From Latin prefix ab– Away; from.
(Oxford Online Dictionary)
Last year, I visited the Dolhuys museum in Haarlem, the Netherlands. Located in a historical building that used to be a lepers, plague, and mad house, it now houses the museum of the “geest”, the mind, with the aim of raising awareness and educating the public about mental illnesses and disorders. After purchasing my ticket, I entered the building and walked through the first door, entering a room that seemed empty at first glance. As I looked around, I saw that the walls were aligned with closets enticing me to open their doors and peek inside. I walked over to the first closet, hesitantly opening it. A light turned on and a voice started speaking to me, a recording of a woman whose name I cannot recall. On the shelves in front of me lay personal items, arranged like museum pieces; An old photograph, a dress, a journal. Private memories laid bare before me while the woman was telling me about her life with mental illness. It was captivating but uncomfortable. I felt like a voyeur peering into the most intimate parts of her mind. The voice kept talking for what seemed like a long time, until I grew tired of it and closed the door. The other closets in the room offered a similar experience, a glimpse into the life of a person living with mental illness. Outside, I heard a group of kids on a school trip and felt nervous that they would come in and disturb this intimacy. But to my relief, they went on a different route.
I continued on my journey through the museum, passing by the dolcels (Dutch for seclusion cells, literally “mad cells”), on to the areas presenting historical and cultural perceptions of madness. Next was the “meeting room” displaying notable individuals who struggled with mental disorders, like Vincent van Gogh and Edvard Munch. The last room I entered was the former “plague hall”, a large space exhibiting a historical collection of objects used in psychiatric institutions. I walked past bizarre restraining contraptions: a chair, a cage bed, and a covered bathtub with a small opening for the face. When I reached the back of the hall, I noticed a few posters suspended from the ceiling. One of the posters immediately caught my attention due to both its design and text. The text was printed on a shiny silver mirror-like surface. Roughly translated from Dutch, the text reads “Have you ever met a normal person? And… did you like it?” (“Ooit 'n normaal mens ontmoet? en… beviel 't?”) As I stood in front of the mirror-like surface, I saw a sort of distorted reflection of myself. The poster was published in 1974 by Stichting Pandora, a foundation aiming to better the social status of people suffering from mental disabilities. By implying that there is something abnormally unique in every person, the poster challenges the concept of normal. It suggests that being ordinary is boring and uninspiring.
But where is the line between sanity and insanity? How much crazy is too crazy? Using categories to label mental illness is tricky. On the one hand, it is important to acknowledge the suffering of mentally-ill people, as well as distinguish between different conditions in order to research and find the best treatment for each disorder. On the other hand, we should realize that “different” does not equal inferior. What we call the “norm” is set according to the majority group, and that makes sense. People suffering from mental illness are a minority outnumbered by the former, and thus form the “other” group, which we name “abnormal”, as it literally stands away from the “norm”. But the purpose of this division should not be about ranking one as superior to the other. “Abnormal” does not mean one is less valuable, just like “normal” does not mean one is better. Categorizing someone suffering from a mental illness as “abnormal” should not carry negative connotations, which only lead to shaming and silencing.
What does the term “mental disorder” imply? Does it mean that one’s brain is sick? Or does it simply mean that one’s brain works in a different way? When a friend acts irrationally, we might say “are you crazy?” When he or she is offended we say “I didn’t mean that you are crazy, but that you acted like a crazy person”. What do we mean when we say “you are acting like” as opposed to “you are”? Does mental illness define a person as being “mental”, or is a person merely afflicted with an illness? Is it just another part of you, or is it the sum of all your parts? In the case of mental illness, we tend to categorize the actual person instead of just his or her disorder, belittling their pain and individuality. However, a person should not be defined by one’s illness; a person is not an embodiment of one’s mental state, but an individual who is afflicted with an illness. But once we put a label on another person, it becomes almost impossible to remove.
Moreover, why is there a hierarchy of “otherness” between “physical” and “mental” illness? Why does a person with a schizoaffective disorder make us feel uncomfortable, while a person with diabetes is accepted as legitimate? Why is the former viewed as unusual and incompetent while the latter is viewed as able and qualified? Why is there still such a stigma about mental illness? It is an illness just like other illnesses. Why should one feel ashamed of mental illness, but not of heart disease? Why is it socially acceptable to talk about diabetes, but scandalous to talk about psychiatric disorders? Why is it acceptable to tell an employer about your asthma without it affecting your status, but perilous to mention that you have a mental disorder?
