Mental illness is not "All in your head"

Every illness, physical or mental, is the combination of a genetic predisposition and an environmental trigger.  My aunt is 93 years old. She smoked heavily from her early 20’s until 86 years old when she had triple by-pass surgery. She has never gotten lung cancer. Pretty clearly, she doesn’t have the genes that respond to that environmental trigger. While we don’t know how to identify all genetic predispositions, it’s pretty clear when two individuals are exposed to the same environmental trigger and one develops an illness and one doesn’t, that genetics is playing a part.

In the arena of mental health, we are only just validating how true this is. Experts no longer believe that addiction is a matter of will power or that people should be able to “snap out of it” when depressed.  More and more the research shows that these are brain diseases and new genetic discoveries like this one for schizophrenia prove that out.  The persistence of old perceptions about will power and being “weak” continue to mean there is plenty of stigma around mental illness.

But consider this - who hasn’t been anxious before a big test? Or depressed after a death – sometimes it doesn’t matter how close you may have been. The world mourned Lady Diana together. What if we really start to think about those events as environmental triggers?  There are a couple of benefits to that, including an acknowledgement that most people fall on the spectrum of having “symptoms” of mental illness. This article from a few years ago talks about why we shouldn’t use mental illness as figures of speech. That saying “I’m OCD” is possibly trivializing a serious mental illness.  I’d rather say that’s an acknowledgement that we’re all in the same boat.  That we all fall somewhere on the range of behaviors associated with mental illness. Stigma is about making someone the “other”, understanding that we share these behaviors means there is no "other."

Look at it this way. Everyone has cholesterol.  For almost everyone, certain environmental triggers are known to increase cholesterol (like not eating well or not exercising). We are all checked regularly for our cholesterol levels.  The first action is to mitigate those environmental triggers if they exist (eat better, exercise more). But for many people, their cholesterol is high no matter what. High cholesterol runs in their family. When the number consistently tops 200 and the LDL/HDL ratio isn’t good, medications are prescribed.  For that person, high cholesterol has become important enough to require treatment.

Applying the same logic to anxiety, most people have anxiety about something: speaking in front of a large group of people; going to a party where you only know the host, etc. If you are still able to do those things or they don’t interfere with how you want to live your life, then no treatment is necessary. But what if your anxiety makes it impossible to leave your house? That probably interferes with your quality of life and should be treated.  It’s easy to see, though, how the difference between “normal” and “needs treatment” is a question of where you fall on the spectrum. Is it interfering with your life?

So the analogy between cholesterol and anxiety wasn’t really the same in one particular way. For cholesterol, we have early screening tools. We have a blood test that helps our doctors know when we are about to be at risk.  The first clue that maybe treatment would help isn’t a heart attack. For anxiety, we don’t have good tests yet; our doctors aren’t really screening for it, and we are not self-identifying before it’s a paralyzing illness (i.e. you can’t leave your house).  One of the biggest reasons we don’t self-identify is stigma.  It’s hard to acknowledge that something like anxiety is interfering with your life until it’s a really big problem because others think you should “snap out of it” or you have a weak personality.  We really need to stamp out these perceptions, first and foremost by understanding that everyone lands somewhere on the spectrum. Everyone has moments of experiencing “symptoms” that often don’t require treatment. And just for the record, it’s easiest to talk about this in the context of anxiety and depression since pretty much everyone has experienced those “symptoms.” But it’s just as true for psychotic disorders. Did you have an imaginary friend as a child? Have you ever heard a voice in your head – maybe your mother’s – cautioning you about something?  

Truly, we are all human beings with the same brain and body mechanics. When and whether we need treatment for any illness, mental or physical, is primarily about luck – whether or not our particular genes meet up with a particular environmental trigger.  Let’s acknowledge that and eliminate the stigma of mental illness. You can start by helping someone you know (1 in 5 Americans currently suffer with a mental illness) the same way you would for a physical illness – bring a casserole, drive a carpool, volunteer support.  Let them know it’s okay to openly tell their story.  Treat them as you did before you knew they had an illness.