Let’s Talk: The Language of Mental Illness

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“Bad enough to be ill, but to feel compelled to deny the very thing that, in its worst and most active state, defines you is agony indeed.”

― Sally Brampton, Shoot The Damn Dog: A Memoir Of Depression

So today is Bell’s Let’s Talk Day (There’s also the Time to Talk Day based in the UK on February 6th, not sure why we didn’t all join forces). I firmly believe that talking about mental health is a critical to improving the well-being of individuals and society as a whole. We have gotten a lot better about talking to mental illness and becoming more accepting of those with mental illness, but there’s still an echo of the belief that individuals with more common disorders such as depression and anxiety are “making it up”/”making a problem for themselves” or that they just need to “cheer up” and “stop worrying.” So we have all these campaigns aimed at decreasing stigma and increasing awareness, but our language shows that we haven’t quite reached our goal. Outside the awareness days, we still often make like if we don’t see it, it doesn’t exist. If we don’t call it depression it’s not depression. There are at least three problems with this attitude:

  1. It hurts to be ignored. Being ignored while you’re in pain and asking for help really is just salt in the wound.
  2. Ignoring it doesn’t actually make it better. If you ignored the fact that your credit card statement was past due, it wouldn’t suddenly decide to pay itself. No, the consequences would pile up.
  3. The silence is isolating and speaks volumes. If people feel they won’t get help, will be called weak, or had their problems minimized, they will often elect to suffer in silence. This just makes the suffering more lonely and shameful. Doesn’t fix anything.

Fortunately here in Canada, we are working to reduce the stigma and improve access to treatment, albeit we are still lacking services and attention in more rural and northern areas including in Iqaluit and the North-West Territories (for more info click here). Even in areas where there is bountiful access to services, almost half don’t seek help (source). But there are many countries around the world where individuals lack access to desperately needed services. In fact, according to the World Health Organization (WHO) more than 75% of individuals worldwide do not have access to the necessary mental health services (source). Problem is that as quickly as we work to break down the barriers, we carelessly build new ones.

The language of mental illness is sort of the problem. Or at least the way we abuse it. 

George Orwell

Have you ever been talking to a friend, describing something really silly or stupid or been miffed by someone’s apparent lack of two neurons to rub together and thrown own the R word? What about had a bad day or been tired and frustrated and declared “Kill me now.” or “I’m ready to kill myself.” Maybe when you realized How I Met Your Mother was cancelled or you suffered another disappointment you declared “I’m so depressed.” Perhaps after watching the Victoria’s Secret Fashion Fashion Show or seeing a really skinny/beautiful person you sighed to a friend “I wish I was anorexic” or labeled anorexics as “lucky”?

I could go on but I’m pretty sure you get the point. We use this type of language so colloquially and inappropriately that we cheapen it’s meaning. We can’t begin to understand the thoughts, emotions, and experiences of individuals with depression if we apply “depressed” to describe our feelings about minor disappointments, such as being unable to go out on a Friday due to homework or shows being cancelled. We make the person with depression feel silly. We cheapen their suffering. By using labels and terms so flippantly we may as well shout at them

I don’t understand you and I don’t really want to

Additionally,our language shows that we frequently forget that people with mental illness are still people and instead label them as their illness. Their label becomes their identity. Which is one of the fundamental grounds for the debate against using diagnoses – they create a stigma, an identity, and a self-fulfilling prophecy. People have depression, they are not only their depression. This distinction becomes more noticeable in cases such as autism and schizophrenia. In my classes they press upon us the importance when writing of not saying things like “Schizophrenics reported…” or “in a study with autistic children…” reminding us to remember their people-hood and say “Individuals with schizophrenia…” or “children with autism…” It may seem like a silly and minor distinction, but I think that this is critical to changing how we view and treat mental illness as a society. Making people their labels makes their illness their whole world, they have nothing else but their mental illness. 

I don’t pretend to be perfect. You would think I of all people would be more sensitive in this department. I remember in high school when kids made jokes about suicide in my class I went to the bathroom and cried from the painful memories their insensitive jokes had dragged up; horrified that they could be so cruel and uncaring. I do try to be more conscious in my use of mental illness terminology, asking myself, “Would I say this to a person actually suffering from this disorder?” (i.e. would I say “I’m so retarded sometimes” to someone who was mentally disabled?). If I wouldn’t say it to someone who knows what it’s like I try to find a more accurate way of describing my feelings and thoughts, and I challenge you to do the same.

