Public Dialogue About Mental Health

Public Dialogue About Mental Health

Public Dialogue About Mental Health

Does superstition play a role in our understanding of mental health?

In his recent book Hallucinations, Dr. Oliver Sacks tells the tale of a woman who couldn’t stop hallucinating Kermit the Frog. Sometimes the frog wore an angry expression; sometimes a sad one - and his shifting moods distressed the patient. When she brought her case to Dr. Sacks, she had two questions: “Am I going crazy?” and “Why Kermit?”

As I’ll explain in a moment, neither of those questions can be answered in a straightforwardly Freudian way. But they do reveal some prevalent cultural superstitions that continue to dominate and distort our culture’s dialogue about mental health.

The word “superstition” has its origin in Latin, where it literally meant “a standing-over” - a thing that remains standing from an earlier period. Superstitions, then, are holdovers; outdated distinctions and vocabularies that continue to inform (or uninform) the ways many of us discuss hot-button issues like death, sexuality and mental health - issues, in other words, where old words and categories serve up doses of comfort at stressful times.

What’s our main mental-health superstition? The belief that, just as we can look for germs in a human body and classify it as “sick” or “well,” we can look for delusions in a person’s mind and classify it as “sane” or “crazy.” But as anyone who’s dealt with cancer knows, the activity of germs may not be the cause of a person’s worst sickness - and as doctors now realize, many of the same bacteria that make us sick can also play crucial roles in a healthy body’s metabolism. By the same token, we’ve all met a few deluded people who still hold down jobs and raise families - and sometimes, even delusions themselves can inspire works of creative art.

This is why the Diagnostic and Statistical Manual of Mental Disorders (better known as the “DSM-IV”) contains extensive lists of diagnostic criteria for most of the disorders listed within its pages: Many are designed to determine whether a patient’s mental state interferes with his or her ability to communicate effectively, hold onto a job, avoid committing crimes, and distinguish between reality and hallucination. This is also why federal law draws a clear distinction between a defendant who’s suffering from a mental disease and a defendant who’s mentally incompetent to stand trial: Even a person suffering from psychosis may remain lucid enough to know that he or she is psychotic; even a person who hallucinates every day may realize the hallucinations aren’t real.

So how does popular culture’s suspiciously superstitiously sharp divide between “sane” and “crazy” play out? As Dr. Sacks’s hallucinating patient knew, revealing one’s own mental oddities means taking some major social risks. A hallucination revelation can be enough to distance family members, stigmatize oneself, and perhaps even run the risk of involuntary hospitalization and observation - a grim prospect if one already finds oneself bearing down on the final decades of life. And so, an untold number of patients who suffer from visual and auditory hallucinations - and other unusual mental disturbances - live out their days in confusion and fear, simply because the risks of telling the truth seem more frightening than the symptoms themselves.

“Kermit,” Dr. Sacks’s patient told him, “means nothing to me.” And it was this seemingly random quality of her hallucination, combined with her fear that she might be losing her mind, that led Dr. Sacks to his diagnosis: The patient wasn’t psychotic or delusional; she was suffering from a rare  disorder of her brain’s visual system. Most of us would agree, I think, that it’d be absurd - offensive, even - to stigmatize a patient suffering from cataracts or retinitis pigmentosa. How is a hallucination of Kermit the Frog any different?

Image credit: Peter Dandy from Wikimedia Commons

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