WARRIORS: “The Upside Of Unrequited” (Chapter. 3)

Written by Andi Bazaar, Co-wrote by Clayton-Euridicé Schofield | Feb 10, 2023

"If you want to fight mental health stigma, this needs to include personality disorders. People are quick to label those that are abusive, racist or portraying any bad behaviours with a personality disorder without acknowledging how harmful that is for those who have one."

Each year, over 800 000 people die of suicide and that is equivalent to one person every 40 seconds taking their own life. Suicide ideation? Self harm? Suicidal behaviour? These are signs of deep unhapiness but not necessarily of mental disorder.

It is difficult to talk about suicide, but talking openly about suicide can help prevent suicide. Let us work together to prevent it and be the light!

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While most youth are healthy, physically and emotionally, one in every four to five youth in the general population meet criteria for a lifetime mental disorder and as a result may face discrimination and negative attitudes.

As with physical health, mental health is not merely the absence of disease or a mental health disorder. It includes emotional well-being, psychological well-being, social well-being and involves being able to:

• Navigate the complexities of life
• Develop fulfilling relationships
• Adapt to change
• Utilize appropriate coping mechanisms to achieve well-being
• Realize their potential
• Have their needs met
• Develop skills that help them navigate the different environments

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One of the easiest ways to stop the spread of stigma surrounding mental illness is by being informed, in the following thread I will be including statistics from top mental health organizations to help educate those who may not be aware of the facts about mental health or illness.

• 1 in 5 U.S. adults experience mental illness each year (NIMH)
• Suicide is the 10th leading cause of death in the U.S. (AFSP)
• Every day, ~129 Americans take their own life (AFSP)
• In the U.S. almost half of adults will experience mental illness in their lifetime (46.4%) (MHFA)
• 50% of mental illnesses begin by age 14 and over 75% begin by age 24 (MHFA)
• 17% of youth (age 6-17) experience mental illness (NAMI)
• About 18% of people ages 18-54 have an anxiety disorder in a given year (JHM)
• The average age of depression onset is mid-20s (JHM)
• Over 70% of youth with depression are still in need of treatment (MHA)
• More than 10 million adults have an unmet need for mental health treatment, this number has not declined since 2011 (MHA)
• Major depression in youth has increase 4.35% over the last 6 years (MHA)

NIMH: National Institute of Mental Health
AFSP: American Foundation for Suicide Prevention
MHFA: Mental Health First Aid
NAMI: National Alliance on Mental Illness
JHM: Johns Hopkins Medicine
MHA: Mental Health America

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HOW EFFECTIVE ARE "MYTHS & FACTS" STRATEGIES AT REDUCING MENTAL HEALTH STIGMA?

A new study suggests that these "campaigns are at best ineffective and may increase mental Illness stigma."

Here’s a topic on this awesome study:

The "myths & facts" strategy is used by popular mental health campaigns, this strategy presents "myths" about mental illness and "facts" that correct these myths.

In this study, the authors tested whether correcting harmful myths about mental illness on an anti-stigma flyer. Surprisingly, the "myths & facts" strategy either did nothing to decrease myths about mental illness or "myths & facts" actually increased stigma toward mental illness after 30 minutes of being presented. However, this effect was not present at 2-day and 7-day followup.

WHAT EXPLAINS WHY "MYTHS & FACTS" STRATEGIES DON'T WORK WHEN PRESENTED ON FLYERS?

"Inherent in this strategy is the need to first present inaccurate information to then provide the correction," which raises the chance people who never held the misperceptions might adopt them.

"Myths & facts" strategies may also increase cognitive load. In other words, it's hard for people to remember what is a myth about mental illness (vs) what is a fact, when given so much information.

THE STUDY DOES HAVE LIMITATIONS:

• It’s possible "myths & facts" strategies work in other contexts like giving a talk, sharing lived experience or correcting others.
• The "myths & facts" flyer only discussed mental illness (vs) looking at diagnosis-specific myths.

TAKEAWAYS OF THIS STUDY:

• "Myths and facts" flyers are likely ineffective at reducing mental illness stigma.
• If you’ve used this strategy before, don’t feel bad (I have too), now we can be more effective!
• Rather than focusing on myths, focus on recovery-oriented messages.

Keith S. Dobson and Savannah Wolf, I thank them for their work on testing anti-stigma strategies.

MENTAL HEALTH STIGMA

Mental disorder is a spectrum of cognitive, emotional and behavioral disorder that interferes with the lives and productivity of people at school, work and home and impact an individual's interpersonal relationship.

