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The Opposite of Mental "Disease"

People outgrow and control mental illness, the opposite of a disease

Dr. Marsha Linehan

Why this is important is that the ruling cultural "meme" -- how we conceptualize and think about problems -- influences not only how we conceive of them, but how we deal with them, and even their outcomes! People often tend to conform to cultural memes (although this post is about the large number who don't do so).

Before turning to the topic of this post -- what we call mental illness -- I do want to commend the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. To begin with, note how the volume doesn't call them mental "illnesses" or, certainly, "diseases." In other words, DSM-IV itself (for which I was an advisor on substance use disorders) recognizes -- and gives importance to -- the malleability of disordered mental states. A disorder doesn't imply permanence, or progression, or inevitable doom. It is about a state that can remediate -- and that may often do so. In particular, I have to point out to people time and again that "remission" in substance use disorders does not require abstinence according to DSM-IV -- it requires the absence or diminution of problems, whether due to abstinence, rare or occasional use, or continued use.

How DSM-V will score on these matters, I can't say -- and I'm not involved in deciding. But I can say that where the volume comes out will be crucial for our mental health.

Let me return now to a series that has just completed in the New York Times by Benedict Carey, with photographs by Damon Winter. The series concerns people who have overcome -- or controlled -- their mental illnesses to live productive -- often outstanding -- lives. Sometimes this means actually outgrowing the problem ("Milt Greek has overcome a prolonged struggle with schizophrenia and now lives a happy, busy life with his family"). Sometimes this means periodically coping with bad periods ("Keris Myrick has struggled with mental illness and is now [a] chief executive. . . .When Mrs. Myrick is going through difficult times, she retreats to a nearby resort hotel"). Sometimes people power on by organizing their lives and working around a mental disorder (such stories are now capturing the fancy of the media, including the life of Temple Grandin, a prominent animal scientist and autism advocate, or fictional portrayals like Showtime's "The United States of Tara").

What's this all about? We have long known about people who successfully deal with mental disorders -- for example, there is a literature about people who have delusions and hallucinations yet are never -- refuse to be -- diagnosed with schizophrenia. But the meme of "disease" makes it far harder to recognize -- to live -- this reality. This other, non-disease reality says: "No one lives a perfect life. How we choose to cope with our particular idiosyncrasies, sometimes quite severe ones, is up to us -- including aspiring to be, and being, a fully functioning and productive member of society in work, in relationships, in the community" (to wit, "Mr. Greek works as a computer programmer and is also a community and environmental activist," as well as living that "happy, busy life with his family").

The alternative is to think of ourselves as suffering from a permanent, excruciating, never curable, never remediable, progressive condition that can only take us down with it.

So why is it that we so rarely hear from people who overcome, or control, addictions and mental disorders without treatment or labeling? Carey deals with that in the person of Marsha Linehan, a prominent researcher and clinician at the University of Washington, who told the story of her lifelong mental condition finally, at the age of 68. After being institutionalized as a teenager, heavily medicated, and undergoing both electroshock and Freudian therapy, she was isolated in a seclusion ward as a hopeless case. If anything, her condition grew worse after she left the institution. What finally saved her was a religious experience she underwent as a young woman, the crucial part of which would now be called (by Tara Brach, among others) "radical self-acceptance." Linehan finally decided: "‘I love myself.’ It was the first time I remember talking to myself in the first person. I felt transformed.”

As Carey comments:

No one knows how many people with severe mental illness live what appear to be normal, successful lives, because such people are not in the habit of announcing themselves. They are too busy juggling responsibilities, paying the bills, studying, raising families - all while weathering gusts of dark emotions or delusions that would quickly overwhelm almost anyone else.

Now, an increasing number of them are risking exposure of their secret, saying that the time is right. The nation's mental health system is a shambles, they say, criminalizing many patients and warehousing some of the most severe in nursing and group homes where they receive care from workers with minimal qualifications.

Moreover, the enduring stigma of mental illness teaches people with such a diagnosis to think of themselves as victims, snuffing out the one thing that can motivate them to find treatment: hope.

Carey has long been the most seminal and important psychological writer at the Times. But, in this series, he has outdone himself by announcing an entirely different paradigm for considering the emotional ills that beset us as a society, that nowhere show signs of declining (rather, all indicators are that major mental disorders are increasing), and which we insist on addressing as medical problems which, paradoxically, translates into their being incurable.

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