Mental Illness and Stigma

I recently watched a TV series called Apple Cider Vinegar. It’s about the wellness industry and the controversy surrounding a young woman who wrote a cook book and developed an app that promoted natural healing of serious illnesses through diet and food. It was a complex story about health, disease, entrepreneurship, social media and most importantly mental illness.

I had previously seen the documentary called The Inventor about the founder and CEO of a failed tech company that claimed to be able to diagnose any disease via a pin prick amount of blood, to replace complicated medical testing. I was intrigued. Another similar story led me to watch a TV series about a New York socialite who funded a lavish lifestyle to build an Arts foundation in her own name, called Inventing Anna.

The re-dramatised TV shows both used a substantial amount of artistic license and the documentary was edited brilliantly, but all three had something in common that got me thinking. All three stories featured young women who were charismatic and connected. All had a complex relationship with the truth and reality - both theirs and everyone else’s. All had a complicated combination of vulnerability, delusion, and ambition. All ended up in deep legal trouble, public shame and private turmoil.

Any conversations and discussions I hear and read about these women are largely hostile. They center around them being manipulative liars with malicious intent, who were out to scam innocent people out of money and there is plenty of evidence to reinforce this perception. All had a vision of something great that they were convinced would help people, but all took unconventional steps, substantial risk and sometimes made miscalculated (or very calculated) decisions to achieve their end goal, without much consideration for any immediate harm they caused others and eventually themselves.

All three women had multifaceted back stories, perfect for creating a TV show about, alluding to contributing factors to personality disorders. All had alleged unconventional and difficult relationships with their early caregivers and had experienced life events that may have influenced their adult personalities negatively.

Whether or not these women experienced a mental health issue at the time of their controversial behaviour is still up for debate and for many is irrelevant. You see, when someone suffers from a mental illness; whether it is diagnosed or not; whether or not it is even clear what that illness is and how it manifests; whether it is genetic or a response to trauma, or both; we still tend to hold people accountable by a basic standard of human decency. This is established by a collective understanding of what is acceptable behaviour and, of course, is debatable, because power often dictates what is indeed acceptable behaviour for some and not for others.

People experiencing mental illness truly believe their own perception of the world and the people around them, even if it is delusional. It is impossible to convey your inner world to others thoroughly at the best of times, let alone when you have a mental health issue. No one will ever know what you are truly thinking and feeling. Even when we do try to communicate with others, we curate our expression to fit the environment or receiver through a process of conditioning. Most people have the ability to adjust how they present themselves to a given person and situation. For some people this adjustment becomes something they perfect to conceal what they are truly experiencing, especially if it is considered anti-social - we call this masking.

So how do we know when someone is genuine or if they are indeed experiencing a mental health issue? How do we determine when someone is being intentionally cruel, dishonest, and devious, or if they simply can’t help it? How do we interact with someone to learn more about their true intentions? How do we hold them accountable, especially when they do harm? Whose responsibility is it ultimately?

In all these cases, it was the law and the media that did most of the investigating, story telling and correcting. And while in some cases, the medical profession entered the conversation, there was not much room for that perspective to take the lead, particularly when it came to promoting empathy or mercy from a mental health perspective. For example, Belle Gibson, the woman who wrote the cook book and designed the app was thought to have brain cancer, something that can show up in a scan, or manifest in evidence such as a tumor. When people believed this to be true, they were more sensitive and empathetic towards her. When it emerged that this was not true, people were understandably angry about the lie. They didn’t really question what caused the lying and most people still assume it was malicious intent. The verdict is still out, but it is clear there may be something else happening. At the time, she claims that she believed herself to be sick and that she was accessing alternative/complimentary medicine to heal herself. This could be a symptom of a mental health condition at play, and while some people have alluded to this, the response has not been as forgiving.

Because mental illness is personality based, cognitive, behavioural, perhaps a confusion of values, a conceptual presentation instead of a physical one, something that shows up in actions, beliefs, thoughts and perception, rather than in the physical body like cancer, sympathy and empathy are largely absent. That it may be a response to trauma, unstable development as a result of poor attachment and inadequate or abusive early care giving, or something else outside the person’s awareness or control, that doesn’t seem to temper a harsh response. Like cancer, mental illness could be a result of a combination of factors that deserve a healthcare response over a judicial and punitive one. In Australia, and I’m sure elsewhere, we have a history of responding to a mental health episode with policing personnel, trained in violent restraint rather than de-escalation and crisis management. Of course, this is the appropriate response when mental illness is the cause of violence for example. How else are we supposed to manage a critical incident once it has already taken place? Perhaps prevention should be our focus.

