Understanding mental illness: To tackle stigma, we need to stop the blanket denial of individual perception

Editor's note: What does it mean to be ‘mentally ill’? In this weekly column, Sneha Rajaram writes about navigating through a ‘mentally ill’ life — encompassing aspects that are both everyday (medications, rights) and contemplative (the universality of suffering)

This month’s historic Supreme Court judgement that read down parts of Section 377 of the Indian Penal Code was important for several reasons. One of them was the acknowledgement that, as Justice Rohinton Nariman said, “Homosexuality is not a mental disorder.” The written judgement takes great pains to explore this, citing the Indian Mental Healthcare Act of 2017 and the normalisation of homosexuality in the USA: “After a thorough review of the scientific evidence, amicus American Psychological Association adopted the same position in 1975, and urged all mental health professionals to help dispel the stigma of mental illness that had long been associated with homosexual orientation.”

 Understanding mental illness: To tackle stigma, we need to stop the blanket denial of individual perception

Illustration by Satwick Gade

And that’s the (accurate) phrase that irked me: “the stigma of mental illness”. Mental illness is currently a stigma, despite our efforts to erode both social and internalised stigma.

A couple of months ago, my Facebook feed told me the WHO had declared that being transgender is not a mental illness. This vindication and destigmatisation was good news, even though we didn’t know yet how much it would change popular perception, even though trans persons continue to be forced to consult psychiatrists before they can begin their transitions. A few weeks later the Indian Psychiatric Society declared that homosexuality was not a mental illness. Again, good news.

At that time I wondered, when will mental illness be declared not a mental illness?

Let me explain: Mental illness, in both the above cases, was a stigma. As far as I can tell, the chief aim in characterising trans and queer people as mentally ill lies in denying their reality and their perceptions, in being able to say that they, and not society, need to change. Now, doing that to mentally ill persons has a similar effect. The schizophrenic isn’t the only one who is prescribed antipsychotics and said to be deluded; depressives are told they view the world through dark glasses, bipolar’s effect on perceptions varies with mood but is nevertheless seen as distorting reality, and people diagnosed with BPD are told their thinking is too black and white.

And now I must immediately contradict myself. Kindly brace for whiplash. There are plenty of instances where certain perceptions of reality are harmful, even fatal, to the beholder. Mania, hallucinations and delusions can all be detrimental to the sufferer’s health and functionality (that sad, sad, necessary, necessary word). Unfortunately one can’t blame the military-industrial complex or neoliberalism for this. Trauma and biology, those two parents of mental illness, have been around for as long as we have and longer. But this is no reason to throw the baby out with the bathwater. Different perceptions of the world only make us richer if we can be open enough. I was once asked by a gastroenterologist who saw my psychiatric file if I had seen A Beautiful Mind. (In general, physicians’ reactions to my psychiatric files have been hilarious – one orthopaedician asked a nurse to come in before he taught me neck and shoulder exercises from across the room, as if she could protect him from the miasma of my unbathed bipolar armpits when I raised my hands.) At the time I felt rather pigeonholed by the Russell Crowe comparison, but I think my gastroenterologist meant well. I think he was trying to tell me, in his own awkward gastroenterological way, that seeing things differently can be good too.

The blanket denial of individual perception has a demoralising and stigmatising effect on the sufferer (as opposed to treating harmful perceptions of reality in as gentle a way as possible – though scant resources, unaffordable treatment and an abysmal psychiatrist-patient ratio are another story altogether). But even more terrifying is the attempt to monopolise “reality”, that elusive epistemological entity. We can ascribe this to science or Big Pharma (some might even go so far as to say they’re same thing), but I’m afraid their thunder has been stolen by – finally I get to say it! – patriarchy, dominant communities, the military-industrial complex, capitalism, the establishment, The Man (even neoliberalism if you will; I’ll allow it here). There are plenty of places where the lines between sane and insane are blurred. Anti-psychiatry critiques might suggest that what we consider “normal” is actually insane – to begin with, so-called sane institutions are conducting utterly irrational, self-destructive, sadistic operations like war, oppression and the destruction of the environment on which we depend for food. These same critiques might suggest that mental illness is the only sane response to an insane world.

Currently, there seems to be no way to pry diagnosis and stigma apart. But I am hopeful that, given enough time, we can do it. So yes, I am waiting for the day when society and institutions will acknowledge that mental illness is not the stigmatised “mental illness” in the form we know today, but rather a normal response to the twin goads of trauma and biology.

Read more from this series here

Updated Date: Feb 25, 2019 13:48:12 IST