Stigma

Is It Helpful to Sanitize Mental Illness?

Is it helpful to sanitize mental illness? Or should we acknowledge that the reality can be messy? – graphic of crying eyes covered by a carnaval mask

Recently, I came across a post that was a myths vs. facts type deal on mental illness stigma. One of the myths identified was that people with mental illness are disabled. The blogger’s response was that on some days, mental illness could make it harder to work for some people, but there are also people who are really high functioning.

This is just one example, but I think it’s part of a bigger issue that sometimes people will try to dress mental illness up in a fancy dress and put ribbons in its hair to show just how acceptable and normal-ish it is.

I wonder, though, if in the rush to move away from scary crazy person stereotype, the people who are more ill/disabled from their mental illness get shuffled off to the back of the closet. If we try too hard to sanitize mental illness, something important might get lost.

I don’t think it’s intentional or malicious when people are saying mental illness is only kinda sorta maybe sometimes a tiny bit disabling, or when “mental illness,” and God forbid “mentally ill” are taken off the menu and instead it’s all about mental health issues/problems/challenges. I think, though, that there is a level of privilege in that position. And yes, I know the word privilege is a very charged; however, I don’t think it’s the really unwell segment who are trying to put the bows and ribbons on.

There are all kinds of different people out there in the world, including the “normal” folks, the “normal” but crazy in a non-psychiatric way people, the people who have a mental illness but are (mostly) well-ish, the people with moderate illness/disability, the people with severe mental illness/disability, that bat shit crazy “normal” people, and the “violent psycho” stereotype. In that whole big rainbow array of craziness and lack thereof, there’s room for a lot of different people.

But an array of different people is hard to put on an anti-stigma logo. And perhaps the moderately to severely ill/disabled people with mental illness can start to feel a little too close to the crazy person stereotypes for a few people who are well enough to pass as “normal.” If I was close to “normal,” who knows, I might not be so keen on the crazy folk bringing down the mentally ill (sorry, problematically mental healthified) team’s overall batting average.

I’m using ridiculous language because I’m not trying to make this about language. I’m also making generalizations because I don’t think it’s about specific details. I just think there’s an overarching question about how we want to represent ourselves as people living with mental illness. If the push is too far towards representing ourselves as “normal”, those of us getting our asses kicked by mental illness might get left behind.

And yes, challenging stereotypes is good. But if people are pointing to celebrities with great careers as mascots of what living with a mental illness looks like, that isn’t necessarily all that much more accurately representative than the crazy person stereotype.

Somewhere in the middle might be someone with ribbons in her hair to disguise the fact that she hasn’t showered for a while, who’s going to work despite the panic attack she woke up with. And a whole rainbow’s worth of people around her, some struggling less, some struggling more. Perhaps the whole rainbow is the best way to capture who we are (and that’s where the rainbow model comes in).

Have you ever noticed any attempts to sanitize mental illness? Do you think people who are really unwell should be part of the public face of mental illness?

Visit the mental health resource directory page for a collection of lots of great mental health resources.

55 thoughts on “Is It Helpful to Sanitize Mental Illness?”

  1. To be honest, I had not noticed this. I don’t think there is particularly anything wrong with saying that some people with mental illness are high functioning, as long as it isn’t stated that all people are like that. But I think “disability” as a concept is a very loaded term that lots of people object to, including for physical disability.

    I guess the parallel for me would be in the autism community where lots of people do not like applying the word disability to high functioning autism, which upsets me a bit as I do experience my autism as a disability in the sense of a condition that impedes my functioning and stops me doing things I would want to do and I want to label it as such, not be made to say that it’s no different from being neurotypical.

  2. For me the distinction is not how fragile or ill you are, but whether you are not a danger to yourself, whether you are a danger to yourself and whether you are a danger to others. I would like to see mental illness as encompassing all levels of functionality for affected parties. But I would also like to see those who are a danger to self and others treated differently so as to try to intervene before there is a serious health event.

    Hope this doesn’t muddy the waters…

        1. I also would like to add in the idea that we (or I) are not at a constant level of mental illness from the time we are diagnosed to the time we leave this world. I don’t know about other people but there were times in my life pre-2008 where my illness had already gotten the best of me. It does me no good to hide that struggle or sugar-coat it or add ribbons and frills. That would be impossible. Also, writing about it helps with the getting over it.

          All I am trying to say is I might be in some sort of recovery at the present time but that in no way means I haven’t been on the dark side of the equation time and time and time again until hitting rock bottom. Also, being in some form of recovery doesn’t rule out the possibility of a relapse either.

          One day at a time (as they say)….

  3. All people who are dealing with mental illness are welcome to be part of the public face. I think it is vital to show all the colors mental illness can have.
    To focus on one subtype isn’t going to do it justice.

      1. Although I notice sometimes that addiction can fall of the wagon and forensic psychiatry isn’t that embraced sometimes when talking about mental illness. I get the feeling that that is sometimes looked upon as another but different compartment.