As a society we don’t accommodate disability well enough anyway. People with physical disabilities can attest to how difficult it is to navigate a world that devalues their right to access and existence. When disability is not physical but neurological - in other words invisible to most, there are less accommodations or considerations. The comments I read about any of these cases are mostly hate filled. There is more awareness these days about neurodiversity, but the backlash is just as strong, and we are leaning faster and more directly towards a Eugenicist mindset. Rather than embracing and accommodating difference in a nurturing way, to avoid escalation and harm, we reject diversity with indifference, judgement, exclusion and control which exacerbates trauma and anti-social behaviour.

On the other hand, what I see a lot of lately is the weaponisation of “therapy speak” or diagnoses. An over correction that excuses all sorts of behaviour and presentations as something that is happening because someone is neurodiverse, for example. This isn’t a new concept. Mental capacity is a consideration in the eyes of the justice system when it is convenient, with all sorts of misapplications and oversights.

Of course, it is understandable to feel anger and betrayal when someone’s behaviour has been harmful. And it is perfectly acceptable to admit that you no longer want to engage with someone who does this repeatedly for whatever reason, whether they can “help it” or not. You are entitled to walk away from someone or a situation that feels risky, unsafe, abusive, and harmful. But there is room for understanding. There is room for changing how we have a conversation about people who simply behave the way they do because they don’t know any better and refuse to or are incapable of learning or changing. If it is our own behaviour, we would hope for understanding, support and leniency too. Some are held to account more severely and frequently than others. I guess it depends who you are and perhaps even what you look like.

What these three young women did caused harm to their victims and the people who cared about them. And they payed for it. Some with jail terms and financial consequences, all with the destruction of their reputation by achieving notoriety for all the wrong reasons. Perhaps they got what they deserved, an equal consequence for their actions. Or, perhaps, we are quicker to judge and punish some people more harshly than their actions deserve, while being lenient towards others who deserve far more consequences for the results of their behaviour, like billionaires and world leaders who are responsible for mass carnage and destruction. Maybe judgement and punishment isn’t the answer and we can have more empathic ways to hold people accountable, make room for change and growth, compensate and nurture victims and set strong boundaries to prevent future risk and harm.

It is an interesting time to be a Counsellor. My goal with clients is to find the balance between empathy and accountability, to help remove the stigma of mental illness, and to provide a space where you can come to a realisation about patterns of behaviour, emotions and thought processes (your own or someone else’s) that may be harmful to the self or others. I firmly believe that everyone is entitled to agency and self-determination, but that freedom comes with responsibility. There is a time and a place for outrage and disgust, and there is a time and place for empathy too. All can occur simultaneously and most importantly, safely.

Stigma prevents people from addressing their mental health issues or dealing with someone else’s in their lives to support them. There is still too much shame, judgement, discomfort and resistance to confronting thoughts and ideas that cause harm, both individually and collectively - whether there is a mental health condition present or not. We simply avoid difficult interactions and conversations because emotional regulation is something we are only now beginning to understand and practice with full authenticity - beyond the coercion of the law, cultural custom, religious practice and social expectation. Our world “leaders” provide a chilling example to the rest of us of what not to do.

People are afraid, embarrassed and ashamed to admit when they get something wrong. So they resist learning, growing and subsequently, moving on. Instead they double down, hold onto their cognitive dissonance and continue on a path of destruction to save face, even if it means losing everything!

I always end up in the same state of mind. Balance. There is no end game. There is no absolute way to do anything. It is an ongoing, fluid and dynamic conversation that must be had. It requires reason, but also emotional regulation. And sometimes, distance, rest and self-preservation. Some things are simply not negotiable.

The only way to address the mental illness epidemic we are facing in our communities and as a global society as a whole is to tread carefully, kindly, with open mindedness, awareness of risk, good intention and a willingness to misstep and correct. We might lose a few along the way, but we might lose less than what we are losing now! It has already been too many.

If you or anyone you know needs urgent support you can contact:

Lifeline - phone: 13 11 14 or text: 0477 13 11 14

Suicide Call Back Service - 1300 659 467

Beyond Blue - 1300 224 636

Kids Helpline - 1800 551 800

You can access a cost and obligation FREE 30 minute online session with me at DHM Counselling by clicking Contact or Book Appointment.