4S Supplemental: Panel Discussion on Mental Health

Mental

It is with a great deal of sobriety and trepidation that I undertake the project of publicly considering the issue of mental illness. Yet once the project was suggested, I knew I had to give it a try. I'm not really prepared for such an undertaking. But another year of preparation would see me no more prepared. So here we are. Let's see where we end up:

Extreme Caution

The first thing we all need to do is repent of the sin of being too quick and brash in our assessment of the mental health of other people. I believe we are all guilty. But I know for certain that I am. So in sackcloth and ashes, I repent and acknowledge the harm I most assuredly have caused others by the mere suggestion that they might be mentally ill, unstable, deficient, or otherwise unwell. I am truly sorry, including for the times that I might inadvertently do so over the course of this exploration.

And with that, I am done apologizing because this is a fucking hard thing to do. We are all children of this age and products of our time. The language of mental illness is baked into our culture like the mold on blue cheese. It wouldn't be blue cheese without it. But it is still disgusting when you stop and think about it. This is why along with extreme caution, I equally call for philosophical charity. As with learning to used preferred pronouns, we are going to slip up from time to time.

Definitions and the consideration of what mental illness isn't

This is where we might encounter our first disagreement. Unlike others who are helping me consider this subject, I am not using a definition from the DSM. Here's the thing: We all use the terminology and few of us have bothered to check a formal definition. As I sometimes say, words don't have meanings; they have usages. It is less about what a linguist says it is and more about what we mean when we use the word. For the most part, dictionaries are compendiums of word usage rather than absolute definitions.

When I refer to mental illness, this is what I mean:

Mental: of the mind, illness: the absence of wellness. Therefore, mental illness is the state a mind is in when it is unwell.

I realize that is a very broad definition and I make no claim that it is even correct. But you might find it helpful to know what I mean when I use the word. It will be equally helpful to know what I do not think it means:

Mental illness is not the state of being incorrect. Being incorrect could be a symptom of mental illness. But there is no reason that should be the first thing that comes to mind. The challenge is that when a person is radically and massively incorrect, we might move mental illness up as a possible cause. Unfortunately, we are not particularly good at gauging when a person is massively incorrect as opposed to just being routinely incorrect.

We all know that the sum of 1 and 1 is 2. If a person says the sum is a million, we would say they are massively incorrect. However, I believe a person is equally, massively incorrect by identifying 3 as the sum of 1 and 1. There are many orders of magnitude difference between 3 and a million. But I would say that the sum of 1 and 1 is so basic, that to miss it by any margin is equally problematic and might suggest a problem.

I fully acknowledge that I might be wrong about the idea that both wrong answers are equally massive. But that just goes to demonstrate the problem. What I deem to be massively incorrect, another might find to only be routinely or mundanely incorrect. This might lead me to suspect someone of having a mental problem when in truth, they are merely incorrect. Being incorrect is not the same as mental illness. And no matter how massive we believe the error to be, we should be extremely hesitant to assign mental illness to the situation.

Mental illness is also not the same as bad or otherwise aberrant behavior. Such behavior could be a sign of mental illness. But it could just be learned behavior based on social and cultural conditioning.

I personally believe that a person driving down the street blaring insanely loud music from their vehicle is socially retarded. But that is just a matter of what society we are targeting. Clearly, in their imagined society, it is perfectly normal and acceptable behavior. The thing I have to remember is that social awkwardness is not the same as mental illness. I am too quick to say that a person is mentally unwell when I see them behaving in a way that I do not find socially acceptable.

Here's the thing: Mental illness can present in all of the ways that I have just said do not define mental illness. If a person is massively wrong about things we suspect they shouldn't be wrong about, it could be that they have a learning disability that prevents them from processing certain kinds of information. If a person acts out in ways that are antisocial, it very well could be a presentation of mental illness. I personally believe that all violent offenders are mentally ill. But I cannot prove that. It is not fair for me to immediately make that connection. Even so, I still believe it.

Who can say?

When we see people demonstrating common symptoms of mental illness, we are too quick to say it is mental illness. But we are not qualified to say. Who is? Medical professionals of a certain discipline are qualified to say. As near as I can tell, they are the only ones qualified to say who is or is not most likely to be mentally unwell. In the same way that you cannot diagnose a heart disease, you are not qualified to say who is mentally ill. The funny thing is that we seldom hold forth on who we think might be suffering from a heart disease. Yet we eagerly announce our opinions about who is mentally ill. Shame on all of us who do that!

This is where formal definitions come into play. With specialized jargon, the definition is still a matter of usage. It is just limited to the usage of the relevant experts who use it. When we look at how experts use the word, it is not so that we can feel empowered to diagnose the mental state of others, but to understand that we have no such right.

Even the professionals have some disagreement over what qualifies as a mental illness. The DSM is constantly changing, combining, eliminating, and adding to the list of diagnosis. I believe there is a general sense that the science of mental health is not as well developed as the science of physical health. We don't tend to trust mental health experts in the same way as cardiologists because there is still so much about the mind we don't know as compared to the heart. We fill in the gaps with none expert opinions when we should be filling those gaps with humility and charity. If you say I am being overly cautious about the subject, I would counter that there is no such thing.

