In what ways is society not ready to accept or deal with mental illness

Great Debates
1

There is a lot of stigma for mental illness, far more than for illnesses outside of the brain. But I get the impression that there are various reasons why mental illness isn’t going to be accepted the same way we accept physical illness anytime soon.

For one thing, accepting mental illness means accepting that dualism is a myth. The idea that our self aware consciousness is not some ethereal thing separate from our brain, but intertwined with it on the deepest level is hard for people to deal with. The fact that a TBI or mental illness can turn a happy and social person into someone who is mean and depressed is scary to a lot of people because it shows our consciousness isn’t something separate from our brains. A person can be a devoted and loving parent, but then suffer a TBI or mental illness and become angry, apathetic and mean. I read a story years ago about a loving and devoted mother who survived a car wreck. She had a serious brain injury and lost interest in her kids. The doctor told her family to hold a mock funeral because the original her before the injury was dead now and wasn’t coming back, even though their mothers body was still there and she was still alive.

Or like how in psychosis or mania a person may become extremely religious. People hold religion sacred and accepting the fact that a biological illness can deeply affect your views on religion is unsettling to a lot of people. People have gone from secular, to deeply religious, to secular again before, during and after an episode of psychosis or mania.

But also some mental illnesses make you dangerous to others, especially the cluster B personality disorders like antisocial personality disorder (sociopathy), narcissistic personality disorder, borderline personality. The dark triad (sociopathy, narcissism and machiavellianism) is strongly tied to destructive behavior. I think some studies show that 2% of the general public have anti-social personality disorder, but 40%+ of people in prison for murder have anti-social personality disorder. My understanding is there there is a large overlap between people who have narcissistic and sociopathic traits (clinical and sub-clinical), and people who engage in sex crimes. Its harder to feel empathy when your mental illness makes you hurt other people.

Or hygiene. Various illnesses like psychosis or depression can make you lose interest in hygiene. That makes it harder to gain acceptance. Feeling a little sad is one thing. Feeling so sad you smell like body odor is something else for a lot of people.

I feel like brain illnesses affect us in ways that deeply affect a lot of unspoken assumptions we have, and addressing that means questioning those assumptions. I think that’s one reason recreational drugs are mostly illegal too, accepting that physical chemicals can affect our sentient consciousness is deeply uncomfortable for a lot of people. One recreational drug can make you feel intense love and compassion. A different recreational drug can make you feel intense rage and irritability. Thats distressing for people to accept.

But why do we put elderly people with brain illnesses like dementia in medical facilities, but young people with brain illnesses are left to rot in the streets? Neither consents to treatment because the parts of the brain that give you the ability to consent to treatment are affected. But for one we take that decision away and for the other group we do not.

So - I've started my medical transition last week
2

IMHO, one unfortunate aspect is that mental illnesses are much more prone to being accused of faked than physical illness, since physical illness is seen as a lot more “objectively proven.” For instance, anyone can claim they have depression, whereas a broken leg is proven or disproven with X-rays. This will forever be an obstacle in the path of people with genuine mental illness trying to get taken seriously.

The other aspect is that most people are at least slightly wrong in the head in our own unique ways, whereas physical ailments are much more yes/no binary. So if you say, “I have depression,” someone else may just handwave it away as, “Ah, I have some depression, too!” even if your situation is 20x worse than theirs.

3

In what ways? Substantially every way.

We lack the technology to diagnose accurately or treat effectively.

The nature of mental illness is its self-destructive or destructive to relationships w others and productivity in society. Our religion besotted society can’t think clearly about either of those first two consequences. And our economics-first society the third is anathema too.

4

That’s another thing I was thinking about but didn’t really elaborate on.

When an elderly person gets dementia they’re treated differently than someone who develops schizophrenia or bipolar in their teens or 20s. The elderly person isn’t left to sleep on the streets or have violent cops sent after them anytime they do something strange.

That elderly person isn’t economically useful anymore. Plus they’ve worked for decades. So as a society we feel they deserve to be in a safe nursing home. Their economic usefulness is over.

But the person who became disabled by schizophrenia or bipolar before they got a chance to work and contribute isn’t seen as deserving help because their long history of economic output isn’t there. Also as was mentioned, on the outside they look able bodied so people assume they can work while we understand an 80 year old can’t work for a living, dementia or not.

On the subject of religion, mental illness raises uncomfortable questions about religious prophets. A lot of religious prophets we revere as conduits to the almighty probably had mania, psychosis, temporal lobe epilepsy, or some other disease that was causing their religious visions.

5

My thoughts based on my own mental illness and others in my family.

My Mom had borderline personality disorder, which throughout my childhood was characterized by violent and erratic behavior, obsessions over imagined betrayals, wildly unstable relationships (4 marriages before I turned ten), wanton cruelty in response to imagined wrongs and enabling of sexual abuse.

