relatively daily basis. 

In an ongoing inquiry, using the ideas brought forward to this point, something very surprising starts to emerge.  Perhaps, mental illness is simply a conversation, one that could indeed disappear.  In other words, it is possible that each and every person is whole and complete as they are, and that views, ideas and notions, even if never heard before by the examining party, do not represent a deficiency (make-wrong).   Maybe it is simply an idea being expressed outside of our past-based experience of what is normal, i.e. beyond what we thought was acceptable based only where we have been.

I am suggesting that what does create mental illness might simply be a combination of contributing factors, such as:

1) the assumption one makes about themselves that they are ill (bad, wrong, deficient)

2) the assumption that the diagnoser makes when labeling the person as ill, (incomplete)

3)  The assumptions that friends, family and community make when they “learn” that this person now has a mental “condition”. 

3) the medications themselves which may be directly contributing to an ‘illness’  by creating unnatural ways of thinking that are truly  ‘abnormal’ (intoxication, altered states)

4) the gains, either subtly or overtly, for the involved parties (patients, families and caretakers alike), that leave the elimination of a mental illness diagnosis less desirable than its persistence.

Without diagnoses and medications, maybe those people who had been treated diligently and with marginal success, would find that their diagnoses could actually disappear, and ultimately that they could return to a much higher functioning level than they otherwise ever could have imagined.  This would be different than what they had been told over the years, as the saddling of chronic mental illness may have left them resigned to accept unwanted treatment, which may have been contributing directly to their sense of illness and disorganization or mood instability.

A miracle might be upon us.  Maybe each and every person really has something to say and, if heard, could begin to heal.  Maybe each and every person is only saying what is so for them given the context of how they see the world or how the world occurs for them on any given moment. By giving these people access to altering this context, a new way of being and acting could become immediately available for them as a direct result.  (Breggin, 1994)

What if transformation itself could be a key to the end of mental illness as a way of being?  This might give those who have essentially had no voice to this point, a chance to speak freely.  It could also give those who care for others (mental health workers, family and friends) an opportunity to fearlessly work and listen to “get” each person who approaches them for assistance, as a way of addressing the dis-ease that led to the meeting in the first place. 

With these people finally being heard, and the separation of “us” and “them” that mental health treatment now exploits being altered, we will have access to a greater sense of communal well being. There will be a larger population of people who know they matter, and a greater curiosity of those people we might have written off as ill.  We might even gain a greater appreciation of the uncomfortable states we often find our own selves in, without the fear of being diagnosed or relegated to a lifetime of mental illness. This will naturally lead to an expansion of self-expression, creating a greater sense of power, freedom and peace of mind for each and every one of us.      

(My Promise)

By 2030, each and every person will know that their voice can be heard and that who they are and what they do matters.  

--Fred R. Moss, MD---

REFERENCES

Books

Breggin, Peter R., Your Drug May Be Your Problem, Revised Edition: How and Why to Stop Taking Psychiatric Medications, 2013

Breggin, Peter R., Toxic Psychiatry: Why Therapy, Empathy and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the “New Psychiatry”  1994

Articles

Moncrief, J, Cohen D.  Do antidepressants cure or create abnormal brain states?  PLoS Med. 2006

Prousky, ND, MSc  Effective Strategies for Limiting Withdrawal and Destabilization, February/March 2012

Books

Whitaker, Robert  Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, 2014

Whitaker, Robert Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, 2010