In recent
years, there has been a significant cultural shift in our stance on mental
illness. There are an increasing number
of mental health advocacy groups, support for mentally ill returning veterans
is higher than ever, and in general there seems to be more compassion and less
blame placed on those suffering from mental illness. Yet, right inside of this newfound
compassion, I believe there is something that might be equally as harmful as
blame and stigma.
When we witness
another human being suffering psychologically, and ask ourselves why they are
suffering, we tend to assume that there are two possibilities. The first possibility is that the person is responsible
for their suffering and they could easily make it stop, but they are choosing
not to. The second possibility is that the
person has no control over their suffering and they are a helpless victim. If it seems that the person’s suffering falls
under possibility #1, then we blame them for their suffering and say things
like “He just wants attention” or “She just needs to get over it.” If the suffering seems more severe, or too
complex for us to easily figure out, we often go with possibility #2 and say
things like “He can’t help it, he’s got something wrong with him,” or “It’s not
her fault, she’s got Disorder of the Month disorder.” It is a type of either-or
approach that we take: Either you are choosing to suffer, and I should be angry
or disappointed with you, or you have no choice, and I should show you
compassion.
Adding support
to this either-or, blame vs. compassion approach, is the “Medical” or “Biological”
model of mental illness. This model
tells us that mental illness is biologically caused, it is a “brain disease,”
or a “chemical imbalance.” It tells us that a malfunctioning brain on the
inside is causing the unhelpful behavior that you see on the outside. This
model naturally steers us in the direction of compassion, because the person is
seen as being the victim of a biological disorder, similar to a cancer patient. We wouldn’t ever think to blame or negatively
evaluate a person who was just diagnosed with leukemia.
So if the medical
model leads to more compassion and less blame, then why not just go with it? Well, there are several problems that go along
with treating mental illness as an out-of-your-control, biologically caused
issue: The first is that there is no
evidence to support this assumption. Widely accepted “facts” like low serotonin
levels causing depression are actually not facts at all. When studies examine the serotonin levels of
depressed and non-depressed people, they look exactly the same. So in the absence of real, measurable proof,
what is often substituted is: “Well the fact that psychopharm drugs work in the
first place is enough to prove that mental illness is biological.” However, you
can’t use the effectiveness of a medication as proof that the original cause…
was a lack of that medication. If you
took an antibiotic for some type of infection, and the infection went away, you
wouldn’t assume that your infection was originally caused by a lack of
antibiotics. And lastly, the
effectiveness of psychopharm drugs itself is questionable. Many studies out there show that
antidepressants work no better than placebo pills, and in countries where there
is no access to antipsychotic medications, many schizophrenic individuals
actually make full recoveries! That’s
supposed to be impossible, but it happens.
But putting
facts aside (see "When Being Right is Wrong"), another, even more important issue with the
medical model is that it just doesn’t work well. The expectation is that telling a mentally
ill person that their problems are due to a chemical imbalance should remove
blame and stigma, promote compassion as mentioned earlier, and help relieve
some of their suffering. After all, if
you’re brain is broken then it is not your fault, and if you’ve been struggling
with something for a long time, it feels pretty good to hear that it is not
your fault.
We were
right about removing blame, and it does seem to promote compassion, but it
turns out that the message, “you have a chemical imbalance,” brings along some
unintended consequences. What we’ve
found is that people who believe they have a brain disease or chemical
imbalance actually report feeling more stigmatized. Who would have thought…. being told you have
a broken brain actually makes people feel……… broken? And when it comes to treatments that promote real,
measurable change in a person’s life, we’ve found that people who are told “your
depression is a brain disease” actually do worse in therapy than people who are
told “your depression is a behavioral issue.”
This medical
model removes blame, allows bystanders to feel more compassion for the
suffering person, yet it does nothing to help the suffering person improve
their life. In fact, the person is being
robbed. By convincing a person that
their brain is causing their problems, we are essentially removing any hope of
conscious, intentional change: Are you depressed? Anxious? Angry? Guilty?
