Mental illness is without question a physical illness that plays out emotionally. The outward manifestation of mental illness is based on an inward physical condition. It’s through our behaviour that we reveal our anxiety, depression, schizophrenia and bipolar disorders and that can be frightening to others. We hear that in everyday conversation, but it can frighten us as well. Don’t think that we don’t scare ourselves sometimes.
Back in the 4th century BCE, Hippocrates wrote that personality and mental health were innate-built in as it were. Had to do with the four humors: black bile, yellow bile, phlegm, and blood. When in balance all was well, otherwise not so good. He was on to something-mental illness is chemical, not moral. Fast forward to the present and we have experts stating that genes determine our anxiety-in that they affect the reactivity of the amygdala-our reptilian brain.
Think of dogs. Some are skittish. Mine goes into full alert mode at the slightest change in the air. Stops, tail out, ears up, nose pointed forward, hackles in the air. Often for something that other dogs would ignore. He’s on red alert when others are at yellow. Same with people like me. We are on higher alert. Our reptilian brain is never resting and in a nano-second our amygdala goes into action sending out all kinds of chemicals and getting our bodies ready to fight or run for the hills. And of course, most of the time, neither option is available but the body is past the point of no return.
When it comes to detecting and responding to danger, the (vertebrate) brain just hasn’t changed much. In some ways we are emotional lizards. Joseph Ledoux 1996
People who don’t like flying will go into full fright/flight mode just thinking about it and if one has to fly, that fear can be paralysing to the point that one’s ability to function is maimed.
No passion so effectively robs the mind of acting and reasoning as fear. Edmund Burke 1756
We all need to come to understand, thoroughly, that one does not choose to be mentally ill any more than one chooses to be straight. Now, armed with one’s diagnosis it’s time to find a treatment. And that can and often includes drugs. It’s never been thought of as a moral failure to take drugs for cholesterol yet I have been told that it is a matter of diet-self-control, a moral thing. Why can’t I just not eat the foods that increase my cholesterol? But we know that’s not true for a vast majority of people. It’s an inherited condition and drugs keep these people alive and well, long past what would have been their freshness date.
Same holds true for mental illness. Far too many experience mental illness as a moral failure, and fear the repercussions; loss of respect, loss of love, loss of a job. I know of spouses who won’t talk about their mental illness for fear it will affect their partner’s job! Tainted in the second degree.
Mental illness, like high cholesterol can be inherited. In 1885 Jean-Martin Charcot wrote “It frequently happens that hysteria in the mother frequently begets hysteria in the son.” And in 2007 Jerome Kagan, a developmental psychologist at Harvard wrote “I suspect that most, but not all, of the large number of human temperaments are the result of genetic factors that contribute to the profiles of molecules and receptor densities that influence brain function.”
Dr. Eric Kandel, the Nobel-Prize-winning neurologist and Professor of brain science at Columbia University contends that the term "mental" illness can distort public understanding of the nature of these disorders. "All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases," he says. "The brain is the organ of the mind. Where else could [mental illness] be if not in the brain?"
But there is something else at play. The culture continues to secrete distaste for the mentally ill. I think too many are stuck in the paradigm of earlier times when the mentally ill were placed in asylums and thought of as animals. The first institution to open its doors in Europe is thought to be the Valencia mental hospital in Spain, in 1406 CE. Asylums back then were known for “deplorable living conditions and cruel abuse endured by those admitted,” often abandoned by their families who were ashamed. La Bicetre, a hospital in Paris, shackled patients to the wall in dark, cramped cellsIn other asylums the mentally insane were beaten, given little food, and had no clothing. In the late 18th/early 19th century, treatments included “bloodletting, purging and induced vomiting, cold water dunking (water torture), and the “swinging chair,” a contraption designed to spin the patient at high speeds. The chair was thought useful in helping patients to vomit, evacuate the contents of their bladder, and lull them into a tranquilized state of mind.”
As timepassed the mentally ill were allowed to stay in sunny rooms and walk outside. At the same time, in the USA “mental patients were chained in basement cells. Public viewing of patients was allowed for entertainment purposes.”
Then came eugenics in the early 20th century. Mental patients were seen as contaminants of the gene pool. Laws were enacted concerning compulsory sterilization. Both The New York Times editorial board and U.S. Supreme Court Justice Oliver Wendell Holmes championed sterilization. Holmes wrote in an opinion that
“experience has shown that heredity plays an important part in the transmission of insanity, imbecility, etc. . . . It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind."
At the same time Freud was writing, “The deficiencies in our description (of the mind) would probably vanish if we were already in a position to replace the physiological terms by psychological and chemical ones.”
As a chaplain, I am proud to say it was the clergy who were the earliest to provide empathic care and today are still at the centre of providing life-saving care for those with mental illness.
Unfortunately, today, despite the fact that the facts clearly point to a physical illness, our perception of mental illness is not changing fast enough. Too many are still stuck in the asylum phase and sadly that includes those dealing with the illness. The visible walls of the asylum may be gone, but remnants of the asylum remain in those with the disease. Almost what one might call a genetic memory. The shame. The fear. The abandonment. The desire to hide the illness can be so strong that too many are choosing to live in their own private asylum, their own private hell rather than seek help.
The illness goes untreated and we lose another sacred life to a preventable death.
“The basis of mental illness are the chemical changes in the brain…There’s no longer any justification for the distinction…between mind and body and physical illness. Mental illnesses are physical illnesses.” David Satcher US Surgeon general 1999
