Mental Illness is Complicated: 4 Half-Truths We Take For Granted

This article makes references to self-harm, drug and alcohol addiction, eating disorders, and suicide. The content is not intended to be a substitute for professional advice, diagnosis, or treatment. If you or someone you know is experiencing suicidal thoughts or a crisis, please reach out immediately to the Suicide Prevention Lifeline at 800–273–8255 or text HOME to the Crisis Text Line at 741741. These services are free and confidential.

Our understanding of mental illness, as a culture, has come a long way. While the damaging mythology of wandering wombs, and refrigerator mothers has been thoroughly debunked and dashed from our collective imagination, a new set of beliefs and truisms have worked their way into the popular narrative about mental health.

I’ve identified four commonly-held beliefs about mental illness that, at the very least, could use some clarification. Before you decide to burn me on a pyre of DSM-Vs, let me be clear. It’s not that these ideas are wrong, exactly. For the most part, these ideas have proliferated because they are meant to combat the stigma associated with mental illness, and that’s a good thing. The problem is that these ideas perpetuate common misunderstandings about mental illness.

Half-Truth #1: Mental illness is caused by a chemical imbalance

Much to my relief, the myth of the “chemical imbalance” has begun to dissipate in recent years. For those who may not be up to speed, it bears repeating: mental illness is not caused by a chemical imbalance.

As a Millennial* therapist, my first education around depression and other mental illnesses came from TV commercials for prescription drugs, and Dr. Phil*. I’ll leave Dr. Phil out of it for now, but for me, the prescription drug commercials claiming that a daily pill could correct a chemical imbalance in my brain set the stage for a decades-long misunderstanding about the etiology of mental illness.

It’s not incorrect to say that chemicals (a.k.a. neurotransmitters) have some bearing on our mental state. But the “chemical imbalance” theory would have us believe that a.) mental illness strikes at random, unaffected by external events, and b.) that medication cures the illness by “rebalancing” brain chemicals. Whatever that means.

Anyone who knows me is aware that I am unabashedly pro-pharmaceuticals. So, what’s the problem?

The problem (not to be dramatic!) is the gross oversimplification of the human experience implied by this framework. The genesis of mental illness depends on a complex system of factors. Genetics, epigenetics, nutrition, health, parenting, culture, minority stress, and trauma all play a role in what happens to our neurochemistry. With so many factors at play, how could the solution boil down to a daily hit of synthetic serotonin?

Psychotropic medication can be literally lifesaving. Much like a patient with heart failure might be prescribed a cholesterol-lowering medication, antidepressants and other prescription drugs can be an important part of a comprehensive plan of care. In particular, medication can provide relief for the acute symptoms that make it harder to work through the trauma or emotions at the root of the illness.

That said, the point is that mental illness is more than just biology or brain chemistry, and combating it means that we have to treat it like the complex beast that it is.

*Strong affinity for listicles

**Like Dr. Jill Biden, Dr. Phil is not a medical doctor. Please let me know when the Wall Street Journal Op-ed on this reprehensible affront to the medical establishment has been published.

Half-Truth #2: Mental illness is just like any other medical illness

Don’t get me wrong — I appreciate the sentiment, and I understand that the motivation behind this distortion of fact is to destigmatize mental illness. I firmly believe that every employer should offer paid “mental health days” and that every health plan should cover mental health treatment equitably (which they currently do. Thanks, Obama).

Unfortunately, this false equivalency has led to a great deal of misunderstanding among mental health professionals and clients alike. Much like the other half-truths on this list, this is an oversimplification that doesn’t serve us.

If you’re paying attention, you’ll recall that in my exposition on half-truth #1, I compared cholesterol-lowering medication to antidepressant medication. Points for your great reading comprehension! My argument is not that mental illness is entirely unlike other medical conditions. My argument is that there’s an important distinction to be made.

When it comes to medical comparisons, I cringe when I hear statements like, “if we’re not ashamed to take a sick day when we have the flu, we shouldn’t be ashamed to take a mental health day”. I wholeheartedly agree, but comparisons like this contribute to confusion about what mental illness actually is.

