Bipolar 2 From Inside and Out

Posts tagged ‘public perception’

How Do We Talk About Mental Illness?

Language matters. What we call things matters. Does language shape thought or does thought shape language? Either way, both are important when it comes to brains.

The latest discussion in the debates over language is what to call mental illness (which is what I’m used to saying). Many of the words and phrases that have been in use for years no longer seem quite accurate.

Take mental health, for example. When policymakers talk about subjects like mass violence, they often speak of “mental health issues” and what should be done about them. The thing is, if someone is mentally healthy, nothing really needs to be done about that. But mental illness is a term that doesn’t sound so easily addressed. Policymakers are notorious for using language that soft-pedals actual problems. Not to mention the fact that when they talk about mental health, they’re usually talking about addiction issues or homelessness (though they still aren’t particularly effective in addressing those either).

Mental health is still a better term than “behavioral health.” I remember when community treatment centers and insurance programs were called behavioral health plans. Again, there was a lot of lumping psychiatric illnesses and addiction together. It was also wildly inaccurate. It was not the behavior that was unhealthy (the way smoking is). Behavior may have looked like the problem, but it wasn’t the cause. Something to do with thought or the brain was. Also, there was no equivalent term “behavioral illness.” That wouldn’t even make sense.

So. We have mental illness as the term currently most used, with SMI (Serious Mental Illness) often used for disorders like bipolar and schizophrenia. Lately, though, there has been a push to replace those terms with “brain illness.” (The companion term is “brain health.”) It hasn’t caught on yet with the general public, though it’s gaining some traction among practitioners, advocates, and those affected by assorted conditions. I’ve heard some people are frustrated that it hasn’t caught on more widely already. They feel the process is going too slowly.

Calling schizophrenia, bipolar, and other disorders “brain illnesses” certainly makes one sit up and take notice more than “behavioral health.” And it jibes with the notion that these mental disorders (there’s another term) are caused by something going wrong in the brain. This is not without controversy, however. There are those who think that referring to depression or bipolar disorder as “chemical imbalances” in the brain or faulty neurotransmitters (or their receptors) is inaccurate. There are various theories as to what causes these conditions, all the way from childhood trauma to gut bacteria. To me, the most likely scenario is that there’s a combination of brain-related factors and environmental influences at work here. Nature and nurture, in other words.

Brain illness is certainly an attention-getting term. That should make it more likely to catch on with policymakers, but I suspect it won’t. It’s not a comfortable concept and there are no easy-sounding solutions to it. I doubt that it will catch on with the general public either. We still haven’t gotten people to move away from crazy, insane, maniac, psycho, or even nuts and stop throwing them around indiscriminately. Hell, we haven’t even been able to convince people that psychiatric institutions don’t use straightjackets anymore.

Does “brain illness” make these conditions sound more treatable? Is it likely to increase compassion for those who have them? Is it likely to make any kind of a difference? I don’t think we’ll really know until it penetrates the consciousness of the person-on-the-street. And I have my doubts about when or if that might happen.

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Garden-Variety Jerks

I see a lot of questions of this kind: My neighbor/sister/friend does this [unpleasant behavior]. Is this caused by his/her bipolar disorder?

There certainly are behaviors of people with bipolar disorder that are unpleasant to those surrounding them. Not taking showers for a week when the person is depressed is one of them. Another, when the person is in the grip of mania, is having sex outside a relationship. Being unable to leave the house is a bipolar-related behavior. So is gambling away your savings. So is standing you up or ghosting you. And blaming themselves for everything. And taking on too many projects and finishing none of them. Talking too fast or too slowly.

Playing their music too loud or parking across your driveway is not a bipolar-related behavior. Neither is littering. Or insisting that you take the garbage out. Or yelling when they are angry. Or becoming huffy when you criticize them.

