While there is debate over the roles of biological susceptibility and psychosocial factors in triggering the onset of mental illness, it’s also worth giving some thought to how the illness experience is shaped by social factors vs. biologically-based symptoms.
Once we are ill, we experience symptoms that are influenced by neurophysiological processes, regardless of whether the origin is genetic, environmental, or more likely, somewhere in between. At a basic level, these symptoms are going to be pretty consistent regardless of the social world we are surrounded by.
Socialization
Most of us don’t live in a box, though, so we’re inevitably members of a social system, at least to some extent. Our whole lives, we are socialized into the system we belong to, which includes learning group norms, beliefs, and expectations.
This means we grow up learning, consciously or unconsciously, how our social system views mental illness. When we become ill ourselves, all of that baggage from our early socialization hits us like a Mack truck. It doesn’t suddenly go away just because we happen to develop the illness. The symptoms themselves may feel heavy, but we also have to carry around the weight of being a person with a mental illness.
Social constructionism
In grad school, I learned about social constructionism, a sociological theory that essentially says that reality, as we experience it, is shaped by social systems. This means that our subjective experiences and the meanings we ascribe to those experiences are inextricably linked to our social worlds. This theory has been applied to mental illness to suggest that it’s impossible to separate the biological, objectively “real” effects of the illness from what our social environment has taught us about what it means to have that illness.
This made a lot of sense to me. Even though I’ve been significantly affected by the biologically-based effects of illness, there is so much more to the illness experience than that. There are the effects of dealing with people who don’t “get” what mental illness. There are the significant effects of stigma, which are profoundly social in nature. If I could have experienced depression in a milieu in which mental illness was considered valid, I might be in a very different place in life than I am today.
Meanings and mental illness
There are so many meanings that society attaches to mental illness that aren’t actually inherent in the illnesses themselves. Beliefs that mental illness represents weakness, not trying hard enough, not being positive enough, not being good enough, or being unpredictable, frightening, dangerous, are all social factors that hold us back from living the lives we want to live.
Imagine what it would be like if mental illness was considered “normal” and treated with the same acceptance and respect that tends to be afforded to people with cancer. Would it make the illness easier to cope with? Even if the symptoms were still there, I think this kind of change in socially ascribed meanings would make the experience of being ill at least a little bit easier.
Have social factors played a significant role in your own illness experience?
If mental illness was treated as a disease (like cancer), I think it would be easier to live. Although I’m open about my bipolar, I still, after 25 years, feel like it’s something I have to hide. My mom could never stand my openness, probably because she didn’t want anyone in her social circles to know that I am mentally ill. It was like, I was something to be hidden away. She’s gone now, but her beliefs still affect the way I view myself.
That seem like the kind of thing that would never fully go away.
Yeah
I feel in a complicated situation, because I’m in two cultures. In the secular Western culture where I work (when I have a job) and where some of my friends are, there is stigma, but it is slowly being addressed. However, there is not much of a social support network; people just leave things to the state (NHS, benefits), not least because friendship networks can be spread over a large geographic area.
In the Jewish community, there’s a lot more support for illness or crisis in general, in terms of emotional support and practical support (cooking food for people who are too ill etc.), but the stigma around mental illness in particular feels greater than in general society. Although I don’t really know first-hand, as I’m so scared by the stories I’ve heard that I’m reluctant to tell people about my issues. When I have told people, I haven’t had any disastrous stories like the ones I’ve heard other people have (being told to pray harder or that sadness is a sin etc.), but people don’t look out for me the way I feel they would if I was physically ill. But maybe that’s wishful thinking on my part and it would be no different if I had cancer. It’s hard to tell.
Presumably there’s been mental illness popping up in the Jewish gene pool for a very long time. Do you think there’s a lack of exposure, or maybe more of a willful ignorance?
