Tag Archives: schizophrenia

Myth#3 Bipolar is more serious than depression and it’s preferable to have anorexia over bulimia

Welcome to part 3 of my mental health myth busting series.
In this one I want to address the unwritten, but most definitely alive and kicking, mental illness hierarchy!
All mental illnesses can be mild or severe, at the severe end, any mental illness can lead to suicide.
It depends how you’re measuring severity so making comparisons is unhelpful.
On a number of occasions I have been in conversation with people who make the distinctions and imply that one illness is ‘worse’ than another. For example, I was in a conversation about recovery and someone said ‘but I’ve got bipolar so, of course, I’ll be on medication for life’, I didn’t want to dismiss her statement about being on medication for life, as it may be true but there’s no ‘of course’ about it.
I’ve known people with schizophrenia and bi-polar come off medication and manage the condition (which has seen them into multiple hospital admissions with life risking behaviour) with diet, exercise and lifestyle choices that benefit their well being.
Equally, I’ve seen people (including myself) try coming of medication (for the perceived ‘lesser’ diagnosis of depression or anxiety) but it’s not been possible. Despite putting every therapy skill and lifestyle technique into action.
Whether a condition is managed with medication for life or by other means, anyone who’s been ill will need to vigilant for symptoms returning or getting worse. Some people will need to manage their symptoms constantly, others may be symptom free; this is independent of diagnosis.
Some illnesses are more common than others, this does not make them less severe.
Some illnesses lead to people behaving more outside the norm e.g. responding to unseen stimuli in psychosis, but that does not mean they are more unwell than someone who experiences symptoms that are more relatable, such as low mood.
An elated, high, manic or psychotic person may or may not put their life at risk. Someone experiencing extreme low mood or generalized anxiety may experience suicidal thoughts daily.
Some people judge mental illnesses by what causes them. This is unhelpful as some are reactive, caused by stress or childhood trauma where others are unrelated to life events – neither is worse than the other, the brain is complicated.
Anorexia is perceived as ‘the one where you’re in control’ and bulimia and binge eating disorder (BED) considered ‘the ones where you’re out of control’. Neither of these statements is true but it doesn’t stop people with bulimia or BED wishing they had anorexia. At times when I’ve binged and purged I’ve worried I’m not ‘doing anorexia right’ and I didn’t think I should be getting treatment. The truth is, all eating disorders are life threatening illnesses, none is more or less severe or concerning than the others. People can die from chemical imbalances caused by binging and/or purging, just as people die from malnutrition caused by restriction.
Holding onto inaccurate beliefs leads people to believe they’re not ‘ill enough’ or deserving of treatment, this is dangerous – early intervention is the most important factor in recovery from any mental illness.
It seems that as awareness is raised about mental illness, some seem to be more ‘acceptable’ than others. For example, someone is more likely to ‘come out’ as having depression, anxiety, bipolar or anorexia than they are about having schizoaffective disorder, emotional unstable personality disorder or binge eating disorder.
The mental health world is indebted to people in the public eye who’ve shared their experiences. We just need a few celebs to speak about their experience of depersonalization, avoidant personality disorder or pre-mensural dysphoric disorder and we’ll start talking about these, no more or less serious but, rarer illnesses.
Our aim must continue to be to make all mental illness understandable and as easy to talk about as any physical illness. It wasn’t long ago that people talked about ‘The Big C” as though saying cancer out loud was taboo and dangerous for some reason. People started to be able to say the word ‘cancer’ and now, there are people making a living out of discussing the most taboo of the all – bowel cancer!
So, there’s hope, we will get there!

Is it a diagnosis, a label or an identity?

I’ve had a number of conversations over the years about the language used around mental illness – it’s complicated matter, made more complicated by people not knowing the power behind their words.

“I am not my illness”

A gentleman I cared for explained he detested being called “schizophrenic”,  because, he explained “you wouldn’t say someone is a cancer”. What he was trying to express was that he is not his illness, he did not identify with his illness, he did not want to be labelled in this way and I really respected this.

Even professionals use words derogatorily

If I said someone “is diabetic” I would not have any opinion or judgement on their personality or any other characteristics. However, I recently heard a paramedic say this patient “is schizophrenic” with so much power, bitterness and judgement, I could tell he was casting aspersions on this person’s character (and appeared to be suggesting he be treated as lesser in some way). I had presented my service users as a “56 year old gentleman with [a number of medical complaints] and schizophrenia” as information that may lead to conclusions about the current presenting complaint. While one person may be able to say someone “is schizophrenic” without any preconceived judgements, this paramedic was not one of them.
Stigma in society is strong, it’s people who are being stigmatised that suffer, those doing the stigmatising don’t realised a subtle language change could have a powerful impact. With this small change, a person is not labelled as their illness but someone who has an illness.

“I am more than my illness”

Mental illness can have a negative impact on one’s identity. When I was diagnosed with anorexia I could have let this be my identity… i could have felt, I am not Frances anymore, “I am anorexic”. I have seen people so consumed by their illness, they may as well say “I am anorexia” – I am not a person anymore, I am an illness. But I did not want to label myself in this way, although it was true I was “anorexic” I preferred to see myself as “a person with anorexia”, then my character and personality traits could exist alongside my illness.
It has been proven that assumptions about what it means to be mentally ill such as incompetence and inadequacy (commonly held) will lead to a vicious cycle of impoverished sense of self and low self esteem, ceasing to try and work or fit into society and poorer psychosocial outcomes and sustained symptom severity. (Read the full article here.) It follows that, if you identify as your illness, you identify as incompetent and inadequate, whereas if you consider yourself to have an illness, you are not your illness, you can distance yourself from these negative characteristics.

