Let's Not Call Things 'Crazy': Language and Portrayal of Mental Illness

 

 

 

M Night Shyamalan’s latest release, Split, came under fire early this year for deriving its thrills from the inaccurate portrayal of a psychological condition (dissociative identity disorder or DID; Rose 2017). Described as a financial success, the movie was criticised for perpetuating the myth that persons with mental health conditions are predisposed to violent and erratic behaviour and lack empathy for the suffering of their victims.

 

Such portrayals stigmatise those with mental illnesses as these are rarely accurate. Contrary to depictions in the media, persons with DID are rarely violent or aggressive, but they do have a history of chronic abuse or trauma as the victim, and are at a higher risk of self-harming (Foote et al 2008) than non-dissociative patients. Psychological horror–themed movies have been a pop culture staple, often amalgamating mental illness with religious themes (for example, demonic possession) to exploit the discomfort of the audience with uncertainty and the unknown.

 

Closer home, Indian movies have also been including mental illness or neuroatypicality in their narratives. Movies like Fashion (bipolar disorder), My Name Is Khan (Asperger’s syndrome), Barfi (autism spectrum), and Bhool Bhulaiyaa (DID) portrayed mental illnesses in a caricatured manner.

 

Taare Zameen Par (2007) depicted eight-year old Ishaan’s journey from being considered academically subpar to an artistic savant diagnosed with the developmental learning disorder, dyslexia. The film follows Ishaan’s deteriorating mental health and self-esteem, as he cannot live up to the benchmarks set for him by his parents.

 

A pivotal scene in this movie emphasises the importance of role models. When success and achievement are narrowly conceptualised as class performance, number of friends, and overt confidence—exacerbated by a dismissal of children’s inner lives and imagination as being unimportant to attaining these goals—the presence of role models similar to the child can help empower them.

 

At the end of the movie, Aamir Khan’s character reveals that he too is dyslexic, while simultaneously epitomising a happy, functional adult. Notably, when labels like “lazy,” “duffer,” and “idiot” were used to belittle Ishaan (then undiagnosed), the film-makers recognised the exclusionary and ableist manner in which using intellectual disability as ad hominem attacks has become normalised (Wolbring 2008).

 

Language and Mental Illness

Language is political. Words do not exist in a vacuum, but operate within psychosocial frameworks that help construct our experiences of the world. The way we use them establishes and persuades perceptions about various social groups (Rhodes et al 2012). It is a potent tool in describing sociopolitical power dynamics (Arens 2009).

 

To illustrate, historically, eugenics was propagated as a form of manually engineered social Darwinism. It sought to segregate, institutionalise and force-sterilise those deemed “feeble-minded” or “mentally deficient.” This was done based not on accurate science, but persuasive labels. Literature on the subject alludes to eugenicists’ fear that the “mentally degenerate” (characterised as belonging to the socially, racially and economically underprivileged) would out-populate the white, upper-middle class, Protestant groups to which eugenicists tended to belong (Sparkes 1999).

 

In several European countries, eugenics was propagated with the sanction of the Church and scientists, and conservatives and the radical left alike. The science behind it was decidedly lacking, as “feeble-mindedness” was not properly defined and imprecise measures of intelligence included those even with a moderately low intelligence score. True to its etymology, eugenics (“of noble birth”) was a political tool to suppress the downtrodden under the guise of paternalistic compassion, rather than a tool to selectively breed and evolve a superhuman with perfect mental and physical capacities.

In India, this cross between racial and ableist prejudice based on misappropriated labels manifested in a similar manner. The establishment of the earliest mental asylums under the British rule occurred amidst tumultuous political conditions. These were purposed to serve “insane” British soldiers and Indian sepoys under the East India Company.

 

The Lunacy Act (1858) was formulated with the objective of segregating “lunatics” away from society, for the “safety of neighbours” (Shaw 1932). European inmates were also accommodated separately from Indians, like in the asylums of Colaba, Mumbai (erstwhile Bombay). Further, as if to cement the notion of the mentally ill as locked-away criminals, control of mental hospitals was entrusted to the Inspector General of Prisons ( Sharma and Varma 1984).

 

The India Lunacy Act (1912) was relatively more evolved than its predecessor, in that its focus shifted from institutionalisation to humane treatment of inmates; albeit, as a consequence of public attention to the miserable conditions in mental asylums, and not compassion for the mentally ill.

 

The most recent revision, the Mental Healthcare Act passed in April 2017, focuses on property and guardianship rights of the mentally ill person and differentiates between an intellectually disabled person and a person with mental health conditions bereft of any developmental conditions. Importantly, it also updates its terminology from “nursing home asylum,” “lunatic” and “criminal lunatic” (Indian Lunacy Act, 1912), to “psychiatric hospital,” “mentally ill person,” and “mentally ill prisoner” (Mental Healthcare Acts of 1987 and 2017; Trivedi 2009), respectively.

Although such revisions could hardly be called path-breaking, these are notable due to the use of contemporary language, signifying a shift towards better cognisance of mental health conditions and the mentally ill.

