I have run into a half-dozen people like this, real smart but with some mental problem. The thing is they are unwilling to get help.
A guy who is very well-grounded, but refuses to admit he is an alcoholic. A clever lady who cannot understand she is depressed. That sort of thing.
Is my thesis literally true? Is it at least a useful construct for understanding the general stiff-necked nature of people who refuse to seek help?
I don’t think it has anything to do with mental illness, but any preceived weakness.
I have known people with swollen jaws and a green tooth that refuse to admit they have a toothache. I have a friend who was a paramedic and he told me stories of people who were clearly having a heart attack and refused to go with him. He tells me his favourite story is they showed up and the guy (having a heart attack) was doing push ups to convince his wife he was all right.
I used to be the systems admin for a large hotel. I would handle all the software and computers and I had complete open door policy. Yet time and time again I’d have people coming to me, after screwing their computers up. I’d fix them and say “Don’t be afraid to bother me, I’m paid to HELP YOU.” They’d say “OK,” then they’d screw it up again, because they didn’t want to bother me or admit they didn’t know what they were doing.
I think it’s any weakness people don’t like to show, whether it’s mental, physical or emotional issues
IANAD, but I absolutely believe that many mental illnesses defend against external attacks.
Depression is certainly self-perpetuating. The symptoms of depression themselves make it extremely difficult for the sufferer to get help. It becomes a kind of vicious circle: Someone in the throes of depression may feel exhausted, hopeless and helpless. Things that outsiders see as simple tasks become too difficult to perform, even – and perhaps especially – when they might offer some lightening of the depression. Because as bad as depressed people feel, the one thing they fear is feeling even worse. If you’re convinced that things are destined to fail, hope turns into a cruel, poisonous viper that you want to stay the hell away from, because if it betrays you, you may not be able to take the disappointment.
So the depression tells you that it’s safer to remain where you are. “What’s the point?” becomes a mantra in response to any impulse to seek help or change, whether the desire for help comes from inside the depressed person or from friends/loved ones. Sometimes that person puts a ‘brave’ or ‘happy’ face on for others, which may be what the OP’s “clever lady who cannot understand she is depressed” is really doing.
Other mental illnesses are also very protective of themselves. Paranoid schizophrenia is notoriously difficult to address because the patient’s own mind insists that every attempt at “help” is actually an attack. Elaborate schemes and plots make complete sense to you. If you’re totally, sincerely convinced your doctors and even loved ones are trying to poison you, why on earth would you swallow the pills they keep telling you to take?
And panic disorders fall into this category too. If you have a panic attack – which isn’t just mild discomfort that lots of us feel, but rather a sudden, inexplicable abiding terror that makes you feel death is imminent (claustrophobia, tunnel vision, tachycardia, difficulty breathing) – you may start living in dread of getting another attack. You’re afraid of the fear itself. This may mean you start avoiding anything that brings on similar symptoms. Avoidance in turn makes you even more fearful, because things that were once normal activities start feeling unfamiliar and scary.
I liken such illnesses to jealous, abusive spouses. You’re afraid to stay and you’re afraid to leave. They create a reality to keep you with them – and all too often, it works.
There was one case in Canada of a very intelligent but bipolar man. When he was on his medications, he fully understood that he had a mental illness - but he preferred the way he felt when he was off his meds. So when he was on his meds, he would refuse to take them.
His attending physician tried to get an order under the relevant legislation forcing him to take his meds. The patient challenged it through the courts, arguing that he had the right to choose to be off the meds and enjoying his natural mental state. It went all the way to the Supreme Court of Canada, which ruled in his favour: Starson v. Swayze.
A much bigger obstgacle to seekiing treatment for mental disorders is the social stigma. Until very recently, mental illness was not understood as a manifestation of physiological problems. Instead, our culture considered mental illness as a moral failing of the sufferer or as a weakness in character. Admitting to mental illness is therefore admitting to not being a strong, upright, solid citizen and contributor to society. Our culture still has this hang-up, and in other cultures it is worse.
A illness that strikes at brain chemistry is no different, really, than an illness that strikes at pancreatic chemistry. Tell a person they are a diabetic, and they may be upset at the implications that has for their physical wellbeing, but they won’t be upset that you called them a psycho.
Adding on to choie’s comments:
I struggled with depression for a long time before I actually spoke to a doctor about it. Fortunately, I am one for whom Paxil works wonders. However, as this was happening, I started to feel as if something was wrong, somehow, but I did not know what. Eventually I realized that some part of me had become accustomed to the depression and the fear, and when those went away, it just felt abnormal. Good, but abnormal.
From my reading and observation (IANAD) some people with bipolor disorder miss the “high” that they get during the upswing, to the extent that they resist anything that takes it away.
Depressive-cynical talking. choie is 100 per cent right IMO.
I think of depression as a mental virus, a soul-eating Ebola if you will. It will mutate to grow stronger, and fight and absorb almost anything you throw at it.
I agree with my sister who once said most people won’t change until the costs of the status quo become higher than the benefit of staying where you are.
For both the alcoholic and the depressed person, they can keep running on a sub-par level of life for a very long time. Myself, I was a high functioning severely depressed person for a very long time. I only began dealing with it when it got extreme, because it was deal with it or die. Literally, dead.