Due to the mostly invisible nature of mental illnesses, they are perceived as less “real” than physical illnesses. If you have the flu, you will probably have a fever accompanied by other physical symptoms; if you suffer from heart disease, your blood tests may indicate that your cholesterol levels are too high; if you suffer from osteoporosis, special CT or Ultrasound machines will detect lower bone density. Attitudes toward mental illnesses, however, are different. Some people view these disorders as “made-up”, claiming that a person who is unable to fit in is just lazy and not trying hard enough. Others may accept such diagnoses but are still wary of ill persons due to prejudices that characterize them as crazy, unpredictable, or prone to violent outbursts. A person with a mental illness is seen as weak, cognitively inferior, and less productive at school and work.
“Crazy” people have always been depicted in a similar manner, be it in visual or textual representations. The invisible nature of their disease meant that they had to be distinguished by their appearance, hence they were marked by visible characteristics like wild hair and clothes, specific physiognomic features, and attributes such as the staff of the mad or fool (a staff or pinwheel attached to a stick, identifying its carrier as mad or foolish). The feebleminded, the insane, and the possessed, were all grouped under the same category. Epileptic patients, for example, were regarded as mad or possessed and forced into mental asylums. The invention of the EEG in the first half of the 20th century, clearly “proved” that epileptic seizures were caused by electrical disturbances in the brain. Indeed, nowadays epilepsy carries no stigma. But what about other affective and episodic disorders? Scientific research has already established numerous neurological elements associated with mental disorders, such as chemical imbalances and disturbances in neural communication in the brain. New drugs have been developed for a range of diseases, and some of the anticonvulsant drugs that are prescribed to stabilize epileptic seizures, for example, are also used to balance moods in bipolar disorder.
Data from the World Federation of Mental Health (WFMH, 2017) indicates that 1%-2% of the population suffer from seriously debilitating chronic mental illnesses, like schizophrenia or bipolar disorder. While these illnesses are lifelong, they can be stabilized with continuous treatment and monitoring. Additional data from WFMH shows that one in four people in the general population will suffer from a mental health issue at some point in their lives.
Indeed, in our culture of perfectionism, we struggle to fit the “norm”, feeling constant pressure to suppress our hardships and put on a façade of happiness. When browsing through people’s Instagram photos or Facebook posts, we see beautiful people living perfect lives. We know that many photos are staged, nonetheless feeling the need to participate in this charade. A person who does not or cannot live up to these expectations is deemed as different. A deviation from the norm makes one an outcast, an object of pity, unsuccessful, crazy. Why do we put on a fake smile just to make other people feel comfortable?
When a person behaves differently, people around him treat him or her differently. When one is suffering from a mental illness, one may not always be able to keep up appearances. Acting like everything is okay while feeling emotionally drained can be overwhelming and lead to social isolation. Many people suffer from mental disorders but are too ashamed to seek professional help. They hear other people use words like maniac, schizophrenic, or bipolar, to describe normal everyday human behavior, while such terms express serious mental conditions that should not be joked about. Yet despite medical advances, a person with mental illness is still viewed as a specimen to be “looked at” in the context of a mental health facility. Long-established stereotypes have become embedded in our verbal and visual language, and the ongoing use of the same ideas keeps the stigma alive. We need to choose the words and images we use more carefully to avoid prejudice and misuse of psychiatric terms.
Back in 2013, reality star Kylie Jenner tweeted a photo of her new hair color with the caption “I miss my black hair I’m so bipolar”. Her unfortunate misuse of a mental disorder to describe how she felt about her hair could have easily been avoided by using more accurate words like indecisive, capricious, or impulsive. In Jenner’s case, one could argue that she was uninformed or unaware of the gravity in her choice of words. A more recent example is the latest campaign by the car manufacturer Opel, featuring the slogan “mad about you” next to the images of a man and a woman confined in white straitjackets. The campaign is accompanied by a music video featuring the woman in the white straitjacket against a white background, lip syncing to a cover version of Hooverphonic’s “Mad About You”. The video alternates back and forth between the “mad” woman and close-ups of Opel’s new car. The cynical use of a stereotypical portrayal of madness as suggestive of a car enthusiast’s infatuation with cars is vulgar and offensive. While Jenner’s tweet can be attributed to ignorance, Opel’s campaign is plainly inflammatory, belittling mental illness and perpetuating biases.
