Welcome to From Insults to Respect. 

Perhaps some of you who have joined us here today have begun to notice that many in the media have begun to replace using the words “mentally ill,” “mental disorder,” or “psychopathology,” with words like, “a person with a mental health concern,” “mental health issue,” “mental health challenge,” or “mental health problem.” This change is viewed by some as more respectful, while others insist that this realm of existence is an illness like any other illness, and we should therefore stick to the original psychiatric terminology.

Why would anyone care what words are used to refer to a group of people? Isn’t one name just as good as another? Try convincing a black person that the n-word is as good as any other name to refer to him or her, and you might begin to see that some people do have strong emotional reasons for their word preferences.

A concept like “mental illness” is used to serve mainly a pragmatic purpose, though in time it may begin to pick up some negative emotional associations that pack a pretty nasty punch in the gut. So, with this in mind, let’s take a few minutes to examine the pros and cons of using these mental illness-type concepts. But first, a brief tour of the health care system will set the stage for our pros and cons discussion.

Brief Background History

For centuries people who were financially well off went to doctors that specialize in treating physical ailments. For those who had money merely for food and housing, home remedies substituted for professional care. Some of these poor folks saw themselves getting worse and worse and ended up desperately crying out for help at hospital emergency rooms.

This presented a moral dilemma for physicians. On the one hand, treating these poor souls for free would save lives. On the other hand, their hospital would be unable to economically survive because it’s expensive to provide treatments for free.

Advocates for moral physicians, the poor, and hospital administrators struggled with this for years. Eventually, the idea came about in most developed countries that the government could create an insurance program that would have all tax payers pay an affordable increase in taxes and this would fund health care at no extra cost for all of its citizens whenever any of them become sick.

Despite most developed countries upon actually trying this approach and discovering it is a workable solution, the United States decision makers set up an alternative that had private insurance companies offer policies to people who could afford its premiums. This expanded to some degree the number of people who were able to access healthcare.

Poorer people, however, could not afford these premiums, and continued to show up at emergency rooms. When hospital administrators pressed for payment, an enormous amount of people ended up bankrupt, while hospitals found the legal bureaucratic process of bankrupt proceedings taxing and financially problematic.

In time, advocates of some doctors, hospital administrators, and the poor increased the availability of healthcare through political action that led to the passage of some aspects of the Medicaid and Medicare programs. With the passage of the Affordable Care Act, even more people can now afford insurance premiums.

So, there you have it, the essential background information needed to consider the pros and cons of the pathologizing and psychiatrizing mental illness concept. In our next section, the concept’s perceived benefits shall be presented. As you read it, please remain mindful that not everyone agrees that each of these perceived pros are indeed pros, especially when long term consequences are taken into account. That being said, bear with me as I temporarily skip over these richly complicating issues until we reach the subsequent “Cons” section.

Pros

The two main pros to the mental illness concept are, 1. connecting the concept to the notion of illness helps to increase access to needed services and 2. it reduces stigma, blame, and guilt.

Increasing Access to Support Services

While all of the health care changes I discussed above were going on, there were individuals who were experiencing concerns regarding their level of distress, dysfunction, abnormal feelings, or behavior. Some went to their clergy for guidance, and this continues to this day. Others who could afford it, went to their medical doctor. Typically, when nothing physically wrong could be found to explain their patients’ concerns, doctors had little to offer other than unsupported theories such as pathological glands, toxic substances in their blood, chemical imbalances, or brain neurology. Often, placebo pills or sedatives were prescribed along with a few kind words of encouragement. However, some doctors took a special interest in just these types of concerns, and began to specialize in treating these patients, calling themselves psychiatrists.

Initially these psychiatrists claimed that because these concerns were due to real illnesses they were the only ones who should be permitted to legally diagnose and treat these types of patients. To bolster their argument, they referred to their patients with medical sounding terminology. Their treatments at first consisted largely with what they called psychotherapy, which was a specialized conversation. Later, lobotomies, new pills, and electroconvulsive treatments were added.

