Some people believe mental distress or mental health problems or mental illness or madness to be an illness and that's the truth of the situation. Others consider the truth is that they're only illness because people call them illnesses, i.e. they are a false construction but real because people believe in them and they have real consequences (though these may be due to society, its maladapted systems and the morals of the time).
Heard of drapetomania? Its worth a google. Its an old diagnosis given to slaves who kept on running away. They were ill weren't they?
There's another piece of the history of mental illness also worth noting. In the Seventies the American diagnostic criteria (DSM) finally removed homosexuality as a mental illness and in the Nineties the WHO finally removed it from their criteria (ICD) which is used in the UK.
So a century ago people said that being gay was an illness and that they should be treated. Now you might be one of those people who still consider it an illness in which case my point is going to fall on deaf ears. Hearing voices, unshared perceptions, schizophrenia, psychosis and their ilk are not illnesses per se.
They can be thought of as illnesses but in the same way that skin colour could be called an illness, so my brown skin may be a disadvantage and I could paint myself white and be less 'ill'. I hope that makes sense: its an illness only as a non-real construct of society.
That's evidenced by a famous study conducted by the World Health Organisation in the Seventies which showed that outcomes for schizophrenia were better in the developing world than the developed world. There are many hypotheses to explain this seemingly paradoxical result. One is the other cultures have different interpretations to the experience of madness and don't use the medical paradigm of neurological brain dysfunction to be treated by antipsychotics and these produce better results. I'm not sure what the situation in 2010.
I've heard that mania is destigmatised in Spain. Hearing voices has a number of interpretations around the world. There are examples in the West too, for example many of the stories in the Bible are of people who heard the voice of god and its easy to see that the story of Abraham could be seen today as a story of a schizophrenic. Goth culture considers depression ok. Black rappers like Dizzie Rascal consider being "bonkers" a good thing. I've had an experience of revealing a previous bipolar diagnosis at a writing group and being told I was lucky.
But in the UK the general stigma of unshared perceptions is as deep rooted and pervasive as the stigma of madness itself. Its one I've seen even amongst antistigma campaigners. Its the thing we don't talk about in public. Its the thing that we associate with axe-wielding psychos and not great artists and thinkers. Its weird and its mad.
Its not surprising. The experience is incomprehensible if never having lived it. I have to admit that some psychiatrists have a modicum of understanding but many still dogmatically see the experience as illness.
The experience that leads to a diagnosis of schizophrenia is also one of the most distressing. Its sad that its often not recognised. Studies have shown up to a 10% completed suicide rate. The pain and suffering is like a rending asunder of everything you knew was real before, the very perceptions trusted from birth become unreal and yet more real at the same time. The very foundations of identity and consciousness are shattered. Terms like "ego death" are more elucidating. That's why it can be seen as an illness because mental healthcare may be necessary to treat the distress but not to tell the individual that there's something wrong with them. If they choose to believe that then its up to them.
This may all sound like an interesting and fairly abstract conversation but there's a harsh reality. Calling it an illness means it can be dogmatically treated like an illness. Its better than the past where unshared perceptions could be diagnosed as as possession, witchcraft or heresy (or canonisation if the voice hearing experience agreed with the paradigm of the Church).
In 2010 it invariably means antipsychotic treatment. Antipsychotic medication reduces life expectancy. Its one of those things the doctors don't tell people. They're an easy treatment to give and forget that a human being is more complex than biology. NICE's guidelines for schizophrenia recommend against therapies like supportive psychotherapy and counselling, preferring medication and CBT. Sadly its an improvement on previous guidelines and there are a a handful of other recommendations for therapies but scant few for the most disabling and distressing mental illness. Drugs are always the first options and they're an easily solution. They're cheap too whereas talking therapy is expensive.
Since the stigma is so high there's no public outcry about the deaths of so many people with this experience. When the evidence comes out about the number of older people dying prematurely when taking antipsychotics for dementia (which is not psychosis but shows antipsychotics used as a chemical cosh) there's a small public outcry. When the public see the figures on people dying from "killer" clozapine nothing happens. This is drug that's used to treat treatment resist
There's a long conversation to be had about what is normal and what is to be considered pathological but I've already rambled long ennough. One more study I'm afraid and that's it.. This one is one of my favourites. Its know to some as the "Thud" experiment. People who didn't hear voices said they did and were immediately hospitalised. When they got in they said they didn't hear them anymore but once they were in their behaviours were pathologised and they were given diagnoses of schizophrenia in remission. (http://web.archive.org/web/20041117175255/http://web.cocc.edu/lminorevans/on_being_sane_in_insane_places.htm)
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