How the "Mental Illness" Label Helps and Hurts

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This is the third of a four-part interview with author and psychologist Lisa Dahlgren. You can read Part 2 here.

For many people who experience neurodivergence, it’s becoming increasingly obvious that theoretical frameworks for the way we view the vast experiences of the human population are more complicated and difficult to categorize than we realize.

For professional philosophers and psychiatrists, an inadequate model that doesn’t quite fit the reality that is life can be reformed into a model that better fits the conditions of human reality. One such case is the rising popularity of the “madness-as-strategy” model proposed by Justin Garson. In this framework, we can view symptoms of mental disorders not necessarily as dysfunctional traits that are to be treated and made to go away through medications, but rather, as traits that offer a sense of purpose and appreciation for what our minds can do for us during times of stress, survival, and coping. Doing so might help restructure the type of research put into treatment for our mental suffering.

Psychology is a relatively new science, only having been highly refined under the standards of “hard sciences” in the last century, compared to the last few centuries and millennia like mathematics and physics. There is bound to be some imperfection, and the necessity to have ongoing conversations that attempt to encompass the diverse range of human experience is an important one to address.

In Part 3 of this four-part interview, Lisa Dahlgren and I discuss how an illness model might not exactly fit the type of experience we have. Learning to balance psychological science with the suspension of an open mind may help us form new theories that can contribute to the advancement of the psychological sciences while we respect science and borrow inspiration from other disciplines.

SM: How do you think the “illness model” impacts those of us who have different types of cognitive experiences?

LD: I can't speak for others, but working within psychology, the illness model didn't work for me. I didn't fit a diagnosis, for one thing. I also felt pressure to suspend my own judgment so that I would conform to a diagnosis. That didn't make sense to me. Additionally, when I didn't accept the illness model, no other model was offered or suggested. I had the most success when I went outside the field of psychology to find my answers. I feel incredibly lucky that I already had an education in psychology and a stable and happy life with full support from my partner. I could take time to explore what I was experiencing and still have the energy and resources to continue my responsibilities with my family.

A downside of the construct of the “illness model” as I see it, is the implication that something is broken. When something is seen as broken, it is seen as no longer useful, and I feel that the entirety of the human experience is useful. Additionally, when something is seen as broken, resources from the community need to be given to either fix it or create something new. This immediately places an individual into competition with the community in terms of resources being used and resources being contributed. There can't help but be dynamics that occur in those circumstances. Some of those dynamics do not seem helpful. Those dynamics also become embedded in the model in a manner that makes them unable to be readily identified and addressed. When that occurs, I think there is real potential for an individual to feel they are drowning in the waters of the construct while simultaneously not knowing they have been thrown into the pool.

The second thing that I reflect on is that when we focus on the “illness” in that model, we tend to experience a type of fear. The sensation moves from being “atypical” to being “unnatural." And that creates fear. What we know about fear is that once fear is injected into a system, all sorts of energy is put into avoiding the fear and what was causing the fear. Time and time again, we find running from fear keeps us from acceptance, creates anxiety, heightens shame, and just doesn't work when it comes to helping heal or to integrate an experience in a helpful manner.

There are helpful aspects to the illness model, however. One helpful effect that stands out to me is the implication in the illness model of personal suffering. The recognition that there is suffering involved in an experience can be relieving. Suffering by ourselves makes the suffering more difficult, and ignoring or dismissing suffering really feels alienating.

SM: I agree that the illness model might not readily give validation to people’s whole, entire human experience. I think that’s why I gravitated towards the psychodynamic therapy, internal family systems, founded by Dr. Richard Schwartz, which is what you used in clinical practice for a number of years. In this framework, I learned to accept each and every “symptom” of my mental illness, while developing a relationship with parts of myself that society or the field of psychiatry may have told me were “harmful” to my well-being.

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Ultimately, I did come around to accepting that my symptoms were actually detracting from my daily life. Once I was able to thank and express gratitude for my symptoms such as voice hearing, vision seeing, and night terrors, I could feel a release from them, and then I was able to transform these “unhealthy” coping skills into parts of myself that were contributing to my life in the present. I realized that my obsessive thought patterns and delusions translated into a deep care for my well-being and uncovered a need for certainty, and I asked that part of me if it would find a new role that could honor its leadership in recognizing my needs. We have since built a symbiotic relationship, and I have done that for most of the parts of me that were forced into extreme roles.

I did find the illness model to be helpful because I did ultimately realize that while I was spending a lot of time talking to voices and believing I was traveling to other realms of the universe or conversing with aliens, I was missing out on the life in front of me, shared with the rest of humanity. When I realized that, I felt a very significant sense of loss. I understood that my choice to depart with this reality and find a safe space with my voices was preventing me from earning more educational degrees, it was preventing me from creative writing, it was preventing me from making healthy friendships, and ultimately, experiencing what life on this Earth with these people had to offer.

As far as personal suffering, there was a lot. And psychiatry does validate that. But I think it’s important that I learned to live with both perspectives to ultimately live in a balanced, rational, and emotionally honorable place with my symptoms and our shared reality.