Addicted? Well, sorry buddy, it turns out you just have a shoddy brain. Your
only hope is to take this pill and pray to the gods that your unruly brain gets
its act together.
Now we
return to the alternative, which is possibility #1: The person is responsible
for their suffering, and they could get better if they chose to. The trouble with this approach is that the
minute we begin assuming the individual has control over their circumstances, it
becomes difficult for us to offer compassion.
It just doesn’t make sense to feel bad for someone who is causing their
own problems, right? I’m going to
suggest that it does make sense, and more importantly that it works better to
do so.
Assuming that
the person is responsible AND choosing to show them compassion may seem crazy
at first, but it begins to make more sense when we look at mental illness as
being less like a disease, and more like a trap. And it becomes easier to do once we realize
that all of us step into this trap from time to time.
Human
beings, as a species, experience pain in ways that no other animal can. Our unique ability to evaluate, remember,
care deeply, and plan ahead, also allows us to evaluate ourselves negatively,
remember painful events, experience sadness when we lose something we cared
deeply about, and worry about a future that has not yet happened. Emotional pain, for humans, is in fact
completely normal. It’s a package-deal. But because this pain can hurt so badly, we
often find ourselves searching for “solutions” to the pain. And in doing so, the bait is set. We all do small, harmless things to avoid
uncomfortable thoughts and emotions, and if we do it in small enough doses we
can get away with it, kind of like tip toe-ing around a trap. But if you put enough energy and time into
trying to escape your own emotional pain, eventually the trap snaps shut. Try hard enough to stop thinking about a
painful memory or a painful thought about yourself, and you will find it is all
you can think about. Try to run from anxiety,
and it will begin to follow you wherever you go. Try to avoid embarrassment and strive for
perfection, and you will find that you are mortified by even the smallest of mistakes. Try to escape your pain by having a drink,
and tomorrow morning you will wake up to find that the pain has returned, and
you now have a drinking problem. These
are just a few examples of the kinds of psychological traps that every last one
of us, to some degree, steps into. Many
times, the only difference between you and a person with alcoholism, PTSD,
panic attacks, or depression, is that they stepped just a little further into
their traps, and they got stuck.
If we
approach mental illness as a type of psychological trap, the issue of
responsibility becomes a little less important.
Imagine you were to walk past a person on a trail who has stepped into a
bear trap (do those still exist?) and is now in a great deal of pain. Technically speaking, that person is
responsible for being in that trap.
Regardless of whether or not they were aware of the trap, they “chose”
to take every single step, leading up to the very last one right into the bear
trap. Yet, nearly all of us would still
show them compassion and would likely offer our help. But for some reason, when it comes to mental
illness, we change the rules. We only
offer compassion if we believe that the person had no control over their circumstances. And if it appears that the person is
responsible, then we blame them and withhold our compassion. This would be kind of like coming across the
hiker in the bear trap and saying “Are you blind? No? Are your legs weird and
they don’t go where you tell them to go?
No? Well then it’s your fault
that you’re in that trap! Good luck
jackass!” We would never treat a physically
trapped person in such a way, and I don’t think we should treat a
psychologically trapped person this way.
People
struggling with mental illness deserve compassion, because we all suffer, and
we all step into psychological traps. They
deserve the assumption that they are responsible, because to say that they are
not responsible is to rob them of the possibility for change. Being responsible
simply means that the person stepped into this trap, and they can actively do
something to step out of it and improve their life. Being responsible means they have the ability
to respond. Ultimately, it means there
is hope, and that hope is not limited to a pill. Compassion alone, without responsibility, can
turn a conscious and capable human being into a victim. Responsibility alone, without compassion, is
blame, and that is like yelling at the hiker for stepping into the bear trap. When we are able to offer a fellow human
being both of these things together, unconditionally, we are saying, “I can see
you’ve fallen into a trap. All of us
do. Let’s get you out of it.”
