These few pages do not attempt to answer the many questions mental illness raises. Rather, they aim to offer a somewhat clearer picture and to ease this encounter.
A good starting point is to note, in very simple terms, the distinction between mental illness and mental disability.
A person has a mental disability when they are stably "arrested" in their intellectual development, with little possibility of change (whether that arrest results from physical or psychological causes).
"Mental illness" is a general term that suggests the possibility of change, improvement, even recovery—or sometimes worsening. But the phrase too often means unreasonable fear of someone incomprehensible and unsettling, someone who delirious or withdrawn into silence.
The two terms oppose each other, at least in theory. In practice, though, do we not sometimes speak of illness as a kind of handicap?
This illness is mental because it affects the higher functions: attention, memory, what we call "mood" (sadness or elation), the capacity for judgment (hallucinations, delusion, and so on), and affection. It is not neurological like a tumor, but it disturbs personality more or less seriously, altering its unity and harmony in the eyes of others.
Judgment and affection are fundamental to human relationships. It is precisely in the presence of others, of their equals, that these patients are troubled and bewildering; it is in their social behavior that they become incomprehensible.
The Expression of Suffering
In practice, we can distinguish two broad categories of disturbance.
NEUROSIS: unreasonable fears (of confined spaces, for example), called phobias; obsessions that the person recognizes as pathological but that do not alter their judgment or social conduct.
PSYCHOSIS: generally more serious, these alter the individual's relationship with surrounding reality (hallucinations, delusions, and so on). The patient is unaware of these alterations.
Between these two broad categories lie intermediate situations, and the intensity or speed of progression can vary. Many labels have been attached to distinguish one form of illness from another, with little practical use. They should not obscure the essential point: these are illnesses that cause suffering, and they are the expression of one person's suffering in their relationship with others and with themselves.
Three Possible Causes
To understand these illnesses, we look in two broad directions (schematically):
- Individual psychology and psychoanalysis focus mainly on the history of a person's emotional development, setting aside the influence of environment;
- the "sociological" school has reacted against the excesses of individual analysis and emphasizes the importance of social and cultural environment (family, school, work, religion, and so on) in which the individual develops and to which they respond.
We must also add the organic origin of certain disturbances (some depressions, for instance) or the organic component that may exist in many conditions. Today, as ideology wanes and pragmatism rises, the old word "neurosis" has nearly vanished from recent American classifications of mental illness, giving doctors greater freedom to help their patients.
How We Can Help
Therapies entered a new era after the mid-1950s. One discovery followed another: tranquilizers, neuroleptics, antidepressants. Many disturbances that seemed permanent can now be improved in the majority of cases, and some can be cured, with hospital stays reduced to a minimum.
But medication is only one aspect of therapy. Medical care must often take the form of individual and personal psychotherapy, in which the patient learns to know themselves better, to accept themselves with their limits and their capacity for change. In this way, they recover a sense of momentum that lets them move beyond the boundaries illness seemed to impose. They are no longer a "patient" passively suffering, but an agent who, with the help of others and if they wish, reclaims their place.
These improvements are possible if the patient has the wisdom to accept what cannot be changed. It is also necessary to choose the form of psychotherapy best suited to their needs, since there are many kinds.
We must also speak of the period of adjustment, which is sometimes essential. During this time, the patient can regain confidence through work and restore with others the bonds strained or broken by illness. Specialized institutions are often indispensable at this stage, as are the intermediate structures that are multiplying.
Through this journey, a patient can come to see, quite concretely, a real possibility of change.
In time, they may recover a sense of purpose for their life and discover that hope is possible again.
—by M.E., from Ombres et Lumière no. 79