  4. For me it’s is totally a rainbow in its colourful glory and in my personal experience what is essentially a mild and manageable mental ‘illness’ or ‘distress’ can easily increase and worsen if not managed appropriately. We all have potential to be ‘bat shit crazy’. I never thought I’d have suicidal thoughts but recent weeks have shown me that thee is a fine line there too. Mental health and mental illness is not black and white, it is many shades and we can all be a range of different colours in our lifetime. That’s what we need to promote and share with others. It is scary but it can happen to any of us and we can fall anywhere in that rainbow for many reasons.
    Not sure that makes sense.

  5. Yes. People shrug off eating disorders as no biggie, but they can KILL you via malnutrition or suicide. They are a giant deal and it’s not a matter of eat more/eat less/quit obsessing. So annoying. And even now, when I look “normal” it’s hard. People don’t get that I still have issues, not that I talk about it much because of the reactions. “You don’t look too thin.” That doesn’t mean my mind isn’t consumed with thoughts…

  6. In the UK some people/coaches/Therapists class Anxiety as “just an emotion” and not a Mental Illness at all let alone a Disability.

    It kind of takes away from the struggle people experience when living with it.

    I feel its important to show all colours of Mental Illness. From High functioning to the paralysis you can experience from any Mental Health Condition.

  7. I think everyone has a voice except those who clearly don’t get it. Using your example of the celebrities as mascot for mental illness. I don’t think so. Not indicative of severe mental illness in the vast vast majority of cases.

  8. Yeah, it’s so individually expressed in a lot of ways. Many mentally ill people can and do function at work, and many can’t. And then there’s the continuum of treatment. Homeless people, for example, might not have access to any treatment at all, whereas those of us who live cushy lives get the best care. Or people who keep going off their meds despite knowing it’s a bad idea, versus people who take them with religious fervor.

    The whole concept of “Oh, you just need to overcome your issues and try harder, and then you can go to work,” is well-intentioned, but… It’s not exactly reliable. In 2007, when I had to talk myself off a ledge after yet another job-gone-bad, I decided then and there that I’d never go back to work, unless I actually WANTED to. Not due to self-imposed pressure, not due to societal pressure, but not counting if I were truly broke and felt like my back was against the wall (which fortunately hasn’t happened). It’s clueless when people think you can try harder and succeed at work. But I think such people can’t visualize the mentally ill experience. It’s similar to how a man can never know what it’s like to be pregnant for nine months.

  9. I absolutely agree with you that in case of people with moderate to severe mental illness, sanitising and normalising can do more harm than good. People with more severe mental illness are already perceived as “less normal” compared with more mildly affected people, and then when people say things like that it’s a myth that mental illness is a disability (and when put in such words it strongly implies, at least to me, that it can never be a disability because a myth is a myth, not something that sometimes is true and sometimes not) they’re either crazifying those more severely affected even more, or invalidating them because, well, you’re not disabled, so why aren’t you working full time and why have you spent all day in bed and haven’t showered for a week?
    I’m not sure if this is correct what I’m going to say, perhaps just my impression, but I believe that what can contribute to this normalising thing is that, unlike with physical disabilities, a lot of mentally ill people even with quite disabling symptoms do not actually have any kind of disability proof or anything like this due to their mental illness.
    And another thing that clashes with this is that, yeah, we have mild/high-functioning mental illness, moderate mental illness, severe mental illness, even people who fluctuate a lot and have a lot of awfully horrific days and mostly good days, but it seems to me like there also is a not-so-small section of people with mental illness who are quite hard to classify as any of these, including myself, as I believe. What I mean is that a person might be pretty high-functioning in one area of their life, but not so much in another, or able to mask their illness quite well in most situations, while not really doing as well as it may appear. Or as in my case, I have dysthymia (which is of course commonly nicknamed as high-functioning depression). Aside from whether it’s actually high-functioning or not for me, I can hide it quite well from people, and also I suppose that if dysthymia was the only mental health issue I had, I might have been a fair bit closer to the mild end of the mental illness spectrum. With the other mental health issues I have (all of which are also typically not terribly debilitating on their own), the mix of all of them doesn’t make me particularly high-functioning at all.
    So again we’re also having a problem of not all people fitting into the ready-made, labelled boxes.

    1. I’m not a fan of the term high-functioning for the same reasons. Reality is usually a lot more complicated than that.

      i also agree about mental illness and disability. it was relatively recently that I shifted to thinking in terms of experiencing disability.

  10. My number one beef is with the media. Let someone go on a mass shooting and they will without facts that the person was bi-polar.
    I say this for a reason, we cannot be pushed to the back of the closet. Those with mental disabilities to raise their voice.
    Mental disability is as real as someone who is diagnosed with cancer. The skeptics will say that you cannot see in any type of scan, therefore it is not real. To that I say b.s.!