I also challenge you to speak out. If you have suffered mental illnesses before, tell the world without shame – everyone needs help sometimes, you wouldn’t be ashamed to tell someone you broke your leg, or had heart disease. The brain is an organ too, it’s part of our body, and it can break sometimes. If you haven’t suffered from mental illness, odds are you know someone who has – go talk to them, ask them about their experience and how they are doing now, give them a hug and an hour of your time. If you are suffering in silence, go get some help – it doesn’t have to be professional, it can be a friend, or even a helpline – but speak up – shout if you have to and don’t stop screaming until someone gives you the help you need. If someone opens up to you – listen, do SOMETHING, and say thank you, because they trusted you with a very fragile and vulnerable part of themselves, and they trust you to care.

“When you’re drowning you don’t think, I would be incredibly pleased if someone would notice I’m drowning and come and rescue me. You just scream.”

― John Lennon

Jenga Towers of Knowledge

This is how I'm coming to see knowledge. Hopefully this isn't my knowledge tower, because it looks like it's going down. Photo taken from: http://www.danceadvantage.net/better-balance/

“We can know only that we know nothing. And that is the highest degree of human wisdom.”

Leo Tolstoy, War and Peace

Some of the most fundamental concepts in human cognition are perception, understanding, and knowledge, I distinguish them mentally but why? Are they distinct concepts or different stages of the same process?

This is how I'm coming to see knowledge. Hopefully this isn't my knowledge tower, because it looks like it's going down.  Photo taken from: http://www.danceadvantage.net/better-balance/

This is how I’m coming to see knowledge. Hopefully this isn’t my knowledge tower, because it looks like it’s going down.
Photo taken from: here

Now that I am questioning everything, I am starting to see learning and the accumulation of knowledge as the progressive construction of a Jenga tower. When we are kids we are not very good at this – our understandings are constantly challenged and the tower falls down a lot. We see a four legged animal with a tail and call it a dog, our parents then correct us. This animal meows, it is therefore a cat. Then we go to the zoo and see a lion, which looks nothing like the cat at home, but we are told that that too is from the cat family.

So I’ve come up with a pretty good mental image of knowledge and learning, but what struck me was the way we share and communicate this knowledge. In cross-cultural psychology a few weeks ago we talked about Whorf’s hypothesis. This is the idea that we all think mostly in words, since we speak different languages, the actual thought content and processes must be different cross-culturally. Which makes sense intuitively, but still I sat back and tried to simply imagine something without thinking of the word or using a word to call an image to my mind. I couldn’t do it. Reasoning that perhaps it was the conscious awareness of this theory that was making this task so difficult, I decided to rally up some guinea pigs. One very confused Starbucks employee and 4 friends later, I came to the conclusion that while the jury is still out on its utility in resolving the relativism/universalism debate, its premise is pretty solid.

So language is a fundamental part of our knowledge and thought processes. In almost every part of the world acquisition of language is a fundamental part of development. If the child fails to learn to speak, barring any organic causes such as being mute or deaf, we assume something is psychologically or physiologically wrong with the child. And with good reason. As inherently social creatures, the ability to speak is fundamental in our ability to communicate and connect with the world, which would theoretically increase the odds of an individual’s survival.

So if language is so fundamental, and assuming we all evolved from a common ancestor, why do we have so many languages? Why are some radically different while others seem so similar you wonder why two languages evolved instead of one. Even within the same language there are multiple dialects, making it difficult even for two individuals who speak the same language to effectively communicate. Language is incredibly complex, and, in my opinion, horribly arbitrary. Last week the point was raised, why do we call a circle a circle? It doesn’t look like what it’s called. I built on this point making my morning coffee – why on earth did one guy say “coffee,” another “café,” and a third, “kaffee?” And why do the Portuguese and French have the same word for coffee but different words for beach?

So if we cannot necessarily communicate our knowledge linguistically in a universal manner, then how do we share and demonstrate our knowledge? Do we need to do so or is that a culturally constructed necessity – we share to prove our worth? Let’s assume that we don’t actually feel a need to share knowledge, it just happens accidentally. Then how do we learn things? We can learn a lot through observation – it’s how most infants first grasp gravity, by dropping things off the high chair. There is an entire school of psychology dedicated to vicarious learning, but that to me is more learning of behaviours. What about our understanding of things we have never seen or that cannot be seen. How do we learn about these things? Through language – I read about them, and I am able to understand. I have never seen individuals afflicted with some of the syndromes I have read about, but I understand the symptoms and theoretical causes. What about the things in our lives that we can’t see – the abstract concepts – like love, fear, and stress?