There are some behaviors that may or may not be bipolar-related – for example, talking about themselves too much. This could be an indication that the person is depressed and brooding (if the talk is about how worthless they are) or manic and aggrandizing (if the talk is about how great they are). Or it may just be that the person has low or high self-esteem that doesn’t rise to the level of pathology. Feeling that everyone is picking on them could go either way. So could taking offense at every little remark. It’s sometimes hard to tell, particularly if you’re not a psychologist.

It’s more than a little weird that people are willing to attribute all kinds of bad behavior to mental illness. But think of all the racist haters and killers that are assumed to be mentally ill. While some may be, it’s an automatic and often unwarranted assumption. It takes away from the attention that ought to be given to real mental disorders and it perpetuates the stigma associated with mental illness. Or it assumes that racism and hatred are mental illnesses. These are extreme cases, of course.

Sometimes bad behavior is not due to mental illness at all. Sometimes what you’re dealing with is a garden-variety jerk. To address the picture above, it’s not pathology to be messy and it’s not a sign of mental illness to be mad at a roommate for being messy.

There’s not a lot you can do if the behavior you object to is caused by mental illness. You may have to simply understand or let the annoyance go. The person may resent that you assume their behavior is a sign of mental illness, even if it is. And about all you can do in that case is help the person get help if you can.

When you’re dealing with a garden-variety jerk, there are other sorts of remedies you can apply. You can call the police on the neighbor with the loud stereo. You can ask the messy roommate to straighten up or leave. You can set boundaries of what you will and won’t put up with and enforce those boundaries firmly but fairly when they are violated.

Of course, there’s always the possibility that the person in question has a mental illness and is also a jerk. If you can figure out what to do in those cases, please let me know.

I’m not saying that mental illness should be an excuse for bad behavior or absolve a person of the consequences of their actions. I am saying that it’s easy to assume that all bad behavior is due to mental illness, just as much as it’s easy to assume that all bad behavior comes from being a jerk, or worse.

In a lot of cases, you simply have to live with it.

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Understanding Mental Illness

My friend Martin Baker (https://www.gumonmyshoe.com/) recently posted a series of prompts for mental health bloggers. Number 29 was: Can you ever really understand if you’ve not experienced mental ill health yourself? Here are my thoughts.

In general, I do believe that having a mental illness yourself is the best and perhaps the only way to truly understand the reality of mental illness – the daily struggles, the need for self-care, the loneliness, and the stigma.

I’ve noted before that my mother-in-law didn’t really understand the concept of mental illness. It was like the time when she saw some women on the Phil Donahue show who were talking about their hysterectomies and the pain and suffering they went through. “Those women are such liars,” she said. “I had it done and it wasn’t like that at all.” It’s a matter of assuming your own experience is true for the rest of the world as well, a common logical fallacy. (Later she came around to believing mental illness existed, at least. I attribute this to spending time with me and my husband and reading one of the books I wrote, Bipolar Me.)

Even my husband – who has lived with me for 40 years, sympathized greatly, and helped me unselfishly – didn’t really “get depression” until he got depression. It was a situational depression that deepened into clinical depression. He’s still on medication for it. I remember him saying that he felt miserable and despondent, and had for months. “Try doing it for years,” I said. “I couldn’t,” he replied.

With a person who doesn’t understand – or even believe in – mental illness, there’s not a lot you can do to change their mind. The images and stories they get from the news, movies, novels, and TV shows tell them that anyone with a mental illness is likely to be a serial killer or a crazed gunman, probably psychotic or at least delusional. Conversely, they can believe that any notorious evildoer must have been mentally ill and probably “off their meds” at the time the atrocity occurred.

We often say that education is the answer. Informing people about the reality of mental illness is supposed to raise their consciousness and help eradicate stigma. That’s all well and good, but getting accurate and informative materials into people’s hands is not that easy. Sure, there are websites, books, and blogs, but the general population simply doesn’t run across these on their own. We who deal with mental illness daily must point them to these resources. Even then, there’s no guarantee that they’ll read or interact with the resources. They have to be interested in and open to the topic.

