Mental Illness Needs Context

 Mental Illness in Context

In “Covert Depression,” I discuss the necessity of “dysfunctionality” for a DSM diagnosis. This post discusses how people don’t need to change themselves to duck this criterion–they can just change friends or locations. Virtually all mental illness can “disappear” under the right circumstances, and we can’t blame people for wanting to reduce anxiety and stress in the least painful ways. Here are some examples:

In the heat of battle, hypervigilance, body tension, and quick anger triggers are functional. When you return from Afghanistan, they become “PTSD.” The discomfort of these symptoms in civilian life is often why veterans often have the urge to re-enter warlike situations (police force, MMA, etc.), where the symptoms don’t constitute a mental illness.

Perfectionism and the absorption of other people’s emotions are anxiety symptoms that work well in hospital environments. Many people with parentification trauma find relief in urgent care settings as nurses or techs, where the “can’t sit still” buzz of their anxiety blends into the environment and keeps them on their toes.

My wife and I have been watching Suits, a show about a top-tier New York law firm. Nearly every character in the show could qualify for Antisocial, Narcissistic, or Borderline Personality Disorders. Because winning at all costs is the most important value in this culture, antisocial (unempathetic) behavior is highly adaptive, and helps lawyers manipulate their way to success. One is more likely to find these symptom profiles among politicians, CEOs, performers, and other high powered public figures.

Someone with attachment trauma—often manifesting as fears of commitment, vulnerability, and authenticity—can enter a “free love” community. In this setting, sex is purely recreational and relationships are expected to be fleeting and non-committal. They wouldn’t have to risk someone getting to know them very well, so risk of deep rejection is low.

Drug addictions are normal, and thus not discussed as “addictions” amongst heavy drug users. 

Some dance cultures endorse lifestyles others would consider eating disorders.

I would never recognize Borderline tendencies in myself if I chose a partner that would take the blame for all my emotions. They would always think they’re the “crazy one,” so I don’t have to.

A teenager’s depression is not dysfunctional if his parents have no boundaries–cleaning up after him, buying him video games, doing his homework, refusing to let him feel natural consequences…

I could give an example of how every disorder could exist functionally in a particular environment. Sometimes the disorder comes first, and people enter an environment that affirms it. Sometimes the disorder arises from the environment. Either way, a cycle perpetuates it: “My new friends convinced me to use drugs, and I stay with them because they accept my drug usage,” etc. But the point is to use this knowledge to help us consider a few things:

-Are there any people or environments that affirm or enable my potentially symptomatic behavior? Am I enabling someone else’s? Am I helping someone stay ill?

-Is this system sustainable? (My aggression is helping me win court cases, but is it undermining my greater goal of maintaining my marriage?; My anxiety to fix helps here at the hospital, but how does it affect my kids?)

-If there is a community that will affirm any symptom, it may be that your boundaries don’t directly help someone change. 

E.g.: “You can’t live in my house while you are using meth.”

“Fine! I’m gonna go live with people who aren’t judging me all the time! (even if those people don’t have homes)”.

You may need to keep yourself and your property safe by kicking this person out, AND they may continue their behavior. Can you make peace with that? Because letting them stay would hurt you while they continue the behavior.

-Knowing that seeking affirmation of symptomatic behavior is an adaptation that reduces anxiety that arises from trauma, how can we develop more compassion? Are there some groups (like politicians or lawyers) that we’ve judged as bad people?