Mental Illness Is Real Illness Too #BADD2014

When I signed up to participate in Blogging Against Disablism Day 2014, I originally intended to write a semi-academic post on what it means ot be disabled and who can identify as such. Then I read Kees Kooman’s Dutch book on chronic fatigue syndrome (ME/CFS), which is aimed at advocating the idea that ME/CFS is a physical rather than psychological illness. Fine with me – there is a lot of evidence that ME/CFS is a physical illness. What bothers me, however, is the idea, propagated throughout the book and in many other places within the chronic illness community, that a physical illness is somehow more real than a mental illness.

I have a mental illness. I also have largely unexplained physical symptoms, which the doctors for now call probable irritable bowel syndrome. IBS, like ME/CFS, is an illness with clear physical symptoms which however have not yet been explained. This doesn’t mean no explanation will be found – many cases of “hysteria” in Freud’s era were later found to be brain tumors, after all.

However, what if IBS and ME/CFS are actually psychological? Does this mean that we don’t want to get better, as Kooman continually suggests. In my experience, living with a diagnosed mental illness, it doesn’t.

I see this kind of ableism towards the mentally ill everywhere. I have met many autistics who resist the idea of autism as a psychiatric diagnosis. While again I am on their side, their arguments discriminate against the mentally ill. It isn’t like mentally ill people always need to be pushed into independence, while autistics and others with neurodevelopmental conditions need lifelong support.

In case you’re wondering why I care, here’s why. The Dutch Long-Term Care Act, which is due to take effect next year, originally excluded those with psychiatric conditions (which I’m assuming includes autism without intellectual disability) from care. People with mental illness needed to get care and treatment through health insurance and locally-funded social support. The mental health platform, supported housing alliance and some other stakeholders fought this exclusion and it seems now that those who’ve been in residential treatment for at least three years on end, will qualify for long-term supported housing. I would qualify under this condition, but the large number of revolving-door patients, who are constantly being admitted, discharged and readmitted, wouldn’t.

The mental illness means not wanting to get better idea also has practical implications for treatment. People with certain mental illnessses, like personality disorders, are already stigmatized for being just a pain in the butt. I have been told many times that I’m manipulative, attention-seeking, and just having behaivor problems that I need to overcome. Of course it is wrong to assume the same of ME/CFS and IBS patients, but why in the world do they need a physical cause for their illness to claim they’re truly suffering?

Let me make it very clear that I’m not saying that ME/CFS is all in your head. I’m saying that if it were, that still didn’t mean you don’t want to get better. Symptoms are real, whether they’re psychological or physical and, if physical, whether a medical cause can be found or not. As a person who has been accused of imagining a mental illness, I want to say that, unless someone is malingering (ie. faking for external gain), it doesn’t matter what the cause of the illness or disability is in terms of whether it is a real illness or disability. Whether you strive for the illness or disability to be cured, by the way, doesn’t determine whether you’re ill or disabled eihter, but that is beyond the scope of this post.


10 thoughts on “Mental Illness Is Real Illness Too #BADD2014

  1. Thanks for writing this. I have m.e and depression, I have felt stigmatised by much of the rhetoric in some m.e communities. Every time I see someone say something like “m.e is real it’s not just ‘all in your head” it hurts. My depression has been just as debilitating and all to real as my m.e. I agree m.e isn’t psychological but when people fight so hard to not be labelled physchological it makes me wonder about underlying stigma towards mental illness. I wrote a post about my experiences of m.e and mental illness here if you’re interested :


  2. I am a former borderline who dealt with a lot of stigma about BPD (Borderline Personality Disorder) before recovering to no longer have it today.
    You might be surprised to hear that I strongly agree with those who say that BPD, and many other “mental illnesses”, are not real physically-CAUSED disorders. They are real illnesses, however, in the sense that they have real symptoms, and there are differences in brain chemistry in those who have them. The issue is what causes those differences and symptoms. What people like me think is that the primary causes of “mental illness” are relational, environmental, and experiential factors. We disagree with those who say that genetics/biology “cause” mental illness, and that they are valid, reliably diagnosable medical conditions. On my blog, I list many well-researched books that refute this genetic-determinist notion.
    None of this means that people with “mental illness” – what I would call severe emotional or personality problems – do not deserve understanding or support, or that their problems in relating, thinking, feeling, and functioning are not 100% real. I am very empathetic toward people with mental/emotional problems, because I have experienced them for many years myself.


  3. I wrote about this issue for BADD in 2011 (it was actually my first BADD post): No More Yuppie Flu!

    I think the reason people with ME object to their illness being called a mental illness is twofold. First, it just isn’t, and calling it one means they don’t get the right treatment. There are diagnosable physical pathologies, particuarly in severe ME, which aren’t consistent with mental illness or any psychologically-based syndrome. In particular, when sufferers have died, abnormalities have been found in their spinal cords.

