new internationalist
issue 209 - July 1990

understanding distress
Illustrations by Clive Offley
EVERYONE
experiences emotional distress. But we each experience it in our own way.
This is why what Western culture calls 'mental illness' is difficult to
define. And it is often made even harder to understand by the jargon of
psychiatry: 'schizophrenia', 'psychosis' and the like. Here is an NI guide
to the different forms of mental distress - the better we understand them,
the less we will have to fear.
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Western
culture, for good or ill, separates the mind from the body. Disorders
of the body are left to medical science. But there is as yet no equivalent
science of the mind. The 'metaphor' of mental illness is the best we
can manage. People who become 'mentally ill' develop psychological problems
which affect their emotional moods and behaviour, and the way they communicate
with other people. Psychologists study mental life and behaviour;
psychiatrists are doctors who specialize in treating disorders
of the mind. They make a distinction between neurosis' and 'psychosis'.
Neurosis is the name given to the more common and less serious
types of mental disorder, like anxiety. Psychosis is when there
is, at times, such severe distress that someone seems to lose touch
with the familiar world altogether. Schizophrenia, for example, is a
psychosis.
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Schizophrenia
does not mean 'split personality'; that is only one very rare form that
this mental illness can take. There is no general agreement about schizophrenia's
cause or cure, and some people even dispute that it exists. Yet one
in every 200 people are diagnosed as having a schizophrenic illness
at some point in their lives.
The condition results in a dramatic disturbance of thought and feeling.
People start to experience the world very differently. They may come
to believe that their thoughts, feelings and actions are under the control
of an external force (thought disorder'). They may experience
visions, seeing, hearing or even smelling things that others can't (hallucinations).
They may be convinced of something for which there is no obvious
justification - perhaps that they are being pursued by secret
agents (delusions).
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Periods
of deep depression alternate with very excited behaviour (mania).
During a manic or 'high' phase people are often very active, unable
to sleep; they may spend vast amounts of money and see or hear things
others can't. They may be irritable or talk so much they become incoherent.
While 'low' or depressed they may feel overwhelmed by despair, guilt
and feelings of unworthiness. They may become apathetic, unable to do
even the simplest task.
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 Imagine
you are about to be attacked. Your muscles tense in readiness for physical
action. Your heart beats faster to carry blood to where it's needed.
You breathe faster to get more energy. You sweat to keep your body temperature
down. Your mouth becomes dry as your digestive system slows. Once the
danger has passed you shake as your muscles relax. We have similar responses
to a wide variety of experience, from talking to someone new at a party
to taking an exam. Some people feel anxiety very often and very intensely.
Sometimes a panic attack results: a pounding heart, sweating, chest
pains, fast breathing and dizziness, combined with a fear of 'going
mad' or out of control.
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A
very 'fashionable' complaint in Western culture at present, stress is
one of the few acceptable' conditions we are free to admit to. We are
even expected to have it. A 'stressful' job can be a status symbol.
Its symptoms can include the loss of your sense of humour. But that
doesn't make it any less serious or painful. It resembles anxiety in
many respects but suggests that the causes are more rational and external
than irrational and internal. To that extent, the present emphasis on
stress may be an encouraging sign of a shift away from the 'personal
pathology' of disorder.
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Our
reactions to the death of someone close to us are particular to us and
to our relationship with them. But many people experience a sense of
shock and loss. We may think we see the dead person walking down the
street, or hear them calling our name. Despair, depression and anxiety
are extremely common. We may surprise ourselves by feeling, say, anger
and guilt towards the person we have lost. Sometimes, particularly if
we lack the formal rituals of grief, the healing of the bereavement
process gets stuck. We simply can't get back to living. We may feet
we are expected to 'pull ourselves together' too quickly - or
we may be unable to react to the death at all, even by crying. Grief
can, and often does, transform people's lives.
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The
number of people so disabled by their distress that they have had to
be cared for in institutions is relatively small. The vast majority
are cared for by their own families and friends, often at enormous emotional
cost. It can be as difficult for these carers to adjust as it is for
the individual in distress.
The maintenance of mental health and the relief of distress
depend on the attitudes of individuals, families, friends, whole societies.
If we are conditioned by fear we make things worse: we get angry because
we cannot understand, or else we pretend that the distress doesn't really
exist.
All of us have a part to play. Support is not always as
easy or as obvious a thing to give as we might like. For some distressed
people any kind of heightened emotion, however 'supportive', can be
destructive. We can't expect gratitude, any more than we ourselves would
want charity from others. We have to learn what is appropriate to the
particular individual in distress. That can be a hard, long struggle.
But it is far better to face it than to run away.
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