I present these examples because they all have physiological responses associated with them – so theoretically they exist in a sense. Our body experiences a visible and measurable reaction to the apparent processes of our mind, at least if you believe as I do that emotions exist and are not simply our brain’s chemical cocktail concocted in response to specific sensory stimuli combinations. So we have physiological responses, which means that our emotional responses must too be real. Different sources of arousal generate different patterns of physiological arousal. So the emotions exist independent of the language we apply to them. Love is still love, regardless of whether we call it love, amour, liefde, or bhālōbāsi. Just as gravity existed long before Newton “discovered” it and gave it a name.

So now I’m really in a pickle. I’ve argued that things exist independent of language, but that we cannot think without language and thus it becomes necessary. I’ve also argued that language is too arbitrary to be crucial for such a universal concept as knowledge but that two people still understand the same thing even if they cannot communicate their mutual understanding.

If anyone knows how to sort that one out, give me a shout. I’ll get you an A in the course. And by you, I mean me.

So for now the idea of sharing knowledge seems too complex and multifaceted to sort out at the moment. Let’s return to the understanding/perceiving debate for a bit.

Building off the language debate and the idea that we have words for things that we cannot perceive, I propose that we understand via inferences. Religion is a prime example of how we believe and understand without seeing things, we have faith based on our internal beliefs. Is religion not fundamentally a human construction? It is a thought process, a set of cognitive schemas, based entirely on our own mental constructions. Beyond perceiving the religiously oriented behaviours of others, there is no perceiving that which is the core of the religion- for example – we do not have an actual picture of Jesus, the only accounts of Him are from religious texts. And for the record, I do not intend this dialogue to be indicative of my position on religion – only to demonstrate that we have ideas that we wholly believe despite the fact that we do not necessarily have any sensory reason to do so. So understanding cannot really be reliant on perception.

Does this mean they are mutually exclusive concepts? Maybe not. After all, both are heavily influenced by knowledge. Which brings us to the question of what is knowledge for? Answering this question will guide the discussion on what understanding has that perceiving does not.

So what is knowledge for? Predicting? That kind of requires understanding does it not? Even if that simply means being aware of correlations between events. Last week the point was raised that we can think we have an accurate method of predicting, but that can be wrong. In the mean time, our observation of the correlations lead us to believe we understood cause and effect. Thus understanding was rooted in predicting. We need to know what comes next. It’s part of survival. Though I will admit that at the moment, I am sitting at a laptop questioning how useful my current behaviour is to my survival. I mean you could say – well this skill is necessary for being able to obtain a career that will allow me to properly support myself since the days of deer hunting as a primary source of nutrition are long gone here in the “western” world. That really is just an ad hoc excuse. Still, my understanding of cause and effect, has allowed me to reasonably predict that, unless my laptop crashes, pushing buttons, will cause the corresponding symbols to appear on the screen.

I seem to be making a very strong case for knowledge=for understanding=for predicting, but that isn’t the whole story as I see it. I have repeatedly referred to myself as a bounty of useless information. I have a whole host of facts held in my mind, that I highly doubt are pertinent to my survival. Like my understanding of the mating preferences and the rationale behind the differential fin length and colour in male and female bettas. I easily could have gone the rest of my life without knowing that and it would not have impacted the likelihood of my survival in any way shape or form. Unless I end up on some game show where the answer to that question will secure me millions of dollars.

Extremely unlikely.

Watching the latest episode of Criminal Minds is also unlikely to impact my odds of survival. As is the fact that I know anything beyond the first 3 digits of pi. It’s still knowledge.

So if it’s not for predicting, and knowing three more digits of pi isn’t really going to help me get anywhere, why do I keep this information? Because I have the neural capacity? Like my laptop I will continue to store useless things until I run out of room and am forced to make some hard decisions? But the brain’s capacity is virtually limitless. Or so nearly every professor I have had has told me. Given how frequently I forget where I put my keys or important facts on test day, I beg to differ. Let’s just go with that though – we can store as much information as we want/need to. If I’m not storing it to predict, why am I storing it at all? This suggests that there must be some other point to knowledge than simply predicting, but that information, however, useless to my survival, does help me understand my world. Even if that understanding is a little useless.