And I recall the general response at the time to be “But bitches be crazy, right?” This idea that women are inherently more irrational has affected people’s willingness to call what my mother had a disorder. You know, hell hath no fury like a woman scorned. And we can’t really hold her accountable for her behavior because, as noted previously, bitches be crazy. You can see extreme examples of this in women aquitted of violent crimes because, well, they’re women.

The excellent musical comedy Crazy Ex-Girlfriend, which is about a woman with borderline personality disorder confronts this issue directly and humorously.

The flip side of this is that sometimes women reacting quite naturally to crazy and abusive circumstances are scapegoated as pathological. The level of prejudice that many mental health professionals have toward women with borderline personality disorder is better than it used to be but still quite disgusting to me. Also women are much more likely to be so diagnosed than men.

We’ll start there. I’ll be back.

6

I think there’s an fairly significant element of it somehow being within their control that is obviously not there with dementia patients. But until that realization, there’s a lot of frustration and bafflement on the part of family and friends.

If you don’t have experience with mental illness and/or don’t have the knowledge and vocabulary, it’s going to be perceived as weakness, mopery, etc… when it’s not. Or that it’s just their inherent personality, when maybe it’s not that, but mental illness instead.

For me, it took a close college friend having a turn intoi severe clinical depression, and me being absolutely perplexed. He seemingly had everything I didn’t- attractive & smart girlfriend, high paying job lined up, good grades, friends, enough cash to not be broke, and despite all that, was super depressed. Meanwhile, I had no girlfriend, no job lined up, mediocre grades, and was fairly skint on top of everything. But I wasn’t depressed; I was actually pretty happy. I realized this wasn’t anything he could control and that it wasn’t at all rational and that he needed help. And sure enough, after some therapy and especially medication, he’s been pretty well for the last 27 years or so.

But I can see people who have never had such a stark demonstration, or people who view this sort of thing as weakness as being particularly unforgiving.

7

And what goes with this is that people with a mental illness seldom act that way all the time. A person with severe depression may function well enough to hold a job, go shopping, etc. perhaps only being a little withdrawn. Sociopaths are often said to be caqpable of being charming and even charismatic. Unless you’re a family member or long-time friend (and often not even then) you may not be unable to understand that a person is functioning despite having severe problems, and it isn’t just some “snap out of it” mood swing.

8

I think this is it for a lot of people. More than a quarter of a century ago, I picked my mother up at the Dallas/Ft. Worth airport for a family event. On the way home, she acted like she was afraid of my driving. She’d inhale sharply, fidget, flinch, tell me to slow down, and at times put her hand on me whenever she felt a car was too close or conditions were unsafe. This was just normal traffic (yeah, it’s D/FW traffic, but still), and I interpreted this as my mother not trusting me to drive. When she yelled “look out” I lost it and shouted at her to keep quiet because she’s distracting me. I’m not the type of guy who shouts at his mother.

It turns out my mother has a serious anxiety disorder. I didn’t know it at the time, but when I learned about it things suddenly started making sense including some of her behavior from when I was a kid. Just knowing she has a disorder made it a lot easier for me to deal with her in the car. I don’t get mad, I just reassure her that everything is fine, I warn her if we’re approaching a bridge, and I’ll even tell her if a particular turn is going to be bad. When I remember at least. Sometimes I forget something is coming up she might have difficulty with.

A lot of us aren’t equipped to recognize let alone deal with mental illness issues. Behavior we might take as someone being a jerk could be a sign of mental illness and we wouldn’t know.

9

Good points.

I’ll add that similar issues crop up in the early stages of elder dementia too. The person becomes more difficult or haphazard or forgetful or slow or … and at first the spouse, family, etc., don’t realize what’s going on. So they react impatiently: “Would you just pay attention to what you’re doing?!”

And even with a formal diagnosis there’s a lot of what amounts to victim blaming; expecting behaviors they can no longer perform or losing your shit the 10th time they tell you about [whatever] today.

Switching to a societal level ..
We have a lot of beds and care support around the USA that are designed for the elderly infirm and the demented. What we don’t have is comprehensive government (read “taxpayer”) supported funding for all that for everyone. Some yes; enough no.

So the folks with enough money or enough family to chip in get the accommodations and help they need, while the rest fend for themselves or slowy rot in somebody’s back bedroom.

For the mentally ill, we have even less public provision. And far less collective inclination to change that. So for the severely afflicted, they end up fending for themselves, largely sleeping under bridges.

10

By strange coincidence two of my closest lifelong friends are psychiatrists and I’ve been talking to them about this issue for almost 30 years now. Almost every time we talk it seems.

Apparently it is only during their careers (since the mid 1990s) have non-psychiatrist DOCTORS stopped using derisive and dismissive language to describe psychiatric patients and their afflictions. And it’s still nowhere near 100%. And especially among doctors of South Asian and East Asian origin. Or maybe in their “safe space” they just feel more free to let their prejudices out.