Public awareness campaigns featuring movie stars and top athletes may help in getting the audience to believe in mental illness in others, and even if they have a mental disorder such as depression themselves. Whether these can counteract the inaccurate and insensitive portrayals of mental illness in the media is still, I think, an open question. Even commercials for various medications for psychiatric illnesses can help people understand a little bit more, though I still believe that many of these ads present a less-than-accurate picture of depression, for example, making it seem no worse than a hangover. And many of the ads promote telemedicine sites for those who have – or suspect they have – some sort of mental disorder. They are less useful for the totally uninformed.

Still, we keep trying to inform and educate. But are we shouting down a rabbit hole or into an echo chamber? Maybe seeing posts from Facebook friends who have mental disorders really does help. I know that some of my Facebook friends have said that my posts and blogs on bipolar disorder have helped them learn.

But in general, I’m pessimistic about people understanding mental illness until or unless they experience it for themselves or in their own families – and maybe not even then. There are those who deny that they have depression, for example, or who may suspect they have a psychiatric disorder but feel that getting help is “for the weak.”

Or maybe I’m just pessimistic today.

Nevertheless, I’ll go on writing this blog in the hope that it will make a difference to someone.

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Is Stigma a Problem? Is Systemic Breakdown?

Some people who have mental illnesses say that stigma is a problem. Others say that’s not the real problem – a lack of social or political action is. I say, why not combine the two?

Stigma Fighters (https://stigmafighters.com/) and other organizations such as the International Bipolar Foundation (ibpf.org/), the National Alliance on Mental Illness (NAMI) (https://www.nami.org/Get-Involved/Pledge-to-Be-StigmaFree), and even Facebook groups, promote the eradication of the stigma surrounding mental health issues. They say that mental illness is stigmatized in our society – some even deny that it exists – because people don’t understand it. This happens when churches say that mental illness is a sign of sin or refuse to welcome people with mental problems into their congregations or have any kind of outreach to them. It happens when a person is honest about having a mental illness and tells her boss or friends about it and receives negative feedback, incomprehension, or the back-away-slowly-and-don’t-make-eye-contact look.

People who believe that stigma is a problem say that stigma is one of the largest reasons that people refuse to seek treatment for their mental disorders. Being seen going into a psychiatric clinic, people finding out that the person sees a psychiatrist, and being ignored or discounted when talking about mental illness are seen as ways that stigma propagates.

People who believe that stigma is a problem promote education as the main solution. If more people understood what mental illness is and how many people suffer from it, they would be less likely to discriminate against those who have mental conditions. Stories about celebrities who have mental dysfunctions or whose relatives do are considered inspiring and helpful. Stars who speak out encourage others to seek treatment (though it’s increasingly true that public expressions of mental illness diagnoses are tied to specific online therapy businesses).

People who believe that political action is necessary also try to effect changes in people’s thinking, but, more importantly, support changes in the systems that are supposed to provide services to the mentally ill. These systems include schools where mental illness plays no part in the curriculum; lack of beds for psychiatric patients in hospitals; the response of police to calls regarding people with mental disturbances; the number of medical schools that provide no information to doctors; the lack of psychiatrists, especially in rural communities, which mean people must wait a long time for services or have no access to them at all; politicians who put mental health issues low on their list of priorities; law enforcement that reacts with deadly violence to calls involving persons with mental illnesses; and health insurance and EAP (Employee Assistance Programs) that treat mental illness differently than physical illness or even addictions. NAMI promotes grassroots activism as one facet of the appropriate response to such problems (https://www.nami.org/Advocacy/Advocate-for-Change).

People advocating for political change also see education as one partial solution to the problems caused or exacerbated by insurance companies, educators, medical schools, media, law enforcement personnel, correctional facilities, and politicians. Political action is seen as the right course to take to improve conditions. (Though it should be noted that people have sent books about the breakdown in societal responses to mental illness to politicians and receive only standardized, unhelpful “thank you” letters that are mostly signed and sent by staffers rather than the political figure.)

