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

Great Debates
21

I do think things have improved. There is a lot of social discourse about mental health especially in younger populations. There are support spaces online, etc. The flip side of that is that therapy language has broadened and often appears in the public discourse either pathologizing everything or divorced from its original meaning.

I think as a culture we often pay a lot of lip service to mental health inclusivity but a lot of people don’t want to deal with people suffering acutely. It’s like people with cancer who have friends distance themselves because of their discomfort with illness and death. Well, as the OP notes, mental illness can be really unpleasant to be around. When I was at my worst I experienced a lot of rejection. It was painful, but now that I’m mentally healthy, I have distanced myself from some people with severe mental illness as a sort of self-preservation tactic. My motive is a bit different, it’s more like I don’t want to be dragged back down to where I used to be.

Trauma has become the buzzword of choice in the public discourse, but a lot of people don’t want to confront what that really means. I wrote a book about two characters with PTSD. Readers were fine with the guy being fucked up, but they were not fine with the girl being fucked up. I had to work extremely hard to get readers to connect with her, and honestly I took it a little personally. I was writing based on my experience having PTSD for over 20 years. It’s not all cinematic flashbacks and cathartic moments of healing. Sometimes it’s dysfunctional, defensive behavior, unhealthy attachments, strained relationships, isolation, paranoia.

The question of to what extent people ought to be understanding and how much grace we ought to give the mentally ill is a good one. For me the calculus is often “How hard are you working on this?” Because I worked my ass off for decades to not make my issues others people’s problem.

My Mom waited until I was an adult before she would even consider therapy. After her diagnosis of Borderline Personality Disorder she spent about a year in therapy for a mental illness that is generally life-long, declared herself transformed, and carried on being abusive and narcissistic.

By contrast, I started therapy when I was 19 and I’m still in therapy. At one point, when my son was first diagnosed with autism, I had two therapists at the same time, one solely for working through issues needed to be an effective parent. Now I’m just down to the parenting one.

So effort matters to me.

22

I agree with many comments, but there is a threshold above which an employee should be let go due to mental condition.

In 2020 I hired an electrical engineer fresh out of college. Right away he exhibited erratic behaviors, and had major problems doing the simplest of tasks. When I finally had a talk with him about it a few weeks later, he said he was autistic and that I must make accommodations for him. I felt bad about his condition, but I needed an engineer who was trainable and could perform basic tasks. I contacted HR, and HR said I couldn’t fire him due to his condition. Long story short, but I was finally able to let him go after a very lengthy process.

So it “depends.” I can see many situations where a mental condition should not be cause for concern in an employment environment. But there is always a threshold, above which action should be taken.

23

I think it just comes down to, can you do your job with reasonable accommodations, or can’t you?

You can’t fire someone for being autistic. But you can fire someone who is autistic who is not able to fulfill their job duties when given reasonable accommodations.

However autism isn’t a mental illness. It’s a neurodevelopmental disorder which is kind of different. The main difference is NDDs are present from early childhood. They are highly heritable and so assumed to be primarily genetic.

However we know so little about the brain, I’m not sure the distinction is such a bright line.

24

The elephant in the room, and I say this out of love for the field of clinical psychology, is that modern day therapy is kind of a clown show. Good therapists exist, but many of them aren’t using evidence-based interventions. Even the evidence-based interventions we have aren’t effective for everyone.

So I’ll bet there are a lot of people who tried therapy, received bad therapy, and rather than trying to find someone else they just decided the whole idea is a scam.

25

I agree, and that applies to a variety of things including mental health conditions. Accommodations can be made but if someone can’t perform a job but if they can’t perform the tasks, then sadly they can’t perform.

US president is one of the most important jobs out there. But roughly 49% of US presidents from 1776 to 1974 had a mental illness, and about 27% were suffering from a mental illness while being president.

https://pubmed.ncbi.nlm.nih.gov/16462555/

The main mental illnesses were things like bipolar, depression, substance abuse, anxiety

Presidents like Bill Clinton and Teddy Roosevelt also suffered from hyerthymia, which is like a chronic form of hypomania. But they functioned fine as president.

Donald Trump by comparison, has malignant narcissism. Which is narcissistic personality disorder, sociopathy, paranoia and sadism all rolled into one. He also likely has frontotemporal dementia. These deeply affect his ability to function as president.

Reagan had dementia towards the end of his presidency.

A US president can function with depression, anxiety, even bipolar. But with narcissistic or sociopathic traits, or dementia, they can’t do the job. It depends on the job and depends on the mental illness.

Surgeons who have sociopathic traits actually see benefits from what I understand, because they do not get overwhelmed by stress or empathy during surgery. But a sociopathic social worker is a terrible idea.

26

There’s also a certain element of “this person is not thinking correctly” in the sense of they’ve got badly programmed software, versus the element of “this person is not thinking correctly” in the sense that they’ve got hardware problems.

My friend I mentioned upthread is one of those people who has faulty hardware, so to speak. All the therapy in the world wasn’t going to fix his chemical imbalances, but the right meds, and he’s right as rain. Meanwhile, in my acute depressive episode, it was very much a matter of flawed thinking, and learning some techniques to better ground myself was eye opening and just what I needed.

Had I gone to a doctor who’d jumped out and prescribed prozac right out of the gate, I’d probably have been very skeptical of mental health treatment from then on out. And my buddy did actually go down the therapy route for a good while before being prescribed medication. Considering his personality, I’m a little surprised he stuck it out that long, although really glad he did.

27

And often, it’s both.

One of the best therapists I had was using an intervention called ACT. I had spent many years trying to fix my depression, and he said, “You know, this is probably not going away. All signs point to you having a biologically based mental illness.”

I imagine some might have found that discouraging, but it helped me tremendously, because I could stop pouring so much time and energy into achieving optimal mental health and learn how to live my life with depression.

And that really helped with my depression.

(What also helped was medication. But with medication you’ve gotta kiss a lot of frogs.)

28

Another thing that I think bears repeating is that mental health is something that needs periodic tuneups, even if you don’t actually have problems. It’s tremendously valuable to have an impartial therapist who you can talk to about your problems, don’t know the people involved, and get honest answers that they don’t have any sort of personal stake in. Unlike say.. friends or family, who usually do know the cast of characters and have their own preconceived notions.

If nothing else, they can help you learn techniques for dealing with people and how to be more emotionally intelligent, which pays dividends throughout your life. One thing I was told is that most people who are upset want one of the “Three H’s”, meaning they want to be held, helped, or heard, and the trick is figuring out which one. At work, it’s almost always the first or third (usually the third, actually), and just being willing to listen to someone gripe goes a remarkably long way to being able to productively work with people who are described as difficult. But I’d never have known to do that without having gone to therapy and learned that bit of wisdom.