What We Owe the Mentally Ill

One of the key ingredients in a successful and meaningful life is having someone who loves us,
someone who shares our joys and pain, cares deeply about our future and is willing to stick with us for
the long haul.

This kind of commitment is never easy and hardly guaranteed, and nowhere is it more tested than when
a loved one becomes seriously mentally ill. Comfortable illusions of stability and security are shattered,
friends don’t come around as often; isolation, blame and recrimination set in.

I’m not talking here about garden varieties of stress, mild depression and anxiety. I mean serious
and persistent mental illness, depression so deep that it’s physically unbearable, psychoses so strong
that they overwhelm material reality, behavior so bizarre and destructive that the person becomes alien
and the "other," even to family and friends.

Mental illness can test the strongest of family and professional relationships. But imagine what
it can do to those who don’t have a stable family, a network of friends or a strong support system
in the community. Imagine being homeless on the street, bouncing back and forth between the psychiatric
ward and jail with no one to call or comfort you, not even a harried caseworker who might be able to
hook you up with meds, get you into a one-room apartment in a low-income housing project, drop off
a food basket and give you the number of a local support group.

It’s one thing to provide medications. It’s quite another to provide the emotional and social
support systems that give the seriously mentally ill a decent chance at recovery — the long term
process of reentry and integration into a network of stable relationships that sustain and enhance what
it means to be human and a contributing member to society.

No one — not any of us — makes it in this world without people who are willing to travel with us
into the darkness as well as the light of our lives. Reams of research, not to mention common sense,
clearly demonstrate that the most successful recovery programs for people with serious mental illnesses
are those that provide a safe and comfortable environment in which to engage other people, activities
that promote confidence and self esteem, support in finding employment and someone who is able to listen
and empathize without immediately rushing to critical judgment and blame.

It’s sad that some people who take this kind of emotional and social support for granted in their
own lives are unwilling to provide it for those who are unable to secure it for themselves. Despite
advances in our knowledge of the causes, conditions and treatment of mental illness, there still
persists the notion that it’s the person’s own fault they’re having mental problems, and they ought to
buckle up and "snap out of it" — on their own, of course.

This attitude — this ignorance, really — is reinforced by a rampant culture of narcissism and
consumerism that glorifies the personal freedom and responsibility of the individual at the expense
of the reciprocity of social relationships that makes that freedom and self responsibility possible
in the first place.

In order to be free to exercise self responsibility, we have to be free from those conditions that
inhibit it: ignorance, disease, poverty, social isolation. Those conditions are compounded by the
nature of the mental illness itself, which often masks their recognition by the patient and thus the
need to accept some measure of responsibility for doing something about them.

Powerful psychotropic medications are a huge help in lifting the masks of psychosis, depression and
anxiety, but they are no substitute for the critical social support networks that make recovery possible
over the long term. We need to provide community-based services such as counseling, job training and
drop-in centers for those with serious mental illnesses in order for them to exercise their own self
responsibility and freedoms. We clearly don’t have enough community-based services now, as evidenced
by the large number of persons with mental illness who live on the street, occupy our jails or remain
isolated in their homes.

A civilized and ethical society can’t guarantee happiness and the abiding commitment of others to
our well being, but it can provide the minimal and necessary conditions that allow us to pursue it of
our own free will. That will is severely compromised in those who have a serious mental illness, and
that is why the rest of us are morally obligated to help them.

Feedback? Send it my way: Roger.Hughes@slhi.org.
*The Drift reflects the views of the author, and does not represent the official view of SLHI’s Board of Trustees and staff.