The Meaning of Mental Health

Rev. David Takahashi Morris

Thomas Jefferson Memorial Church

Unitarian Universalist

November 3, 2002

Imagine yourself in a small group of people. You’re all listening politely to a speaker at the table. She asks for responses and you rise to speak. Suddenly your voice fails and words won’t come out of your mouth. You try to find some graceful way to say you can’t continue, but instead you mumble incoherently and collapse into your chair. Your water glass spills. Several of the group members try to help you, and emergency assistance is called. The session ends in chaos, and you’re taken away in an ambulance.

A few days later it’s reported to the group that you’ve had a stroke, strong but not devastating, the result of chronic high blood pressure. You’ll stay in the hospital for a week or so, then recuperate at home for a while. Your treatment regimen is adjusted to help guard against recurrence. Of course you’re flooded with cards during your convalescence. The group meets without you and talks about how sad everyone is about what happened, and how they all hope for your quick recovery. The next time you show up for a meeting, you’re welcomed warmly.

Now imagine the same scenario, right up to the point of your departure: The failed attempt to speak, the disruption, the group response to an emergency. But in this second scene, you’re admitted to the psychiatric care wing of the hospital. You’ve had a recurrence of schizophrenia, an unusually severe episode for you. Once again, you’ll stay in the hospital for a week or so, then recuperate at home for a while; once again, your treatment regimen is changed to help guard against recurrence.

What happens next? Are your friends and acquaintances reluctant to send cards, not wanting to embarrass you? Does the group talk about whether you ought to be allowed to return? When you’ve recovered sufficiently to come back, are you treated differently?

An estimated 54 million Americans suffer from some form of mental disorder in a given year.  The National Alliance for the Mentally Ill describes mental illness as “a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines.” Mental illnesses are more common than cancer, diabetes, or heart disease. Like these three groups of diseases, mental illness results from a convergence of chemistry, circumstance, and choices. Like these three diseases, mental illnesses are treatable, but not curable within present medical knowledge. Yet the fact is that we treat the victims of mind and brain disorders differently from the victims of other diseases.

The writer William Styron, in a memoir of a near-fatal depression called Darkness Visible, writes that “in virtually any other serious sickness, a patient who felt such devastation would be lying flat in bed, possibly sedated and hooked up to the tubes and wires of life-support systems. . . . His invalidism would be necessary, unquestioned and honorably obtained. However, the sufferer from depression has no such option. . . . He must try to utter small talk, and be responsive to questions, and knowingly nod and frown, and, God help him, even smile.” Mental illnesses are the only diseases whose victims are expected not only to pretend they aren’t sick, but to make the rest of us believe it, too. Instead of receiving compassion and acceptance, too often they experience hostility, discrimination, and stigma. 

Our societal response to people coping with mental illnesses is born of a combination of ignorance and fear, each reinforcing the other. The stigma attached to mental illness makes people reluctant to talk about their experience, knowing that they will face suddenly uncomfortable friends and family members, sanctioned discrimination in the workplace, and a medical system that is not legally required to treat their illness like any other.

One example of ignorance and fear working together is the silence and misdirection around what actually kills people who commit suicide. The National Alliance for the Mentally Ill reports that a survey of managed-health-care responses to mental illness found that most plans do not specify that a suicide attempt is a medical emergency requiring medical intervention and emergency treatment. Yet in a very real sense, suicide is to mental illness what heart attack is to cardiovascular disease. William Styron argues strongly that fear and shame keep us from saying that a person who has committed suicide died of depression. But we must learn to say it, he says, or we will never understand how devastating and dangerous these illnesses can be.

Fear, ignorance, and shame surround the subject of hospitalization as well. The hospital can be a sanctuary for people in crisis, an opportunity to stabilize, to be safe, to escape from the need to pretend nothing is wrong. Yet how do we respond to someone who has been hospitalized for treatment of depression, bipolar disorder, or schizophrenia? How do we allow our health-care system to respond to their treatment needs and their financial situations?

