There’s a common sentiment in mental health advocacy that recovery is not only possible but is also a stance rather than a cure for the illness. This idea is profoundly captured in the works of Patricia Deegan, who uses the metaphor of a “hero” to depict individuals with psychiatric disabilities. While the idea is meant to humanize and empower, the complexity of living with functional impairments often casts a shadow over this hero narrative.
Understanding Deegan’s Hero Metaphor
Patricia Deegan asks us to suspend our perception of individuals as merely “chronic mental patients,” urging us to see them as heroes. She posits that those with psychiatric disabilities could be incredibly strong, enduring circumstances that many could not. While the intention behind Deegan’s metaphor is empowering, it simplifies the complex nature of mental health conditions and their daily impact on individuals.
The Challenging Reality of Functional Impairments
Let’s examine functional impairments—a term I define as an obstacle that makes it difficult or impossible to complete a task due to a prevailing mental health disorder. These impairments are disruptive and emotionally taxing.
Functional impairments come in different shapes and sizes and can be as debilitating as they are varied. For example, some people with social anxiety may find using public transport nearly impossible, affecting their ability to hold down jobs or maintain social relationships. Others may have obsessive-compulsive behaviors that necessitate elaborate rituals before leaving the house, making even the most straightforward outing daunting. These functional impairments don’t just affect the individual; they ripple into the lives of family, friends, and even employers.
Picture an average day with an average mood. You’re wrapping up, reviewing the day’s successes and challenges. Then, you read an outstanding mail requiring your attention, and suddenly your day stops. You can’t handle the task because of your chronic issue with mail correspondence, a condition you’ve had since your initial diagnosis.
This is more than just an inconvenience. This impairment poses a significant barrier to carrying out essential daily activities. And yet, the healthcare system and many diagnostic tools disregard these “grey areas,” focusing instead on diagnosable mental health conditions or urgent crises.
The Paradox of “Passing”
The term “passing” signifies the ability to present oneself as not having a mental health issue. It creates an illusion, perhaps enabling someone with a high-functioning form of depression to excel professionally while crumbling in their personal life. Take, for instance, Sarah, a high-performing lawyer who seems to “have it all” but secretly struggles with a debilitating eating disorder. To her colleagues and even her family, she is “passing,” but at what cost? She cannot access the support she needs because she doesn’t seem to “qualify” for it.
People who can ‘pass’ as not having a mental health issue often find themselves in a precarious situation. Monetary advantages may offer them the luxury to mask their issues temporarily, but they often don’t qualify for much-needed assistance. They fall into what I term “clinical-case management grey areas”— not urgent enough to be a crisis but significant enough to hamper the quality of life. These people most need our attention and whose issues should alert us to the genuine crisis in mental health services.
Discrepancies in the Hero Narrative
Returning to Deegan’s hero narrative, it is essential to note that feeling like a “hero” is not universal. When facing impairments like the fear of opening mail, the idea of being a hero feels far-fetched, even alienating. Instead of empowerment, asking for help under such circumstances can dehumanize one, contrasting with Deegan’s empowering vision.
I remember when my fear of receiving mail was at its peak. Opening the mailbox would initiate a panic attack, and I would leave bills and correspondence unopened for weeks. This phobia disrupted my life to a point where my credit score plummeted, and I could not make even simple financial decisions. It’s not the grandiose challenges that always measure our courage but these small, seemingly mundane tasks that become insurmountable obstacles.
Bridging the Gap
While Deegan’s advocacy work provides a new lens to view recovery and mental health, it may not fully encompass the lived experiences of those with functional impairments. The real challenge lies in acknowledging these nuances without diminishing the empowering elements of the recovery paradigm.
Society often turns a blind eye to functional impairments, wrongly assuming they’re not as “serious” as other conditions. However, these impairments’ emotional and logistical toll on people can be overwhelming. Society can be more supportive through the widespread implementation of mental health education, destigmatizing mental conditions, and offering community-based resources explicitly aimed at functional impairments.
The Crisis in Mental Health: A Call for Attention
The healthcare system is primarily structured to respond to diagnosable conditions or severe crises. However, the real crisis in mental health is the lack of attention to the “grey areas”—the functional impairments and the people who can usually ‘pass’ but sometimes can’t. We need to devise more adaptive, inclusive frameworks for mental healthcare that recognize the complexities and diversities of mental health disorders.
In conclusion, while the hero metaphor may inspire and humanize, it’s critical to understand that the mental health journey is laden with complexities. The significance of establishing a more adaptive, inclusive approach to mental healthcare cannot be overstated. While it may be convenient to look at mental health through the black-and-white lens of “diagnosable conditions” and “emergent crises,” the grey areas are where many are lost, suffering silently and alone. True empowerment lies in acknowledging these complexities and adapting our systems and narratives to include heroes, anti-heroes, and everyone in between.
Author Info:
Max E. Guttman
Max E. Guttman is the owner of Mindful Living LCSW, PLLC, a private mental health practice in Yonkers, New York.
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