I say that education is the best response to both of these problems. Education of the general population about the realities of mental illness will lead to less stigma. Education of the voters, their representatives, and their local communities will help to lessen the inequities and difficulties that now abound.

This will not be easy. Education about the realities of mental illness is hard to convey to either citizens at large or politicians and others who have some degree of authority. Until it touches their own lives, people will largely be blind to the problems. Educational campaigns and the testimony of celebrities may help educate individuals. But politicians are likewise only affected by the aspects that touch their own lives, such as the public revelations by those like Kitty Dukakis (wife of former presidential candidate Michael Dukakis), who has been quite open about her mental difficulties and her ECT treatments (https://www.amazon.com/Shock-Healing-Power-Electroconvulsive-Therapy/dp/1583332839).

What I fear is that these individual occurrences will motivate only a small number of people enough to make a change in society as a whole. It’s easy enough to say, “Oh, Catherine Zeta-Jones has bipolar disorder. Too bad for her, but that doesn’t affect me” or “Someone in my family has a mental illness, but my constituents won’t support legislation to benefit the homeless mentally ill or to provide halfway houses in their neighborhoods. Better to spend my time and influence on stopping terrorism or drugs.”

But until or unless something changes, mental health will still be swept aside or ignored outright. People at large need to understand that just because mental illness hasn’t touched their lives so far, it still could in the future. Public officials and public servants need to believe that mental illness issues are vital to their communities and something that can be made better if only they have the courage and compassion to make the necessary changes.

Stigma-fighting or political action? Both are problems that need solving and education is at least part of the solution to both. And it appears that it’s up to us, those who have mental illnesses, to do the educating.

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The Rights of Mental Patients: An Early Crusader

In 1887, investigative journalist Nellie Bly pretended to be insane so that she could report on the conditions in a New York asylum. The results of her sojourn there were the subject of her book Ten Days in a Madhouse and became the catalyst of increased funding for mental institutions. (I wrote about her in https://bipolarme.blog/2016/03/20/what-is-sanity/.)

Now there is a book that recounts an even earlier example of a woman who publicized the conditions in an insane asylum. It has a bearing on the rights of mental patients and involuntary commitment.

The legal rights of mental patients have been much discussed of late. Involuntary commitment is a particularly thorny subject. Some people decry it as a violation of civil rights. Others point to its usefulness in cases of extreme danger to self and others, but also in cases of anosognosia that do not quite meet that standard. “Assisted outpatient therapy” is one version of involuntary commitment that has many supporters. (See my post https://bipolarme.blog/2020/03/08/systemic-breakdown-and-involuntary-commitment/.)

Long before this became a matter of debate, and a couple of decades before Nellie Bly’s exposé, a woman crusaded for the rights of mental patients and against the practice of involuntary commitment. Of course, the involuntary commitment she decried was of married women by their husbands, and in 1860s Illinois, husbands were perfectly able to do that. The causes cited could be as varied as novel reading and masturbation (two separate categories). For Elizabeth Packard, the reason her husband gave was that she was insane because she disagreed with his religious opinions and dared to teach her opinions to others.

Karen Moore’s book The Woman They Could Not Silence recounts Packard’s story, in detail. Meticulously researched (as was Moore’s previous book, The Radium Girls), the nonfiction work is based on many primary sources, including Packard’s own writings (from when she was in the asylum and hid her papers, in one case inside her hat, as well as the book and pamphlets she published) and newspaper accounts of her crusade and her trial.

Packard’s trial was a result of a law she had promoted requiring a civil jury trial before a married woman could be committed, instead of on her husband’s word and the recommendation of an asylum doctor. Interestingly, immediately before the jury trials were mandated to begin, hundreds of married women were miraculously “cured” and released from the asylum where Packard had been held.

