Adding Insult To Injury (how the language of mental illness promotes misunderstanding)

We thank an unknown contributor for a pithy summation of the problem with our society’s discussions on mental illness: ‘Talking about mental illness spreads ignorance far and wide’.

The discussions we are having as a society about “mental health” may be raising our awareness about mental health issues, but getting us nowhere closer to understanding severe mental illness.  Duejusticeproject makes a robust distinction between “mental health issues” and severe mental illness.

We suggest that one of the contributing factors to pervasive ignorance is the way we speak the language of mental illness in everyday life.  The lexicon of psychiatric medicine can be the thrust of barbs and insults.  We speak of people who have high hopes or goals in life that are unrealistic as being delusional or out of touch with reality.  Friends, family, and strangers may be casually accused of being psychotic for utterances and actions that go beyond the pale.  Many a commentator, writer, or member of the intelligencia, has used the term “schizophrenic” metaphorically to refer to a process or condition that is conflicted or divided against itself – when in fact, Schizophrenia is neither a personality disorder, nor a split personality.

So when we hear accounts in the media of the accused killer being psychotic, suffering from delusions, or diagnosed with Schizophrenia, those conditions are well within our comprehension – so we think.  No wonder the juror finds an undisputed diagnosis of severe mental illness, as evidence by a long history of illness, or multiple hospitalizations as not being particularly compelling evidence to support consideration of the NGRI verdict.   Delusions and psychosis are tragic symptoms for the person afflicted with severe mental illness, yet during these media events, web forums are ablaze with venomous indictments against “deranged” mentally ill killers.  This is a manifestation of stigma and stigma is ultimately caused by lack of comprehension.  Studies have shown that juries are highly likely to regard mental illness as an aggravating factor rather than mitigating.

In high profile cases of violence involving individuals afflicted with mental illness, the media and law enforcement authorities speculate in earnest about motive, which paradoxically, operates in the realm of a shared reality – the real world that all of us perceive and navigate in our more or less normal waking consciousness.  There is rationality (so to speak) in a motive of revenge for the perpetrator who retaliates against his or her enemy or someone who is the source of a grievance.  This context represents a sort of presumption of sanity in the common vernacular that carries over to the courtroom.  Few people understand that motive that is conceived from psychosis and delusion is not meaningful in the reality that is external to the afflicted person – in the world of sanity.

Popular culture can hardly be blamed for its casual use and abuse of these medical terminologies. On this account, we may justly apply M’Naghten’s Rule, where popular culture knows not right from wrong.  We partially blame the persistence of discredited Freudian thinking about human behavior that has made us all into lay psychologists, licensed to use the language of severe mental illness.

On the flipside, we do not hold the medical profession blameless in this matter.  We take issue with the fact that the medical profession has failed to recognize that these terminologies are impediments to widespread comprehension of severe mental illness.  We charge that some of the terminologies of psychiatry are not suitably descriptive of the severity of,  or  potentially horrific consequences of certain symptoms or disease states.  For example, depression is something that most of us have experienced in our lives.  Much of the stigma associated with depression has been reduced by speaking openly and broadly about it in the media and in public discourse.  We have turned our attention to depression in young people, calling for early detection and improving access to mental healthcare, with the goal of preventing suicides and violence against others.  Yet, we at Duejusticeproject strongly suspect that most people who act out in the bizarre violent behaviors typical of high profile media stories have something more serious going on than the type of depression that most people can conceive of , i.e. the reactive or situational type, which the medical profession classifies as adjustment disorder.  This type of depression is rationalized – triggered by some specific stressor such as a traumatic life event or driven by internal conflicts, anxiety, and a host of other emotions and psychological states.

Clinical or major depression is most often caused by a chemical imbalance or other abnormal status of the brain rather than an external or internal stressor.  It may be interactive with situational depression.  It may even develop downstream from reactive depression in certain people. Clinical depression severely afflicts the way waking consciousness is experienced and so perhaps it should be described as a dysphoria where there are broader neurological symptoms.  The medical profession classifies clinical or “major” depression and Bipolar illness as mood disorders, which is unfortunate.  Calling these very serious and potentially life-threatening conditions by a terminology that can also be used in a description of the disposition of a healthy but cranky teenager (i.e. “mood”) contributes to widespread misconceptions in the general public.  Some of these medical terminologies of psychiatric medicine predate the times when medical science began to understand that devastating brain diseases such as Schizophrenia, Bipolar, and Clinical Depression (esp. w/ psychosis) were highly heritable biological disorders involving abnormal electrical activity in the brain, (neuro) chemical imbalances and structural anomalies of the brain.

Getting a grip on how words or terminologies inform our perceptions of severe mental illness is a step toward an examination of the knowing right from wrong legal test.  Ultimately, understanding of severe mental illness in our society could be promoted if lay people and medical professionals would just stop speaking the same language.

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