 

Speaking of etymology, even within medical nomenclature, words evolve after gaining regressive and exclusionary connotations. For instance, the phrase “mentally retarded” was considered a politically correct improvement over “imbecile,” “idiot” and “moron,” which were originally descriptors for degrees of intellectual disability in intelligence tests until the 1960s, after which the pejorative connotations of these descriptors overshadowed their original meaning and intent.

 

Currently, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has replaced “mental retardation” with “intellectual disability” (APA 2013). Denying the utility of such political correctness, Harvard psycholinguist Steven Pinker coined the phrase “euphemism treadmill.” Euphemism treadmill is the process by which words acquire new connotations by virtue of their association with a concept already deemed a certain way.

 

His assertion is that the “name becomes colored by the concept; the concept does not become freshened by the name” (Pinker 1994). The implication is that new words describing old concepts will not become free from negative perceptions, but that the new words will soon be deemed pejorative as well, owing to their association with a negative concept.

 

In the mind of this author, such an assertion makes for an apt critique of political correctness when it is not accompanied by authentic intentions of the speaker. However, being politically correct and meaning the things one says while being politically correct are not mutually exclusive. If anything, the euphemism treadmill makes for an excellent reason why political correctness should be accompanied by cultural changes that reify the politically correct diktats.

 

We must remain mindful of the culture within which words are used, their histories and context, all of which are instrumental in the evolution of their meaning and future usability. Neurodiversity is an example of such “reculturing” of conversations and contexts surrounding mental health conditions and neuroatypicality.

 

Looking Ahead

Neurodiversity is the idea that certain neurological conditions (such as those that exist on the autism spectrum, attention-deficit/hyperactivity disorder [ADHD], and dyslexia) are natural variations in the human genome, and should not be pathologised as these have keen traditionally.

 

Analogous to cultural diversity or biodiversity, neurodiversity was borne out of a need to change the narrative regarding how we address mental health conditions, without delegitimising the specific needs of people with these conditions. Neurodinersity suggests that some of the advantages in the mental capacities of neuroatypical persons might be because of (and not in spite of) their uncommon neural configurations.

 

For instance, people with dyslexia are able to recognise patterns easily, can deciphar peripheral visuals with greater acuity than the general population, and have a higher than average ability to manipulate visual imagery in 3D, compared to people without dyslexia, although empirical evidence for this last claim remains inconsistent (Chakravarty 2009; von Károlyi et al 2003). Persons on the autism spectrum tend to be visual thinkers as compared to those who are not (Grandin 2009). Persons with Asperger’s syndrome, a high-functioning variation of autism, have a higher than average propensity to see details.

Studies on relatively known mental health conditions, such as depression and anxiety, are also being investigated for biological underpinnings that would aid treatment, as well as correlations with intelligence, tendency to ruminate and its possible utilities (Baer 2016, 2017).

 

In addition to structural support for the neuroatypical, currently lacking in South East Asia (Sharma 2016), living conditions and quality of life can be leveraged by systematising inclusivity cultures. This matters in particular to vulnerable groups most severely affected by lack of such support.

 

Women (Carlson 2001), and caste and class minorities (Ganguli 2000; Nandi et al 1980) have a history of institutional subjugation, exacerbated by disability, which cyclically predicts economic decline (Trani et al 2015). Additionally, healing premised in politically sanctioned but scientifically unsupported ideologies interact with minority group memberships uniquely to exacerbate or stagnate their conditions (Nortje et al 2016).

 

To revert to our original discussion about Split and DID, it has been argued that instead of contributing to a narrative that stigmatises persons with DID, the condition itself can be interpreted as a form of resilience in the aftermath of extreme trauma. A symptom of fissioning personalities in the face of threat might be evidence of the brain’s persistence in adapting to self-preserve.

 

References

Ahrens, Kathleen (2009): “Analysing Conceptual Metaphors in Political Language,” Politics, Gender and Conceptual Metaphors, London: Palgrave Macmillan UK, pp 1–5, viewed on 28 July 2017, http://link.springer.com/10.1057/9780230245235_1.

 

APA  (2013): "Highlights of Changes from DSM-IV to DSM-5," Focus, Americam Psychiatry Association, Vol 11, No 4, http://doi.org/10.1176/appi.focus.11.4.525.

Baer, Drake (2016): “Why Psychologists Say Anxiety Is the ‘Shadow’ of Intelligence,” Science of Us, viewed on 29 July 2017, http://nymag.com/scienceofus/2016/09/psychologists-say-anxiety-is-the-shadow-of-intelligence.html.

Baer, Drake (2017): “Psychologists Think They Found the Purpose of Depression,” Science of Us, viewed on 29 July 2017, http://nymag.com/scienceofus/2017/02/a-new-way-to-understand-and-treat-depression.html.

Carlson, L (2001): "Cognitive Ableism and Disability Studies: Feminist Reflections on the History of Mental Retardation," Hypatia, Vol 16, No 4, pp 124–46, http://doi.org/10.1353/hyp.2001.0054.