I don’t know. I guess part of it in the Orthodox world ties in with the Victorian attitudes to marriage, the idea that someone should be ‘good’ husband material or a ‘good’ wife material and so the presence of mental illness in them or even their family would be a big negative. The fear that if it was known that you were mentally ill, not only would you not get married, but you wouldn’t even get dates because no one would agree to go out with you. And of course this becomes self-perpetuating.
There’s an article online I read a while back that I can’t find at the moment by Rabbi Dr Abraham Twerski, who is a Hasidic rabbi and also a practising psychiatrist about stigma in the Orthodox community in regard to marriage. It’s really horrifying. People who won’t admit to their spouse that they are on medication even after marriage. People who come off their meds so their new spouse won’t find out. People who break off dates or encourage their children to break them off because the other person has mental illnesses. Really horrifying. Some of it, he says, is lack of exposure because of the stigma. He tells the story of someone who told his son or daughter to stop seeing someone because the date had (medication-controlled) mental health issues and he didn’t want that in his family. Rabbi Twerski told him that, statistically, most families have some mental illness and the man said that his did not; Rabbi Twerski concludes along the lines of “Because of doctor-patient confidentiality, I could not tell him that I had treated his wife for a mental health issue before they were married.”
Wow, that’s bizarre.
From what I’ve read online, I think it’s not limited just to Orthodox Jews, but to other traditional sub-cultures.
Interesting.
Yes so true 💗 I agree with you. They think it’s easy to snap out of it like it isn’t a real illness. Society still has somehow a taboo of mental illnesses. It’s getting better but there are still many people who don’t understand it
And that’s why it’s so important for us to keep talking about it!
Definitely. Since 2014, I have become so much worse in social situations which therefore heighten my anxiety. It’s almost like standing underneath a giant magnifying glass, and others can see I’m that messed up.
An tremendous post, Ashely! Very good indeed.
Thanks!
I live in a very small town. I used to be a leader in the community. When things went south for me, I completely withdrew. I one day tried to explain to a woman why I don’t visit any more. She did not listen and were angry with me. Well she could have come and visit me too.
That’s so sad.
Very much so. It’s the reason I took so long to get help.
Have social factors played a significant role in your own illness experience?
My family going back at least a couple of generations (probably more) has had mental illness in one form or another. In my grandparent’s time, it was NOT discussed (in polite society), and the idea was that if one were ‘mentally ill’, one was automatically a raving lunatic and placed in an asylum, far from ‘normal’ people. Same idea with my great-grandparent’s time. My parents saw a change in that mode of thinking, but not by much. My mother (more obviously affected than anyone I knew) believed rather strongly that the stigma of that illness was a thing to be ashamed of and to deny. Her spouse and her children suffered and had their own ends shaped by her. I knew from a relatively young age that I was ‘different’. My siblings don’t seem to be as affected, if at all. They don’t understand me and it angers me that they’re so glib about something they have no idea about. Dismissive and judgmental. But recently we had a frank talk and I hope I was able to educate them a little bit about what it means to have dysthemia and BPD, but I can’t be sure they still ‘get’ it. I’ve come to realized that the old adage about how we react to such things is true. I can’t control how they react to me, but I can control how I react to their reactions. Social factors continue to be a challenge in my own experience.
It’s unfortunate how resistant people tend to be about changing their attitudes, even when the old attitudes are clearly problematic.
this was such an interesting read!
Thanks!
I am schizophrenic and bipolar. people cannot tell this when they meet me. Once, this was not true I wore my illness on my face. Today, I am social. Some of my old friends treat me differently just to feel superior. I outgrew my illnesses but they still see me as sick. I am out of the closet at my workplace at Walgreens and at my church. I am treated well in both places. Today, I told my assistant minister I was schizophrenic. Two people at our table got up and left. To Hell with them. Just shows me who my friends are. Feels good to come out of the closet. The stigma is in the eyes of the mental health profession. They are the ones who think it’s a sin to be nuts. My father was always very open with other people about my illness. That helped me to by open too.
People can be so cruel. I’m glad your father has been a positive influence.