Allie Long

Still Ill: Categorizing the Mentally Ill Allows Us to Ignore Their Danger Signs

After a suicide, we often ask what we could have done and we shout that if only that mentally ill person asked for our help, we’d help. That is a delusion.

 

[Trigger Warning: Readers who may find the topic distressing are advised that this article addresses suicide. If you or anyone you know has suicidal thoughts or tendencies, please seek professional help or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.]

 

We had no idea.

If only we had known.

We wish there was more we could have done.

Why didn’t they reach out?

How could we not notice?

No offense, but the reactions and remarks in the aftermath of a suicide can come across as self-indulgent. Yes, I get it. The inclination to ask these questions when someone dies this way is to look for a reason – to comb through every detail of that person’s life to find the Capital-R reason.

What was the last straw? Could it have been treated? Could it have been pinpointed if only closer inspection had been paid?

Honestly, with our current approach to dealing with mental illnesses’ more taboo symptoms, we will keep asking ourselves these same questions in a rhetorical sense without seeing any tangible, measurable progress.

The reason why? We don’t have any real conviction or intent to consciously change how we view the warning signs of suicide. We will continue shrugging our shoulders in the wake of suicide after suicide and say, “What could we have done to stop this?” while we put our fingers in our ears and close our eyes when the warning signs start to show.

As someone who has quite literally been talked (and medicated) down from the ledge numerous times, I can say that we are generally so quick to dismiss even the loudest cries for help that it genuinely astonishes me when people have the gall to say they would have welcomed a person who has committed suicide with open arms if only he or she had opened up to them.

It’s just not true. Mentally well people do not know how to deal with mentally ill people when they, well, act mentally ill.

In theory, everyone is endlessly empathetic. In practice, there is a firm line in the sand between what is an acceptable level of ill and what is cause for writing someone off as crazy. There is no ambiguity.

There are misconceptions about mental illness that dominate the public consciousness and fuel stigma and misunderstanding. We are seeing these dismantled to some extent when it comes to depression, eating disorders, generalized anxiety disorder, and other neuroses, but – not to undermine the suffering of those who have those specific mental illnesses – there are still disorders that scare people out of a willingness to listen.

 

“High-functioning” and “low-functioning.” This kind of categorization allows us to use productivity and adherence to social norms as the metrics by which we measure the severity of a mental illness.

 

We are quick to dehumanize people who suffer from hallucinations, delusions, and other “scary” symptoms because those symptoms, in turn, scare us. I am by no means saying that people unconditionally welcome those with more “common” mental illnesses, but at least we are comfortable uttering the names. At least we don’t recoil at the mere mention of “depression” or “anxiety.”

Bipolar Disorder? Borderline Personality Disorder? Schizophrenia? Those are different stories.

What separates the “scary” from the “not scary”? Generally, I would say psychosis, whether that is extreme paranoia, delusions, hallucinations, or some combination. Even more generally, it’s what the cultural imaginary conjures when we think of the mental illnesses for which psychosis is one of the more prevalent symptoms.

I can speak to this at least anecdotally. Am I depressed? Fine. Am I hypomanic? Fine. Do I have OCD? Fine. I can also speak to this symptom-wise. Am I feeling hopeless? Fine. Am I feeling incredibly sociable and energetic? Fine. Do I have a nagging sense of existential despair? Fine. Can’t I sleep? Fine. I sleep and eat a lot? Fine.

The less severe symptoms result in disbelief of the mental illness and subsequent frustration with the sufferer. The more severe ones result in a look that says, I’m backing away from you slowly. Forever.

It doesn’t – it cannot – work like that if we are trying to actually reduce the number of suicides – if we are trying to actually figure out “what else we could have done.” It starts with stepping out of our comfort zones. Oh, you’re scared of mentally ill people? Well, just imagine how they feel.

Two buzzwords I hear when discussing mental illness (and other chronic illnesses/disorders) are “high-functioning” and “low-functioning.” Our obsession with this kind of categorization is relentless. It allows us to use productivity and adherence to social norms as the metrics by which we measure the severity of a mental illness. And guess who bears the brunt of the fallout from this disingenuous attempt at assessing the risk factors of suicide? Yeah, the people who we categorize.

But this goes beyond productivity and the ability to maintain seemingly normal relationships. We like to place symptoms in these categories too, as opposed to acknowledging that the symptom isn’t so much the warning sign as are the severity and pervasiveness of that symptom.

 

“Are you experiencing thoughts of suicide?” Don’t expect me to tell you. Your question is asinine and intended to assuage you of any legal culpability.

 

When I was severely depressed and when I was hypomanic, I was always suicidal – every minute of every day. I oscillated between comfort in knowing I could end it all and sheer terror (and maybe excitement?) in knowing my body had the ability to act on my mind’s darkest desire. But guess what? I wasn’t always actively suicidal. In fact, I was probably only in danger two or three times.

If I disclosed I was suicidal, however, no one could take a minute and listen for the difference between “I wouldn’t mind just, like, ceasing to exist” and the glazed over, emotionless, empty stare of someone who has reached a point of, well, satisfied (and maybe even smug?) resignation.

I even experienced this in therapy because, you know, mental health professionals could get in serious legal trouble if a patient killed himself under their care.

“Are you experiencing thoughts of suicide?” YES, OBVIOUSLY! THAT IS LITERALLY A SYMPTOM OF MY DIAGNOSIS. BUT DON’T EXPECT ME TO TELL YOU BECAUSE I DON’T WANT TO BE LOCKED UP. YOUR QUESTION IS ASININE AND VERY OBVIOUSLY INTENDED TO ASSUAGE YOU OF ANY LEGAL CULPABILITY.

When we categorize symptoms as “scary” and “not scary,” we fail to see where “suicidal ideation” and “a vague sense of hopelessness” overlap.

But we love band-aids. It is easy to hospitalize someone who is acutely suicidal. It is a lot more difficult to deal with the underlying disorders, environmental factors, and prejudices that lead to that end.

That’s why I get so frustrated with people who tout the efficacy of things like the Suicide Hotline. Yes, it may work in a dire situation, but in the long-run, the illness will persist.

It is a catch-22 for those who have mental illnesses. They are told to open up and are promised empathy in return, but in order to open up, they need to be assured that empathy will be given. So far, there is not much that leads them to believe they will receive empathy.

At best, they will garner sympathy at a distance from those who are scared of and unwilling to understand their symptoms.

At worst, they will be dehumanized, made to believe they are making up their symptoms, and the target of the moot question, “What more could we have done?”

Yes, living with someone who is mentally ill is difficult. I even catch myself jumping on this train of thought occasionally, but it’s difficult to be close to anyone who suffers from any kind of chronic illness.

But if it’s difficult for us, we have to stop and ask ourselves, Then how difficult must it be for them?

 

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