As an illness, the flu is not an apt comparison to depression, for instance. The flu is a viral contagion that strikes at random and makes us feel terrible for a week or two. Usually, our immune systems eradicate it without medical attention, and we move on with newly established immunity.

If you want to make comparisons of physical illness to depression, heart disease and type II diabetes are closer relatives. Both of these conditions develop slowly over time, due to a combination of genetics, environment, diet, and exercise. When they’re diagnosed, they can be managed with a combination of lifestyle changes and medication. The severity of their symptoms vary from day to day, and worsen without treatment.

Depression is, usually, a chronic illness caused by a complex web of factors that conspire to mess with our brain chemistry. We can stop the stigma against mental illness, but let’s do it in a way that doesn’t perpetuate misinformation.

Half-Truth #3: You can’t just “snap out of it”

I hope that at this point in the article, you’ve begun to trust me enough that this listicle item won’t be taken with offense.

I concede that we can’t just “snap out” of depression, of anxiety, of psychosis, or of any other acute symptomatology. This is undisputed.

What I have come to find, though, is that the “you can’t just snap out of it” campaign has been taken out of context, leading some to believe that they are completely powerless over the course of their illness. And I’ve seen this feeling of powerlessness take on a destructive life of its own. Whether through self-harm, disordered eating, substance use, or — at its most extreme — suicide, a seeming lack of control over one’s mental health can be devastating.

The good news is that while most symptoms can’t be turned off like a light switch, we know what can make symptoms better and worse. Medication, nutrition, sleep, exercise, life stressors, exposure to nature, isolation and connection, sex and lack thereof, all affect the presentation of mental illness. While it doesn’t always feel like it, we have some control over all of these factors. I encourage my clients to harness each of these powers as part of their recovery, and they work.

So next time that a friend, a patient, or you, are suffering from a bout of depression, say this instead: “How can I support you in taking steps to feel better? I know that you can’t just snap out of it when you feel this way, so I am here for you as long as it takes.” It’s not very catchy, but it is realistic.

Half-Truth #4: Diagnoses

A frequent occupational hazard, I was recently chatting with a friend about some of his mental health challenges.

“Some days my OCD is there, but other days it’s my anxiety. It’s almost like they’re related”, he said.

Let’s unpack that.

To some clinicians, the Diagnostic and Statistical Manual of Mental Disorders, is The Definitive Truth. Others would just as soon toss the whole thing in the trash. If it helps to illustrate where I stand on the matter: I recently went looking for my copy of the 700-page manual in my 600 square foot apartment and could not locate it.

I am of the opinion that diagnoses absolutely have utility, and not just for insurance billing. If a particular constellation of symptoms responds to a particular course of treatment, then we should give that particular constellation of symptoms a name. We don’t have to reinvent the wheel every time a patient presents with low mood, fatigue, insomnia, and lack of appetite. That’s called “depression” and we know what to do about it.

The problem that I keep bumping up against is that we approach each individual diagnosis as if it’s a unique, singular illness occurring in some mental health vacuum. For what it’s worth, there are a whole host of other problems with the DSM-V (the pathologization of everything, for example), but that’s for another article.

My friend, it turns out, was on to something. His OCD and anxiety are related. In fact, as far as the way I approach treatment, they’re one and the same. Oh, and he has a depression diagnosis too.

It’s no coincidence that mental disorders occur together. Like the constellation of symptoms that comprise a diagnosis, we need to look closely at the constellation of disorders a person is diagnosed with, and understand that they are inextricable from one another. It is likely that my friend will find that the same issues are at the root of his OCD, his anxiety, and his depression. Approaching each illness as a separate issue won’t get you very far. Instead, find the common thread, and follow it.

So, what’s the common thread of this article?

Mental health is complicated. Take care of your physical, spiritual, social, and emotional wellbeing. Ignore anyone who claims to have a silver bullet or miracle cure. And don’t be afraid to challenge what you hear, even if it’s well-meaning.