Ramisa Rob: Mental illness is not lack of willpower

Monday, February 18, 2019 - 3:58pm

The most common misconception regarding mental health is the pervasive idea that you can address it by simply exercising willpower. According to a Texas survey, about 40 percent of people believe that depression is a lack of willpower. Similarly, I have had countless short-sighted conversations with my friends, family members and even Uber drivers who render medical and therapeutic assistance irrelevant by contending that depression or obsessive compulsive disorder can be combated with tenacity, as if individuals who seek treatment aren’t trying hard enough. These individuals — who are not mental health professionals — believe themselves to be doctors at the mere suggestion of mental health and begin diagnosing themselves and others. When we hear the phrase “heart disease,” no one ever declares themselves a cardiologist or diagnoses everyone they know with cardiovascular diseases. Yet, when it comes to mental illness, one that involves another organ — the human brain — we all presume credibility to offer unwarranted easy solutions, such as “just pull it together” or “try calm.com.”

I recently had an argument with my cousin when he jokingly mocked my harrowing experience with clinical depression in high school by calling me “weak” and then describing his “depressive episode” when he was upset with the outcome of the 2018 general elections in Bangladesh. We must eliminate such insidious inanities in mental health conversations and educate ourselves. J Raymond DePaulo, professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, has stated, “‘Stressful’ life events can lead to depression in some people and discouragement in others. One is an illness, the other is a natural response to misfortune,” and we must learn this crucial distinction.

Contrary to the erroneous belief that individuals with mental illness are weak and do not have the willpower to fight, I have always tried hard and I have persevered. No matter how much I meditated or worked out, I could not concentrate and multiple times I could not sleep for even a minute for up to five days in a row, but not a single person was aware of my pain. I concealed the scars of my self-inflicted injuries and I went to class every single morning. In sophomore year, at my lowest point, when I realized I was on the verge of death, I fought every part of what was happening in my mind and dialed 911 myself and was immediately hospitalized for an attempt to commit suicide. Seeking help to find a will to exist in this world was my willpower.

From my experience, I have noticed that people often conflate depression with ordinary sadness, anxiety disorders with impatience, attention-deficit/hyperactivity disorder with casually zoning out in class, bipolar disorder with mood swings. As Maria Yagoda wrote in her essay in Broadly, “I exercise, I eat fruits … I do all the things that people suspect will cure me of depressive episodes, which they mistake for sadness … and I still need pills.” Likewise, when I tell individuals that I take Adderall for ADHD, as prescribed by my doctors, they insist they also have ADHD but can function without medication, tacitly hinting I am weak because I take pills. The unsolicited declaration that you have been through the same amount of misery but you are stronger than those who receive treatment reflects grave ignorance about mental health.

These misinterpretations demonstrate our inability to accept mental illness as a biological, chemical imbalance. The Diagnostic and Statistical Manual for Mental Disorders defined mental illness as “a behavioral or psychological syndrome or pattern … the consequences of which are clinically significant distress … that reflects an underlying psychobiological dysfunction.” In other words, mental illness is a biological issue and, just like any other physical illness, it requires intervention that often includes medication. But psychiatric medication is another aspect of mental health that is heavily stigmatized.

The universal distaste for medication as treatment for mental health is the reason why I eschewed psychiatric help for years, why many of my friends prefer to suffer alone and potentially why Kanye West has publicly announced stopping his medication for bipolar disorder, without a doctor’s recommendations. Even the term “pill-shaming” has been coined to hypothesize the widespread shame attached to psychiatric medication. The societal mentality that those who take pills are “weak” was stated as a prevailing factor for people to abandon their medication.

The narrow-minded presumption that mental illness is choice or a temporary state of mind you can handle with positivity, yoga and a couple of breathing exercises is the reason why I chose to quell my horror and added another layer of pressure on myself when my life was hanging by a thread. A study mentions that clinician Julie Hanks has said, “Believing that someone can control their illness isn’t just unhelpful; it ‘may create another layer of pain or shame when the person suffering fails to make themselves feel better.’” A 2004 report by the World Health Organization stated that between 30 and 80 percent of people with mental health concerns never receive mental health treatment. Clinical psychologist David Susman analyzed the report and stated that fear and shame, lack of insights and feelings of inadequacy were some of the main reasons behind people not seeking help.

On the brighter side, Edmund S. Huggins accounts his own clinical experience and concludes that mental health treatment does “improve symptoms and quality of life by about 20 to 40 percent for most patients.” I strongly believe that if I had reached out for help earlier, high school and college wouldn’t have been so difficult for me, because my life significantly improved once I started the appropriate medication. But psychiatric care is undeniably tricky and dysfunctional. Improving the accessibility for mental health care is also a topic worth debating. Medications from pharmaceutical powerhouses are suspicious and it took me a plethora of different psychiatrists and multiple different combinations of Ritalin, Lexapro, Xanax, Clonazepam, Trazodone, Zoloft, Wellbutrin, Ambien, Seroquel, Lamictal and Benadryl (I might even be missing some) to find the regimen that works for me. I have many concerns regarding the lengthy process of getting help, but that is for another column.

First, we must accept the medical and biological component of mental health because to deny it is to sustain the delusive notion that mental illness is a period of heartbreak one can will their way out of. Though it can be flawed, medical treatment is a necessity for many individuals: It can address symptoms and prevent relapses. Research shows that depression has nothing to do with being lazy and weak and that therapy and medication can precipitate recovery. A depressed person cannot simply force themselves to be happy because often times they cannot even control their source of happiness when they are experiencing a shortage of dopamine, the neurotransmitters that regulate emotions, especially motivation and reward.

We must understand that mental illness does not indicate personal failing in any way because it has nothing to do willpower. We have to stop pushing individuals to fight a debilitating disease that is not in their own control because this pressure has cost many lives. A 2018 study published by Psychiatric Services and Centers for Disease Control and Prevention concluded that untreated severe mental illness is a significant factor in the rising suicide rates in the United States. Thus, in order to save lives, we must implore individuals going through a rough time to reach out to a counselor and psychiatrist because it can ease their pain and make their lives more livable.

Ramisa Rob can be reached at rfrob@umich.edu.