Key Learning Points So Far:
The portrayal of mental illness by writers/creators affects stigma. Stigma leads to negative treatment once individual is identified (‘marked’) as mentally unwell.
Up to 1 in 4 people can be affected by mental illness so if any of the topics discussed here affect you contact your health professional (General Practitioner in the UK).
Spoiler Alert:Here there be spoilers. Deal with it. I will try not to reference anything currently showing in cinemas, but I make no promises.
Part 2: What is Mental Illness
Everybody thinks they know what mental illness is, and to an extent that may be true, but not as often as one would think.
For example, a person with Cerebral Palsy is often mistakenly assumed to be mentally ill, perhaps due to the similarity of the movement disorders to side effects of antipsychotic medication or movement disorders seen in schizophrenia. Also, the casual observer may mistake a neuromuscular problem with speech as a problem with thought (we’ll come back to this later).
Mental illness is defined in the UK’s Mental Health Act 1983 (amended 2007) as ‘any disorder or disability of the mind’.
But what is the mind? There is no agreement among scientists or philosophers as to the definition. See Jayne, 1976 for an interesting discussion on this.
To simplify for the purpose of clarity, most would agree that there is more to humanity than the physical being. The software part of us, the ghost that drives the meaty shell, could be termed the mind (yes, that was a ‘Ghost in the Shell’ reference). Mental illness could be defined as dysfunctions of this, except that’s not right either.
Delirium is a state that mimics many if not all symptoms of mental illness and is brought about by a physical problem, often an infection or toxic state. There is a hypothesised condition called PANDAS that is a kind of OCD brought on by a streptococcal infection. Cartesian duality is a joke when considering mental illness. The body and mind are inextricably linked. Look up psychoimmunology.
Definitions, as you see, are difficult and are useful in some but not all circumstances. Their purity is ontologically suspect.
One thing that is certain is that mental illness is socio-culturally defined. Society decides what behaviors and/or subjective experiences are deviant and need treatment or exclusion from the group. This is why the criteria for mental illness differ from country to country. See classification systems ICD-10, Chinese Classification of Mental Disorders (CCMD-3) and the abominable DSM 5. There are those who do not believe that mental illness even exists as a distinct entity, and that those we call mentally ill are responding to the situation society has placed upon them.
As a writer, the important thing to note is the cultural context within which you are defining mental illness. It is not necessarily transferable. A person with depression in Brighton may present different symptoms from a person in Brasilia. Do not extrapolate from what you think you know. Culture determines presentation. It may be completely acceptable for a man in Wisconsin to state that he is depressed, but be complete social death if the same is done in Brazzaville. Depression occurs in both societies, but the symptom mix may be much different. The content of delusions may very well depend on which society the person comes from.
Note that while definition varies, stigma appears to be near-universal.
Note that mental illness tends to be defined or conceptualized as syndromes, which are collections of symptoms that form a distinct entity.
Note that there are many terms in psychiatry/psychology that appear to be simple English, but with different meaning. A simple example is the word ‘paranoid’ which, in psychiatry, means ‘self-referential’ and not what you find in the OED. Likewise ‘depression’ does not just mean ‘sad’.
Note also that deviant behaviour/experience does not equate to mental illness.
For you to define something as mental illness there should be:
A. Absence of intoxicants (drugs, alcohol)
B. No organic cause (head injury, stroke, septicaemica etc)
C. Sustained behaviour/experience. A single hallucination does not make you psychotic. A low mood is not enough to diagnose depression, and besides not all people who have depression have low mood. Possession states can be normal in some cultures eg South Sudan Nuer and Jinn possession. Linda Blair was of course not from southern sudan and we can agree that her experience was abnormal.
D. Suffering in self and/or others
In the next part we will discuss a practical way to determine if someone is mentally unwell.
Jaynes, J, 1976: The Origin of Consciousness in the Breakdown of the Bicameral Mind. Houghton Mifflin Company, New York
Mental Health Act, 1983