Is a mental illness like diabetes?
Having a mental illness is like having diabetes.
It is the most resounding mantra of mainstream mental health. I probably heard it hundreds of times in the first few months of my employment in the mental health system; investigating the true meaning of this phrase was literally my entryway into critcal thinking about mental health care in our society.
What does it really mean when someone (almost inevitably a professional) says this?
They say it means a reduction of stigma — for if mental illness is like diabetes, it’s nobody’s fault, right? Just a biological fact of life for some folks.
Paradoxically, they say it means there’s something fundamentally flawed and wrong about your brain, your neurochemistry. They say this chemical imbalance can only be corrected with lifelong medication compliance. Adherence to the doctor’s orders gauruntees you a good life (or the best possible under such conditions); non-compliance is a recipe for disaster.
Is this comparison of mental illness to diabetes in any way useful, or is it misleading and inherently stigmatizing?
Let’s let someone who has truly lived this metaphor, experiencing it first hand as a pschiatric survivor, answer the question for us.
The following are excerpts from a brilliant essay published anonymously in 2006 in the Schizophrenia Bulletin. The author, who reports a diagnosis of “schizoaffective disorder,” explains eloquently and succinctly why, for him/her at least…
Having a mental illness is NOT like having diabetes.
The Hospital Experience:
A diabetes patient in hospital can expect a clean, hygienic ward peopled by staff who treat the patient with respect, as an equal, who explain the illness and the treatment regime, and who co-opt the patient as an important agent in his or her own recovery. A psychiatric patient, however, might well find a ward that is rundown and peopled by staff who do not seem to have the same expectations of respect for patients and of a generally good professional working relationship between staff and patients. A psychiatric patient might instead, as I did in one of my hospitalizations, find staff who avoided talking to the patients as far as possible and whose only interaction with patients was to give commands.
The author is not the only one to have observed this trend of the division between staff and “patients” in mental hospitals. See this fascinating study for more.
Schizoaffective disorder rips straight into the heart of the family, causing shame, anger, guilt, and self-blame from parents and siblings, as well as casting blame on the patient. Parents ask, where did I go wrong, and patients ask, if I had had a different upbringing could I have avoided this disease? With diabetes, however, there is no sense of blame, guilt, or shame; rather, people hear the diagnosis, learn (perhaps over time) about the condition, and come to accept the limitations of the condition.
In (naturally occurring) diabetes, there is no place for blame. It doesn’t appear to be a particularly useful or therapeutic concept. I find myself thinking that the same is probably true of mental illness. There’s a firestorm of protest going onover at Mad In America right now about Michael Cornwall’s supposed blamingof families for the mental illness of their children (the article which stirred up so much criticism happens to be one of his best — I highly recommend you check it out).
Ultimately, I think we are best served by abandoning the conecpt of blame altogether. One commenter there put it so well:
I think that the problem of laying the blame on families is better resolved by getting the blame out of the equation rather than getting families out of it. It’s not about who did what to whom; it’s about understanding that we become who we are within the relationships that are important to us, so understanding them is part of understanding who we are. I think it’s when we take those relationships out of the equation that people start to look broken or crazy or mean.
So the first step is to get rid of blame. The next is to understand the significance of the relationships.
Kermit Cole, commenter at Mad In America; emphasis added
And now back to our anonymous author…
Diabetes treatment does not require the same sacrifice of personal privacy that nonmedical treatment for schizoaffective disorder does… Diabetes medicine does not change who a person is; it does not turn one into a zombie, negating the highs as it flattens out the lows; it does not change the way one operates or, in fact, change what it is to be that person. Medicine for schizoaffective disorder does.
Finally, the author suggests an alternative metaphor:
If I could choose a replacement analogy, I would say schizoaffective disorder is like a whirlwind: it comes out of nowhere, strips you naked and sucks you dry, and swiftly vanishes, leaving you empty and shaken but alive, wondering if it really did happen and whether, and how soon, it will come back again.