Sunday 6 July 2014

Some thoughts on mental illness...

The online mental health sector ("community"?) is, as a rule, brilliant.  Supportive, informative, campaigning, stigma-busting sort of brilliant.  

But there are just a couple of matters I would like to get off my chest.  I've not really thought these things through, and they are both quite nebulous subjects, so I write this more as a discussion starter and would love to hear your views.

1. Mental health <==> mental illness?

Within both the mainstream media and the mental health sector there seems to be a confusion in the usage of the terms "mental health" and "mental illness".  Quite often, it seems to me, the former is used when we mean the latter.  My own view is that we need to be clear and specific.  But we also need to widen the discussion to encompass both the mentally well and the mentally ill. 

I remember one of the tweets during the inaugural "#MHMonday" twitter chat.  It was along the lines of "only people with mental illness would want to chat about mental health, so the distinction is immaterial."  No!  EVERYONE has mental health.  Everyone has a very important stake in mental health services.  Therefore discussion should not be limited to just those with a diagnosis of mental illness.  

Excluding the mentally healthy from the conversation is illogical.  Mental illness can come and go, and can feature widely different symptoms and problems.  Sometimes it is very obvious and visible, but often it is quite hidden.  Mental illness strikes at random, and is no respecter of previous medical history, or privilege, or current happiness or state of mind.

There isn't a "cancerous" and a "non-cancerous" population, and there isn't "mentally ill" and "mentally well" either.  To think otherwise is to somehow segregate the mentally ill, as if they are a different type of people, more prone or susceptible.  Weaker, even.

We know this isn't the case.  And as more and more of us (including politicians, sportsmen, business leaders, entertainers) choose to tell our stories of mental illness  this can only become more obvious.

Normalising mental health and mental illness in this way, might encourage more people to pay as much attention to their mental wellbeing, as they do their physical health.  It also might encourage more people to care about the "car crash" which is the current state of mental health services.

And all of this needs to begin at school, in the classroom.  From schools, to the workplace, to social situations, we aren't that great at talking about mental health and this needs to change.

2. There is a spectrum of mental illnesses, with some more ill than others?

It seems to be an innate human characteristic to compare ourselves with one another.  From keeping up with the Jones to getting ahead at work or winning on the sports field.  So it's no surprise that even within the mental health community, some people are judged to be "more" mentally ill than others.  Some voices are given more weight, and (for sure) some illnesses are given vastly more resources.

Having now experienced full-blown psychosis, I do think a little differently about my previous mental illness (chronic depression and undiagnosed bipolar affective disorder).  I am as guilty as anyone of downplaying the more chronic illness, as somehow less severe or less warranting of attention.  I rarely write about my depressive episodes here on the blog, and I am incredibly fortunate that they are becoming a more distant memory.

When in the throes of postpartum psychosis, I was lucky to have round-the-clock specialist nursing care and access to renowned perinatal psychiatrists.  When struggling though bouts of debilitating depression, by contrast, I had the occasional GP consultation, followed by a prescription for some pills and (on one occasion) a self-help "book prescription"CBT.  

The psychosis was horrific, that is true, but if you asked me to choose between a month-long psychosis or a decade-long depression battle I really think I would choose the psychosis.  I asked The Husband what he would pick if he could choose a mental illness for me, and he too picked the psychosis without hesitation. But he did stress that he would only ever choose that if he could be assured of the same level of care.  Untreated psychosis is undoubtedly more risky than untreated depression.  I lived essentially untreated for about 15 years with depression.  I very much doubt I could have lived for 15 days with untreated psychosis.

So it comes down to this: each mental illness presents different treatment challenges, and symptoms. Some illnesses require intensive care while others may be able to wait a little longer (just as in physical healthcare).  But they all warrant treatment.  It is scandalous how little care there is for people with long term mental health conditions.  We have more intensive and better-resourced care for acute illnesses like psychosis because the immediate risks (to themselves and to others) are much more obvious.  Psychosis is ugly, loud, and extremely frightening to witness.  The voting, tax-paying, public does not want to be confronted with psychosis in their neighbourhoods, so it is treated quickly (I am not at all saying treatment is perfect, far from it, but it does exist).  But depression and anxiety... Well, for the most part they don't seem to bother anyone else, so lets just offer them a cheap, one-size-fits-all, remedy and send them on their way.

The result?  Years and years of human suffering and pain and lost productivity and socio-economic outcomes.

So yes, there is a spectrum of mental illness.  This is a biological and psychological fact (the brain is a weird and wonderful thing!).  But far more worrying is that there is also a spectrum of mental health care.  Not only are some people waiting too long for treatment, but they are not getting treatment at all, or the wrong sort of care.  The door to mental health care swings open only if you are violently unwell (at real risk of harming yourself or others), or if you are sectioned under the Mental Health Act (hence why some well meaning doctors have admitted using this as a blunt-edge tool to gain access to services for their patients).  

Until this changes, my family and I will continue to be thankful I had psychosis, and continue to pray that my depression days are over.


  1. Also I probably could have named the chat something else like "Mental illness monday" but that didn't have the same ring to it and also Mental Health also sounds a little more positive than Mental Illness. Also the aim for all of us (those with issues and those without) is to be mentally and physically well. Anyway, the twitter chat was a bit of a spur of the moment thing so maybe I should have put more thought into the name but I kind of just wanted to get on and do it.

    1. Dammit. my first one never went in! oh well. more or less explained it on FB.