Once released from the asylum, three years after being committed, Packard became a tireless campaigner for the rights of the involuntarily committed and of married women (who at the time were not entitled to their own money or property, or even their own children). Packard also exposed the abuses that mental patients suffered at the hands of asylum staff, including isolation, beatings, and cold water baths (near-drowning) used as punishment. Another policy that she sought to have changed was withholding mail from mental patients. Packard had been prevented from reading supportive letters that her relatives had written.

Women dabbling in politics was not common, or approved of, at the time. Packard was able to influence lawmakers and other officials with a combination of her compelling speaking style, her eloquent presentation of her cause, and her remarkable tenacity. To say that she had an agenda is putting it mildly.

The prologue to The Woman They Could Not Silence begins, “If she screamed, she sealed her fate. She had to keep her rage locked up inside her, her feelings as tightly buttoned as her blouse,” and the book ends, “There was a world out there that needed reforming. And she was determined to do it.”

The Woman They Could Not Silence (subtitled One Woman, Her Incredible Fight for Freedom, and the Men Who Tried to Make Her Disappear) was selected by A Mighty Girl (http://www.amightygirl.com/), which serves as a clearinghouse for books, toys, and other products for adults and children, as one of their “Pick of the Day” recommended books for adults.

I highly recommend it too.

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COVID News and Mental Health

Many people have been blaming COVID for depression and other mental health problems. They have said that quarantining and uncertainty have raised the level of anxiety in the general population, and quarantining has caused depression. These increased levels may be – probably are – accurately reported, but I don’t think they necessarily indicate an increase in the incidence of mental illness in our society.

The depression and anxiety that people are feeling are, I believe, natural and expected reactions to the pandemic conditions that prevail. I’m not trying to minimize these experiences, but most people have never experienced clinical depression or anxiety and so don’t understand the nature of the actual illnesses. What depression and anxiety the pandemic has caused is likely to clear up when (if) the pandemic does. This is situational depression and anxiety.

This is not to say that people experiencing pandemic-related depression and anxiety don’t need help. Of course they do. “Talk therapy” may do them a lot of good, and there has been an upswing in the number of online and virtual counseling services available. Whether these people need antidepressants and anti-anxiety meds is a question I’m not able to answer. My best guess is that they don’t, at least not long-term courses of drug treatment, as their symptoms are probably not indicative of mental illness. Short-term anti-anxiety meds may do some good.

I do think that the pandemic and the reactions to it have been triggering for many people who do have mental health conditions. People with OCD who are germophobic saw their most extreme fears become reality. People who have Seasonal Affective Disorder may have suffered more from lack of sunlight during the stay-at-home orders and quarantines.

Many people are in extreme denial, believing that the pandemic is a hoax and refusing to take any steps to prevent its spread. Is this a symptom of mental illness? I don’t see how threatening officials and doctors who promote pandemic precautions is a sign of mental health, but are the people who do this delusional or are they merely at one extreme end of the anxiety spectrum?

I understand that people’s perceptions of reality differ, but it annoys me when people deny mine, which currently is made up of snot and phlegm, as well as depression and anxiety. We can have these academic debates, but for my husband and me, at least, the pandemic has pushed us from believing that it is “out there” to realizing that it’s in here, in the most literal and alarming sense.

My husband has tested positive for COVID, and I have a terrible sore throat and cough, so I likely have it too. We’re resting and taking Coricidin until we hear from our doctors what to do. A dear friend has sent us a pulse oximeter, with instructions to get more help if our O-sats fall below 90.

All this is messing with my head. I was entering a depressive phase anyway. Now I’m not sure if it was due to my bipolar disorder or my immune system crapping out. (Just FYI, my husband and I are both triple-vaxxed. He probably got the virus at work and undoubtedly passed it on to me. I can’t imagine I would test negative now.)

I don’t think our illness is life-threatening, though honestly, it could be. You never know with COVID. And now, that’s part of my reality.

