Monday, December 30, 2013

Of Minds and Men: Some End of Year Reflections

A peculiar trait in human beings: anything we don't understand, or anything we find different from ours, we tend to put in boxes. Or, apply labels to it. Perhaps it is an aid to understanding, perhaps it makes us feel comfortable and in control over the vicissitudes of life in uncertain times. But in doing so, rarely do we consider the splash damage. Mental illness is one of those oft-used boxes, which we easily and cavalierly assign to things that we find ranging widely from grossly unpleasant to merely different.

This - it is important to note - is not a situation without consequences. When we attribute random bad things to mental illness - which in itself is a wide open spectrum and doesn't lend itself to easy categorizations - we diminish the humanity of those individuals who struggle, and live, with mental illnesses of various degrees. We, who are privileged to lead our lives without the debilitating effects of certain mental illnesses, are accustomed to wearing that privilege on our sleeves. It is the matter of a mindset, incidentally a part of the same mindset that often engages in 'gaslighting' those - especially women - who dare to be different and think differently, thereby diminishing and silencing them. Gaslighting refers to a kind of emotional manipulation which makes the recipient believe that they are unhinged and irrational in their way of thinking.

In a similar manner, the casual reduction of every behavioral quirk to diagnosis of mental illness can make everything worse for people living with real mental illnesses, shaming them for a condition which is beyond their control. It is, hopefully, not difficult to imagine how this is detrimental. As a friend of mine puts it eloquently: assigning unpleasant things to mental illnesses is lazy bigotry, at best the repetition of unthought, unexamined prejudicial social tropes; it is something we should take note of, and consciously try to eschew.

The problem with attributing weird, horrid or unpleasant behavior to mental illness? Let me draw upon the wise words that the above quoted friend of mine wrote elsewhere.
[Begin paraphrased quotes]

Most of us are not psychiatrists or psychologists or in any way qualified to diagnose mental illness in anyone. Even if any of us is actually a licensed psychiatrist, remotely diagnosing someone's mental health conditions over the internet based solely upon a few comments or a quirky video is extremely unprofessional and possibly illegal, too. Many of us feel qualified to comment upon the mental health of others because we may have had some experience of people with mental illness in our families, or perhaps we may have had some form of a mental illness ourselves. It is, however, extremely important to recognize that the said experience does in no way confer special expertise upon us, neither does it qualify any of us for anything other than describing our own experiences.

Most importantly, mental illnesses do not reduce to simple behaviours. Checklists and medical codes that psychiatrists and psychologists use - such as the DSM-V, ICD-10 et cetera - are descriptive, not definitive. Their use is for codification at the start of longer diagnostic processes, and the interpretations must be augmented by reference to observed clinical experience and research data. The labels associated with mental illnesses are not tools to be bandied about by those professionally unqualified and inexperienced in their use to score rhetorical points during discussions on the internet. Reducing complex issues to simple slogans is one hallmark of the above-mentioned lazy bigotry, and this is done only out of ignorance and prejudice, not knowledge or suitable professional humility. A far greater understanding of the context and all relevant details is needed. This is why, even in emergency mental health care, diagnoses of patients by qualified mental health professionals may take a long time.

Our actions of throwing unpleasant behavior into the mental health box are often informed by common prejudices which attempt to dictate that behaviour we deem aberrant or abhorrent is somehow indicative of medical (as opposed to merely behavioural) differences. There is a wide spectrum of human behaviour, much of which is horrid, not all of which is pathological. Therefore, readily attributing behaviour we deem unpleasant or bad to mental illness is not even supported by available evidence. Many perfectly sane people do far worse and far more self-involved things than make a stupid comment or post an embarrassing video on the internet.

As a matter of perspective, there are live, generation long arguments within the relevant medical fields about which, where and how behaviours are pathological; it is well known that there are enormous grey areas - given which weird behavior on the internet cannot be a hallmark of diagnosis of mental illness. Associating bad behaviour with mental illness is one of the major reasons stigma about mental illness persists in every society. The lazy examination of someone's bad behaviour as being due to mental illness indelibly associates bad with mad. This is a perpetuation of the idea that "mad" people are "bad" people. This contributes to people not being "out" about their diagnoses, to people being refused jobs because of their diagnoses, to people losing relationships with friends and loved ones because of their diagnoses etc.

[End paraphrased quotes - A more verbose and delightfully sarcastic version can be found at: my friend's blog]
Now the toughest part of this essay: a confession. I, too, have been guilty of engaging in this kind of behavior. I have observed (via YouTube videos) people doing quirky things - I can off-hand recall at least two YouTube posters who persistently put up videos of excessively bad vocal and dancing performances. Along with others in private groups, I have poked fun at those videos - which is fine and understandable as critiques of the demonstrably bad performances.

But the most unconscionable action on my part has been that I have occasionally indicated my opinion about the status of mental health of these people - saying that they "may need professional help" - an opinion that I am not professionally qualified to proffer. And that was indeed wrong of me - despite the fact that these people don't know me and would never know or care for my opinion. The realization that I may have dismissed their humanity and human quirks summarily by attributing the label of mental illness diminishes me as a human being, regardless of whether they know it or not.

It is a tough proposition, no doubt. In India, the words 'mad', 'crazy', 'insane', 'cuckoo', 'bonkers' and so forth, including their vernacular variants, are used very easily, even lovingly at times, and they are never intended to be clinical diagnoses, only refer to personal quirks. Which, to a reasonable extent, is fine: I am not much for language policing (except when I see grammatical errors - HULK SMASH!). But as with everything, the context is very, very important in these, too. We (that's the Royal 'We', meaning 'I') simply must be more mindful of what we say, where and how we say it. We must be mindful of privilege and ugly prejudice in our everyday communications.

We owe it to our own humanity to make the world a better and safer place for everyone.

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