Chakravarty, Ambar (2009): “Artistic Talent in Dyslexia — A Hypothesis,” Medical Hypotheses, Vol 73, No 4, pp 569–71, viewed on 28 July 2017, http://linkinghub.elsevier.com/retrieve/pii/S0306987709004058.

Foote, B, Y Smolin, D I  Neft, and D Lipschitz (2008): "Dissociative Disorders and Suicidality in Psychiatric Outpatients," Journal of Nervous and Mental Disease, Vol 196, No 1, pp 29–36, http://doi.org/10.1097/NMD.0b013e31815fa4e7.

Ganguli, H C (2000): "Epidemiological Findings on Prevalence of Mental Disorders in India," Indian Journal of Psychiatry, Vol 42, No 1, pp 14–20, http://www.ncbi.nlm.nih.gov/pubmed/21407903.

Grandin, Temple (2009): “How Does Visual Thinking Work in the Mind of a Person with Autism? A Personal Account,” Philosophical Transactions of the Royal Society of London, Series B, Biological Sciences, Vol 364, pp 1437–42, viewed on 28 July 2017, http://www.ncbi.nlm.nih.gov/pubmed/19528028.

Nandi, D N, S P Mukherjee, G C Boral, G Banerjee, A Ghosh, S Sarkar and S Ajmany (1980): "Socio-economic Status and Mental Morbidity in Certain Tribes and Castes in India –  A Cross-cultural Study," British Journal of Psychiatry, Vol 136, No 1, http://bjp.rcpsych.org/content/136/1/73.short.

Nortje, G, B Oladeji, O Gureje and S Seedat (2016): "Effectiveness of Traditional Healers in Treating Mental Disorders: A Systematic Review,"  Lancet Psychiatry, Vol 3, No 2, pp 154–70, http://doi.org/10.1016/S2215-0366(15)00515-5.

Pinker, Steven (1994): “The Game of the Name,” New York Times, 5 April, viewed on 28 July  2017, https://stevenpinker.com/files/pinker/files/1994_04_03_newyorktimes.pdf.

Rhodes, Marjorie, Sarah-Jane Leslie and Christina M Tworek (2012): “Cultural Transmission of Social Essentialism,” Proceedings of the National Academy of Sciences of the United States of America, Vol 109, No 34, pp 13526–31, viewed on 28 July 2017, http://www.ncbi.nlm.nih.gov/pubmed/22869722.

Rose, Steve (2017): “From Split to Psycho: Why Cinema Fails Dissociative Identity Disorder,” Guardian, viewed on 29 July 2017, https://www.theguardian.com/film/2017/jan/12/cinema-dissociative-personality-disorder-split-james-mcavoy.

Sharma, Prateek (2016): "When Bigotry Invades Mental Healthcare: Women, Sexual Minorities Are Most Vulnerable to Harassment," Scroll, 1 November, https://scroll.in/pulse/820412/when-bigotry-invades-mental-healthcare-women-sexual-minorities-are-most-vulnerable-to-harassment.

Sharma, S and L P Varma (1984): "History of Mental Hospitals in Indian Sub-continent," Indian Journal of Psychiatry, Vol 26, No 4, pp 295–300, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3011190&tool=pmcentrez&rendertype=abstract.

Shaw, W S J (1932): "The Alienist Department of India," British Journal of Psychiatry, Vol 78, No 321, pp 331–41, http://doi.org/10.1192/bjp.78.321.331.

Sparkes, Russell (1999): “The Enemy of Eugenics,” Chesterton Review, Vol 25, No 1, pp 117–29, viewed on 28 July 2017, http://www.pdcnet.org/oom/service?url_ver=Z39.88-2004&rft_val_fmt=&rft.imuse_id=chesterton_1999_0025_40545_0117_0129&svc_id=info:www.pdcnet.org/collection.

Trani, J F, P Bakhshi, J  Kuhlberg, S S Narayanan, H Venkataraman, N Mishra and S Deshpande (2015): "Mental Illness, Poverty and Stigma in India: A Case-control Study," BMJ Open, Vol 5, No 2, http://doi.org/10.1136/bmjopen-2014-006355.

Trivedi, J K (2009): "Mental Health Act, Salient Features, Objectives, Critique and Future Directions," Clinical Practice Guidelines – 2009, Indian Journal of Psychiatry, pp 11–19, http://www.indianjpsychiatry.org/cpg/cpg2009/article7.pdf.

von Károlyi, Catya, Ellen Winner, Wendy Gray, and Gordon F Sherman (2003): “Dyslexia Linked to Talent: Global Visual-spatial Ability,” Brain and Language, Vol 85, No 3, pp 427–31, viewed on 28 July 2017, http://linkinghub.elsevier.com/retrieve/pii/S0093934X0300052X.

Wolbring, Gregor (2008): “The Politics of Ableism,” Development, Vol 51, No 2, pp 252–58, viewed on 28  July 2017, http://link.springer.com/10.1057/dev.2008.17.