So, so far we’ve got:

  • knowledge is a jenga tower that may collapse on us at any moment
  • knowledge isn’t only about predicting, we can understand, without predicting
  • language is arbitrary and varied which suggests that it is wholly independent of knowledge, but it is also a fundamental aspect of how we think and cognitively organize the world

We still need:

  • to differentiate between understanding and perception
  • to figure out the role of language if it cannot be fundamentally part of knowledge and yet it has to be

Tonight, let’s just see if in one super messy Venn Diagram, I can sort out understanding and perception.

As you can see I got a little distracted and started doodling. This is the product of an hour of work.

As you can see I got a little distracted and started doodling. This is the product of an hour of work.

As you can see, I’m not sure anything was really sorted out. Except that in my opinion, since perception is theoretically the stimulation of sensory neurons activating neural pathways – perception requires external stimuli, while understanding, can also be entirely internal, as in the generation of novel ideas and imagining possible situations. The only other distinction I could make was that in a sense, perception was more about the singulars. Yes, to a degree the perception of those singulars is impacted by prior experience, thus becoming a product of the integration of multiple events, but the sensory events that are key for perception, are unavoidably singular and unique. Understanding, requires the integration of multiple events and mental experiences.

So the understanding-perception debate seems to be resolved, at least for now. Maybe sometime in the next week I’ll resolve that language-knowledge linkage.

  “Life can only be understood backwards; but it must be lived forwards.”

― Søren Kierkegaard

The Human Factors of Science

Good way to look at it no?

It is impossible to disassociate language from science. To call forth a concept, a word is needed.

Antoine Lavoisier

Well that ladies and gents was the most confusing two hours and ten minutes of my life. This week we watched a movie (La Question Humaine, for those of you looking to be confused) that, on the surface at least, was about an industrial psychologist who had been heavily involved in the restructuring of a factory based corporation. The man appears to lose his mind over the course of the film as he attempts to determine if the CEO has lost his. I am exhausted after watching the film once, and Dr Lamontagne wants us to watch it multiple times.

The film drew a number of interesting parallels between the language used during the Holocaust and the language used in the corporate world of figures, profits, and units. Which for some reason, despite multiple references to the Holocaust throughout the film, did not dawn on me until the end. I’m still digesting a lot of what the film had to say though so I’ll get back to you on that one later.

A second parallel emerged as I thought about all of this on the bus ride home – the film was in French, thankfully with English subtitles, but a language barrier was created. It distanced me from the film in the same way that scientific language distances itself from humanity. In the context of the film, it allowed Dr Kessler to distance himself from reality – by describing layoff procedures in scientific terms with scientific rational, he didn’t have to deal with the fact that those criteria were applied to people. People who maybe had families that depended on them, or who had just undergone a difficult time. Dr Kessler of course tries to deny that he played a role in cutting the staff from “2500 units to 1200 units” by saying that he only created the criteria, and justifying why those criteria were valid. For example – laying off alcoholics because they were a safety hazard and would be unable to react quickly enough in an emergency situation. I found this example particularly amusing, because by the end of the film I was convinced that they were all alcoholics. EVERY time two characters met to talk – they either poured a drink or already had one. Even while at work they pulled back wall panels to booze stashes. I mean REALLY?!

So all of this brought me to the question: are we seeking to understand the mind or define it with jargon, facts, and data so that at the end of the day our understanding is no clearer but we have at least described our lack of understanding scientifically? Something to think about on the bus.

The film was introduced as a discussion of the human condition and the limits of science. Science in the sense of operationalized concepts and a world of pragmatics. We talked about the brain and behaviour as subject matter, but what about beyond that? How far can science really reach? There is still a lot of thinking I will have to do before I fully understand the film and all its nuances, but it did tie into a lot of the thoughts I’ve been working on this past week. Psychology often aims at sorting human behaviour into all these scientific terms, but in doing that does psychology not lose sight of its subject matter?

I have spent a lot of time pondering what exactly psychologists are in the clinical sense. When someone goes to a therapist or counsellor, what are they expecting? We expect them to fix our problems, make us see the light of day, and clear up the confusion in our lives. In my experience, that isn’t exactly what they do though. Instead, they help you find the solutions you already had. So then do they effectively become trained listeners? Maybe so – but as pretty much all of my graduate school searches have shown – they work from the “scientist-practitioner model,” which basically means that everything they do in practice is based on research that has been done and shown to be effective in treatment. And yet we acknowledge that, especially with children, treatment is not universal – individuals respond to treatments differently, there is no one-size-fits-all approach, at least not one that’s been discovered yet. I have not had any clinical training yet, so who knows – maybe they will teach me how to connect with people, and be objective at the same time, and know which research to apply when. Seems like a pretty big ticket item, no wonder I will be in school for the next 7 years.

