Mental Illness: From Pathology to Stigma
In 2012, I had about a 20% chance of living due to my drug and alcohol addiction. Fortunately, I was able to get sober, and I live an incredible life today. One of the root causes of my addiction was my untreated mental health issues. We never talked about depression, anxiety, trauma, or any other mental health issue at home or in school. As a kid growing up with an alcoholic mom, the anxiety and depression I felt was just part of life, and substances became my way to self-medicate.
Once I realized that mental illness was one of the leading causes of addiction, I went on a mission to spread awareness and try to educate people. In my mind, we weren’t talking about mental health nearly enough. But now, we see people throwing around words like depression, anxiety, and trauma all willy nilly. Even people who like to be organized claim they have OCD. Recently, Simone Biles removed herself from some Olympic events for mental health reasons, and while criticized by some, many were inspired by her decision to focus on her mental health.
I’m no arbiter of who does or doesn’t have mental health issues, but as with many topics, it feels like we’ve course-corrected too much.
Mental illness rates have been on the rise for years. We have more people being diagnosed with mental illnesses than ever before, but more worrisome, we’re medicating more people than ever. As a skeptic and someone who tries to be science-minded, I sit back and ask a bunch of questions because the stats can be misleading:
Did something change in the world that is making people more susceptible to mental illness?
Are the numbers higher because more people feel comfortable talking about their mental health issues?
Are we over-diagnosing people due to vague, subjective guidelines in the DSM, which is leading to higher numbers?
It’s 2021 and we still don’t have a definitive way to diagnose mental illness subjectively. So, how accurate is this data?
Where’s the line between normal emotions and a disorder? And is there any sort of consensus about this demarcation?
Fortunately, there are a lot of fantastic people talking about these topics such as Allen Frances, Jessica Taylor, Randolph Nesse, Lucy Foulkes, Ethan Watters, Maia Szalavitz, and David Poses.
These are only some of the people having important discussions around this topic, but for the purpose of this piece, I wanted to focus on some of their ideas to further the conversation.
When I was cancelled in 2019 for my mental health YouTube channel, I started diving into books about overdiagnosis and over-medicating people of all ages. While this is definitely a problem, based on my personal experience, I’m not sure what the answer is to this very real problem.
Today, I wanted to break down what some of these great thinkers and advocates discuss about topics from the DSM, to diagnosis criteria, to the disease model of addiction, and more. But finally, I want to discuss how I believe a diagnosis helped me in my own recovery and how I can’t help but wonder how many others there are like myself.
Saving Normal with Allen Frances
I’m currently re-reading Saving Normal by Allen Frances to prepare for my interview with him on the podcast. I truly believe his book should be required reading for every mental health professional as well as many others. Frances was involved with earlier editions of the DSM and wrote this book to explain the “civil war” within the community over the DSM. According to the latest Diagnostic and Statistical Manual (DSM-V), most of us could be classified as having multiple disorders due to such vague criteria for symptoms.
His book really helped me understand how we got to a place where we’re feeding kids Ritalin and other amphetamines without taking into account that maybe it’s not ADHD. This isn’t the only issue either. Most psychiatric medications have a ton of side-effects, which is why we have to be careful about how we diagnose people and treat their “illness”; especially with the billions of dollars Big Pharma uses to make even more money off of pushing pills. But most importantly, Frances argues that we need to have better conversations around how some “symptoms” are totally normal and don’t need a diagnosis.
Evolving with Randy Nesse
With his book Good Reasons for Bad Feelings, Randy Nesse exploded my brain. For the first time, someone wrote a book getting down to the evolutionary reasons for why we experience low mood (or depression), anxiety, and other symptoms we pathologize. The other day, I had the opportunity to interview him for an upcoming episode of the podcast, and it was such a pleasure. More than most, Nesse realizes that it can be extremely advantageous to experience symptoms of fear or low mood, and sometimes, it’s just a glitch in our design. One highlight from our conversation is when we have a nice laugh about how it’d be a lot better if some people experienced more anxiety due to their out-of-whack optimism bias.
If you’re about to give a life-changing presentation in front of 100 people, maybe you should have a little anxiety. After a breakup or the loss of a loved one, you should feel a little depressed. While not every feeling has a good reason, the reality is that hedonic adaptation is an amazing thing. We’re a resilient species, so maybe time is the best medicine for certain situations.
The Cultural View with Ethan Watters
I have no clue how I never heard of Crazy Like Us by Ethan Watters, but I binged it when I discovered it. Watters really highlights how America’s idea that we’re the best and smartest is infecting other countries and cultures with our ridiculous ideas of how everyone has some sort of mental illness. For example, one story I’ll never forget from his book is about how armies of therapists from America and Western countries thought something was wrong with people who weren’t traumatized after a natural disaster.
PTSD is a very real disorder, but we don’t talk nearly enough about Post-Traumatic Growth. There are countless people who come out on the other side of an experience stronger, but others don’t. Watters opens our eyes to the fact that maybe a person’s community and relationships are the most effective form of treatment. Although the PTSD chapters stuck out the most for me, Watters also covers how different cultures deal with illnesses like schizophrenia and more.
The Disease of Addiction with Maia Szalavitz and David Poses
Maia and David are awesome and both came out with new books this year. While both are big advocates for harm reduction, David’s book The Weight of Air is more of a memoir of addiction and Maia’s Undoing Drugs takes a look at the history of harm reduction and failed drug policies. I’ve recently had them both on The Rewired Soul podcast to discuss their books and a bunch of important topics around harm reduction and the stigma of addiction.