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Sharing About Bipolar

Sometimes I despair. I have realized that part of the meaning in my life is to share with other people the realities of bipolar disorder. At times, I think I have failed. I know I shouldn’t let the fact that others, such as Gabe Howard, Pete Earley, and Laura Pogliano, to name but a few, do it better than I do discourage me. This is not a contest. Everything any of us does to spread the word about bipolar and other mental disorders is a positive thing.

Here are some things I have tried.

Books. I wrote two books based on my blog posts. Neither of them sold very many copies. The first one was published by what I’d call a seat-of-the-pants indie company, and the other one half by them and half by myself, so quasi-self-published. I had a book reading/signing at the local Barnes & Noble. Two people came. We did have an interesting question-and-answer session, even drawing in a couple more people from the cafe where we set up.

I promoted my books, but not very well. There were a couple of podcasts. On one, for first-time authors, it was evident that the host had never read my book, though I sent him one. He asked me questions like, “Are there any other creative people in your family?” My interview on Bipolar Girl went better, but I had no way to gauge the response. I got a write-up in the local paper, but it was clear they wanted me to buy an ad, which I was unable to afford and my publishing company was unwilling to fund. The publishing company did send out form letters to various outlets, but I completely misjudged who should receive them. There were no reviews.

Tattoos. The idea behind the Semicolon Project was that people concerned with suicide awareness and prevention would get tattoos of semicolons. (The idea was that a semicolon is a place in a sentence where a writer could have put a period and stopped, but chose to go on.) When people asked about the peculiar punctuation tattoo, one was supposed to open a dialogue with them about suicide, suicide helplines, and the like. I got the semicolon tattoo and also a bipolar tattoo (a colon, half a parentheses, and another colon to make both a smiley and frowny face). Like this : ) : Gabe Howard has used this symbol on his merchandise, such as t-shirts, mugs, and stickers, and I hope he has achieved a great response. But no one has asked about either of my tattoos, so I have never had to explain them.

Blog. This blog is the most successful of my methods of reaching out to others to get across my message about bipolar disorder and mental health. It reaches a few dozen readers every week, unlike the thousands of viewers that many sites get. I cross-post my blogs to other sites like The Mighty, Medium, and Thought Catalog, when appropriate. I had somewhat of a better following on Medium, but then their Invisible Illness section decided they wanted posts with more research than I was able to provide, and from writers with higher academic degrees than I have.

The Mighty has been the most consistent in featuring my posts and the most successful in garnering responses. They also sent me a The Mighty t-shirt and hoodie, which, again, no one asks about.

I don’t mean to whine (though I suppose I am), but I sincerely wish I could reach more people. There are many in this world who need to hear the messages about mental health in general and bipolar disorder in particular. Of course, I’m not a celebrity, so I’m not likely to be featured in news stories or TV ads. But, since I am out of other ideas, I will keep on with this blog and any way I can think of to spread the message.

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What God Gives You

There are two expressions, common in “inspirational” memes, posters, and the like, that rub me the wrong way.

One is “What doesn’t kill me makes me stronger.” I addressed that one in a post (https://bipolarme.blog/2014/11/10/suffering-and-train-wrecks/) roughly seven years ago, and now I’m ready to tackle the other.

“God doesn’t give you more than you can handle.”

Let’s take a look at the premise. It implies that God gives us all our trials and troubles. Already, I have problems with that. Perhaps God is love and the devil gives us trials and troubles. Perhaps neither God nor the devil is involved, and life gives us trials and troubles. Perhaps even we give ourselves trials and troubles. It strikes me that these are equally valid propositions, though many people favor one or another.

At the heart of it, though, is the fact that there are trials and troubles in our lives, whoever or whatever gives them to us, and we must handle them. Wherever they come from, they will not be more than we can handle, the saying states.

