Four Myths About Mental Illness

I am crazy, insane even, and I own it (and the words). I’m bipolar. My Twitter name is Madwoman Out of the Attic.

Let me say next what I’m not: Anyone’s least favorite president. The billionaire who’s either heading for Mars or emailing pink slips. Or the neighbor who keeps telling you about lizard people.

Nor do these folks and I have anything in common.

There’s been a massive increase in folks slinging around the word “crazy” over the past six years. Or “deranged, “lunatic,” or “insane.” Don Lemon said one night that a political figure "is putting crazy on top of crazy on top of crazy on top of crazy,” in an "insane reality show.” (He piles up several more “insane’s,” but I’ll spare you.)

My existence is not a metaphor for bad behavior. “Insane” means, literally, “out of health.” Borrowing it or words like it to create insults is deeply biased. I’m guessing most who do so wouldn’t want to think of themselves as stigmatizing those “out of health.”

It's hard to hear something as fundamental as a part of me used to mean "awful." Here are four myths to help this go away.

Myth 1: The mentally ill are violent or like to promote violence.

The media reinforces this one, showing the mentally ill, particularly the schizophrenic and bipolar, as violent. One researcher who tracked primetime television found characters with such a “major” diagnosis were 10 times more likely to be violent than other characters.

The mentally ill are actually about 10 times more likely to be victims of violence. Forensic psychologist Joel A. Dvoskin, whose field is risk assessment, calls the difference in violence between the mentally ill and those who are not “slight.” Dvoskin points out that the odds of a schizophrenic man with a gun killing a stranger is one in 144,000. A Swedish study looking at siblings with and without diagnoses found no difference between them in violent behavior. Just a small fraction of gun violence is connected to mental illness. These aren’t truths you’ll find on your favorite cop show.

Myth 2: Psychiatric patients are medication non-compliant.

This is true in the sense that they’re human like everybody else. Half of all patients in this country with long-term prescriptions do not take them as prescribed. Many prescriptions are never filled. People don’t take medications because they can’t afford them, experience severe side effects, or just stop when they feel better. This happens with antibiotics as well as with antipsychotics. Only with psychiatric patients is avoiding medication considered proof of illness.

Myth 3: Mental illness is the result of bad brain chemistry or brain processes.

Recently, a study appeared that showed serotonin is not implicated in depression. In a 2019 article, Ronald W. Pies wrote that psychiatry was poking holes in the so-called "chemical imbalance theory" by the early 2000s.

Genetics and brain structure research are equally ambiguous. The truth is we don’t know what causes mental differences. But the brain chemistry theory remains embedded in the group name of drugs like Prozac, a systematic serotonin reuptake inhibitor (SSRI). Prescribing doctors still often present the drugs this way.

Antidepressants are more effective than placebos, but they have a high failure rate and a high placebo response. It can feel shameful to hear that your brain lacks the right chemical components, and those components should “fix” it.

Myth 4: Delusional or psychotic thinking is far removed from normal thought.

The DSM defines delusion as “a fixed belief that is not amenable to change in light of conflicting evidence.” This definition fits many things non-psychiatric. Beliefs exist on a spectrum, are frequently irrational, and serve purposes once their context is understood. None are simply the product of a brain in a state of “disease.” In a TED talk, philosopher of psychiatry Lisa Bortolotti describes a man who feels persecuted, pointing out that the belief helps him make sense of a lifetime of being treated badly.

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Beliefs may be different from facts or may be distressing. But all exist somewhere in the realm of human mental experience. In the same TED talk, Bortolotti says she believes she does above-average work—but in a survey, more than 94 percent of college professors believe that they do above-average work. “The math,” she says, “is not on my side.”

“Insane” is no longer used widely as a medical term. It’s still a legal one. It means someone isn’t guilty because they didn’t have the mental capacity to know, on any level, what they were doing. It exonerates.

Millions of Americans believe in conspiracies and in the policies of any prominent politician you can name. Tens of millions of Americans in the 1950s believed with Joe McCarthy that America—particularly Hollywood—was a hotbed of Communism. Were McCarthy and his followers insane? Consistency of thought means yes.

If you use these words but would say you don’t mean crazy, lunatic, or insane in that real sense, it’s simple—don’t use them. To do so is ultimately not just biased thinking but lazy thinking. I love you, Don Lemon, but you can do better than just piling up the "crazy."