11

Also, even a hint of mental problems is career suicide in some fields. I watched a close friend lose his security clearance, then his job, then his home because he asked for help navigating some serious mental problems. He’s now homeless because untrained and overpaid mall cops were the ones evaluating the seriousness of his mental issues.

One of the major improvements of retirement is that I can now seek counseling without endangering my income.

12

Yep. We’re just starting to deal with this in my former industry. And pretty much only for situational depression, nothing more … interesting.

Of course if you’re having any kind of problems, being scared and unhappy about that is normal. And looks to you a lot like depression. Seeking a diagnosis before you know which problem you really have means rolling those large dice with everything riding on the outcome.

[ETA: Ref the FlyDubai almost-crash yesterday that may be terrorism or may be a suicide attempt …

Every time something like that happens, the public and legislatures almost worldwide make noises about hardening the line on aircrew mental health screening. Not making it more humane. Which of course will only drive the statistically inevitable problem cases farther underground until they hit crisis. So dumb.]


I know a now middle-aged physician who was having depression adaptation problems during the year long ritualized hazing called “residency”. So 20-ish years ago.

She sought help in accordance with the school’s / hospital’s advertised processes and almost lost her career. Much like sexual harassment in much of Corporate America, what the posters say HR does and what HR really does are polar opposites.


Yep. I’ve not had the mental side of things, but I have to say that not having the FAA’s nose in the physical side of my overall medical tent has been a great relief.

I’m about to embark on a new phase of my rest-of-life diabetes management and I’m glad they don’t get a look in. Some research suggests in this particular case they’d be OK after a short vacation while we test for adverse reactions. But there are a lot of other permutations of that table which mean “Congrats! You’re permanently retired. Shame you might be mid-career w kids to feed.”

13

So, what you are clearly saying is, if you have any fears of depression, stress, psychosis, or any mental health issue whatsoever, you should never, never, ever say or mention anything about it or else your career will be over before you even know what happened. Got it. Are you able to see an actual doctor, though? If you make an appointment with a psychiatrist, can your employer somehow find out about it?

14

We are not ready to accept or deal with mental illness because to do so threatens our commonly-held beliefs about free will and choice. About the way we understand responsibility, fault, and blame. About the way we understand justice and punishment. About the way we understand identity and personality. About the way we ascribe value to human lives.

It calls into question whether social and economic systems are truly meeting the needs of most of society, or just a sub-set with a particular psychological profile.

It challenges the paradigm that we all are equally capable of making the same choices most of the time, and that failure to make good, healthy, or safe choices is a question of simple, well, choice.

It asks us to consider that our assumptions about what people “should” be able to do easily and happily, both personally and societally, is in fact causing harm and distress to large numbers of people.

15

Pretty much. As noted, there is significant movement of the FAA’s mighty bureaucratic supertanker towards non-career-ending help for situational depression. Many folks have been treated, recovered, maybe even on continuing meds (from a very short list), and are still flying. But that’s it. So far.

Of course a second hurdle to keeping flying professionally is when your employer finds out. Which company personel regs may require you to tell them. Some companies, with a LOT of union chivvying are cool (enough) with it. Others, and especially non-union outfits don’t give a shit about you and you’ll be unemployed before you can get out of the boss’s office.

Liability doncha’ know. Crazy people can’t be trusted.

You are required by law to report every encounter with the medical profession, even dental hygienists, to the FAA every 6 months. On pain of loss of license if caught concealing anything, even the dental hygienist.

As a practical matter, FAA’s ability to snoop into private doctor’s records is nil. So a lot of underreporting goes on. Now.

There was a semi-scandal maybe 5 years ago where the FAA requested and received VA medical records. Which was permitted by various features and gaps in the relevant laws. At which point they found a substantial fraction of veterans = former military pilots had extensive VA medical histories. Mental or physical histories, but obviously physical being the far more common case. And in many cases findings of disability.

Substantially none of which had been reported to FAA as required.

Cue outrage from the veterans groups that they had been singled out in a witch hunt. Not really; the FAA looked at what records they could get. They’d have preferred to get everyone’s records. Shame about HIPAA still keeping the FAA out of everyone’s med records. For now.

The reality was a bit less scary than the headlines, in that a large fraction of military pilots get a sorta gratis civil license that’s available upon leaving the service. But a hefty fraction of those folks don’t go into professional aviation, in fact don’t fly at all, and hence have no reporting obligation to the FAA.

But those who do fly, even as hobbyists, do have the obligation. Of the pro pilots, the FAA slaughtered a few careers of the most egregious offenders. Pour encourager les autres.

16

I think you’re on to something here.

