Something incredible happened to me in the psychiatric ward of St. Vincent’s hospital: a patient told me that he was “perfectly normal”, and I believed him. In retrospect, it should not have been so incredible; however, going in with the social stigma of mental illness staining my perception, it was difficult to see it as anything but. The patient’s name was Daniel and he was a builder who constantly wore a black beanie and a leather jacket around the ward, even when he was in his pyjamas. I thought that perhaps he even slept with them on. He was soft-spoken and walked with a drag in his feet, but this was probably due to heavy medication.
When I first immersed myself in the world of psychiatry, I was surrounded by people who seemed far from “normal”. We had schizophrenics, manic depressives, clinical depressives, psychotics, anorexics, borderline personalities, obsessive compulsives, autistics, paranoids, and schizoids. They all took Aripiprazole, Fluvoxamine, Chlorpromazine, Quetiapine, Sertraline, Temazepam, Diazepam, Clonazepam, and Fluoxetine. I found myself in a completely different world where everyone spoke a foreign language and where people were only secondary to the cold, lyrical words of psychiatry.
I was sitting with Daniel in the art room, watching him draw, when he said those words to me. Not words of psychiatry, but words that were his own. I found it difficult to talk to him those first few days. He was always distracted, staring off into the distance as if he was watching a movie only he could see. He would do this for hours, sitting in a green chair with stuffing spilling from the tears, staring up at the ceiling with unfocused eyes, his lips slightly parted and moving ever so slightly. I watched him from the corner of my eye, unable to communicate with him, until I walked into the art room to find him drawing. That was when we had our first conversation.
It began with me doing the routine Q & A the citizens of this strange world practiced in place of greetings.
“What brings you here?”
His forehead furrowed but his pencil kept moving. “I don’t know. They said I’m anxious.”
“About life, I guess.”
“Aren’t we all?” I said.
The pencil paused. Daniels met my eyes with his and it was shocking. “That’s why I don’t know why I’m here.”
The so-called bible of psychiatry is the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM. According to the American Psychiatric Association (APA), the DSM is “the standard classification of mental disorders used…in a wide array of contexts and…by clinicians and researchers of many different orientations” (American Psychiatric Association 2014). Nick Haslam of the University of Melbourne posits that the misconception of diagnosis from the DSM has led to the rift between normality and mental illness (2013, p.36). Because of the common-sense ideal that physical illness and mental illness are fundamentally different, Haslam states that “Psychiatric conditions all too easily become defining identities that set some people apart from the rest of humanity, pervading and diminishing their personhood” (2013, p.36). In other words, we stop seeing the mentally ill as people and begin seeing them as their illness.
It was always going to ‘us’ and ‘them’, no matter which side of the rift you were on. Us: the mentally ill. Them: the sane. Us: the sane. Them: the mentally ill. People tend to forget that mental illness is not static – it fluctuates, soars, plummets, disappears, and crushes. In Daniel’s case, he had only been ill for two months out of the twelve. For those two months, he had been on one side of the rift, with the mentally ill. For the rest of the year, he had been on the other side, with the ‘sane’. It is because of this fluctuation that I cannot rely on this social construct of ‘us and them’. It only exists in the minds of those who cannot fully comprehend what humanity really is.
Two weeks in, I met a girl who lost her ‘personhood’ due to her extended time within the system. Her name was Jess. She had strawberry blonde hair, a snub nose, and an intense dislike of water (she would get her liquids from strawberry milk). She had been in and out of the system (whether it be general hospitals, psychiatric wards, or long stay facilities) for several years due to her severe chronic depression. She was very easy to talk to and we quickly became friends. When we engaged in the standard Q and A, she told me that she was hit by a train months prior and had, until recently, been recovering in the general hospital.
“Why were you hit by a train?” I said.
She gave me an incredulous look. “I’m a chronic depressive,” she said.
It quickly became clear to me that she felt comfortable in identifying herself by her illness. Countless psychologists and nurses and counsellors had beaten this label into her over the past several years, until it seemed like it was all she was. This, in turn, fed her overwhelming dependency on the system until she was no longer able to fathom the idea that she was ever once a healthy individual. She lost all her dreams in a haze of medication and emergency rooms, and she killed time by smoking and drinking milk.
“I don’t like to do anything,” she told me. “Not now.”
“I’m sure you had hobbies and interests before you became ill, Jess,” I said.
A surprised look came over her face, as if she had not thought about it until now. After some deep thought, she tentatively told me that she used to love drawing.
“Why don’t you join me and Daniel in the art room?” I said.
“I can’t. Not now,” she said, turning her attention to her cigarette.
“I’m too depressed.”
A few days later, Jess joined us in the art room and drew for the first time in years.
Jose Silveira from St. Joseph’s Health Centre in Toronto states that the DSM is used to organize symptoms only, and that “it’s purely diagnostic; it doesn’t reflect risks associated with conditions” (in Kingston 2013, p.52). The ‘bible’ of psychiatry reflects the current nature of the mental health system: we are too trigger-happy with labels. People, like Jess, get buried under the label they are given. The psychologists and counsellors treat the illness, not the person. The language of psychiatry is harming us, instead of helping us.
Of course, there needs to be a balance with this, like with everything. Diagnosing illness is a normal part of medicine, whether mental or physical. Without it, we could never understand the nature of the problem and begin the process of healing. However, as Peter Kinderman from the University of Liverpool states, there seems to be a label for every human fallacy, including sexual disinterest and overindulging in vices like alcohol (in Kingston 2013, p.52). So how does this reflect on us? What does this attitude say about humanity? It seems to say that we see ‘being human’ as an illness. The fallacies, the flaws, the falls, these are the things that everyone experiences, and yet, we have clinicalised it and slapped a burdensome label on it.
My experience at St. Vincent’s wasn’t the first time I stepped into the psychiatric world. But it was the first time I realised that perhaps I should shrug off the label and assume more responsibility for my own care. For almost a decade nothing had worked for me, because nobody was seeing me as a complicated and individual human being. They were only seeing me as the psychiatric world wanted to see me: ill, dependent, something to treat quickly and push on. There is so much more to mental illness than being psychotic, schizophrenic, depressive, or obsessive compulsive. These are just shapes strung together into words that only have the context we apply to them. The people in the system like Jess, Daniel, and me – we weren’t these things. We were people suffering from various aspects of life, whether external or biological.
But the language of psychiatry does not allow for this humanisation of mental illness. It would be difficult to harness in such a clinical setting. It is up to us, as individuals, to realise that though the label may be placed on us, it doesn’t define us. We should protest if we don’t agree, have a more open dialogue with the workers in psychiatry, and shrug off the label if it becomes too burdensome and take charge. These thoughts have led me to become aware of the rift that social stigma has created between us and ‘normality’ – when in fact, it is “perfectly normal” to fall now and then. It is not, however, normal to fall under the crushing weight of the labels created to help us in the first place.
I was one of the lucky ones. I realised this just before I was to be assimilated into the system. I managed to shrug off the label and unlearn the language before becoming too comfortable and too dependent on them. Jess, unfortunately, is still in the system, and probably will be for the rest of her life.
©Yuki Iwama, 2015
American Psychiatric Association 2014, ‘DSM’, American Psychiatric Association, viewed 22nd October 2014, < http://www.psychiatry.org/practice/dsm> .
Kingston, A 2013, ‘Is she a brat, or is she sick?’, Maclean’s, vol. 126, no. 11, p. 52.
Haslam, N 2013, ‘Modern Madness: The labelling of mental illness gets a shake-up’, The Monthly, May issue, pp. 32-36.