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After writing every month for the past year about topics related to stigma toward people diagnosed with mental illness, I will now be posting less frequently. I want to thank everyone who has read this column regularly, and appreciate the comments that many of you have shared, by email and in person.
In this concluding regular column, I would like to discuss what I think is a way forward from the tendency for people to look down on and mistreat others that are labeled as “mentally ill.” In a nutshell, it is that we must recognize that what we call mental illness, and psychosis in particular, is part of the human experience. In fact, it is arguably a defining feature of the human experience, although it certainly manifests itself in extreme and often disruptive ways among those who are considered to have a psychotic disorder.
On one level, we must recognize that the symptoms of psychosis are part of the human experience because they likely can occur to anyone under the right conditions. In fact, although the major psychotic disorders of schizophrenia and bipolar 1 are rare, occurring in approximately 1-2 percent of the population each, studies estimating the prevalence of psychotic experiences in the general population find that up to 25 percent of people endorse having them at times (though most of them at the “subclinical” level). Psychotic experiences (such as perceptual disturbances, confusion, and fantastical beliefs) may enter into people’s lives in many ways. Certainly, some people experience them beginning in young adulthood and experience significant impairment in relation to them, but this is by no means the only path. Some people develop psychotic experiences only when under the influence of certain substances. Others experience them occasionally and at times of great stress. Others experience them frequently but find them to be pleasant and not disruptive in any way. Others experience them only in adolescence and not afterward. Others develop them more regularly and significantly starting in mid-life, after many life accomplishments. Still others experience them much later in life, sometimes in tandem with medical conditions and memory loss.
Given the varied presentations of psychosis within the human experience, it behooves everyone to empathize with those experiencing psychosis, as they should readily recognize that there may indeed come a time when they too may have such experiences and need others to respond to them with dignity, respect, and humanity. This is why I find it particularly abhorrent to see professionals, members of the media, and “advocates” using terms like “the mentally ill” or “schizophrenics,” as if the individuals being discussed were a different breed of human.
On another, perhaps more fundamental level, psychosis is part of the human experience because it is related to what makes us human. This is particularly the case with illogical beliefs known as delusions. Delusions are related to the fundamental human need to make sense out of the disordered information that we are surrounded by. Many things happen in the world and in life, and it is a particular challenge for us as humans to view them as random or not occurring for any particular reason. When developing a delusion, people are trying to make sense of the senseless and weave it into a coherent story. Sometimes the story that is developed facilitates a sense of one’s significance in the world, something that people also have a need to establish. In a personal account of her past psychosis, British researcher Clara Humpston articulated this well, recalling: “Each gesture from strangers in the street had become a signal and a message to me. I could not easily decode their messages and had to assign meanings to them myself regardless of whether or not there was any meaning in the first place. It was a permanent state of 'there must be a meaning in what I have just observed—what is it?'”
Delusions are illogical, to be sure, but so are many of the “normative” stories that people share in society, such as supernatural beliefs and conspiracy theories. The endorsement of conspiracy theories (some frankly bizarre) waxes and wanes, but at specific points in time, polls have found that up to a third of Americans endorsed views such as that the Apollo Moon landing was faked, that the 9/11 attacks were orchestrated by the US government, or that a US President was not actually a citizen and had faked his birth certificate. While illogical, these views are not delusions because they are endorsed by large groups of people, but they share with delusions their origin in the human need to find a “hidden” answer that explains that which is upsetting or seemingly incomprehensible (at least to some people).
None of this is to diminish the significant impact that psychosis has on people when it is persistent and pervasive in one’s life. Psychosis does impact relationships, jobs, housing, and health. But so does stigma—by way of discrimination, social rejection, microaggressions, and even hate crime. If we can diminish stigma, we’ve at least won part of the battle.
