What Does It Mean to Externalize a Mental Illness?

Why is there so much shame and stigma attached to having a mental illness? Do we feel guilty when we get a sinus infection? Or when we get in a car accident and break a bone?

In fact, it’s often this sense of secondary shame that perpetuates the symptoms of mental and emotional health problems. For example, the person with social anxiety is likely able to attend a get-together with friends. But they internally berate themselves for not feeling comfortable. “Why am I like this? How is everyone here so calm except me?! Why can’t I just be normal?” And those aren’t unfair questions. But they are unhelpful.

A major element of this shame and confusion arises from the societal misconception that mental illness reflects individual virtue, strength of character, and/or a person’s choice. The way we talk about mental illness, in contrast to physical illness, underscores these beliefs. For example, although there is a movement towards person-first language in the field of therapy, we might refer to someone as an anxious person or use controversial terms to describe their personality like, “she’s neurotic,” or “he’s a narcissist.” But we would never say, “she’s cancerous,” or “he’s a flu virus.” These statements are laughable! And be honest: If I ask you to imagine a neurotic woman, a rough image probably pops into your head. But if I ask you to imagine a man with the flu, what does that tell you about him?

While it’s true that no virus or bacteria can be scientifically isolated as the “cause” for any mental illness, we can reason that mental health problems must not be a function of individual choice because, well, why would anyone make that decision? Is it a sign of characterological weakness? If so, then why are psychiatric medications effective? Surely, we can’t medicate someone’s character. Is mental illness a sign of virtue-less-ness (is that a word)? If it were, then surely society’s great figureheads like Abraham Lincoln, Winston Churchill, and Martin Luther King, Jr. wouldn’t have suffered from severe depression symptoms.

It’s time we move towards a more etiologically agnostic view of mental illness. Oof. That’s a lot of syllables. But essentially? We don’t know what causes it and we shouldn’t care. I’m aware of the interesting research on biological precursors to various mental health-related symptoms. I’m aware of the research into the effects of adverse childhood experiences (ACEs, i.e., trauma) and I’m aware that how we think impacts how we feel. But can we ever look at a friend struggling with mental health symptoms and know exactly why? And even if we could—would it matter?

This is why I so strongly advocate for the separation of the human from the mental illness. Some therapies refer to this, in part, as cognitive de-fusion: the experience of being aware that your thoughts and feelings do not define the entirety of your existence as a person. In fact, you are only slightly in control of them. We ought to explicitly separate the human from the illness in a manner that mirrors medical diagnoses. Depression, for example, is a heavy enough burden to carry without having to feel guilty about being depressed.

Practice speaking to yourself and others in a manner that conveys this important message. Try saying, “My brain is creating anxious thoughts” instead of, “I’m feeling anxious.” Try saying, “My body is feeling tired” instead of, “I’m tired.” You are not your mental illness. Tweaks to our language, along with the support of a therapist, can meaningfully impact the way you live a value-consistent life in spite of your mental health struggles, whatever they may be.

As a person whose brain produces lots of anxious thoughts, let me encourage you to release yourself from shame and guilt by changing the way you talk about your lived experience.