Of course, this is down to the individual and if saying “I’m bi-polar” or “I’m schizophrenic” does not impact on their ability to see themselves as separate from the illness that’s their prerogative. Or, if they want to be identified as their illness, that’s also, up to them. Perhaps I’m saying, from within a mental illness it can be very difficult to see the path to recovery, how you see yourself in relationships with your illness can be the turning point. In my opinion, recovery and turning away from being consumed by mental illness is possible for everyone (recovery may not mean cure – but that’s a subject for a different blog).
When is a diagnostic label unhelpful?

I’ve had other conversations with people who think we should do away with mental illness diagnoses all together as the words can have such a negative impact on the experience. It can be very confusing when some words can be used by the general population, for example feeling depressed or anxious are valid and appropriate emotions, however, clinical depression and anxiety disorder are very different experiences, in some ways a million miles away from the basic emotion.

For other diagnoses there are other problems e.g. the use of derogatory terms, such as “schizo” which has been used to mean “unpredictable criminal”. Personality disorder is a confusing term, we think (as society) we understand what is meant by personality so if someone’s personality is disordered, surely, their core being is fundamentally altered/damaged? Well, no, personality disorders are extremely complex (usually with relational difficulties) and there is much discussion about changing the label to fit the experience better.

Of course, diagnoses are an essential part of communicating. It’s helpful if a collection of symptoms has a name so that treatment can be targeted appropriately. However, I have also had the experience of an inaccurate diagnosis being used which then had a negative impact on the treatment I received.

In the end, once I was on medication to control my symptoms, it didn’t matter what my diagnosies were – the therapy I needed was for someone to sit with me while I discovered who I was and grappled with emotions I’d never allowed myself to experience.

Language changes, this is normal

The word spastic used to mean “muscle spasms”, a common symptom of cerebral palsy – it is now an offensive term, because of how it was used, and has fallen out of use. The media may hide behind “the dictionary definition”, but if we follow this through, we can still use the word spastic, but we don’t. The “dictionary definition” of “schizophrenic” is “a person with schizophrenia” or “contradictory or frantic and disjointed” but this is as at odds with the definition of diagnosis. Many people still think someone with schizophrenia has a split personality or they are violent (which is an inaccurate belief). Continuing to use the word in different contexts perpetuates this misunderstanding of the illness.

Just hoping people think about what they say…

It’s not hard to change, “schizophrenic person” to “person with schizophrenia”.

Breaking down stigma is vitally important in a cruel and judgemental world. Not realising the power behind our words can have a negative impact on those affected by the illness by perpetuate societies misunderstanding, judgements and stigma. Even if you do not mean offence by the words you use it can have more of an impact than you realise.

Schizophrenia Awareness Week

1 in 100 people in the UK have schizophrenia. When I say this word, what do you think? An axe-wheedling murderer? Or a young lady, up and coming in graphic design?
The media would have us believe all dangerous criminals are “schizos”, I’m not hiding from the fact that some criminals have schizophrenia but some criminals will have eaten beef in the last 24 hours before committing a crime…do the media ever mention that?! People who have schizophrenia are not automatically dangerous. Often it is said that they are more likely to hurt themselves than others, while this is true the reality is that they’re not going to hurt anyone.
Schizophrenia is comprised of positive and negative symptoms. Positive symptoms include hallucinations (perceiving (hearing, seeing etc) things that are not there in reality) and delusions (a belief contradicted by reality). Negative symptoms may include flat mood, poverty of speech and movement and general apathy. The positive symptoms can appear quite confusing and even scary while the negative symptoms often linger well after an episode has passed.
It is very sad that people with schizophrenia often find themselves stuck in the mental health system. A survey has shown that due to lack of appropriate support people are unable to get on with functioning lives. With the right medication and the appropriate support symptoms can be managed but what is “appropriate support”?

  • Being encouraged to talk about unusual experiences
  • Not colluding with or condoning beliefs
  • Not being excluded purely on diagnosis
  • Considering reasonable adjustments to enable full functioning (e.g. allowing the use of headphones in a busy office environment)

2 out of 3 people with schizophrenia unfortunately say lack of support has had a negative impact on their opportunities in education. Schizophrenia is likely to lower your self-esteem and confidence so a lot of encouragement is needed. It’s important to make very small step when trying to achieve goals – this support does not need to be provided by professionals; friends and family are important. Unfortunately 9/10 have said lack of appropriate support has had a negative impact on their ability to maintain relationships, which will obviously reduce the amount of support they have, it’s a vicious cycle.
Often, people with enduring mental health problems have to rely on charities to provide the support they need. 1 out of 3 with the diagnosis feel things have got worse in the last 2 years. This could be in part down to:

  • The NHS concentrating on mild/moderate depression and anxiety; while the IAPT (Improving Access to Psychological Therapy) services are excellent the resources have had to come from somewhere.
  • For more sever illnesses, crisis services are in crisis and the Community Mental Health Team can only see those who reach the “critical” threshold as they‘re working at the limits of capacity.
  • Universal systems to help people off benefits and back to work are inappropriate. While I think enabling people to work is excellent, most people need specialist support with an understanding of the unique difficulties they face. Universal systems are set up to fail and could ultimately cause unnecessary mental health crises.

So, what can we do?

  • Join Time to Change (have a look at their pledge gallery – what can you pledge?)
  • Find out what your local mental health service provision is and write to your local CCG encouraging them to commission specialist mental health services in supported living, community care and employment education and training.
  • Join campaigns that ask the government to take the crisis the mental health services are in seriously.
  • Listen out for people talking derogatively about schizophrenia or other mental health conditions, try to challenge them to improve knowledge and awareness.

It’s up to all of us to drive the changes needed to improve the lives of people with mental health conditions.
Mental Health Foundation
Mind info on schizophrenia
Rethink Mental Illness info on schizophrenia
Time to Change get involved