  11. For me where I found the most stigma about Mental Health is with the people that worked under me at work. Having a voice with Mental Health as everyone experiences it differently Taking away someone’s voice is not a good thing..

  12. Interesting Ashley – I think it’s part of a wider issue of trying to over simplify the complex – often the so called evidence based interventions don’t work for really ill people or ask too much of them so the help ends up going to those less in need who are functioning enough to access it – definitely a large colourful rainbow of different experiences and I agree not always helpful when perfect looking celebs are the poster people for mental distress xx💞💞

    1. I’ve been doing some reading lately on stigma, and one of things that kept coming up is that perceived homogeneity gives something firm for stigma to latch onto. Yet homogeneity isn’t the reality at all. ❤️

  13. Totally agree with this! Because I’m what is classed as high functioning the majority of the time I never get taken seriously when I start to crash! In the build up to my full on crash I ask and ask for help but because I’m able to articulate what is wrong and how I need help I get brushed off. Usually it ends in hospilization where I get discharged with the cmht in place. They proceed to visit me every few days for a while, tell me how resourceful and switched on I am and even sometimes ask me why I’m in the service!! 🤦‍♀️🤦‍♀️ because I needed you like 5/6 weeks ago before this point!!! It’s infuriating.

    1. It really is. Anyone who works as part of a mental health service should know that symptoms and functioning aren’t static, and one may deteriorate faster than the other. Assumptions really don’t accomplish much

  14. “Do you think people who are really unwell should be part of the public face of mental illness?” is a tricky one too.

    Do they want to be? Would they want to when they are well or when they’re unwell? Would they be seen as vulnerable and unable to make this decision? Would it be seen as exploiting the’ really’ unwell?.

    1. I wasn’t thinking of pushing individuals to disclose. I was thinking more along the lines of representing to the public that, in general, the experiences of people with mental illness can range from very well to very unwell.

  15. I feel mental health/ illness is almost on a Spectrum. There is a wide variety of “mental health issues” out there and so many reasons for why it happens to who it happens to. I know that they’re tons of people Who are able to manage quite well with their depression and/or anxiety but it all depends what they’re dealing with/ what level they’re on and those are not the only things that can be affecting your mental health. Some days I am able to manage quite a bit while other days… well I feel quite far from normal! When they say Depression hurts… it really does…. mind, body and soul. However, I think everyone knows that mental illness goes far beyond depression and anxiety.

  16. Hi Ashley. I’m sorry I missed this one earlier, as I think I weigh in on it. Having recently made a move between two parts of the country with vastly different cultural values, I can perceive in retrospect how much of mental illness was “sanitized” in the area where I used to live.

    I’m still in touch with some old friends from the S.F. Bay Area Peninsula / Silicon Valley area, and in some circles it’s almost “trendy” to have a mental health diagnosis that one discusses freely — almost casually — while displaying a high-functioning personality in the work force. In a way, this does a disservice to those whose mental health conditions actually do debilitate them and keep them from being able to function in the workaday world.

    While mental health disorders are often stigmatized, in that culture they were almost glorified. If I person does have to leave their job, they are often met in parting with an employer or co-worker saying: “Well, you shouldn’t feel bad. It’s not really a big deal. I myself have been diagnosed with Major Depressive Disorder and I have to take an SSRI, but I still work.” Then of course the departing person feels even worse than ever, because their disabling condition has been minimized.

    Here in Idaho, I’ve encountered mostly the opposite. The stigmatic misconceptions around mental illness are so strong that a person who cannot work is often perceived either as “lazy” or “having a drug problem.” People seem to have no way of explaining to themselves a person’s abnormal behavior, other than to write it off as the side effects of “some drug.” So the phenomenon is not “sanitized” in the least, and those with known mental health diagnoses are often regarded as lepers or pariahs.

    I’m not sure which is worse. Excellent, thought-provoking post & discussion.

      1. On more than a mere moment’s reflection. I realized that the highly stigmatized side is definitely worse – as well as (I think) still more prevalent.

        It’s interesting that this came up, because a friend I have been discussing “black and white thinking” on another forum. One thing that has emerged is that our language does not support “middle ground,” “grey area,” or “rainbow variations.” We often have single words to adequately describe the extremes, but we need to use many words to describe places in between.

        For example, there is the word “high” and the word “low.” But is there a single word for “three quarters of the way from low towards high?” No there’s not. And I just used nine words to describe it.

        Because of this need to use more words in such descriptions, the brain shies away from the ardor of that task, and defaults to the more approximate “black and white” word, simply because the brain prefers to process fewer words, for the sake of simplicity.

        There are actually a few studies on this. I can track them down if you’re interested.

          1. That’s a good question. Maybe a bit of both? I also wonder how much of this is specific to the English language, or perhaps Germanic / Teutonic languages. It’s not something I know much about.

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