For a while now, there’s been a debate around the disease model of addiction, and Maia did an excellent job arguing against this model in her best-selling book Unbroken Brain. David discusses this often in his advocacy writing as well. The argument is that not only does labeling addiction as a disease tend to increase the stigma, but it can make the person with the addiction feel helpless. In fact, there’s an interesting study that involved shocking people who were thought to have a “disease” rather than an illness based on situational factors.
Victim Focus with Jessica Taylor
I’ve only recently discovered the work of Jessica Taylor, but she’s a badass and inspires me on a regular basis with her conversations around mental health and stigma. Taylor argues that how we treat and diagnose victims of trauma, abuse, and violence is completely wrong. Like others listed above, she argues that we need to understand that trauma responses are completely normal after some of the hell people have been through.
Today, we had a brief discussion about BPD on Twitter, which lead me to do some research:
I’ve heard some arguments about how Borderline Personality Disorder isn’t a legitimate diagnosis, and this is also an important conversation. I’ve personally worked with hundreds of people diagnosed with BPD, and it’s such a stigmatized illness. But in this video I came across from Jessica, she makes a great point about how personality actually works.
Jessica is also an author, but I have yet to read her books. You can check them out here.
Finding Balance with Lucy Foulkes
I loved the books from each but if there was a gun to my head and could only pick one book, the award would go to Lucy Foulkes and her new book Losing Our Minds. In her book, Foulkes gave the most well-rounded view of the mental health conversation that I’ve ever come across in the book. She covers everything above and so much more, and I can’t wait to chat with her on the podcast. This is such a tricky, complex conversation, and you’ll walk away from her book with a better understanding of the nuances of what’s been going on.
My Personal Experience
I think the most interesting thing about reading so much and being able to chat with so many deep thinkers on the podcast is how many challenges are more complex than we realize. I agree with every argument from each author listed, but at the same time, I disagree based on my personal experience.
Do we over-diagnose? Yep. Does this perpetuate the stigma? Of course. Do people also have legitimate illnesses that must be diagnosed and treated? Absolutely.
And I think just about every author on this list would agree with these statements as well. Personally, I don’t know what the solutions are because while I agree, I also feel like being labeled with a diagnosis was one of the most important parts of my recovery.
When I got sober, my anxiety came back with a vengeance. I started having panic attacks and mood swings over the slightest things, and this was months after I detoxed. Fortunately, my mom is a psychologist who is also sober, and she recommended I see a professional. When I explained to her what was going on, she said she thought I might have a Generalized Anxiety Disorder and depression.
I can’t even put it into words, but once I had that diagnosis, it felt like 1,000 pounds were lifted from my shoulders. My entire life, I just felt like I was “crazy”. Why did my mind race constantly? Why was I so afraid for no reason? How was everyone else able to be happy while I was miserable? I felt extremely alone, confused, and lost.
But once I had a diagnosis, I thought, “Now that I know the name of it, I can do research and find the best ways to treat it.”
Real quick, for the purposes of the conversation we’re having, I think it’s important to note that I was diagnosed after a 15-20 minute conversation. To this day, I don’t even know how accurate that diagnosis is. For all I know, she could have been guessing. But that’s another place I’m conflicted because I finally had a direction for my recovery.
When I was diagnosed, I was put on Lexapro, which helped a ton. But eventually, I had to up my dose because I built a tolerance. Months later, it wasn’t helping as much as it was, and that’s when I started researching various forms of therapy. Aside from my medication, I got really into mindfulness meditation, and I started journaling and gave therapy a try. Which one worked? I don’t know. But they all helped.
Over the last 9 years, under medical supervision, I’ve come off of my medications multiple times. My drug of choice was prescription medications, so I personally just don’t want to be dependent on any medication. Unfortunately, my depression and anxiety eventually comes back, so I go back on them. Currently, I’m on Prozac instead of Lexapro, and we’ve lowered and upped my dosage a couple times over the years.
So, what’s going on?
Do I have a chemical imbalance? Do I even have a disorder anymore? After years of sobriety and resolving many of the environmental and situational issues, did that fix me? If it did, why does it keep coming back when my life is amazing?
The reality is that I don’t know. All I know is that I don’t know where I’d be if I didn’t get some kind of diagnosis. I understand that a diagnosis of a disorder can be stigmatizing and make a person feel helpless, but for me, it may have saved my life. Even with the disease model of addiction, I don’t know if I agree with it anymore, but it helped me realize I’m not a terrible person and maybe I just react differently to substances.
Years ago, I realized that even though I like to think of myself as a special little snowflake, I’m not all that unique. So, if a diagnosis and the disease model helped me recover, who else can it help?
We may not have the answer to this question, but it needs to be taken into consideration. I’m a fan of the biopsychosocial model, and this model really highlights how different we can all be. For now, until we have definitive tests of how people will respond, I think the best we can do is take these situations on a case-by-case basis and not be too rigid in our thinking. This is the only solution I can think of where we help the most people while also understanding everyone’s differences with mental health issues.
I’m always open for a conversation and to be shown what I might be missing or where I may be wrong, so feel free to email me at TheRewiredSoul@gmail.com