Many people don’t like the implications that people’s self-medication/drug abuse/addiction could be caused by something other than a lack of willpower/grit. They like to think of the world in a rather us/them sort of way, where “them” is the set of people who for whatever reason (in their minds) choose to engage in a whole host of counterproductive and often self-destructive behaviors. Or at the very least, sub-optimal behaviors.

So you get a kind of “Well, they chose to be a drug addict/poor/single mom/etc.” attitude that allows them to more or less mentally write off that person by invoking the “they’re choices, their consequences” invocation.

By acknowledging that mental illness can at the very least, significantly affect decision making capacity, it opens the door wide open for acknowledging that a whole host of other things may not be choices that are as cut and dried or in someone’s control as they might want. And it also demands a different response from otherwise compassionate and kind people. So they don’t open that door even a crack, because that’ll upset their entire worldview, which is disruptive and painful to most people.

And even among those who do acknowledge the impact of mental illness, there’s a lot of uncertainty surrounding what’s the illness and what’s the person’s personality. I mean, I’ve known a few people who were mentally ill, and who were just assholes. It’s awfully hard to tease out what’s the crazy talking, and what’s just them being jerks. So again, it’s easier for most people to just ascribe a lot more agency to their behaviors than to try and figure that out and remain sympathetic and compassionate. To some degree this is natural; you do have to draw boundaries and enforce them, regardless of whether it’s the mental illness or simple jerkishness causing them to push/disregard them. And I imagine that if it happens enough, it quits mattering exactly why they’re doing that, only that it stop.

17

It’s amazing they haven’t considered the obvious drawback to this, which is that people with mental health issues will hide it until it gets severe enough that it really will impact air safety. If people get the intervention they need sooner, that would be less likely to happen.

The world of clinical psychology is pretty horrible about this also. When my husband was on neuropsych rotation for his PhD, the hours they were working were so unreasonable that one of them collapsed from exhaustion and hit her head and had to be hospitalized. The following morning everyone was given a lecture about the importance of self-care.

Also a lot of psychologists in academia get unofficially blacklisted because of mental health issues. When Linehan, the creator of Dialectical Behavioral Therapy, revealed that she had diagnosed Borderline Personality Disorder herself, it was a big freaking deal. But she was so famous and respected in her field she had the luxury of doing that. I notice, however, that she framed it more as a problem she used to have more than a current struggle.

18

The have considered it. It’s a well known well-discussed very obvious consequence.

But the political / regulatory / PR climate simply does not permit telling the general public that the FAA says it’s OK to fly airliners full of ordinary people while being treated for e.g. bipolar.

The FAA is now sticking its neck waay out there by letting people under treatment for situational depression fly airliners. Imagine the blowback were one of those pilots to successfully commit suicide dragging 50 or 350 passengers to their doom at the same time. FAA thinks they’ve got enough safeguards in place. But do they?

As a separate matter, given the true state of the psychological / psychiatric healing arts, there are many people who simply cannot be helped by current tech. If you’re one of those and raise your hand, even if the FAA was totally accommodating to trying to treat you, once that fails, then what? You’re screwed; still out of a job.

There is specialty loss-of-career insurance available to pilots. However it’s eye-wateringly expensive and is only a partial replacement for lost wages. And in most cases has significant benefit reductions for mental as opposed to physical disqualifications. Why? The same reason most health insurance is similar. The nebulous and often ineffective current state of the healing arts, and the societal belief in widespread malingering and that many mental problems are defects of character, not of cognition.

This thread is about far more than the airline piloting biz. But that biz happens to be a very well instrumented test case microcosm of what every other job and every other person is also dealing with. Including you, your son, and your poor beleaguered husband.

Good luck to us all; we’re collectively going to need it.


With no disrespect to the OP, IMO he asked the wrong question.

Rather than asking in what ways society is not ready to deal with mental illness, he ought instead have asked in what ways it is ready. Would’ve been a much shorter and more succinct thread.

ETA: Ref @Jasmine just below I too agree. The OP’s premise and analysis is accurate. I was just quibbling with the rhetorical choice in his title.

19

I can’t argue with the OP’s premise. We’ve been very educated regarding mental illness for quite some time now. We understand how it manifests itself and the things that can be done to treat it. Yet, mental illness is still in the eyes of far too many an unshakable stigma. This attitude shows even in health insurance where, in most cases, coverage for physical ailments is far more extensive than for mental ailments. I can’t see this social attitude changing anytime soon.

20

I think that is a common attitude not only in aviation but also the military, first responders, attorneys and medicine. Seeking help can destroy your career.

Ironically these are also careers where it is a common stereotype that a lot of these people have serious mental health issues. Lots of PTSD, dark triad traits, depression, substance abuse and also personal issues with infidelity (the 5 P’s) as well as domestic violence.

Basically careers where people need mental health care the most are the ones where people are punished the most for seeking it.