Some of the mental illness includes psychosis which is a break from reality that usually comes from anxiety and depression. With that, people looked at it as drifting from social norms and loss of control which might cause harm for themselves or others.

Centuries ago, 5000 BCE different cultures had different views of mental illness for instance the Hebrews believed that mental illness is satanic or religious possession, and only exorcisms can heal the person.

The European, viewed mental illness as an imbalance in the body that might influence the mental health of people, that includes blood, phlegm, bile and black bite which believed to be a unique component that shapes the personality.

It is necessary to highlight the history of racism in medicine. The majority of people of color does not trust the mental health system and that’s for different reasons such as the history2 of racisms anchored in medical research, diagnosis and clinical management.

For instance, white women are over-diagnosed with depression, while white men are over-diagnosed with anxiety rather than psychosis. People of color are over diagnosed with psychotic disorders such as schizophrenia.

Baghdad has opened the first psychiatric hospital In 792 CE and later on was followed by other asylums. Treatment was implemented by humanistic physicians, medical astrologers or traditional healers.

At La Bicetre, a hospital in Paris, the staff used to control patients movement by using cuffs and collars, their movement was limited only to enable them to feed themselves but not enough to lie down to sleep, they were forced to sleep upright.

By 1792, Philippe Pinel who is a French physician and the founder of the moral treatment which classified the needs of patients with mental illness. Moral treatment is treating mentally ill people with respect and compassion for them to feel better.

The early 1950s, the Anti-psychiatry movement has emerged and it fought against pharmacological treatment, coercive hospitalization and other psychiatric practices. This movement addressed the economic and cultural stigmatization against-individuals with mental illness.

A lot of them were justified as “imperative of labor” by this justification, individuals who were living at poverty, criminals and have mental illness were all isolated and denied access to jobs.

Many signs were not seen as symptoms of a mental disorder but rather as an existential fight for personal freedom, when people of color used to demand for their freedom there were viewed as mentally illness.

A decade later, Franco Basaglia who is an Italian psychiatrist have exposed that mental illness is not a disease but an expression of human needs. Please do not stigmatize people with mental illness for they’re disabled enough by their state.

Borderline Personality Disorder / Emotionally Unstable Personality Disorder is one of the most misunderstood, stigmatised anr complex mental health diagnoses.

One could write pages relating to the condition BPD and a layman’s understanding would still be incomplete. For this reason I am going to try and keep it short, simple and concise as I can and explain to you what BPD is to me.

• BPD is intense feelings of loneliness and an inability to sit with myself without resorting to poor coping behaviours.
• BPD is extreme emotional vulnerability and sensitivity, feelings of severe internal distress are triggered easily.
• BPD causes a slow return to my baseline, this means strong emotions and cognitions tend to take a long time to dissipate.
• BPD feels like I am "dying inside" immense emotional turbulence and pain, distress beyond explanation.
• BPD is feeling as though my emotions are so impossible to live with that they will surely kill me, most of the time it feels as though my emotions are in control of me and I am not in control of my emotional world.
• BPD is impulsive behaviours and an inability to "think before I act" and "learn from my mistakes" time and time again.
• BPD is extreme and rapid mood swings ranging from periods of depression to somewhat dysphoric and delusional bouts of mania.
• BPD is paranoia and anxiety, especially in interpersonal circumstances.

Problems with "attachment" especially with authority and care-giver figures (e.g. therapists, teachers, etc)

Self-destructive tendencies, especially self-injurious behaviour mostly through cutting, this has also manifested through eating disordered behaviours, alcohol and drug abuse. Others may struggle with sex, spending, gambling and other addictive behaviours.

Lack of sense of self. Having to define myself based on my external world and lacking a fundamental secure sense of a "true me," only being able to have an idea of who I am by looking at evidence and cues in the people also world around me.

Difficulties with appropriately expressing my anger often leading to heightened displays and outbursts of intense pent-up emotion, a highly severe guilt amd shame complex in response to every imperfect interaction or perceived personal failure.

Feelings of self-hatred, self-loathing, hopelessness, despair, especially in response to making mistakes that impact others. Black and White thinking as well as the tendency to engage in catastrophic thinking, mind-reading and jumping to conclusions.

High perceptiveness of people and circumstances around me, to the point of unhealthy and paranoid hyper-vigilance. Feelings of being misunderstood by the world and people around me and of never fitting in, always being on a different wave-length.

Splitting: "Rapidly changing perceptions of myself and people around me from one extreme to the other."

I wouldn’t be like this if I knew how to not be like this. When you’re fighting BPD, you’re fighting a silent battle, no one sees how hard you’re constantly having to fight your mind.