There are costs and benefits to everything, and while you may perceive the life of the alcoholic and depressive and unbearable, there’s clearly something they are both doing to cope that allows them to keep going the way they are. Both of these diseases take an awful lot of effort to overcome, and neither one seems to be motivated to go to the effort.
Hey, that’s succinct and brilliant.
It might seem metaphorically true but it can’t be literally true - an mental illness isn’t an entity that has a will of its own. And it’s not like a physical infection or parasite which can evolve through natural selection and condition the carrier to increase its chances of being passed on to another host.
There is some genetic component to acquiring a mental illness but that’s not the whole story. Even if it was, what advantage would there be to the gene for it to make the person ill and resistant to treatment? Anecdotal evidence from my professional experience suggests that people presenting with the symptoms of mental illness are less likely to reproduce, not more. Once they recover they would be more likely to pass on their genes.
I’m not aware of any other mechanism by which an illness could literally self defend.
It’s really hard to say how much of this is inherent to mental illness and how much of this is related to the fact that in terms of treating mental illness, we are only a little past “bleed and purge the patient until their humors balance.”
I’ve known many people whose mental illness was effectively treated by modern science, but I’ve known plenty of others that found the field to be a quagmire of conflicting advice, scams, ineffective treatments, false-starts, horrid side effects, and unintended consequences. Treating mental illness is genuinely risky. This doesn’t mean that people shouldn’t try, or that it’s all bunk–it clearly isn’t. But there’s legitimate reasons why the person with the broken brain would be more hesitant about going to the doctor than the same person with a broken leg.
IANAD
I think that one aspect of most mental illnesses is poor self-esteem. Even when it’s not a causative, or an early-stage symptom, I would imagine that it would result quickly from the first inklings that one does not feel/think/perceive in a fully functional manner.
If one is already feeling bad about oneself, then admitting to the problem would seem to bring one down even further. What could be more corrosive than the idea that one’s brain is somehow flawed? It threatens one’s entire reality.
Soooo, I can see how the idea/admission might seem impossibly threatening - as if it might be the straw that broke the camel’s back. The person fighting for his/her last scrap of self-esteem would therefore fight hard against the diagnosis.
In the animal world, I know many animals will try their damnedest to mask any physical illnesses because showing that weakness easily makes them more vulnerable to attack. It’s interesting to see how that kind of relates to people and not wanting to expose mental illnesses. Perhaps we’re hard-wired the same way to not want to show signs of weakness or vulnerability?
Oh, I don’t know. Have you found your other, third-party friends agree with your diagnoses, or has all this been a one-man crusade so far?
I have a friend whose five-times-married, workaholic father loved to give self-help books out at Christmas.
I don’t think an illness, mental or otherwise, has a consciousness that seek to can defend itself. But consciousness has a consciousness and maybe that’s what’s seeking to defend itself. If a person is depressed then that is a part of his personality, for good or bad. Other people who are seeking to cure him are seeking to change his personality - to essentially turn him in to somebody else. Even if he acknowledges that that other personality might be happier then his current personality is, it’s still a willful act of self-destruction as some level.
This reminds me of a relative of mine. He is a young adult now, bipolar and has probably been that way since middle school, and has been placed in a facility several times due to bizarre behavior. He was released from a recent stint in there and was believed to be taking his meds, but…read on.
He caused an art school to be evacuated because he’d left a suspicious item in there (it was just a fanny pack, but you never know), gone outside and ranted/rapped while standing in a trash can, and took off some clothes. This ended up on some local news.
Into the facility again. Then out again. He won’t take 2 of the 3 meds because he hates the side effects. Got contacts just so he’d look weird and ended up with a red, swollen eye.
His parents are constantly worried and can’t comprehend why he keeps getting released. I can understand that. But I can also imagine that the side effects are unpleasant, so I can’t totally blame him for not wanting to have them.
He says he knows that he’s got a problem.
I just don’t think the prognosis is very good in this case.
I am a retired Army officer. Generally the psychiatrists agreed with my diagnoses, or I with theirs.
The trouble is that our understanding of the brain and its chemistry and pathology currently lags well behind our understanding of the pancreas. The best that can be done for many mental disorders is to “manage” them, with varying degrees of success and side effects.
In terms of the social stigma question, it’s possibly relevant to note that other people don’t expect to have to react with an improperly functioning pancreas.
IANAShrink, but it’s true in my case - I know I have at least some measure of bipolarish whacky going on, but whenever the idea of getting my brain picked at by a doctor suggests itself while I’m in manic mode, a part of me is quick to point out that “This is who you are. This is who you’ve always been. This is an integral part of you. If it somehow magically vanishes, or some pills turns that “off”, then you won’t be you anymore. Do you want to ego-die ? Don’t do that, Dave”. In depressive mode, things are much easier : “Heh, what for ? What’s the point ? We’re all gonna die and none of it is going to matter anyway. A brain the size of a planet, call this job satisfaction etc…”
I don’t think I’d describe it as the whacky fighting back so much as me being afraid of change or something like that, though.
Suppose a person had a mental problem which did not “self-defend” as you describe. In that case, the person with the problem would be in a much better position to deal with the problem. So logically, when you encounter somebody with a mental problem, there is a good chance it’s a mental problem with these sorts of qualities.