Mental illness takes many forms and has many effects. One of its most painful effects touches both those who suffer from it and those who love them. People who are afflicted find it difficult to make deep connections with other people. They often withdraw into themselves. They need people to be there for them for the long haul, but their withdrawal into silence demands great understanding and endurance of their family, friends and carers if they are to stay close.
Although medical and psychological discoveries and better regulation have improved the treatment of mental illness in Australia, the need still outweighs the resources available. People with mental illnesses need others to help them build and develop relationships if they are to thrive. But the same trends that help the better treatment of people also tell against the crucial building of relationships.
The first trend has been to medicalise mental illness. This has had enormous benefits. It has encouraged researchers to identify chemical and genetic causes, and to find chemical ways of curing or lightening the illness. The lives of many people who suffer from mental illness have been greatly blessed. It has also lessened the stigma associated with mental illness by showing it to be understandable and open to cure.
But it has also increased the range of human discontents placed under the canopy of mental illness, and the expectation that these can be treated medically. This can lead to neglect of the curative and sustaining power of relationships from family and friends both in mental illness and in other conditions brought on by loss and trauma.
The second trend has been to commodify the response to it. The limited resources available to treat the mentally ill dictate a high level of efficiency so that as many people as possible might benefit. This demands that those working with the mentally ill account for the type of service they provide and the time spent on each person. This naturally leads them to focus on the material outcomes of each meeting and not on the quality of the personal engagement they have with their clients.
This trend allows more people to receive treatment, which can also be monitored. But it also makes it more likely that the human contact between people who provide the services and the people who are ill will be brief and focused on the service, not on the person who is ill. It makes it more difficult to build the trust necessary if the therapeutic relationship is to foster the connections of the mentally ill person with themselves and with others. Without support the patient may also be less likely to be faithful to medication, particularly if it has unpleasant side effects.
The third trend has been to criminalise the consequences of mental illness. Many mentally ill people neglect to take the medicine that holds their illness in check. They may then act violently or abusively. Others may become addicted to alcohol and other drugs, partly as a way of drowning out pain and loneliness. Their consequent anti-social behaviour, including violence and dealing drugs in order to sustain their addiction, brings them into the justice system, to criminal convictions and often to prison. That is why in prisons the proportion of people suffering mental illness is so high.
This trend is understandable and has some limited fringe benefits. In the absence of places where mental illness can be safely treated it responds to the demand made by society that people should be safe from violent and unpredictable behaviour. Prisons, too, may be relatively safe places where people may be provided with appropriate medication, and occasionally find help to deal with their illness.
But when the consequences of mental illness are criminalised, the stigma attaching to the mentally ill person is reinforced. Prison commonly diminishes people's self-respect and leaves them further isolated in a harsh environment. The relationships they need to nurture are diminished rather than enhanced. Imprisonment is not a favourable therapeutic environment. It also diminishes people's self-respect and isolates them further.
Mental Health Week is an occasion to recognise how, compared with 50 years ago, life has changed for the better for many people with mental illnesess. But it is also a reminder of how many people's lives are still blighted by mental illness. They would perhaps be cured were more resources available.
It is also a time to reflect on the importance of relationships in the lives and treatment of those who are mentally ill, and to value the care given by family and friends and in programs that are based on building relationships.
Andrew Hamilton is consulting editor of Eureka Street. This week is Mental Health Week.
Human mind and brain image by Shutterstock