Mental Illness is Invisible Illness
Photo by Emily Underworld on Unsplash
In a previous post, I wrote about some of the common challenges and misunderstandings that people with invisible illnesses experience. However, that post was primarily focused on physical invisible illnesses. Now, what I am about to say might be a little controversial, but I believe that mental illness, cognitive disorders, and neurodevelopmental disorders are invisible illnesses too. Mental Illnesses, cognitive disorders (such as dementia and Alzheimer’s disease) and neurodevelopmental disorders (such as Autism Spectrum Disorders and learning disorders) do not usually have overt visible symptoms when you first look at a person, and so by definition they are invisible. Of course, many of these conditions manifest in behaviors that may clue others in to the that fact that perhaps something might be going on beneath the surface, but otherwise we may never really know just to look at someone [do we ever really know anything just by looking at someone?. That is the definition of an invisible illness.
People with mental health conditions, cognitive disorders, and neurodevelopmental experience many of the same challenges and misunderstandings as people with physical invisible illness.
Challenge #1: “you don’t look sick”
Just like people with invisible physical illnesses, people who experience depression, anxiety, bipolar disorder, schizophrenia, and other mental health conditions do not visibly look as though they are sick or are suffering, and they experience many similar challenges as people with physical illness. However, people with mental health conditions, cognitive disorders, or neurodevelopmental disorders also face additional stigma associated with misunderstandings about mental health in general (which are addressed below).
Challenge #2: The rollercoaster of ups and downs
With most chronic medical conditions, whether classified as physical or mental, people will experience good days and bad days. It can be hard to explain to others why you seemed fine yesterday and today seems to be more challenging, but the truth is that this is how almost all chronic conditions work. It can be extremely frustrating for the person with the illness to not feel as though they can plan ahead, or that their plans may get ruined at the last minute if their symptoms decide to act up at the wrong time. It can also be embarrassing if someone is surrounded by others who are unsupportive, uninformed, or who lack understanding about invisible illnesses. Which brings us to challenge number 3…
Challenge #3: The impact on family, friends, and relationships
In the previous post on invisible illness, I discussed how the unpredictability of the rollercoaster of invisible illness make it hard for friends and family to anticipate the outcome what any given day or interaction with someone with an invisible illness. In general, people tend to be comfortable with uncertainty, and so if loved ones don’t know what to expect, it can create tension. Additionally, when symptoms gets in the way of participating in shared events, going out with their friends, or other interactions with loved ones, overtime the friends may stop inviting…leading to changes or loss of the relationship. This can apply to any symptoms (physical, emotional, or behavioral); for example, it could be chronic pain, lack of motivation from depression, panic from social anxiety, or sudden changes in mood due to dementia. It may also be the case that friends and family do not know how to address or respond to symptoms, and their discomfort may cause them to distance themselves.
Additionally, when other people do not understand the unpredictable or “invisible” nature of invisible illnesses it can contribute to unhelpful comments such as, “but you were fine yesterday”, or “I don’t understand why you can’t just get your life together”. Many times, people with mental health conditions and learning disabilities are wrongly labeled as “lazy”, “crazy”, or “seeking attention”. If friends and family make hurtful comments that invalidate the experience of the person living with an illness, then the person who needs support may be more likely to pull away from others.
Those with mental health disorders also face some situations that are unique to having an invisible illness that is not “physical” in nature.
There is a huge misunderstanding in many cultures (including Western society) that mental health problems are less severe, or more within your control than physical health problems. This is problematic as this belief increases stigma and serves as a significant barrier to treatment for people with mental health and cognitive concerns.
Just like people with illnesses that are typically categorized as “physical” in nature, people with mental health conditions, cognitive disorders, and neurodevelopmental disorders did not ask for these experiences, and for some people they can be extremely distressing, uncomfortable, and in some cases life altering- just like physical conditions.
Most mental health conditions also have a physical component in the form of differences in the way that neurotransmitters are active in the brain, or the way that the brain processes information; for example, it is widely accepted and backed by research that schizophrenia may be associated with an imbalance or dysfunction of the neurotransmitter dopamine in certain portions of the brain (Lau et al, 2013; McCutcheon et al, 2018)**, and the fact that depressive disorders respond well to medications that work on the neurotransmitters of serotonin and norepinephrine (Sánchez-Salcedo et al, 2021) suggests that these neurotransmitters are involved in depression. We tend to forget that the brain is an organ that is part of the physical body, and that it can work inefficiently or incorrectly just like any other bodily organ.
Additionally, some mental health conditions such as depressive disorders or the depressive episodes associated with bipolar disorder* are associated with physical symptoms that closely resemble those that are characteristic of invisible physical illnesses. People with depressive disorders may experience fatigue, loss of appetite, sleep disturbances, and changes in the speed at which they move (American Psychiatric Association, 2013). These physical symptoms of a mental health disorder can have a major impact on an individual and their quality of life. Regardless of what the root cause is or the label that we assign to the symptoms, these experiences can have a huge negative impact on a person if left untreated.
There is a common misunderstanding (or lack of understanding) in the US that mental health symptoms are usually the result of situational factors. For example, an episode of depression may be preceded by a relationship break-up, the sudden loss of a job, or death of a loved one. Another example may be the development of post-traumatic stress disorder (PTSD) after surviving a horrific accident or assault. Most people can understand how these experiences are linked in time, but this type of thinking also leads people to believe that all mental health disorders must be due to challenging situations. In other words, many people have a hard time understanding how someone else can be struggling when “everything looks fine” or when there is no clear event that kick-started the emotional or mental symptoms. While it is certainly true that challenging life situations can increase one’s risk for the development of certain mental health conditions, that is not true for every person or every mental health diagnosis. Many mental health conditions have a strong biologic component, and in some cases, it can be hard (if not impossible) to tie down a situational trigger.
Living with an invisible illness of any kind can be challenging and take a toll on the whole person. I encourage you to share this post with others so that we can all become more aware and informed about invisible illness in all it’s forms.
Notes:
*These are just a few examples of mental health conditions disorders that have symptoms that overlap with physical symptoms of illness; this list is not exhaustive.
**There is ongoing debate and continuing research being done as it relates to the dopamine hypothesis of schizophrenia. Researchers have found varying results as relates to dopamine dysfunction in schizophrenia. Readers are encouraged to learn more about other potential contributing factors to schizophrenia by visiting the National Alliance on Mental Illness (NAMI) at https://nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia
Additional Resources:
Alzheimer’s Association
Center for Mental Health and Aging
https://www.mentalhealthandaging.com/common-topics/memory-loss-vs-dementia-vs-alzheimers-disease/
National Alliance on Mental Illness (NAMI)
https://nami.org/About-Mental-Illness/Common-with-Mental-Illness
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Lau, C. I., Wang, H. C., Hsu, J. L., & Liu, M. E. (2013). Does the dopamine hypothesis explain schizophrenia?. Reviews in the Neurosciences, 24(4), 389-400.
McCutcheon, R., Beck, K., Jauhar, S., & Howes, O. D. (2018). Defining the locus of dopaminergic dysfunction in schizophrenia: a meta-analysis and test of the mesolimbic hypothesis. Schizophrenia bulletin, 44(6), 1301-1311.
Sánchez-Salcedo, J. A., Cabrera, M. M. E., Molina-Jiménez, T., Cortes-Altamirano, J. L., Alfaro-Rodríguez, A., & Bonilla-Jaime, H. (2021). Depression and Pain: use of antidepressant. Current Neuropharmacology.
