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The Reality of Mental Illness


A lot of psychology textbooks claim that people with mental illnesses and symptoms, such as delusions, panic attacks, hallucinations, or dissociation, do not know they’re having those symptoms. It’s said that those things feel entirely real to the person having them, that there is no way they can tell the difference between the “true perceptions” and the false symptoms.

Boiled down, it’s the idea that people who are “crazy” don’t know they’re “crazy”.

The basis of that belief is that mental symptoms really do feel real. That is true. When you’re first hit with one, like a feeling of danger from PTSD or you see a new person who wasn’t there two seconds ago, those things feel real. All of them originate in the same parts of the brain that real things do. Real sight and hallucinations come from the same vision parts of the brain; feelings from PTSD danger and feelings of “real” danger both come from the same emotional centers in the brain.

But we also know that reality, dream, and imagination all use the same parts of the brain too–and nobody claims that people can’t tell the difference between those things. Just because they’re in the same parts doesn’t mean we can’t know the difference, We may not know how the brain tells the difference, but it does know.

If your argument is that reality is “outside your head” and imagination is “inside” it, that doesn’t fly–all perception is inside your head; there is no mental difference. The mental experience of reality and a hallucination are the same, as far as we can tell–just like reality and imagination are the same.

We can tell the difference between imagination and reality.

We can also tell the difference between hallucination and reality.

Think of it as calibration. It takes practice for you to learn how to control your emotional responses, so that you don’t burst out in anger like a toddler every time you’re frustrated and have a bad thought (though some people never learn that). That anger and bad thought is a real feeling and a real response to a real stimulus. You still must learn to control it because you know is not appropriate to act on it. You have learned to tell when it is appropriate to act on and when it is not. It is within most people’s power to learn this calibration.

Similarly, a mental symptom is a real feeling, a real response (sometimes to a real stimulus, sometimes not; this detail isn’t important). More generally, a mental symptom is a real experience and a real thought. Just like “normal” people, the person having it has to learn to tell whether it is appropriate to act on it. The difference is that these people cannot control these things, so no amount of practice trying to “calm down” gives them control over it. These people have to deal with it in some other way, often by avoiding the situation that causes it or by leaving when it happens.

A person with a mental symptom is just as capable of learning to calibrate their responses as a “normal” person. There’s nothing about mental illness that messes with that ability. What’s different between the two people is that a normal person who’s flying off the handle is given space to calm down; a person who’s known to be mentally ill, however, tends to be screamed at and prodded into further agitation. Doing that to “normal” people is called being an asshole.

Nobody questions that we can all learn to tell when it’s appropriate to act on our feelings of anger, on any of our feelings and thoughts. Nobody questions that we all know the difference between imagination and reality. But for some reason, nobody wants to believe that mentally ill people are just as good at telling when it’s appropriate to act on their feelings, on their perceptions, that they’re just as good at telling the difference between reality and mental symptoms.



This is what is meant when we say that science is not objective. Science is just as bigoted as the people conducting it are: people think the disabled and mentally ill are gibbering idiots, that we are less capable than our “normal” counterparts, so that’s what “the science” says too. You need to be able to ask what our assumptions are based on, why we have those assumptions, and a we need to be able to let those go rather than putting them down to error. It’s very easy to ignore “the numbers” that tell you there’s no reason to believe the mentally ill are idiots when society has believed for centuries that we are.

We know what’s going on. Self-reflection and assessment is a basic human ability. It’s an ability that lots of intelligent animals have, too. The idea that we can’t is used to justify treating us inhumanely, to remove our autonomy and to silence us when we speak about the horrors that are done to us. It’s one more tool to control people.

And when the definition of “crazy” can be changed at will to target anyone society doesn’t like (ex., schizophrenia shifted from “uncooperative housewives” to “angry black men” during the civil rights era), that means anyone could be next. “Crazy” and “can’t reason properly” has always been used against people we disagree with and want to control. The atheist, Christian, and the republican are just as at risk of being labeled the wrong kind of “crazy” as the person who does want mental health services.

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