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In a Relationship with: Mental Illness; Relationship Status: It’s Complicated

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by Megan Kolano, PsyD

Austen Riggs Center Fellow and therapist Megan Kolano, PsyD, reflects on the term “mental illness” and how it is used in a variety of ways.What is “mental illness”? As today’s way of describing a particular cluster of human experience at the edges of the bell curve, “mental illness” is just a term. It marks a kind of suffering, but says nothing about the nature of the experience or the person experiencing it. As such, it will always mean more than any one person intends, while simultaneously missing the mark. 

As a term, “mental illness” is a tool that can be used in a variety of ways. For some, describing their experience as “mental illness” links them to a community of others who might finally understand who they are. For others, such a term is worn like a scarlet letter that promises judgment and exclusion. “Mental illness” can become a possession (something one has) or an aspect of identity (something one is). It can be taken up in ways that connect or isolate, depending on the person and the context. 

One criticism of the term “mental illness” is that it upholds the myth that the problem is located inside one person’s mind/brain and fails to recognize the ways that “mental illness” is often located between people. It takes (at least) two to tango, as they say, but such insidious interpersonal or social trouble often gets lodged in one person or group who experiences and expresses the trouble on behalf of others. From this angle, some “mental illness” can be thought of as a role that is inhabited, a role developed by a group in need of a place to locate a trouble, a role that one might be able to move into and out of throughout one’s life. 

Perhaps the most popular criticism of the term, however, is that it is stigmatizing. When it comes to the wider culture, there is no way to disentangle ourselves from our complicated history with “mental illness” – as a sign of danger, fragmentation, and perhaps even annihilation. On a smaller scale, perhaps “mental illness” is a designation that provides people the freedom to not listen or to dismiss someone’s thoughts/feelings/words as illegitimate: “She’s mentally ill and sees the world in a skewed way.” When “mental illness” is used to attribute causality, either to silence or to sanction behavior, it is being used to undermine a person’s agency. And if it brings more judgment than help, perhaps it is time to move on and find a new term with a blanker slate. 

What does it mean for one person to identify as having a mental illness while another person rejects the term?Who gets to determine when the term “mental illness” is a discriminatory faux pas and when it is a revelatory lifeline? As Sartre said, “we are what we make of what others have made of us.” In taking a sweeping stance in favor of or against use of the term “mental illness,” one risks missing the very authority taken up by the person claiming “mental illness” to begin with. What does it mean for one person to identify as having a mental illness while another person rejects the term? How does each person use those words in conversation? How does one’s identity in relation to “mental illness” affect her role in her family and community? How does the term burden? And how does it affirm and relieve? Keeping a focus on the “and” seems crucial here. As a signifier, “mental illness” serves many functions, even seemingly contradictory functions, simultaneously repelling some while attracting others. 

These are a few of the questions we consider in our work with patients and with one another. When we can pause our own opinion of the term “mental illness,” and hold a position of curiosity about how each person positions themselves in relation to it, then we can learn something about how they relate to their mind, emotions, family, community, country, and place in the world. And in so doing, we can support them as they begin to reclaim their agency and capacity to choose.

 
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