In the last few decades, other professionals, such as psychologists, counselors, life coaches, and social workers began to compete with psychiatrists in providing conversation-type services to this group of people at significantly lower hourly rates. Psychiatrists, realizing they were the only professionals that could legally prescribe drugs, began to focus on the pill prescribing side of treatment. The pharmaceutical industry, for their part, came up with some pills that were marketed as “antidepressants,” “anti-anxiety medications,” and “antipsychotics.”

To expand their client base, psychiatrists along with the powerful pharmaceutical lobby, made the case that since these mental illnesses were illnesses the insurance industry and government agencies should offer health insurance plans that covered mental illness treatments. When this succeeded, two other mental health services providers–licensed psychologists and mental health counselors–provided research findings indicating their psychotherapy approaches offered relief to those viewed as having a mental illness. Decision makers became convinced, and in recent years, more and more health insurance plans are including coverage for a limited number of psychotherapy sessions.

This increased access to treatment to a wider number of folks, and in the United States, advocates were able, through the Social Security Administration, to provide additional types of support for people it refers to as having a “serious mental illness.” Its Social Security Disability Insurance and Supplemental Security Income programs provide funds and help with housing.

So, one of the major perceived pros of the mental illness concept is that by tying psychological concerns to the concept of illness, it probably made it easier to convince decision makers to expand access to services for those struggling with these challenges. Additionally, for psychiatrists, other mental health service providers, and the pharmaceutical industry, their businesses have flourished.

Reducing Guilt and Blame

The mental illness concept, it has been argued, reduces for many parents feelings of guilt when their offspring begins to develop mental health concerns. Interestingly, many in psychiatry initially were the ones who actually increased parental guilt despite utilizing the mental illness concept. They had argued that schizophrenia is caused by bad parents, and especially by bad mothers (see HERE for a scholarly review of these theories).

In brief, mothers of patients were presumed to have provided a lack of authentic love of their child. Schizophrenia, and depression, according to other psychiatrists blamed some of women’s psychological concerns on their fathers molesting them. And so parent advocacy groups such as the National Alliance On Mental Illness (NAMI) jumped on the notion that mental illnesses were blamelessly due to an illness like any other illness such as diabetes or cancer. Most current psychiatrists are supporting NAMI’s position.

Despite the biological approach having failed over decades to find a relevant brain lesion or source of infection, or to nail down the hereditary nature of conditions referred to as mental illnesses, the “brain disease” idea still manages to alleviate parental guilt. It also alleviates the guilt of many patients who are told by people close to them that they should just snap out of whatever is concerning them. “You can’t just snap out of cancer, can you?” these patients argue. “My doctor says I have a real illness like any other illness, and I am acting responsibly because I went to a doctor, got diagnosed, and I’m taking my prescriptions.”

So, there you have it, the main perceived pros of the mental illness concept. By incorporating the word “illness” in naming this concept, which had already successfully helped to increase access for physical illness services, it appears to have eased the way to convince decision makers to provide access to services to address psychological concerns. Moreover, parents of the mentally ill labelled patients, along with the patients themselves, found that believing these concerns were illnesses like any other illnesses reduced their sense of guilt.

Cons

In seeking to weigh the pros of the mental illness concept with its cons, let’s break this task into four parts–1. insurance and government services issues, 2. illogic of trying to equate mental illness with physical illness, 3. psychiatric treatments causing more harm than good, and 4. confusing guilt with responsibility.

Insurance and Government Services Issues:

As mentioned above, one can theorize that the mental illness concept made it easier for insurance executives and government decision makers to agree to support providing services to people dealing with psychological concerns. In thinking about this, let’s first consider what really happens in the insurance industry when these types of decisions are made.

Long before mental illness policies were added to health policies, insurance companies had been offering policies that required no required illness connection. Examples of this are car insurance, theft insurance, flood insurance, etc.