The evidence of our eyes, and perhaps our own lives, says that this simply isn’t true. Plenty of people encounter (or have given to them) more than they can handle. Think of the homeless mentally ill. Are they able to handle what they’ve been given? The woman with her third miscarriage? The veteran with catastrophic injuries? Sure, some of them face their conditions bravely, but others don’t, and they’ll never make the news as “inspiration porn,” the uplifting stories of people who can and have overcome their afflictions, which is predominantly what we hear about in the media.

The fact remains that some people do receive more troubles than they can handle. There are serious mental illnesses that have no treatment. There are injuries and horrors that leave a person scarred inside and out. There are troubles that are so bad they contribute to death by suicide. In these and other cases, someone or something (or simply life itself) has given certain people more than they can handle.

The premise behind the saying, however, is that God never gives YOU more than YOU can handle. What I’ve said doesn’t mean there is no hope – only that it might come from a source you don’t expect. That might be the same God who ostensibly gave you those trials. It might mean another person, or a group of people, or a society can help you with what you need to make it through.

It’s not necessary to leave it all up to God to solve these problems. And it may be that we cannot rescue ourselves. But perhaps we can be that person, or one of those people, who can help someone whose troubles are more than they can handle by themselves.

I won’t argue whether it is because of the grace of God that other people help. But the original saying, in all its simplicity, is too simplistic. I believe that troubles and trials come to us from somewhere in the world, not from God, and people in the world are ultimately the ones who can help us handle them.

I’m not trying to deny the actions of God in the world. I’m saying that we must do our part to solve these problems too. Donate to a good cause. Volunteer to help. Listen to someone who’s hurting. Even just buy a box of cookies from a Girl Scout. Let’s make that “you” an “us.” God (or life) never gives us more than we can handle – together. (Note: Don’t even get me started on “God helps those who help themselves.” That’s not even in the Bible. Go ahead and look. I’ll wait.)

And why is this post in a blog on mental illness? Because that’s one of the things that some people can handle and others can’t, whether it was God or genetics or brain chemicals or trauma that gave it to them.

Simone Biles: Mental Health Is Health Too

There’s been a lot of media interest lately in Simone Biles. The gymnast described by many as the Greatest of All Time withdrew from the Olympics, citing mental health reasons. Many news outlets and commenters have been understanding, but some have not. A Texas Deputy Attorney General, for example, called Biles a “selfish, childish national embarrassment,” which he apologized for six hours later. A podcaster called her “weak,” and said that her performance showed that “when things get tough, you shatter into a million pieces.” After Biles pulled out, the team won a silver medal, with the Russians getting the gold.

Many have compared Biles with Kerri Strug, who performed the vault in the 1996 Olympics, despite having an injured leg. At the time she was praised for her courage and strength, although it turned out that the American Women’s Gymnastic Team would have won the gold even without Strug’s dramatic vault.

Biles’s situation and its comparison with Kerri Struggs serves to reinforce the idea that only physical injuries are “real” and that talking about and acting on mental health matters is not acceptable. Yes, Olympic swimmer Michael Phelps has talked about his struggle with depression, but only after the Games were over. It was brave of him to talk about it, but he received little to no backlash after deciding to talk openly about depression and suicidal ideation.

As in so many other situations, mental health and mental disorders are considered less “real” than physical disorders. And the pressure put on athletes and Olympic athletes in particular can be a factor in damaging their mental health. Athletes have long been encouraged to “play through the pain,” even when that results in severe physical injury. Few have considered how playing through psychological pain affects athletes.

Added to the stress of competition and the pressures of fans, parents, and coaches to succeed, many athletes have suffered through physical and sexual abuse. Simone Biles has commented that she is part of the #MeToo movement that has brought attention to previously unrecognized instances of sexual harassment and exploitation. In a lengthy tweet, Biles revealed that she was one of the victims of team physician Larry Nasser, who is now in jail following over 100 counts of such behavior. “As I continue to work through the pain,” Biles tweeted, “I kindly ask everyone to respect my privacy. This is a process, and one that I need more time to work through.” She could have tweeted the same thing regarding her recent mental health problems.