Stigma keeps people from seeking treatment; stigma keeps people from turning to their communities of care for the support that they need. The stigma is real, and it affects every institution we interact with – including our churches. How well equipped are we here to accommodate people who are affected by mental illness? How different is our response from the societal norms around us? Typically, responses to a person with mental illness oscillate between denial – pretending that nothing is different about them – and rejection – blaming the victim for their behavior and avoiding their company.

What are we afraid of?

The diseases themselves can be truly fearful, agonizing and debilitating. Perhaps part of our fear is the knowledge that we, too, may become a mental health consumer one day. One in four families is affected by mental illness; are there any real grounds for believing ourselves immune? In the company of a sufferer, in Beaudelaire’s elegant words, we may “feel the wind of the wing of madness” too closely.

America’s emphasis on self-help and self-mastery, which our own Unitarian forbears raised to the level of “salvation by character development,” may make us especially fearful of the reality of diseases that are beyond our control, that can take away our self-esteem, our self-reliance, even our knowledge of ourselves.

Our fear may be of the unpredictability that can afflict mental health consumers. This is an acute problem for Unitarian Universalists, with our very high regard, bordering on worship, for rationality, self-reliance, and self-direction. The outward signs of a mental illness are often behavioral.  People may be extremely quiet or withdrawn, or they may burst into tears or have outbursts of anger.  Even after treatment has started, they may exhibit anti-social behaviors that can be disruptive and difficult to accept. We’re embarrassed when people “behave badly” – or worse, among U.U.’s – “unreasonably.” We try to alleviate the embarrassment by ignoring them, or pretending nothing out of the ordinary has happened, and by avoiding them in the future. This is stigma at work.

Last, our fear may come from the media portrayals that are all too often our primary source of information about other people. Newspapers often stress a history of mental illness in the backgrounds of people who commit crimes of violence. Television news programs frequently sensationalize crimes where persons with mental illnesses are involved.  Comedians make fun of people with mental illnesses, using their affliction for fun. 

But by naming our fears, and knowing their sources, we are set free from the trap of having to live out of them over and over again. Here in this community, a religious community devoted from its earliest history to the ideal of an undivided human family, we have a special responsibility – and a special ability – to move beyond our fear and ignorance to become a genuinely accepting and affirming spiritual home for those who are marginalized because of illnesses they did not cause. You see, we believe that the categories that divide us are false. We believe that the differences among us are cause for celebration and for care, not for fear and isolation.

Here we can affirm that love, compassion, honesty, and genuine respect are the foundation for our interactions with one another. Here we can affirm that illness is just illness, and that we are called not to pretend that it doesn’t exist, but to recognize that it is only part of who a person is. Here we can learn about and understand the struggles in each others’ lives. Here we can promise to listen to the voices of those among us who live with mental illness, learning about their experience, their needs, their hopes for their spiritual community. Here we can hold ourselves accountable for staying in relationship even when it is difficult, even when the other party temporarily loses the ability to stay within bounds by herself or himself.

Above all, here we can be called to do the work of justice in society on behalf of our brothers and sisters. We can learn about mental illness, and work to dispel ignorance and stigmatization. We can challenge distortion and sensationalizing when we encounter them. We can advocate for changes in laws and in medical and social policies that punish the mentally ill for having mental illness. We can think about our own interactions with our students, our classmates, our colleagues, our employees, our family members on the subject of mental health. And we can become, here in the church and in the world outside, part of the support community for wellness which mental health consumers are strongly encouraged to create for themselves as part of becoming managers of their own conditions and treatments.

Last, I want to speak from my own experience directly to you in the congregation today who are dealing with mental illness in your own life or your family. You are not alone. There is hope, and there is help. If you have not already sought treatment, or created a treatment program for yourself, I urge you as strongly as I can to do so. Do not let society’s fear and ignorance block you from caring for yourself. Take advantage of the many resources that exist in this community to help you with your care. And look among us for the allies you deserve. May we all become part of a community of wellness and a community of wholeness for each other.