Ill Communications

There are some things I prefer to stay quiet about, or joke about, rather than take them seriously. One is anything that relates to mental illness. One reason for not wanting to talk about mental illness is the fear that by doing so, not having any special words for it, I myself will become mentally ill: like when Nietzsche says gazing into the abyss leads the abyss to gaze back at you. (Incidentally I had a brief episode in my teens, in the course of a ‘what’s-it-all-about-Alfie’ moment when I tried to read Thus Spoke Zarathrusta, and, since I hadn’t developed any sort of knowledge beforehand about what Nietzsche was all about, it all ended quite abysmally.)

So the first question I ask myself is whether there is such a thing as mental illness, and that leads me into Foucault territory, in particular the matter of the relation of expert psychatric opinion: in his Abnormal lectures, he talks about how this opinion ‘(made) it possible to put in place or, in any case, to justify the existence of a sort of protective continuum through the social body ranging from the medical level of treatment to the penal institution strictly speaking, that is to say, the prison and, if it comes to it, the scaffold’.

I am afraid that, when confronting myself with this sort of thing on my lunch break, my response is like that of the Water Rat from Wind in The Willows, that what we are talking about is ‘the Wild World. And that’s something that doesn’t matter, either to you or me. I’ve never been there, and I’m never going, nor you either if you’ve got any sense at all. Don’t ever refer to it again, please’.

The problem is that it’s hard not to be confronted with the matter of mental illness, or mental health, even on your lunch break. Yesterday the Guardian reported on Robert Enke, the German goalkeeper who committed suicide, reporting his as wife saying that he ‘spent years trying to hide his mental illness, fearful it might destroy his career and cause the authorities to take away their adopted daughter, before he finally killed himself.’ and that ‘Enke, 32, who was a favourite to start in goal for Germany at the World Cup in South Africa next year, having overcome a series of personal tragedies and professional setbacks, left a suicide note in which he apologised to family and friends.’

What interests me here is the application of the term ‘mental illness’. Clearly he had been plunged into inestimable turmoil on account of his daughter’s death. But wouldn’t his response -his deep turmoil- fall into the normal range of reactions to such an event? So to talk about how he was mentally ‘ill’, for me, nearly -I am being deliberately tentative here- implies that there was something abnormal about his state of mind, when, given the circumstances, it would be something to be expected as falling within the normal range of responses. Or to put it another way, had he shown no outward reaction at all, and continued as though nothing had happened, would we be talking about him being mentally ill, even though that would be an abnormal response? You might counter that there are lots of people who lose children and do not commit suicide, and that’s true. But most of them are plunged into uncontrollable grief, and many go through long periods in which they find it difficult to go on living. Should we talk about them as mentally ill too? Or is it only when a number of boxes are ticked, in terms of a set of clinical criteria -the expert psychiatric opinion again- that we can talk about them as mentally ill?

There are millions of people prescribed anti-depressants in order to cope with life after losing a loved one. If they stopped taking anti-depressants and acquired the symptoms of clinical depression, would we describe them as mentally ill? If so, would it be right to talk of people currently under such medication as -thinking of a current trend- possessing an underlying medical condition?

It feels as though in many cases, the category of mental illness -backed up with a scarcely more precise diagnosis like ‘clinical depression’- serves, in similar cases, to explain away, to place under control, the infinite fragility and contingency of everyday life. Maybe having this apparatus of knowledge, control and treatment in place serves to tell us that in the end, everything can be turned out all right. Yet it seemed Robert Enke for one had developed a fear of the same apparatus that was supposed to come to his aid.

Perhaps every instance of what we encounter as mental illness through interaction and observation with the subject, can, with sufficient tools of investigation, be identified in neurobiological terms, that is, they have a physical manifestation, and they are therefore physical illnesses and ought to be treated with medication, surgery or therapy, to alleviate suffering, as with any other physical illness. The problem is that the general category of ‘mental illness’ has a stigma and physical illness does not.

There is a long history of investigation into the stigma attached to mental illness and the culture in which it flourishes, and I am almost entirely ignorant of it. However, I guess that part of the stigma arises from the idea that a person with mental illness cannot be trusted to follow the same rules and conventions as a ‘sane’ person. When we talk about someone as mentally ‘disturbed’, maybe what we often mean is that they have the potential to behave in a way that disturbs the normal course of events. They defy what is held to be reasonable behaviour. Hence talk of lunatics, nutters, headcases, loopers, madmen and madwomen and so forth goes way beyond the description of people who have been clinically diagnosed as suffering from a mental illness.

It may be that the stigma is also grounded in the fear that there is no underlying sanity in the rules and conventions we accept as necessary. If I am confronted with someone who by my lights refuses to accept the same rules and conventions as me, then he or she may pose a danger to my own sense of who I am and what I do. If I can resort to classifying this person as ‘mentally ill’, then this bolsters the proper order of things as I perceive it ought to be, and I can appeal to the brute facts of the ‘protective continuum’ mentioned above to cope with the disturbance.

An useful example of this occurred with the case of the man who railed against Pat Kenny on the Frontline show on Monday last. In the course of investigating why a man would do such a thing, in defiance of conventional behaviour, the Irish Independent, the Evening Herald and the Irish Times drew attention to Mr O’Brien’s ‘history of mental illness’.

Had the individual in question possessed a heart or kidney complaint, I doubt it would have been mentioned, because it would have been deemed entirely irrelevant. But it seems permissible to see mental illness as permeating every aspect of what a person with a ‘history of mental illness’ does. Furthermore, the introduction of the question of the man’s mental illness invites the reader to imagine that one would have to suffer from mental illness in order to create a disturbance on the show in the way that Mr O’Brien did.

Yet at the same time, while the TV show operates according to certain rules and conventions, there is no ultimate justification for the existence of these rules and conventions, since neither the form nor the content of the show are derived from some universally accepted natural order of things. Also, it was clear that many people were sympathetic to what he had to say. Whilst I might not share Mr O’Brien’s analysis, or his way of getting his point across, I see nothing that renders his intervention any less ‘sane’ than the extremely artificial and rarefied environment in which his actions took place. But if we are led to understand his intervention in terms of ‘mental illness’, it gives us a starting point for returning things to proper order.

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