How We Make Mentally Ill People Even More Helpless

Scene from ‘Space Jam’ (Warner Bros)

Recall the 1996 hit ‘semi-animated’ movie Space Jam, starring basketball superstar Michael Jordan, Bugs Bunny, Daffy Duck, Lola Bunny and so on? Those of you who do should remember how Jordan’s team─comprising half a dozen Looney Tunes characters─managed to defeat the ‘Monstars’ (a group of animated minions who stole the playing skills of basketball superstars like Charles Barkley and Shawn Bradley).

During one of the breaks, Bugs Bunny was trying to encourage his team, all of whom were discouraged and depressed over being crushed (sometimes literally) by the Monstars. So what did the maverick hare do? He whipped out a bottle of what was labelled ‘Michael’s Secret Stuff’ and told the Looney team that drinking it would grant them new powers to defeat their opponents. With the amused (and, frankly, dumbfounded) Michael Jordan looking on, all the members drank the ‘secret stuff’ and─ voila!─proceeded to outplay and whip their opponents back to hoop hell. Of course, if you haven’t guess by now, it was plain water they were drinking. Nothing special at all.

The movie thus bizarrely illustrates two non-bizarre facts: 1) Beliefs determine behaviour and 2) we ‘see’ ourselves through how others treat us. Let’s examine how this related to mental illness.

Social conditions which combat mental illness

Decades ago, Nancy Waxler (see Note 1) studied the occurrence of mental illness in places like Sri Lanka, Ceylon, Mauritius and compared them to similar cases in industrialised societies. In her findings she concluded that the following conditions served to accelerate recovery from mental illness to ‘normality’:

  • If a mentally ill person is believed not to be ‘responsible’ for her illness i.e. if it’s held that her condition is caused by ‘evil spirits’ or witchcraft or whatever
  • If a mentally ill person believes her fundamental ‘self’ to be unchanged i.e. if she sees only her ‘spirit’ or ‘soul’ as being held captive or damaged by demonic forces
  • If there is no stigma attached to mental illness and if the society in question does not ‘make much’ of mental illness; the effects of mental illness are believed to be brief with no serious lasting effects
  • If a mentally ill person is not required to ‘take on a sick role’ and seen to be unable to perform normal role obligations i.e. if mental illness is not viewed as form of deviation from social norms
  • If the very idea of mental illness doesn’t create a substantial change in the behaviour of family members of the person in question, thereby sending implicit and explicit messages to the person that she is, indeed, ‘mentally ill’

In her study, Waxler observed that recovery rates are higher in non-industrialised places, so she theorizes, precisely because most of the conditions above apply. Unfortunately, in modern societies like UK and so on, people manifesting mental disorders are immediately ushered into formal treatment and given definite signals about ‘how’ to behave appropriately. Basically, the person is informed over and over that ‘you have a problem’, that ‘you are responsible’ and that ‘you need help’ and that punishment and reward will accompany the compliance and lack of with regards to required behaviour (e.g. taking medication and so on).

In other words, Waxler stated that often it is the societal response to a ‘mentally ill’ person that will determine whether he or she remains sick. All individuals, mentally normal or otherwise, behave in accordance with the expectation of significant others, especially those in authority.

This suggests that if I begin exhibiting symptoms suggestive of, say, schizophrenia, the behaviour of my spouse, bosses and close friends may contribute towards me either continuing or discontinuing said symptoms! Ironically, if we have loved ones suffering from mental disorders, maybe the last thing we should do is help them ‘confirm’ that they are, in fact, ill? To continue doing so may be to unnecessarily ‘trap’ the person in a sick role.

Things get worse if formal medication is seen as aligned to highly structured bureaucracies; just think about the ‘process flows’ in today’s hospitals. The bottom line is that mentally ill people forced to endure such labyrinths end up feeling powerless to resist the messages confirming them in their illness and, usually, helplessness.

How can we help?

I’m no mental healthcare professional, so I can’t prescribe anything. I’m surprised and concerned, however, that the above perspective─known as social labelling theory─is hardly discussed. In fact, if I haven’t gone around scouring the e-library databases I wouldn’t have found Waxler’s article.

In Malaysia, practically all of us are pro- modern medicine. Our approach is to see mental health as largely a chemical matter, thus requiring mainly treatment in the form of pills which can knock out a blue whale, let alone homo sapiens. This may or may not be true, but surely one effect of this is to defer treatment to that monolithic behemoth of an institution known as the hospital (with all the risks that entails).

Unfortunately, and inconsistently, we also have a tendency to assign a huge amount of blame to the patient. Often it isn’t clear if we’re concerned about said person’s mental health or just pissed off that he can’t be normal anymore. At the very least, let’s learn to be kinder to our suffering loved ones?

To repeat Waxler’s hypothesis: It is often a community’s response of labelling a mentally ill person which sustains the illness.

‘Nuff said.

Note 1: The landmark text is Waxler, N. (1974). Culture and Mental Illness: A Social Labeling Perspective. Journal of Nervous & Mental Disease, 159(6), 379–395. As always with such theories, questions and pushbacks exist. I’d encourage interested readers to 1) read Waxler’s original article and her other works, 2) read up other theories, not least those which challenge Waxler. An important note, though, is that Waxler’s work focused mainly on schizophrenia.