People seem to brand those with BPD as bad or “crazy” people. The truth is that there are over 200 combinations along with varying severity levels of the 5-9 qualifying symptoms of BPD. It’s not only cruel, it’s illogical to judge all people with BPD as inherently bad.

“People with the diagnosis of BPD need to be heard, we are all too often silenced by services and professionals. People with BPD are not a bunch of stereotypes, we have emotions, feelings, dreams like everyone else. We just feel too deeply.”

Just been diagnosed with "Borderline Personality Disorder?"

I’m here to tell you the stereotypes aren’t true, there’s nothing wrong with your personality. Don’t believe everything you read, you deserve understanding and care. Things get better!

Living with BPD or people who have it is a blessing and learning curse in itself. Stay patient, focus and appreciative. People with BPD are many things, often loving, kind, passionate, creative, determined, giving, ambitious, brave and caring.

The stigma around BPD is so wrong, 99% of the people I’ve come in to contact with are absolutely loving, giving and caring.

I get so defensive of BPD/EUPD. I know many have been misdiagnosed Trauma Not PD but I wasn’t, my diagnosis helped me make sense of why I became so unwell and it really gave me hope in one day recovering from:

• Eating Disorders
• Addiction
• Depression
• Anxiety
• Psychosis
• OCD / PTSD

There's nothing at all "abstract" or "mythical" about DSM mental disorder constructs, each causes clinically significant suffering and impairment also some can lead to total disability plus death. Many have biological correlates, those none has known pathogenesis or diagnostic lab tests.

"No, it is not a (mental disorder) that causes suffering and impairment, it is events, circumstances, relations etc etc that cause suffering and impairment."

This (the argument that the 'mental disorder' has causal agency) is very odd logic indeed and is oxymoronic in respect to other statements (made by the same individuals).

So, we're told that the diagnoses are merely "constructs" or helpful (or otherwise) labels for observed patterns of human experience. The label, then can't *cause* anything (other than confusion and lead to iatrogenic harm through the mistakes of clinicians) we're told that they are aetiologically neutral, which again speaks to the idea of a "social construct" and indeed we're told (with a degree of frustration) that we don't even have to point out that they're social constructs.

That's a given and yet, those commentators seem to have forgotten their own advice, as they're now claiming that these unequivocally "social constructs" have different epistemological roles as entities that have causal agency.

My conclusion (and I'm sorry to be critical but apparently it's ok to be critical as long as you don't have the temerity to criticise diagnoses from outside the profession) is that the underlying assumption — violating the principle of aetiological neutrality is that what we're *really* talking about is an assumption of an underlying pathology a disorder or dysfunction in structure or process which gives rise to the phenomena listed in the diagnostic criteria and has effects has consequences, has agency and which is reflected in the diagnosis.

If so (if that assumption is right), then all the claims of aetiological neutrality of the universally agreed idea that these are social constructs that the diagnoses merely label patterns of observed phenomena, rather than reflecting disease are misleading.

If I'm wrong and all those claims for diagnosis are still held to be true then (and coming back to the start of this thread) then the diagnosis, the "mental disorder" can indeed *cause* nothing.

And so, as my friend so correctly pointed out, we have events and circumstances in our lives that have consequences.

Sometimes, inappropriately in my opinion those experiences are pathologised as "disorders" and it’s so very sad that then we start down the route of searching for dysfunction (rather than addressing the problems), medicating (with all the iatrogenic harm that follows), misleading people struggling to make sense of their experiences here, weaving intellectual Möbius strips from the philosophy of causality.

“If you want to fight mental health stigma, this needs to include personality disorders. People are quick to label those that are abusive, racist or portraying any bad behaviours with a personality disorder without acknowledging how harmful that is for those who have one.”

You can be a bad person and not have a mental illness just the same as you can be a bad person and have one, associating bad behaviours with mental illnesses is stigmatizing, contributes to false narratives and misconceptions and hurtful towards those who are struggling.

A SPECIAL THANKS TO:

• Dr Oliver Schofield, MD (Consulting)
• Dr Seth Gryffen, MD (Consulting)
• Timothée Freimann schofield (Photographed)
• Clayton Euridicé Schofield (Co-writer/Editor/Journalist)
• Scott Wynné Schofield (Publisher)
• Henrie Louis Friedrich (Analyst)
• Jwan Hofflér Conwall (Art Interior Design)
• Hugo-licharre Freimann (Ass Director)
• Shot at GQ’s Studios by José Schenkkan and Benjamin Schenkkan Joseph
• In appearance by "E. Pierro-luccá Schofield" / Emmanuel Piero-luccá Schofield (Model)