Exorcising our demons

I believe that religion people have a language of mental illness that is different but equivalent to the language used by secularists. We speak of exorcising our demons as a metaphor for eliminating our own crazy. Talk of the demonic has become an acceptable way of addressing mental illness. Christians are even getting comfortable with the idea that many demon possessions in the gospels were examples of mental illness rather than the activity of supernatural beings.

Colloquially, a demon is anything that disturbs our sense of mental wellness. Even secularists are not above talking about demons of lust or greed or addiction. It is not the invasion of supernatural, evil beings. We all know that. But sometimes, Christians really do mean that. They fluidly switch back and forth between demons as mental illness and demons as fallen angels.

It is common to speak of our better angels and inner demons. For most people, it does not imply a belief in literal spirit beings. It is often a stand in for mental health language that has not been well defined by religious culture. For that reason, religious people seem to have a more difficult time talking about mental illness. They have the propensity to assign symptoms of mental illness to malevolent agents. No matter what you think about the existence of such agents, I believe that philosophical charity demands that we entertain the possibility that this is the only safe way Christians feel like they have for addressing the issue.

In the same way, Christians need to repent of the many accusations and insinuations over the years that the beliefs and actions of secularists are caused by demonic activity. For it is just their way of saying that we are mentally ill. We are manifesting the behavior of someone who is not fully in possession of their own faculties. Frankly, I would rather they just say that I am mentally ill. But I suspect that what they are saying amounts to the same thing.

Symptoms and suspicions

What are we supposed to do when we suspect that someone we are interacting with is mentally ill? I know that what I said earlier might seem to place such speculation out of bounds. It doesn't. While I cannot diagnose someone's mental health through casual interactions, I still have to deal with the social realities that many people all around me are in fact mentally ill. I don't know when someone is going to blow a fuse and pull out a gun and start shooting. But I can read the signs of instability and began preparing for such an eventuality by either trying to defuse the situation, or inching my way toward an exit.

My suspicion doesn't mean that I am right. But I did inherit the genes of the people who ran like hell when they heard the snap of the undergrowth in the woods. I fully intend to be one of the people who lives even if my intuition about the situation is wrong. I find that being wrong and alive is better than being wrong and dead. That's just me.

How we interact with a person we know to be mentally unstable is different than how we interact with a person who is more or less mentally healthy. With mentally healthy people, we can eagerly engage in debate and perhaps even a friendly bar fight. Even when real anger strikes, everyone should expect to walk away alive and back for round 2 the following week. You cannot be so carefree if your interlocutor is a mentally unstable person with a loaded chainsaw in the trunk of his stolen car. That's not fun, nor safe, nor healthy.

No brand of moderation I know of allows me to make moderation judgements based on a person's mental health. I won't do that. But I will have to modify my interactions with a person if I begin to strongly suspect they have a serious mental health issue. That seems only prudent. So we have no choice but to dabble in the realms of symptoms and suspicion.

Symptoms that concern me in no particular order, include, but are not limited to the following:

• A person speaking loudly, singing loudly, or otherwise making a lot of noise in inappropriate social situations
• A person who hears voices or other sounds that no one else around them can hear
• A person who claims they would obey an authority despite the order being antisocial or even in violation of their own conscience
• The expression of too much confidence in propositions that do not merit nearly as much confidence
• A person who is massively incorrect about things that the average person has no trouble knowing
• Outbursts of anger or displays of emotion when such emotions are not what one would expect in that situation
• The inability to recognize their own cognitive dissonance even when pointed out
• The inability to recognize when one is holding contradictory beliefs when such a contradiction is obvious to everyone else
• The inability to focus long enough to hold a conversation
• A person who believes they are being clear when everyone else finds them utterly incoherent

I could go on this way for a long time. But I think you get the point. None of these things are proof of mental illness. But when I encounter these symptoms repeatedly from the same person, I begin to suspect that something is awry.

Conclusion: Man in the mirror

This writeup should cover the first hour of podcast conversation. I leave it to the panelists to fill in the rest. This is a subject about which I have no expertise. I do, however, encounter mentally ill people frequently. Some are obviously mentally retarded on a field trip with a group. Other encounters are not so obvious and much more fraught.

The other time I encounter mental illness is when I look in the mirror. I think back on the many influences in my life that led me to this point. Many of those influences and experiences were not good. They left scars. I took damage. On that, I will say no more.

I am just one of the countless damaged humans wandering Manhattan in search of the perfect hot dog. The adventures I collect along the way are priceless and disturbing. I am weirdly encouraged by the idea that mental damage seems to be the norm rather than something that is unique to myself. I am even overly proud that I am not among the worst sufferers.

But then, in the quiet of the morning after shaking off unspeakable dreams, I am faced with the man in the mirror. That is when I am most certain that none of us have escaped the worst of the mental damage. I've seen shrinks. And they seem happy to let me go on my merry way without medication. So here we are: me and that goddamned mirror -- shuddering at the thought of what those shrinks might have missed. Like I said, this exploration is fucking hard!

See you in the comments...

David Johnson