    The other is that the “mental illness” label is used simply to discredit both the illness and the sufferers, and the language used by disbelievers is very derogatory and sometimes misogynistic. It’s not contended that the mental illness is of the same order as bipolar disorder or schizophrenia; rather, it’s that it’s a stress-related illness with psychosomatic symptoms which can be cured through exercise or counselling; however, professionals look for “stresses” even when there are none. It’s not the only illness where this tendency exists; I heard of a girl with a serious gastric disorder who was sectioned because doctors were convinced she had anorexia, and another who was incontinent as a child because she simply lacked bladder muscles; the doctors assumed it was caused by her parents’ divorce and did not even bother to examine her, so she was just left as she was until a new doctor took over.

    The response “but mental illness IS real!” is a common one in response to complaints from ME sufferers that they are treated “as if mentally ill”, particularly from professionals. From them it is always a means of deflecting the complaint back onto the complainers, by making it look like they are prejudiced against mentally ill people. Another tactic is to claim that the “mind/body dichotomy” is false. All means of defending a pet theory and discrediting sufferers of a condition they do not understand.


  4. If you don’t mind the idea that ME CFS is a physical rather than psychological illness why are you then complaining about it? .

    If you think that ME folks are getting better treatment here such as being abandoned in a bedroom for more than thirty years like my sister then I suggest you phone up your politicians and demand the same level of care.

    I don’t want sound annoyed here but treating ME as a mental illness with treatments which don’t work on ME such as CBT and GET is not going to help those with a mental illness.



    1. We’re complaining about it because language like ‘real illness’ with the assumption that mental illness is NOT a real illness is harmful and hurtful. I complain because everytime I see a comment like ‘but it’s real it’s not ‘just depression’ ‘ it hurts; I can’t snap out of my depression any more than I can snap out of my m.e. You can talk about m.e and it’s physical basis WITHOUT being offensive and insulting to people will mental illness. No one here us suggesting we treat m.e as a mental illness just that you treat people with mental illness with more compassion and take more care over using language which can stigmatise and alienate. It’s attitudes like that that have meant I don’t feel comfortable in many m.e ‘support’ spaces. People with chronic illness such as m.e are more lonely to have co-morbid mental illness such as depression and anxiety so is it too much to ask that people show some consideration with the language they use and the attitudes they profess?


    2. Steve, I never said that ME/CFS is a mental illness. There is clear evidence that it is physical, as Matthew also said. I did not say that people with ME/CFS should be left in bed (I in fact said nothing about the right treatment for ME/CFS). What I did say is that the comment that “it’s not a mental illness, it’s real” is insulting to those with a mental illness. Of course, as Matthew said eloquently, different causes warrant different treatment, but please note that the kind of CBT promoted for ME/CFS doesn’t work on many individuals with “just” depression either.

      As for what hte response is to accusations that ME/CFS is a delusion, I don’t know, but I can understand hta tpeople say it isn’t a delusion. They howeve rshouldn’t go on to connote that delusions aren’t real experiences. I have been accused of imagining a mental illness and seeking attention, and this can hurt terribly. I hope however that one day people stop accusing others of delusions, attention-seeking etc. as if these arent’valid experiences (attention is a human need so it’s normal to seek it). I don’t have all the solutions to how patients ccan achieve this goal, and besides I don’t think patients are solely responsible. My post was meant to educate on this topic (that the cause doesn’t make an illness more or less real). I dislike the hierarchy of illness, whereby mental illness is somehow lesser than physical illness. This says nothing about what treatment should be used for which cause of illness, and I didn’t say that doctors should blindly assume a stress-related illness when they haven’t looked for the cause.


  5. Treating ME as a mental illness so as not to upset the mentally ill is not going to help the mentally ill or those with ME .


  6. Steve, no one here has suggested for one second that we that treat m.e as a mental illness but that ppl just stop using insulting and inaccurate language and assumptions about mental illness and engaging in ‘who has it worse’ top trumps. That shit HURTS. To be honest it hurts even MORE from ppl with illnesses that are misunderstood and stigmatised by the general public and medical professions.


  7. Using real or not real over ME or mental illness hurts those who have a very real mental illness which the Author has failed to comprehend when he or she wrote the book or maybe it was deliberate?
    i apologize failed to understand that you were not attacking those with ME

    I will just ask one simple question when ME folks are accused by a psychiatrist that ME is a delusion what is most likely response to that statement?


  8. It seems so strange to think mental illness has anything to do with not wanting to get better. I *suffer from* PTSD and depression, whereas I *am* autistic. I have no desire to become non-autistic, because autism doesn’t cause suffering. But by definition, depression and PTSD are all about suffering. When a condition is defined by unhappiness, then it should be pretty obvious that people with that condition are unhappy about having it.


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