A recent article in The Progressive, “A Matter of the Mind: Rethinking Mental Health” made several interesting points about the vague and subjective nature of mental health diagnoses; written by our classmate, Tracy Zhao PO ’13, it certainly deserves a read. However, although we are in agreement with her point that binary definitions—the view that people are only either “normal” or “mentally ill”—found in mental health pathology are disconcerting, as neuroscientists and mental health activists, we feel compelled to respond here to several troubling points raised in her article.
To begin, Zhao argues that issues of mental health must be viewed contextually. We agree that context (age, culture, socioeconomic status, sexuality, etc.) should be a large factor in diagnosis, and this is indeed the direction in which the mental health establishment is moving. However, for several reasons we feel it is misguided to claim mental illnesses are completely contextual.
Current research suggests a biological basis to mental illness; for example, serotonin transporter length polymorphisms influence affective disorders, and dysfunctional adolescent synaptic pruning may lead to schizophrenia. Although it is widely accepted that these predispositions are often augmented by environmental or contextual factors, as the severity of an illness increases, context matters less and less. Being totally incapacitated by an illness—unable to function, unable to eat, unable to sleep, unable to live—cannot and should not be considered normal in any context.
Also troubling is how the article describes mental illness treatment in an Orwellian fashion, citing “different systems of surveillance and control” and “[a] plan that required strict adherence and cooperation.” Such descriptions suggest that entering the system of mental health is akin to a prison sentence, an analogy which could not be more untrue. Treatment for mental illnesses does not destroy lives; it saves them.
To illustrate, Zhao writes about a friend of hers who, like Caitlyn Plefka PO ’13, has structured her life around weekly visits to a therapist, medication regimens, and behavioral changes. Plefka, however, chooses to see her treatment in a different way: Without these visits, she would not have much of a life to structure. Describing the system of help that empowers individuals who have lost agency to mental illness in negative terms does not help consumers of mental health services and in fact increases the stigma associated with seeking professional help in the first place.
Finally, we would like to address what Zhao describes as an “informal network of care, whether they were aware that they were helping me or not, [without which] I could not have reclaimed my sense of mental health.” Although peer networks are a necessary accessory form of any support, and fortunately have worked for Zhao, we find it irresponsible to rely solely on them, particularly in circumstances involving self-destruction.
Indeed, it is dangerous to use untrained individuals as primary therapists, as you trade resources designed to help for individuals who are often unsure how to help and afraid not to. By relying on untrained friends and family, you hold them hostage with the threat of your possible self-harm. A friend you rely on for therapy quickly can become your last line of defense, a dangerous, stressful, and unethical position to put someone in.
So although we agree that there must be more dialogue about mental illness, more than anything we would like to impress upon you that seeking help for mental health issues does not, as Zhao writes, limit life options. Our mental health establishment exists to expand the options of those whose lives are limited by illness. If you have been affected by mental illness, be it yours or that of someone you love, join us for Mental Health Alliance Coming Out Week April 1 and show pride in our individual mental illnesses and the ways we overcome them. Come celebrate neurodiversity. Come celebrate being able to take back control of our lives.
Authors Plefka and Nick Clute-Reinig PO ’13 are majoring in Neuroscience. They live with Major Depressive Disorder and body image issues, respectively.