If we call someone mentally ill, in some ways we may be recognising their predicament as a powerful one, and their need for support. We might also be assuming their state of mind as faulty. But what if its much more than that? What if it is an expression of emotional conflict that needs, not to be cured, but to be understood and reconciled with?
We can go deeper than trying to say what is wrong with someone, how ill they are, or what category they fit into. We can instead ask: How do parts of them feel? What might different parts of them need? And what are the contexts in which these experiences have emerged?
We may also see the social context as an important place in which to create change. An individual's difficulties are intertwined with their social network. Therefore, rather than seek to merely fix the faulty individual, we may want to bring the people around the person together and find new - and more helpful - ways of relating that benefit everybody.
A challenging mood or behaviour can be seen as having its own logic; its own purpose that needs to find new ways to be heard and new ways to express itself. For example, a young person's refusal to eat may be a way to seek control in a life where the young person has felt they had very little control. If we can give that person the experience of trusting relationships. Then, gradually, new forms of safety will be experienced and the reliance on controlling food intake will be likely to diminish. If we merely call this behaviour an eating disorder and attribute it to mental illness we may miss the opportunity to learn from the behaviour about what is lacking, and needed, in the young person's life.
Calling someone mentally ill may allow us to not think about our role in the development of their distress, and what our role could be in ameliorating it.
I once sat with a young man who had paranoid ideas - and his warring, separated parents - for an hour and a half in my kitchen. By just having a meeting based on dialoguing principles the son’s paranoia lifted significantly. I am not offering a blame-the-parents model here. We are all connected, and affect each other. We all have different sensitivities. Responsibility is shared. Moving towards understandings of painful events that acknowledge responsibility but also avoid blaming and morally judging each other are important in any peace process.
But if we assign someone the role of being mentally ill, we begin a cold war against their distress. We refuse to listen to possible reasons for their distress in the social contexts around them. Reconciliation will be unlikely to occur.
Personally I prefer the terms 'confusion' and 'distress' to the term 'mental illness,' although ultimately all terms are limiting in their own ways. Many people hold onto the term 'mental illness' to signify the extremeness of what they have been through. So, in offering alternative conceptualisations we need to tread carefully and acknowledge the intensity of people’s experiences. I think if we can broaden the language about our individual sense of disharmony and turbulence we can have greater freedom to understand our complex lives.
We have in the UK a national mental health anti-stigma campaign called Time to Change. They have spent millions of pounds on media initiatives aiming to reduce fear and discrimination for people who have been given psychiatric diagnoses. Time to Change says it’s good to talk about mental illness. The argument goes; the more we talk about mental illness the more acceptable it will be in society and the less discrimination people will face.
I agree it’s good to talk about a taboo subject but only if that talk - as well as encouraging empathy - uncovers new ways to see problems and find solutions. I recently challenged Time to Change about how much they use terms like 'mental illness' - and diagnoses -because I think, used rigidly, they can add to stigma and misunderstanding. Even the concept that 1 in 4 people have a mental illness encourages a conceptual division - between those thought to be sane and those thought to be insane - that may make empathy more difficult.
If we replace the illness model with one that sees suffering and confusion on a continuum, then it is easier for us all to relate to each others’ predicaments. This feels more inclusive, rather than separating off the 'ill' from the 'well' in an artificial and compartmentalised fashion. A group of us are planning to write to Time to Change about the language they use. This article is about an alternative way of looking at what gets called mental illness. But first I will share a few reflections on this tension between wanting to embrace this phenomenon many call mental illness and the desire to re-frame it so we can embrace it more wholeheartedly.
My impression is that many people accept the term mental illness and find it useful in their lives. I don't want to offend them, I don’t want a war of ideas with them where I hope to get them to convert to my way of thinking. I do want to suggest that many people may wish to hold the term mental illness very lightly or not even use it at all. In my eighteen years working as a psychologist I have generally found non-medical terms to be more helpful in trying to help people find more peace and agency in their lives.