So, if clinical psychology is about relying on research in practice, then we must consider the scientific side of the coin that informs them how to best work. Science to me is very cold and matter of fact. One of the key components of good science that I was taught in first year (good as in believable and worth something to the world), was that it could be replicated, but to be replicated EVERYTHING had to be defined objectively. I have read numerous studies describing “participants” as a series of numbers – mean age and range of ages, gender distributions, ethnicity distributions, etc. Hundreds of people, collapsed into a set of statistics – people collapsed into numbers. Measurement tools are broken down in extensive detail, procedures explicitly stated. Which is wholly necessary – don’t get me wrong here, I think research is important, it is what shows us where we are wrong, how things have changed. Without some form of research we would still believe the Sun revolved around the Earth, women were responsible for the sex of the child, drinking during pregnancy had no ill effects, and insanity was the result of possession by evil spirits.

Science knows some things with more certainty than others – which is why those areas are more broadly accepted as a science. Does that mean that for something to be science it has to be known with absolute certainty though? Because the black holes seem like prime examples of where we only know part of the story, and I am quite certain we’ll never know the whole story, since no one is going to volunteer to jump in one. Or get sucked in. Or whatever else happens for a person to enter a black hole. Maybe they have to be a teenager and do something embarrassing? And then a black hole opens up in the middle of the room?

Seems legit.

Seems legit.

Without engaging once again in my internal debate of ‘is psychology a science?’ – allow me to present the full line of thought from this week. Firstly, psychologists are generally presumed to be these all knowing beings of the human mind, at least by the laymen. I have been asked numerous times, the instant I say that I am in psychology, to “psychologize me.” As if I just walk around keeping mental files on everyone and all the accumulated knowledge will suddenly come to me and I will explain your entire being in 5 minutes.

The aim of psychology does seem to be to understand others, to generate patterns that allow us to predict what our fellow humans will do. And if we throw in the animal psychologists, we are trying to predict the beasts too, but let’s just keep it relatively simple. So we are assigned with predicting and understanding humanity, and all its complexities, its differences, its weaknesses, and how we can fix people when they are ‘broken’ (by society’s standards). And yet, I don’t think there is a single person who would agree that they have themselves entirely understood, that they know everything that could go wrong and exactly how to fix themselves if something in their psyche were to go awry. We try to understand others without understanding ourselves. Which leads us to try and remove ourselves from our subjects of study, but is that really possible? Psychologists are meant to be/assumed to be wonderfully rational, but are they not human too? We elevate them to robotic attitudes, but does that no separate them from humanity by elevating them to such a rational level? By speaking in technical terms and jargon, we separate ourselves from what we are talking about – PEOPLE. Even if you take subjects of study to mean areas of mental health, such as depression – your subject is part of a person. It is a potentially abstract concept, but that abstract concept is still a part of a person. You can never fully separate the subject of study from its host. Just as you cannot remove psychologists from humanity. We try to, we assume that they are inherently rational, wise, and aware of themselves in a way that we cannot be – but at the end of the day, they may be just as confused about themselves as the people they see.

Which I realize may make it sound as if I have no faith in psychology and I think science is useless when it comes to the human mind.

That’s not exactly the case. I am studying psychology, and haven’t given up and changed majors since coming to these realizations. More so this has made me aware of the importance of both the human connection and the scientific terminology. The terminology allows us to have universally understood concepts. Can you imagine if something as simple as a “collie” or a “cat” meant something different to every person you encountered? It would be chaos. Thus the language has a purpose – by describing clinically depressed people in terms of scientifically agreed upon terms, you are ensuring that all professionals will understand. At the same time, you have to recognize that in psychology, those terms apply to people too. We are not describing the behaviour of atoms. People are not depressed patients, they are people with depression.

End game?

We can’t reduce people to numbers and facts all the time. In the scientific research element, it may be helpful to allow us to come to an understanding of how certain things related to the human condition MAY work – for example what factors may contribute to the development and maintenance of depression, or to evaluate relative effectiveness of several potential treatments for eating disorders. However, at the end of the day, the research will be applied to actual people. Science, at least in psychology, must never forget that. It also must remember that it is neither universal, nor always accurate in its understandings.

Good way to look at it no?

Good way to look at it no?

“Words are a pretext. It is the inner bond that draws one person to another, not words.”

 Rumi

ALSO: Quicky side note: Thursday’s post is being moved to Saturday! Spread out the goodness a little more now that this section has been added!