DO COPING PROBLEMS MEAN YOU’RE MENTALLY ILL?

Most people think of mental “illness” as analogous to physical “illness.” They see “illness” as a black/white affair, which might work when talking about physical illness: You’re either sick or you’re well; you have a fever or don’t; you have appendicitis or don’t; you have cancer, kidney stones, a broken leg, or you don’t.

When it comes to “mental” illness things are more subtle. There usually is no clear line separating being ill and being healthy when it comes to our psychological functioning. In fact, unless you have a clear organic (physical) condition (such as brain damage) that causes psychological pathologies (hallucinations, delusions, an inability to process social signals, etc),  you will do well to avoid the phrase “mental illness.” (It’s no accident that this blog is not called “thementalillnessblog.”)

Unfortunately, “mental illness” is being tossed around a lot these days because of “unexpected” behavior, be it inexplicable mass shootings or unusual actions at high levels of government. People using the phrase, however, really don’t understand the consequences of applying this description to someone.

“Mental illness” is typically a negative label we apply to someone who is behaving “strangely,” or in ways that bother us. Furthermore, the label carries all kinds of negative stereotypes, biases, and evaluations against the person so labeled. Unfortunately, like any label, it tends to stick and guide our behavior toward that person, even in the face of contradictory evidence. Rosenhan’s classic study in 1973 illustrated the effect quite nicely.

Rosenhan and some graduate students got themselves admitted to various mental hospitals by going to admissions offices and complaining about hearing voices. All were successfully admitted and diagnosed with psychotic disorders. Once admitted they acted entirely normal, but were never discovered. Their treatment consistently mostly of pills to take, which they managed to flush down the toilet. After an average stay of three weeks, all were released with a diagnosis of “schizophrenia in remission.”

One of the lessons of the study was how the fake patients were treated by the professional staff as real patients. Even though the students behaved normally, once they were labeled “mentally ill,” everything they said and did was evaluated in that context. One student took lots of notes, behavior that was recorded as “compulsive note-taking.” Had he been labeled as a student, his note-taking would have been seen as quite normal.

When I taught abnormal psychology in the early 1970s, every year I took my class for a tour at a nearby state hospital. The head psychologist at the hospital took great delight in having a patient give us a tour without telling us he or she was a patient. Obviously the patient was high-functioning and stabilized on medication (which really was the case with most of the patients). After the tour we would all gather in a room and the psychologist would answer the many questions the students had. First, however, she would begin this post-tour session with some questions of her own:

“How was the tour? Did [name of tour guide] show you lots of wards and answer all your questions?” The students always had a lot of praise for their guide.

Then the psychologist fired the cannon shot: “You know [name of guide] is a patient here,” [gasps from the students!] and diagnosed as schizophrenic” (providing this information would be a violation of HIPPA privacy rules today!). Then she would launch us into a discussion of the danger of labels like “mentally ill” being put on others.

Just imagine if you walked into a meeting with many people and spotted someone unfamiliar. You ask a friend, “Who’s that guy over there? I’ve never seen him before.”

“Oh, that’s John,” your friend says. “Seems he’s been in an institution for the mentally ill and just got out. Ralph [supervisor] has known him for many years and decided to give him a job.”

How will you look at John? Will you rush over and welcome him to the organization? Will you watch his every movement for signs of pathology? Will that label “mentally ill” that is attached to him influence your interpretation of his actions? If John swats his hand at a mosquito you don’t see, will you think, “Omigod, he’s hallucinating!” (If your friend does the same thing, of course, you will probably conclude, “Must be a mosquito in here.”)

The message we want to convey is that the term “mental illness” is a label observers put on someone whose behavior is atypical; it is also a label that carries all sorts of negative stereotypes; and finally, applying the label leads to erroneous perceptions of actions we observe in another. The bottom line is that using the phrase is probably not at all helpful in our everyday interactions.

The flip side of the mental-illness card can also be quite damaging to your coping efforts. That is, how many of you get pangs of anxiety and hesitate to do something because you wonder, “What if I look like a fool? Everyone will probably think I’m mentally ill or something.” Your irrational thinking that you will be labeled mentally ill leads you down that self-defeating path of avoidance and poor coping.

Consider this exchange between a client (C) and a therapist (T). The client has social anxiety problems and is afraid of passing out when in crowds. Note how the therapist challenges the client’s irrational thoughts:

C: I picture myself walking in a crowded mall and getting so panicky that I faint.

T: You faint? Has that ever happened?

C: No……….but it could.

T: I don’t think it’s likely that you will faint if you engage in some of your relaxation breathing exercises. But so what if you did faint? Why would that be so bad?

C: Are you kidding? I would look like a fool. People would think I was an idiot………a total ass.

T: If you were walking in the mall and saw someone collapse, would you think they were some incompetent loser?

C: Hmmm. Well……….not really……….I guess I would think they were sick or something……….maybe hadn’t eaten or taking some medication. No…………I see what you’re getting at……….no, I wouldn’t think they were a loser.

T: So what does that tell you about how realistic your fears are? And by the way, suppose you really do faint, and you wake up and people are standing around you, laughing, pointing at you and saying, “What a loser! Can’t even shop in the mall!”

C: My God, I would die of humiliation?

T: You would physically wither up and die?

C: Well, I would at least be embarrassed as hell.

T: Well, good luck going through life without being embarrassed at times. But remember, you can’t control how others react. You can, however, control how you evaluate situations; you can enable yourself to say, “So what if I faint? If someone sees me as a loser, that’s their problem. The fact is, plenty of people will help me and I’ll get through it.”

In this example, notice how the client’s irrational thinking leads to all sorts of problems. In addition, the client is all wrapped up in trying to control the reactions of others. Both these actions are sure recipes for coping disaster. The point is, and we make it often in this blog, if you want to cope effectively, you must work at keeping your thinking realistic, and at identifying those things you can and cannot control. Getting all obsessed with the term “mental illness” will distract you from that task.