I just heard on the news that some guy went on a shooting rampage at a mall. After covering all the horrific details, the reporter on the scene looked into the camera and said, “His family says that he has a long history of mental illness. He has had depression.” Arrggh! That kind of statement really irritates me.
What is Mental Illness?
We seem to be working at cross-purposes in our country. On the one hand, there’s a push to destigmatize mental illness. On the other hand, there is a push to explain incomprehensible, horrific, murderous human behavior by playing the mental illness card. We can’t have it both ways. The term mental illness has become a de facto substitute for evil.
It’s no wonder that people don’t want to go to a psychologist or psychiatrist! Nobody wants to be labeled evil, and since we don’t tend to use that actual word anymore, the term mental illness is coming to mean the same thing.
Most cases of depression certainly don’t qualify as mental illness … not even using a realistic definition of mental illness. A realistic definition of mental illness (NOT the one floating around which makes it synonymous with evil) is that somebody has lost touch with reality due to an organic brain disease or through loss of brain functioning. Here are some signs of mental illness (this is not a comprehensive list):
* Hallucinations. The person sees or hears things that other people don’t. We won’t get into whether it’s possible for someone to be psychic or not — let me just say that in mental illness, the hallucinations are accompanied by a loss of functioning. Their ability to take care of themselves in an adult manner is compromised because they are interacting with the hallucinations rather than the physical world.
* Delusions. These are bizarre beliefs that someone holds that fly in the face of logic. Quite often delusions seem to be the person’s attempt to explain the hallucinations, since the two usually go together.
* Loss of functioning. This covers a broad spectrum of things that can go wrong. Some examples are: “word salad” in which the person talks and acts like they are making perfect sense, but it is a jumble of words; catatonia, or going for long periods of time without moving at all; impairments to the various types of memory; such poor reasoning skills that their behavior and speech is nonsensical to observers. Loss of functioning can also include manic behavior – when the mood and energy become so high, and the tempo of their thoughts and behavior becomes so fast, that they become destructive to themselves and maybe others.
Are the mentally ill violent?
Most people who genuinely could be seen as mentally ill are not going to be violent. In fact, when their functioning deteriorates to the point they can’t anticipate and deal with a dangerous situation, they become vulnerable to human predators that will do violence upon them.
When a genuinely mentally ill person does become violent, it usually is because they think they are in danger themselves. For example, when the hallucinations feel threatening and dangerous, and they lash out in response to the hallucination, they can actually hurt other people in the real world. I think this is what scares most people about the mentally ill — you can’t see what they see, or hear what they hear, and so you have no way of predicting when and if they will become dangerous.
People can also become violent during a manic episode. As noted above, their mood and energy go through the roof, and their thoughts and behavior are really racing. Their thoughts can be delusional too — especially delusions of grandeur because their mood is so high. It’s not a fun time for them, and many times they become irritable and can become highly agitated and angry. This may be the root of the public perception that “depression is mental illness” – because most people who suffer from mania also experience episodes of severe depression. So, somebody who goes on a rampage during an episode of severe mania is noted to “have a history of depression.” However, let’s be clear that not all people who experience episodes of mania will become violent. Of course, they need treatment as soon as possible to reduce their danger to themselves and others, and to get them back to functioning normally.
What about depression?
It’s true that really severe cases of depression can lead to psychosis (the technical name for hallucinations and delusions). However, the vast majority of people who become depressed do not experience psychosis. They experience varying degrees of disability, from a long-lasting but mild sense of numbness and brain fog to a crippling inability to get out of bed and perform any life functions at all. Even the severely depressed though are not usually “seeing things” and when they have the energy, they can conduct a reasonable conversation.
Depression is extremely common. Some think that the incidence of depression is actually increasing in our younger generations, so it’s something that we are going to have to deal with for a very long time. An amazing number of people conduct their lives as usual while in the midst of depression — they go to work, go to their kids’ ball games, mow the grass, pay the bills, run for office. They just have to push themselves every step of the way and feel like they are constantly depleted and exhausted. Nothing is funny and nothing is fun. They don’t sleep well and they either have no appetite or they overeat just to get a little energy. They feel irritable when they don’t feel numb, and they don’t feel like their family or their job is getting their best. They have a hard time getting the negative, self-critical, gloomy thoughts under control. It’s a miserable way to live, but they don’t hurt anybody, they are good people, and they live up to their responsibilities. They actually feel worse than the nondepressed about snapping at their spouse or kids, or about forgetting something at work, because they already feel so bad about themselves. The last thing they need is to fear getting help because somebody might label them as “mentally ill.”
ABOUT ME
I am Dr. Kimberly Thompson, a clinical psychologist in private practice in Lubbock, Texas. I work with mothers and their children to help them heal, grow, and live their most vibrant lives. My particular expertise is pregnant and postpartum women, and moms of “littles.” My book, Perfect Mothers Get Depressed, is available on Amazon and from Praeclarus Press. If you live within driving distance of Lubbock, you can work with me face-to-face; if you live anywhere else in the state of Texas, you can work with me via online therapy. Send me a message if you need more information, or call my office at (806) 224-0200 if you’re ready to book an appointment.
