“Sick” is a charged word.
I take a “sick day” from work when I am not well. It isn’t a phrase freighted with meaning. But in other contexts, it is.
If I have a fever, people tell me to feel better. They look sympathetic, but what if instead I am having panic attacks?
If I say to someone, “You’re sick,” I don’t mean they have a fever or body aches. I mean there is something wrong with their minds, and I don’t mean this in a neutral way. I don’t mean it the way I would mean they have a broken arm. I mean that something in their minds is broken that makes them worth less than me. I mean there is, perhaps, something wrong with their character, that they may be dangerous, or simply unlikable. Like a lot of slang, it’s vague–and that’s not unlike my “sick day,” which I might take if I have a fever and body aches, or vomiting, or a pounding sinus headache and a runny nose, or even intense pain from having my appendix removed. But the meaning is not vague. It’s demeaning.
Even suggesting that someone “needs help ” is usually done with the intent to demean that person. When our minds are uncomfortable, it’s a completely different matter than when our bodies are uncomfortable. Feeling lethargic and that life lacks meaning is much more negative than having a scratchy throat and an itchy nose.
For the most part, there isn’t a stigma about contracting physical illnesses–perhaps there used to be, but there isn’t now. As I said, for the most part, because some illnesses remain stigmatized and controversial–HIV infection, for example. And leprosy still won’t win you friends in most places. Some people are so germ phobic they give you dirty looks if you cough. Even if you cough into your sleeve. But still, socially speaking, it’s generally okay to break your leg in a skiing accident. No one looks down on you for catching the flu. But that isn’t the case for mental illnesses.
What that seems to lead to is a lot of debate over what it means to be mentally ill, and what it means to be “sick” when it comes to our minds. Who is really “sick?” The person who can’t sleep at night, has flashbacks, and feels suicidal? Or the individual who assaulted them in the first place?
Perhaps both. My mind is unwell when it doesn’t function adequately enough for me to live a meaningful, constructive life. We all have bad days and low moods, but when I can’t have fulfilling relationships because of the interference of trauma symptoms, then I have an illness.
At least that is how I think of it. I think of mental disorders as being much like having a broken bone or a deep laceration. The bone needs to be set and casted. I might need crutches. I might need to elevate that limb to reduce the swelling. The laceration needs cleaning, stitches, a bandage that keeps the wound glued together. And the wounds needs time to rest and heal without too much disturbance.
I need treatment for my trauma symptoms as well. I may need to learn some relaxation techniques so that I can start to calm the intense rushes of fear. I need someone to tell the trauma to. I need to think through what happened so that I can form new ideas about life that both account for the trauma and allow for a positive view of myself and the world. I need to pick apart the fear structure so that reminders of the trauma cease to prompt an intense emotional reaction for me. I need that as much as a broken bone needs to put back in place.
I can understand the stigma of mental illness. When our minds are not well, we don’t function the way we should or would like to. Our relationships are affected negatively, our job performance is affected. We may act out and harm others. We may simply be unreliable.
But I have to tell that I don’t do my job well when I have the flu either. And long-term illnesses that require debilitating treatments are hard on relationships as well. Very sick people don’t have the energy to give to their partners sometimes. There is an interruption in the normal pattern of give and take until a certain degree of health is regained. Physical ill-health has some of the same consequences as mental health problems.
I don’t think the debate should be whether a psychological condition counts as a sickness or not, but about what it means to be sick. Being “sick” should not mean the individual is worth less or is to blame for his or her condition. We don’t need to blame someone with bipolar disorder or anorexia anymore than we need to blame someone for contracting malaria or inheriting Duchenne’s muscular dystrophy.
That doesn’t mean there isn’t responsibility involved. If you are sick, you need to get treatment and you need to try to either manage your condition effectively or get well. If I have cancer and refuse treatment, I will have to accept that I may die. If I am depressed and refuse treatment, I will need to accept I may find myself unable to do my job, unable to maintain relationships, and I may become suicidal. I may also die.
When there are effective treatments available, and I don’t seek them out, then the progress of the disease in my mind or body is my fault. But it is not my fault I’m sick in the first place. It is not even my fault that a cure may take time and effort and will not occur overnight. It is not even my fault if there is no cure at present, and the best I can do is to manage my illness.
Instead of debating what counts as a mental illness, we need to stay focused on how to continue to take care of ourselves when those in our lives are psychologically unwell–because illness of any kind places strains on relationships and impacts daily life. And we need to support one another so that we can all heal from whatever ails us.