Mental Health…but for Whom?
Mental Health. We all want it, right? We all want to be happy and healthy. But, like physical health, mental health rarely focuses on happiness, and instead focuses more on minimizing disease, or the unwanted side effects of disease. Mental health is not designed to “make people happy,” it is designed to diagnose and treat the mentally “ill.” Often the diagnosis relies on subjective reports such as: “interferes with work,” or “has difficulty forming new relationships.” The diagnosis is often based less on measurements related to the person’s health and happiness, and more on whether the person himself is an inconvenience to others. For example, a narcissist doesn’t generally view his personality disorder as a problem, but it’s largely considered a mental illness because it’s a problem to other people.
This diagnostic paradox is an odd feature of mental illness that we don’t see in physical illness. We don’t look at a person’s facial features and declare that they are so ugly that it’s an illness because it offends others. The physical illness is almost exclusively diagnosed by the physical harm that may befall the patient, not the patient’s family and friends. True, there are some exceptions with regards to infectious diseases, but generally speaking, physical illnesses are important because they can cause pain, dysfunction, disability, and death to the patient.
Mental illness doesn’t need this requirement. A person may have a personality disorder that doesn’t necessarily harm them in any concrete way, but it’s inconvenient for others, so we label it as an illness and treat it as such to minimize the discomfort to others. It is clear that many famous artists, musicians, and writers had bipolar disorder, many of whom had the disease before the Diagnostic and Statistical Manual of Mental Disorders (DSM) existed. If all of these individuals had been treated, it is likely that their significant works of art may never have been produced, since it is clear that many of the great works were produced during the manic periods in their lives. But now, most patients with bipolar disorder are treated with mood stabilizers, which are designed to prevent these manic episodes, and end up dulling some of the cognitive functions in the process. This means that it is possible that an artist like Van Gogh would never have painted A Starry Night, or a musician like Kurt Cobain might never have written his award-winning songs.
The point here is not to argue for or against medications to stabilize one’s moods, or advocate that a short but legendary life is better than a long but forgotten one. It’s only to point out that in this weird world of mental illness, we take into account other people’s feelings about the illness, rather than what is necessarily most pleasing to the patient. Ideally, we would like to both prevent Kurt Cobain from committing suicide while also retaining his intense periods of mania and creativity. If we viewed mental illness strictly from the viewpoint of what is in the patient’s best interest, then research and medication would be aimed at achieving this positive balance for the patient. But instead, we try to mainly minimize suicide risk and make the patient stable and predictable. As a result, we have more people with bipolar disorder living longer, and with lower rates of suicide. But the inner subjective experience of many of these patients is a dulled existence, where their previous episodes of creative production are now absent or severely blunted. Surely, the patient isn’t happy to feel like a muted version of himself, even if it does extend his life. Yet, having to choose between an intense but short-lived life or a long but boring one is not an ideal situation.
I hope that eventually mental health, or wellness as it’s slowly being called, can shift towards more patient-centered approaches to both diagnosis and treatment. I would love the goal of mental health to actually be maximizing the happiness and meaningfulness of a patient’s life, rather than simply minimizing any downs, or avoiding any threat of suicide. I think balancing these two goals is key, and future research should be aimed at not only stabilizing a patient, but also helping him to achieve his full potential. If Van Gogh could achieve intense periods of creativity and production, why can’t we help him to achieve this more readily, and also catch him when he falls down into depression? Why can’t we foster these intense individuals while also keeping them alive?
To circle around, if we do care about the impact of mentally ill people on the world, perhaps we should also care about the potential loss of bipolar extremes if everyone with bipolar disorder is medicated. Imagine no more Van Goghs, Kurt Kobains, and possibly myriad other creative persons and religious leaders alike. We don’t actually know with certainty how many previous famous people had bipolar disorder, but I imagine that there were more than we know. If we lose the gifts that these men and women have given the world, then it’s not just the individual with bipolar that loses, but also the world at large. The world is better for having had these intense individuals grace us with the gifts of their mania, and I would hate to see these potential gifts wither away if we simply medicate everyone into a boring and predictable state.
I demand more from our mental health professionals, and our mental health researchers. I insist that we don’t dismiss mania merely as a disordered state that we should try to destroy as effectively as possible, but rather as an intense human experience that we should try to cultivate and explore if possible. If mania is a form of volatile genius, then let’s not throw out the baby with the bathwater, but figure out how to clean the water, and keep the baby. One could argue that spirituality is a mental illness too, since there is little concrete evidence in reality for it, but we know that it can also help people get through incredibly difficult times when nothing concrete has worked. Mania may lie behind numerous inventions, creative explosions, and even social movements. If we try to work with these mental illnesses, and find the benefit to society, we can hopefully create a place where patients with bipolar disorder are allowed to experience their intense euphoric and creative moments, and also have a safety net available to protect them from depression. It’s going to require an adjustment to the way we view our mental health, but it’s one that has the potential to help both the patient, and society at large.