Mainstream media continues to misuse psychiatric terms that have no bearing on the reported story. A few months ago, Haaretz published an article featuring a new book about the current reality in the Parisian suburb of Seine-Saint-Deni, where secular and religious Muslims live side by side. The article’s subtitle describes it as “the schizophrenic reality between drugs and prostitution, and prayers and burka” (Shlomo Papirblat, 25 March 2018). But describing the complexity of the Muslim situation as “schizophrenia” is an ignorant misconception of a severe mental illness.
How many times have we read or heard a news report about a violent crime, with statements like “but he always seemed so normal”, or “she comes from a normative family”? And how often are violent crimes immediately assumed to have been perpetrated by a “mentally unstable” person? Studies show that only 3%-5% of violent crimes are committed by people suffering from mental disorders. A mentally-ill person is much more likely to be the victim of a violent incident, and is at an increased risk of self-harm or suicide (Teplin, McClelland, Gary M., et al, 2005). In addition to shaming mentally-ill people, stigma can also affect future opportunities and lead to workplace discrimination. Studies show that about 70% of people with mental disorders conceal their illness from others (California Well-Being Survey, 2014; Madaus, Joseph W., et al. 2002).
Although society is more open about discussing matters of mental health, there is still a lot of misunderstanding and stigma. Depression may have become less of a taboo, but what about other illnesses? The mentally-ill are still not accepted as part of the cultural norm. They are silenced and forced to hide in the shadows or wear masks. Can we even tell whether our coworker or classmate is suffering from depression? Anxiety? Schizophrenia? Bipolar disorder? Many people expect the mentally ill to look and act a certain way, unable to believe that they are functioning individuals in society, living and working among them. Mental illness does not have a “face”. It is an “invisible” condition. It is “easier” to be sick inside while looking fine on the outside.
But silence is an act of violence. It reinforces the invisibility of the oppressed. It makes us blind to the distress of others, whether we are aware of it or not. The theme of silencing is thoroughly explored by Rebecca Solnit in her essay A Short History of Silence. Solnit focuses specifically on the historic silencing of women, who were denied education and freedom, effectively making them voiceless. In her words, “If to have a voice, to be allowed to speak, to be heard and believed is essential to being an insider or a person of power, a human being with full membership, then it’s important to recognize that silence is the universal condition of oppression, and there are many kinds of silence and of the silenced” (The mother of All Questions, 2017).
Silencing can be active or passive, conscious or subconscious. But in order to scrutinize cultural norms that are taken for granted, we need to bring them to light. It was not that long ago that mentally-ill patients were removed from society and isolated in asylums. Today we are fortunate enough to live in times when treatment for a wide variety of diseases is available, making it possible to lead a productive life despite being afflicted with chronic illnesses. Although disorders like schizophrenia and bipolar are lifetime conditions, they are episodic in nature, and can be regulated with medications. But misinformed stereotypes discourage people from disclosing their mental illness. Schizophrenia and bipolar are not multiple or spilt personality, and being mentally-ill does not necessarily mean that one will suffer from a psychotic episode.
People with schizophrenia experience disorganized thoughts, affecting their view of reality. Symptoms include hallucinations and delusions, but experiences vary, as there are different subtypes of schizophrenia. Having one psychotic episode does not mean that more will follow. After recovering from an episode, or in between episodes, people can live a fulfilling life. Bipolar disorder is a chronic mood disorder characterized by repeated episodes of hypomania and depression. Previously known as manic depression, it was introduced under its new name, bipolar, in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (1980). It was a first step toward reducing prejudice by discontinuing the practice of calling sick individuals maniacs. The main subtypes of the bipolar spectrum are bipolar type I and bipolar type II, which are differentiated by the severity of manic episodes. People with bipolar I go through more episodes of hypomania than depression, with the mania being full-blown, sometimes leading to psychosis. People with Bipolar II are more prone to depression and experience a “milder” form of mania.