Another factor in the language surrounding Biles’s decision to remove herself from the Olympic competition is how many people talk about how she personally denied “us” a gold medal (as if all Americans were in contention for the medal) or ceded the victory to the Russians. Ideological matters ought not to be a point of discussion regarding an athlete’s mental health. But they are. People forget that the Olympic Games are just that – games. Too much patriotic fervor is whipped up based on the outcome and the international goodwill of the Games has been lost.

Along with the fact that an amazing athlete was strong enough not to let the pressures of competition further affect her mental health. Simone should be praised for her decision, not called weak and childish.

Words Matter

“Sticks and stones may break my bones, but words will never hurt me” is one of the worst lies that grownups tell to children. Children threw stones at me when I was a child (though they fortunately never broke my bones). But the many, many words they hurled hurt me deeply internally, rather than externally. I was bleeding inside from them, as much as I bled externally from the rocks.

Plenty of children feel the pain of words. We say, “Children are cruel” and leave it at that, or tell children to simply ignore cruel remarks. We have anti-bullying campaigns that are notably ineffective, especially in the face of cyberbullying. Children who hear demeaning words from their parents, teachers, or other adults are likely the most damaged.

People with mental disorders feel the pain of words, too. There are many ways this happens.

One of the most common taunts, often used in popular media, is “psycho.” One may possibly excuse Robert Bloch, who wrote the book Psycho in 1959, and Alfred Hitchcock, who made the movie in 1960, because they were products of their time, when microaggressions and the concept of nonracial slurs did not exist. American Psycho (2000), has much less of an excuse. In movies such as these, “psycho” is shorthand for “serial killer.”

But now “psycho” is in common usage in phrases such as “psycho bitch from hell” (which is anti-woman as well as offensive to persons with mental illness). Songs such as “Sweet But Psycho,” “I Might Just Go Psycho,” and “Am I Psycho?” are recorded.

“Craziness” is also taken lightly in words and phrases such as “cray-cray,” “cuckoo,” “maniac,” “lunatic,” and “cracked,” not to mention “bonkers,” “bananas,” and the more offensive “batshit crazy,” “bug-fuck crazy,” and dozens of other words. There’s even the stereotype of “crazy cat lady.” It may seem cute or silly to call a friend one of these words in a joking manner, but the person who does have a mental illness hears such a word as an insult. Even if it is just overheard, it tells a lot about how the speaker regards the seriousness – or unseriousness – of mental disorders.

There are lots of other examples. “Off their meds” is one. It, along with plain “crazy” or “psycho,” is quite often applied to mass shooters, suicide bombers, and other offenders. While it is true that some of such people have mental disorders, the terms are thrown around long before anyone finds out whether the person is diagnosed with a mental illness or is on psychotropic medication. It is the default explanation. Julie Beck, in an article in the Atlantic, called the easy leap from mass killing to mental illness “a consistent and dangerous narrative.”

Other usages seem innocent enough, but really aren’t. “The weather is bipolar,” meaning it changes quickly, is common. It isn’t accurate, however. Only a person can have bipolar disorder, a serious illness. Applying it to oneself when you change your mind or have a momentary mood swing, is also inaccurate. Likewise, “schizophrenic” is used to describe something or someone that has two sides, or that seems incomprehensible to the viewer. “Multiple personality” (more correctly called Dissociative Identity Disorder, or DID) is shorthand for someone who exhibits different sides of his or her personality on different occasions. People who disagree with you politically are not “insane” or “crazy” either, unless they have been diagnosed with a psychiatric disorder by a professional.

These ways of speaking hurt the persons they are spoken about, but also the mental health community. Fear of being called “psycho” or “crazy” is one reason that some people don’t seek treatment for a disorder or conceal it if they do.

And that’s a sin and a shame.

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