In deciding to offer a policy to customers, insurance companies simply use actuary data to decide how much to charge people so the premiums would provide a profit. This is what they actually have done when deciding how much to charge for a policy that provides coverage for those who receive a “mental disorder diagnosis.” So, logically, there is no actual need for insurance companies to see mental health concerns as illnesses.

Some may argue that insurance executives, when considering whether or not to offer policies to people who are declared as having a mental illness probably first considered the following. By limiting services to just folks whose concerns are serious enough to warrant a mental disorder diagnosis, this would keep the number of people accessing services to a more manageable level. Thus, the system would avoid becoming overloaded with clients, and insurance premiums would remain manageable.

However, here is the counter argument. Mental health service providers now using the current “diagnosis” approach are not turning anyone away who has mental health insurance coverage. Professionals are in the business of increasing their clients. The current “diagnosis” system is so vague that anyone currently seeking services are easily provided with some “diagnosis” regardless of their expressed psychological concern.

So, with regards to the question, Was it easier for insurance executives to decide to offer policies that provide mental health support services because of the mental illness concept, there is really little logical support for this. How about for government decision makers? Again, we find example after example that the government provides support for reasons other than illness. The Federal Emergence Management Agency (FEMA) funds are used when an earthquake or flood devastates a community. Local, state, and federal funds are used to provide extra services to school age students who fall academically significantly below average. No illness connection is required to convince anyone that these kinds of services are in the best interest for our communities.

So, in conclusion, when insurance executives or government officials decide whether funds are to be used to provide assistance to people, employing a concept that includes the idea of an illness is simply not a necessity.

The Illogic of Equating Mental Illness
With Physical Illness

A diagnosis of a physical illness requires the doctor observing the presence of a physical pathology. A diagnosis of a mental illness occurs when the doctor does not find any evidence of the presence of a physical pathology such as a virus infecting the body, an MRI identifying an internal lesion, etc. There is no actual diagnosis when a psychiatrist says he or she has made a mental illness diagnosis. The doctor simply has a conversation with the patient and assigns what is referred to as a diagnosis despite research studies indicating this type of classification system lacks reliability and validity.

Rather than using an “illness” metaphor to convince insurance companies and government decision makers to provide support services for the concerns now being addressed by them, it would be more logical to refer to these concerns as “mental health” concerns and develop a classification around this concept. The word “health” in such a  classification system would be used to provide the logical argument that professionals dealing with mental health concerns are part of the allied health professions. The reason for thinking of these professionals as health providers follows:

Many of the concerns that would fall under this type of classification system (behavior, emotion, mood, addictions, meaning of life, death, dying, managing chronic pain, work, relationships, education, eating, cognition, sleep, and challenging life situations) have been identified in scientific studies as “physical health risk” factors. For example, people who express a concern about being addicted to alcohol are at increased risk of developing sclerosis of the liver (O’Shea, Dasarathy, & McCullough, 2010). Those who express concerns about eating more than average may be at greater risk of diabetes and heart disease (Mokdad et al., 2003). Quality of interpersonal relations, lack of sleep, depression with thoughts of suicide, and various other concerns or clusters of concerns can be studied for the degree of physical health risk that they pose.

The Mental Illness Concept Encourages Medical-type Treatments For Mental Health Concerns, Which has Led to More Harm than Good

According to the scientific evidence, the types of services that have come about as a result of medicalizing these types of concerns with “mental illnesses” terminology, has been far more harmful than health promoting. Medical doctors, which include psychiatrists, think of treatments chiefly in terms of surgery and medicines. Early in the psychiatric profession the surgical operation that it came up with was referred to as lobotomies.

First introduced in the 1930s, this highly traumatic brain procedure was once seen as a miracle cure for mental illness. But it soon became apparent that many patients lost their ability to feel emotions and became apathetic, unengaged, and unable to concentrate. Some became catatonic, and a few even died. After a few years it became clear it resulted in far more cons than pros, and has since been discarded.

