Saturday, January 15, 2011

Mental Illness

The other day I was listening to The Current on CBC. Yes, I know how some of you feel about the CBC, but this is not that blog. They gave some stats on how many people have or will have a mental illness, and how many of those people will not get the help they need. They are astonishing numbers:

  • 1 in 5 Canadians will experience mental illness during their life.
  • About 8% of adults will experience major depression during their life.
  • About 5% are affected by anxiety disorders.
  • Per the Current, only a small percentage of people get the treatment they need.

I didn't hear the entire program, but it's clear that the stigma attached to mental illness is in some ways worse than the mental illness. People fear what they don't understand, and most people don't understand mental illness.

When we look at a physical injury to the body, it's usually pretty clear what needs to be done to fix it. We recognize that the cure is likely to be incomplete, in that there may be scars, bone may not heal completely, tendon and cartilage are difficult to heal, nerves don't repair themselves, we can replace organs but can't yet regenerate them, and so on. In each case we can see the damage and impairment, and can usually help the person cope. Unless they've done something really stupid to themselves, we don't blame people for these injuries. Being injured is part of even the most careful life.

We can't see mental illness, we can only see behaviour and compare it to previous behaviour. A major change may be an indication of a mental illness. But here is where we get into the problem. When someone breaks a bone, we all recognize that medical attention is required, and that person will need a period of recuperation. We do not recognize that a broken bone is an acceptable condition, nor is there a "broken bone" culture saying it is discrimination to treat that broken bone.

In our society there is a behaviour continuum. We expect a certain range of behaviours from other people, and are tolerant of a somewhat wider range. However at some point those behaviours become unsafe for the person involved, and those around them. Where do we draw that line? Where does self expression, or eccentric behaviour, or protest behaviour cross the line into an actual mental illness? How can we tell? Who gets to decide?

In an earlier era we used to lock up such people, and under the guise of treatment the medical system experimented on them. Then we let them out to try to cope on their own, which is something that many of the mentally ill simply can't do. They need at least some level of assistance. Yet there are some people who argue such assistance is wrong, that treating at least some mental illness is a form of personality control, that these people have made a choice to be that way and are happy and should be left alone. I fully note there are several arguments there, and that people or groups might argue some of them, but not all.

I was astonished to discover a few years ago there were people protesting having a Cochlear implant placed in deaf children. They said it was an assault on deaf culture, that it was better to have a child fully embraced by and be proud of the deaf community, rather than be a marginally functional part of a hearing community.

It comes back to a wider question of what is "normal" for humans? How much deviation from normal are we willing to accept, and how much treatment are we prepared to pay for to get back within that range? For an example fairly close to home, it is widely recognized that physical activity is good for you.  Train for Ironman and you start getting some odd looks from people. There is the feeling that swimming, biking, and running for more than 20 hours a week is a bit excessive. Seems fine to me. Then there is the ultramarathon community, and I start raising my eyebrows at the activity level required. Normal? Within those wider bounds? Or is this getting into a compulsive behaviour?

Staying clean is another example. I typically have one shower a day. Lots of days I have two. There are some days I have three. Compulsive? No, considerate given how much I sweat during workouts. I'm sure my co-workers and cat thank me. But without the workouts, would 3 showers a day be across the line into compulsive? If so, is it worth treating? I've worked in jobs where my hands got dirty. Very, very, dirty, in several senses of the word, necessitating hand washing at least a half dozen times a day. Compulsive? How many times a day is normal? Does that change now that we know what an effective mechanism our hands are for transmitting disease?

One form of mental illness is substance abuse. Booze, tobacco, crack, cocaine, gasoline, glue, and others are well documented for the impact they have on the lives of the victim, their families, and society. Some people escape from these, but most don't. It's common for people to be told that tobacco is having a major impact on their health, yet they don't quit. They can't quit.

Oops, hit publish button by mistake, and I'm off to swim camp. To be revised. Come back later.


  1. Because of the shooting in Tucson here in the US, there have been calls, by pols with more influence than intelligence, for draconian laws making it easier to lock up not just allegedly mentally ill people, but also anyone who suspects these people may be a "danger" and don't report them to ... well, just about every authority in the world short of the commissioner of Major League Baseball.

    The level of ignorance of the way harmless mentally ill people (and mere eccentrics!) were abused by such lock-'em-up-and-throw-away-the-keys laws in the not-that-distant past on display in such articles is as appalling as it is remarkable. Yet these essays get published in agenda-setting rags like TNR.

    Here in the US, the solution to every problem has become: jail it; shoot it; or, if you're lucky, cow it into submission with threats of jailing or shooting.

    George Bush instituted a torture regime here in the US and started two wars that have led to literally hundreds of thousands of deaths of innocent civilians; Obama has continued and expanded both of these policies, after getting elected on a platform of promising to end them. In campaigning, he acknowledged the illegality of the previous regime; and it is a well-established principle of International Law (since Nuremberg) that those who wage a war of aggression, which the Iraq war is, should be prosecuted. Yet Obama, upon taking office, said we must "look forward, not backward" - essentially saying Bush, Cheney et al. would have impunity. Because Obama himself expects that for his crimes when he leaves office.

    People like this guy in TNR cheered these decisions on.

    But the mentally ill?

    Lock 'em up for life REGARDLESS of what they've done.

    That's America now.

  2. What "normal" is is culture specific and perpetually evolving. Typically we delineate normal from abnormal by asking whether the behavior interferes with functioning or is harmful to self or others.

    I agree that it is a thin line between normal and abnormal. And depression and anxiety are v prevalent, most people, for ex., have at least one panic attack in their lives. The term "mental illness" is so stigmatizing and unhelpful. Education is really what we need more of, as well as, obviously, more access to treatment for those in need.

  3. One of the problems of mental illness is that it often makes it difficult to get help; it's like if someone breaks a leg and you say "well, why don't you just walk to the hospital and get it fixed?" You can't get help if you don't know how to get help.


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