MH@H Mental Health

Is Mental Illness More of a Reason or an Excuse?

Is mental illness a reason or an excuse? (There's a difference)

This post was inspired by a recent post by a fellow blogger about the psychology behind excuses. I left a comment about distinguishing between reasons and excuses, and I thought the idea was worth some further expansion.

The Oxford English Dictionary includes many definitions for “reason”, but these are the most relevant for this purpose:

A cause, ground, or motive

  • Of a fact, event, or thing not dependent on human agency

It defines an excuse as:

That which is offered a reason for being excused; sometimes in a bad sense, a (mere) pretext, a subterfuge

  • A plea for release from a duty, obligation, etc.

The differences may be subtle, but I think they’re actually really important. The word excuse carries with it a lot of negative overtones. It sounds like an attempt to get out of something that you really should be doing but just don’t want to. I find the sub-definition of reason very interesting, i.e. that reasons aren’t dependent on human agency. Agency refers to the capacity to freely make choices and enact them, so if a reason is not dependent on agency then it is outside the realm of our control. Mental illness in many ways falls into that category; yes, we have some ability to bring about change to a certain extent and in a way that varies over time, but we can’t control the fact that we have an illness.

It seems like people with limited knowledge about mental illness or other invisible disabilities often have a hard time grasping why we can’t do something because of our illness. As a result, they may think we’re being lazy or making excuses if we call in sick or are unable to work due to our illnesses. This is a very different kettle of fish from what I would consider a reason – recognizing that our illness is causing problems for us, and proactively making decisions about what choices will be best for our mental health.

Mental illness can also twist our own thinking so that we start limiting ourselves with excuses but justifying those limits as being bona fide reasons. Depression might make showering really, really hard, and once a week is about all that’s manageable. But maybe depression starts to become an excuse if it’s used as justification to quit trying altogether. Sure, maybe I’ll reconsider next month, depending on how things are going, you know… It can be a tricky balance to find. For me it comes down to making an effort. Maybe I’ll try and then give up today, tomorrow, and the next day, but if I try and get it done the day after that, that’s not about excuses.

The way I see it, excuses are about running away. Reasons are about acceptance of what is, and figuring out how to do the best we can given realistic constraints. Excuses look for ways not to try, and reasons are the opposite. Relying on excuses is disempowering, while acknowledging reasons can be very empowering. Excuses show a lack of insight, while reasons demonstrate that we do have insight into our illness.

What do you think? Is there a difference between reasons and excuses when it comes to how we handle mental illness?

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25 thoughts on “Is Mental Illness More of a Reason or an Excuse?”

  1. This is such an important topic. I had a friend once who was psychotic NOS, and she needed her meds. On them, she was pretty much the epitome of normal. No issues at all. She had a young son who she loved and had fought to get custody of, and her dad was helping raise his grandkid with her.

    This is where it gets… interesting. She wouldn’t stay on her meds at all. She’d go off them and wind up completely out of touch with reality in a manic way that she was addicted to. She’d wind up in a horrible situation of who knows what, and then back to the mental hospital. She’d be medicated and be fine and be released, and the pattern would repeat itself.

    She talked to me often about how the Bible says medications are bad. I researched it on her behalf, and I think the Bible was talking about street drugs, not medications. I sent her that info with references. It took me a while to realize she wasn’t God-fearing; rather, she wanted an excuse to not medicate. She was crazy addicted to the high of being unmedicated.

    So one time, she wound up in the mental hospital again, and she contacted me from their computers, which they allowed her to use. She was giddy as a kid on Christmas morning when she told me the nurses had forgotten to medicate her! Any hour now, the happy high would kick in!

    I facepalmed at the impossibility that the nurses had “forgotten.” They were testing her. They knew she’d go off her meds as soon as she was released, and they wanted to know if she’d say, “Excuse me, but you forgot to give me my pills.”

    So there I was in the awkward position of knowing that with near-certainty, and I had no idea what to say to her. I settled on giving her a very firm, near-hostile lecture about how she needed to go ask for her meds. She unfriended me after that.

    I still worry about her, but I also have very little respect for her decisions, especially because of her young son who needed his mommy. 🙁

  2. I think there are some stark differences personally. To me? The reason (factual basis) for my own mental illness is a combination of genetics (familial trait) plus nuture (patterns of behavior which exacerbate the imbalance in the chemistry or whatever it is that makes my brain function different from ‘normal’ people). Those are the REASONS. The excuses (blame, guilt, whatever) are not factual. They are what I’ve used to hide behind (sometimes), and what I observe others who suffer with mental problems, to use as reasons for their behavior or lack of conscience (morals) etc. Some blame the mental illness for their poor choices, which may have some factual basis; BUT until they turn and face the fact that they are in control of themselves, regardless of what mental illness they suffer with; they’re still making excuses for themselves. In my opinion.

    Interesting question! 🙂

  3. Yes, there are definitely reasons and excuses. They are often mixed or maybe not. What may seem as an excuse to someone who never suffered from a mental health condition, may be a legitimate reason to not do something or to act a certain way.

  4. I often battle my excuses because I feel they come from my anxiety. If I don’t want to go work out it’s because I’m anxious about going to the gym. If I don’t want to go to that event it’s because I’m anxious about being around a group of strangers. It’s hard for me to distinguish between what’s an excuse and what’s a legitimate reason. I find myself searching for justification for my choices frequently because I wonder if I’m just not working hard enough to challenge anxiety. It might be helpful for me to consider the difference b/w excuses and reasons. Thanks for bringing up this topic!

  5. Had to share! I’ve had family not understand that I can’t just control my behavior. I’ve even been referred to as a brat (hence my blog name). They also don’t think mental illness is real. On the other side of the coin, I realized I had to make the choices to get better (meds, therapy, etc.) to help my emotions & behaviors improve.

      1. Agreed! I watched a video on Youtube of this man ranting & raving that mental illness wasn’t real except schizo phrenia. Then going off about how his ex was bipolar & she’d use it as an excuse to be “crazy” & cheat. (his words)

  6. When I was keeping regular therapy appointments, my counselor kept calling me out on just how often I run when I get scared. I was the queen of excuses to get out of things that flared anxiety. I still do it but now I’m learning to be more honest in my reasoning and on occasion when my only reason to not do something is am afraid , I make plans anyway and make myself. It’s so hard but it does reap good things.

      1. I just wanna throw out there- I LOVE your blog. Do you work on it fulltime? Your content is amazing

  7. This is a great post! I have often described bipolar disorder as the reason behind some of my behaviors, but I have NEVER used it as an excuse. So important that you have made this distinction between the two. I also really liked how you brought in the term ‘justification’. In my world, bad behavior can never be justified by my bipolar. Once that I realize I am engaging in a negative or risky behavior, it is my responsibility to correct or manage it.

    Great insight! Thanks again!

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