The medical profession of psychiatry has now turned to the treatment option of prescribing “antidepressant, “anti-anxiety,” and “antipsychotic” pills. As it turns out, when the long term effects of consuming these pills is considered, overwhelming evidence indicates far more harm than good (see HERE). In brief, data indicate rising disability rates since these drugs became the standard treatment. Standard mortality rates for schizophrenia and bipolar patients have worsened as well. Long-term studies tell of higher recovery rates for schizophrenia patients off medication. There is evidence that tells of how depression has been transformed from an episodic disorder into a chronic condition in the “antidepressant” era.

Why, then, do so many people who have received this type of treatment report that they are being helped by them? It has to do with how most psychoactive drugs create the illusion that they are helpful (see HERE, and HERE). The best way to understand how this illusion is created, is to consider how people come to believe smoking cigarettes help them to deal with their stress. Thus, in a study published in the American Psychologist, researchers found the following:

Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known.

This same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and the drugs that psychiatrists prescribe. They all create the illusion that the pills improve their functioning initially through a placebo effect. Then, once their bodies adapt to the drug, each time they haven’t taken the drug for a few hours, they begin to experience a withdrawal effect that they attribute to their mental health concern returning. When they take their next pill, their relief from the withdrawal effect abating is experienced as pleasant, and with that, the illusion has been accomplished. For many people, it is only by gradually withdrawing from these addicted substances can one safely recover from this type of addiction (see HERE for support to safely withdraw from these drugs).

Confusing Guilt With Responsibility 

As for the belief that framing mental health concerns as an illness like any other illness reduces blame and feelings of guilt, this too is an illusion. Despite this belief, many people continue to blame parents for their offspring acting in certain socially unacceptable ways and they continue to blame the patients as well (see HERE). By the way, many also feel guilty when they get certain physical illnesses. For example, tobacco related illnesses often are met with a regretful twinge.

Rather than trying to convince oneself that a mental illness diagnosis somehow significantly reduces stigma, we would be better off considering the difference between blame and responsibility. Guilt and blame are associated with the attitude that the guilty party deserves to be insulted and punished, something I don’t at all support. In contrast, responsibility indicates that when working through troubling experiences, you recognize you have an important job to do. This job involves allowing yourself to fully experience the physical sensations that come, not as something awful, but as something useful and containing even some aspects of great beauty. It is like sitting beside a sparkling blue ocean listening in a caring way to a good friend who is going through an anxiety or grief experience, and empathizing on a physical level with what he or she is experiencing. This experiencing leads as naturally as life itself to seeking ways to address the concerns that bring about anxiety and grief.

Even if no immediate promising ideas come from a particular episode of spending time in this way, taking responsibility involves keeping hope alive. This means that you recognize that with particularly challenging situations, it takes an extended time to fully address such concerns. In the coming days, new, fresh ideas may yet come your way, or the situations that brought about the concerns may change in unexpected ways to your advantage. In contrast to acting responsibly, experiencing guilt when feeling anxious or grief becomes an aversive experience. The mental illness label pathologizes the concern, but there is a potential of improving one’s life with the experiences that get these illness conceptualizations.

Taking responsibility for one’s concerns, in my opinion, involves welcoming these experiences, kind of like you might a friend, for these experiences enrich our lives if handled responsibly. If you have something more pressing to take care of for a short period of time, it can make sense to gently delay your interaction with whatever anxiety and grief you have to deal with until a more convenient time. However, the responsible thing to do is to soon invite these experiences back so you can spend some time to work through these types of concerns. Daily meditation, quiet walks in natural environments, and journal writing, are free and ideal ways to do this.

Wow, this post has gotten quite a bit longer than I intended. I think I’ll give it a rest at this point. With that, I bid you a warm adieu.

My Best,
Jeff