Bipolar and schizophrenia experiences are individual; there are no set rules. However, many people with mental illnesses are able to function “normally” during stable periods with the help of medication and therapy. Receiving treatment does not mean that a person is “fixed” and can move on. It means that one is more stable and can go months or even years without a major episode. But “mild” symptoms can still be debilitating and disrupt one’s life. The constant struggle to hold down a job and keep up appearances while cycling between different moods and energy levels can be exhausting.
So when a person divulges his or her illness, do not belittle it by saying things like “but you don’t look bipolar”, or “Just snap out of it”. You also don’t “look diabetic”. You can’t snap out of major depression by thinking positively, just like you can’t snap out of cancer by thinking positively. The social stigma of mental illnesses leads to self-silencing and self-stigma, affecting self-esteem. Such feelings of worthlessness and shame isolate the ill person, who becomes a prisoner of his own mind.
In Madness and Civilization: A History of Insanity in the Age of Reason (originally pub. 1961, English tr. 1965), Michel Foucault describes the practice of putting mad men on outbound ships as one of the methods used to expel the mentally ill from the city (Foucault presumed that such actions transpired due to visual depictions of “the ship of fools”, although it has since been disproved that this practice really took place). “Confined on the ship, from which there is no escape, the madman is delivered to the river with its thousand arms, the sea with its thousand roads, to that great uncertainty external to everything. He is a prisoner in the midst of what is the freest, the openest of routes: bound fast at the infinite crossroads. He is the Passenger par excellence: that is, the prisoner of the passage."
The word passage has numerous definitions. It can be a portion of a book, but also a passage of time, or a passage from one place to another. It embodies the passive feeling of waiting while time is passing you by, as well as the active journey of moving forth. Whereas in the past, mentally-ill people were actively silenced by locking them away in mental institutes, today’s madmen are free from their shackles. But they remain emotionally imprisoned in their silence. The passage is comprised of the passiveness of staying silent as well as of the activeness of breaking the silence and naming the problem. Because if there is an actual problem, if it can be named, then there must be something than can be done to redress the situation.
How can we put an end to the stigma of mental illness? To that end, I pointed out several issues that I think play a key-role in society’s attitude toward mental illness: Unconsciously associating “normal” with respectable and “abnormal” with inadequate; reducing sick individuals to a label with negative implications; assuming that a person with mental illness is defective compared to one with physical illness; and our tendency to pretend and conceal “undesirable” feelings from others.
Regarding the first issue, I pointed out our habit of identifying “normal” with natural and accepted, as opposed to “abnormal” which we deem unnatural. Abnormal should not be synonymous with faulty, but this bond has yet to be severed. As for the second point, we need to stop referring to people by the label of their illness. A person is not a tag, but an individual suffering from an illness; a person is not “schizophrenic” or “bipolar”, but an individual suffering from schizophrenia or bipolar disorder. The next issue requires us to refrain from treating people with mental illness as incompetent and mentally inferior to people with physical illness. Understand that while medication and therapy can help manage and relieve symptoms, a person with mental illness still struggles to face the world and lead a productive life.
Lastly, don’t assume that someone you know well and seems “normal” cannot be suffering from a mental disorder. If at some point they share it with you, don’t say things like “are you sure?” Don’t assume it must be something “mild” just because that person has been able to function and hide it for so long. Mental illness has no “look”, and a mentally-ill person does not bear a mark of Cain. However, verbal and visual language has not yet caught up with this transition. We are still faced with the challenge of developing new visual images to represent such people in a non-stigmatizing way, as individuals in their own right, while maintaining their vulnerabilities as persons afflicted with mental illness.
“Doe maar gewoon, dan doe je al gek genoeg”. This popular Dutch proverb advises to “just act normal, then you are already acting crazy enough”. But what defines a “norm” as such? Is abnormal normal, or is normal abnormal? Norms include people who are not “normal”. Bad things can happen under the guise of “norm”. Those who do not fit in the “correct” group are shunned and silenced. Yet categories such as mental health, physical health, gender, skin color, and personal beliefs should form no basis for a perceived hierarchy; we all have a right for equal opportunities.
A person is first and foremost an individual. He or she may suffer from an illness, be it visible or not, but the illness does not define one’s identity. Being different does not make one inferior to another. Suffering from a mental illness does not mean that there is something wrong with you. It just means that your brain works in a different way. And that’s okay, because ab-normal is standing away from the typical. And standing out is outstanding.