My recent posts got me to thinking about the term mental illness and how stigma-laden it remains to this day. As a society, we’ve come a long way from the bad old days when most people were too ashamed to admit going to a psychiatrist, when families kept those members with obvious psychological problems hidden from view. Back then, a moralistic aura surrounded mental illness, as if having one implied that you (as well as your family) were morally defective and therefore to blame for your emotional difficulties. This view of mental illness still prevails on the religious right — as in the claim that homosexuality is a “lifestyle choice,” for example, and that gays are obviously making the “wrong” one.
In society at large, the easing of stigma has a lot to do with the marketing of psychiatric medication to address “chemical imbalances” over the last few decades. Nowadays, you don’t suffer from mental illness, you have a mood disorder, a result of faulty brain chemistry rather than a moral defect and of course, not your fault. While I strongly object to the widespread overuse of anti-depressants, I do believe that removing the shameful stigma surrounding depression and manic-depressive illness has been a good thing. It’s difficult enough to struggle through depression without feeling you’re a bad person to boot for being “abnormal.”
Furthermore, during the last 50 years, the psychological/behavioral territory defined as “normal” keeps growing broader. Andrew Solomon’s excellent book Far from the Tree tells of many families who embraced a child’s “deviance” (Down’s Syndrome, autism, transgenderism, dwarfism, etc.) rather than hiding it in shame and whose lives were immensely enriched as a result. We live during an “anti-shame zeitgeist,” as I discussed in a recent article for The Atlantic, and this is mostly to the good.
But here is the irony, at least for me: while removing the social stigma attached to their difference is undoubtedly helpful for these individuals, only by confronting the (often unconscious) shame they feel is emotional growth possible. Completely denying the existence of shame promotes defensive identities meant to ward it off. There is no external cause for shame and therefore I do not feel it. From my perspective, the distinction between social shame and core shame has been lost; removing one doesn’t eliminate the other. As you may recall, I define core shame as the felt awareness that your development went terribly awry, departing from what Winnicott referred to as the “blueprint for normality” built into our genes.
Just as the pharmaceutical industry argues that depression results from a chemical imbalance, the transgender argument often focuses on altered brain chemistry to “prove” that transgendered individuals really were “born that way” or that they actually do occupy a body that doesn’t match their psychological gender. Even if this proves to be true, that would imply that nature somehow got things terribly wrong. Statistically speaking, its incidence is several standard deviation units away from the norm. We can enlarge our ideas of what is normal — and I strongly support social tolerance and laws that protect the rights of those who are different — but it won’t eliminate core shame.
When I referred to transgenderism as a mental illness, many people heard it as support for social stigma and for those who seek to persecute this minority group. Instead, I meant to focus on core shame, as I usually do. Let me be clear: I do not think that transgendered individuals ought to feel shame; I’m only saying that, on an unconscious level, they inevitably do. We can and should do all we can to eliminate social stigma, but (in my view) it doesn’t help anyone to collude in a defensive identity that denies core shame. On the other hand, I suppose that shoring up their defenses does help people to keep pain at bay even if it does stand in the way of deeper psychic growth. Maybe for those who can’t afford or access quality treatment, supporting a defensive identity is the best we can do for them.
In a larger sense, something that corresponds to “mental illness” exists, but the term is apparently too laden with social shame. What then are we to call it? The DSM prefers “disorder,” as in Bipolar Disorder vs. manic-depressive illness, but even that word has become tainted, hence the shift from Gender Identity Disorder to Gender Dysphoria. Maybe in the end, we’ll all come to agree with Thomas Szasz that the concept of mental illness is a complete fiction, a label society uses to control people whose behavior deviates from what is acceptable. Maybe everyone will eventually be considered “normal” and we’ll have completely eliminated shame from our lives.
It occurs to me that my views on shame are difficult for many people to grasp because they involve a kind of cognitive dissonance. How can social shame be bad, a force to be resisted, and core shame something to be “embraced” and explored? Because most people equate the feeling of shame with having been shamed by others, they naturally believe that removing those external shaming messages will eliminate shame altogether. If only society would stop shaming people with different mental illnesses, we could erase the shame those individuals feel … right?
If only it were that simple.
P.S. — I have a new article for The Atlantic, about the inevitable narcissistic injury involved in growing older. You can find it here.