11 Mar

Lordy this is a long post! Before/if you read it I need to say that its contents are not intended to discourage someone from trying to get help for someone else, nor to absolve anyone of consequences for their actions. These caveats will make more sense once you’re in the thick of it.

“Some of them clearly need mental health support” is something I’ve heard loud and often in regard to the recent anti-mandate occupation of Aotearoa’s parliament. It comes from the media and people I know, in both cases I think with good intentions; a genuine attempt to understand and sympathise with who and what they see.1

But fuck are those words problematic. And fuck you should not say them.

 I’m going to attempt to explain why and I’m going to do it in two ways. First through short blunt analogy. It’ll probably be enough for some people and yeh, stop reading if you want. Second via painfully constructed analysis, way too long and complicated. For nerds only. 

(Full disclosure – I have bipolar disorder and live this stuff and it is exhausting and annoying as fuck. Yes, I have a vested interest).

A short and blunt explanation:

Saying “some of them clearly need mental health support” about people you do not know, based on only what you see is the equivalent of:

  • Seeing a stranger with a visible disability and saying out loud, they “clearly need physical therapy”.
  • Hearing a stranger speak a language you don’t recognise and saying out loud, they “clearly need support to learn English”. 
  • Seeing a stranger who is larger than you and saying out loud, they “clearly need help with nutrition and managing their diet”.

Everyone understands these kinds of comments are not ok. Even if they're 'true' you do not know it and either way it is none of your business.

The ‘clearly need mental health support’ statement is exactly the same.

A long and nerdy explanation:

Now I’m going to discuss why someone – who wouldn’t comment on disability, language, size etc. – will confidently proclaim that a bunch of people they don’t know “…clearly need mental health support”. 

As with any group, it is undoubtedly true that within the Wellington occupation were people with mental health issues. It’s also true that at some point or another everyone in the world – and therefore in the protest - needs ‘mental health support’. These are acceptable statements of fact. But when people say, “some of them clearly need mental health support” (in relation to Wellington or anywhere else) they do not mean either. They’re not referring to statistical probability but are expressing an opinion. It’s one that reflects and reinforces a world of assumption and ignorance. 

I’m going to explain how under the following headings – 

  • Using the wrong words: conflating ‘mental health’ and ‘mental illness’
  • Thinking you know more than you do: mental health awareness doesn't equal mental illness expertise
  • Making a behaviour-based diagnosis: don't assume things based on what you see

Using the wrong words

When people use the term ‘mental health’ (and/or ‘mental wellbeing’) in relation to extreme behaviours, they usually actually mean ‘mental illness’. The two things are relentlessly conflated but are not the same. 

Simply put, a person’s ‘mental health’ relates to their ability to deal with emotions, thoughts, life events, social connections, the state of the world etc. whereas someone with a ‘mental illness’ has a diagnosable condition, often chronic.2  Everyone has mental health, just like everyone has physical health. Not everyone has a physical illness and not everyone has a mental illness. 

Here are some lack-of-distinction examples. The first (alarmingly) comes from the Canterbury District Health board website. It states, 

“Mental distress, disorder or illness should be seen as subsets of a person’s capacity for mental health…the greater your mental health, the greater your resilience…”3  

This sentence seems to link the cause and/or experience of mental illness to the quality of someone’s mental health. I guess the idea is if you’re emotionally stable, socially connected, taking plenty of walks in the forest etc. then your chances of getting bipolar (or some other complex psychiatric disorder for which they cannot be exact about the cause) are less? And if you do get it you’ll hallucinate fairies instead of monsters? Good mental health is important for all but it can’t reliably prevent or minimise the symptoms of mental illness.

Those ubiquitous social media four-panel cartoons are my second example. You know the ones where a character with a big head and big eyes and a quivering lower lip flips back and forth between wanting vanilla and wanting chocolate because bipolar and it’s so cute? Indecision may be a mental health issue but it’s not a mental illness. I know these comics are light-hearted but there are so many of them, all reinforcing the confusion.

Thinking you know more than you do

All this health/illness conflation means at a subconscious level people think they know more than they do.4  If mental health and mental illness are the same thing then increased understanding of one is by default increased understanding of the other. And wellbeing discourses like ‘awareness’ uniformly apply.

It’s a whole tangled misguided benevolent oblivious socially-legitimized fantasy that plays out as follows -

The person who says, “some of them clearly need mental health support” does so because (undifferentiated) mental health campaigns have made them ‘mindful’ of  ‘mental health behaviours’. In verbally responding to these they’re helping ‘remove the stigma’ and in recommending intervention they’re being ‘supportive’.  

None of this is bad per se, it’s just when ‘mental illness’ is really what’s meant it gets all wrong and offensive. It changes from kindness to arrogance. Here “some of them clearly need mental health support” translates as “based on what I think I know about mental illness I diagnose those people I've never met have it and I determine they require some kind of official, possibly medical, treatment”.

Making a behaviour-based diagnosis 

There are a bunch of behaviours society says ‘clearly’ signal mental illness. Some are aggression, substance abuse, and belief in conspiracy theory. These were all part of the Wellington occupation and the "...clearly need mental health support" diagnosis rests upon them.

This reflects a self-fulfilling loop, again to do with the health/illness conflation – ‘obvious’ mental illness behaviours are ‘recognised’ and (sympathetically) called out. This reinforces perceptions of behaviours which reinforces a sense of expertise which allows for calling out which reinforces perceptions which reinforces a sense of expertise which allows for calling out and so on… 

There are lots of  mental illness behaviours not commented on by outsiders (for example fatigue, drinking lots of water because your meds have dried out your mouth, making puns). This is because they’re not recognised and/or people are aware they lack the knowledge so shouldn’t assume and/or people understand there are boundaries and overtly sticking their nose in is inappropriate. This frame should not be selectively applied. It should be used with all the behaviours all the time.

Links do exist between mental illness and aggression, substance abuse and conspiracy theory belief, and it would be remiss if I didn't acknowledge this. They are however insanely complicated. Here and now it is enough to say that these relationships take the form of correlation not causation. This means you can never definitively say mental illness causes violence/addiction/delusion, nor can you say violence/addiction/delusion cause mental illness. There are plenty of people for example, with bipolar who don’t believe in the lizard people, and plenty of lizard people devotees without bipolar. 

I do not think it is ever ok to state “some of them clearly need mental health support” about strangers, based on only what you see them do. I know it is well-meant but it’s offensive, arrogant and unhelpful. I hope I have explained why. Now I am exhausted.

There has also been the oh-so-jolly and hilarious “they left the door of the loony bin open” response to the protesters. That one rules.

2 Mental illness is technically defined as “…a syndrome characterised by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.” - Diagnostic and Statistical Manual of Mental Disorders (5).

I’m really hoping some coms dude wrote this and not a doctor.

4 It’s also to do with media depictions of mental health conditions but that’s another post.  

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