The fine line between eccentricity and mental illness
21 June 2018
I sometimes wonder, if there were aliens circling the Earth observing its human occupants, what they would make of us?
We’re a pretty weird bunch.
We constantly wage wars upon each other, causing untold death, pain and injury. We work ourselves to the bone to keep up with fashion and buy the most expensive car or furniture. We believe odd things in the context of religion; in supernatural beings who can bend and break the laws of physics and biology and chemistry. We destroy the very environments and creatures that support us, nurture us.
As strange as these behaviours may be from an alien context, however, what I am really interested in, is the behaviours we in the West describe as mentally ill - psychiatric disorders.
Typically a psychiatric disorder involves thoughts, feelings or behaviours that the majority of society, and those in positions of power, find threatening or strange. One immediately (and perhaps unfortunately) thinks of the person who is “truly mad” – suffering psychosis; acting in very bizarre fashions; not responsive to regular communication; violent to themselves or others. And we can certainly find people in our own Australian society who exhibit such symptoms. Indeed, as a society we are very judgmental about people who don’t “fit in”.
But there are also a large number of people who may act or feel or think in ways that are strange, but not necessarily pathological – not necessarily sick. There are people who are eccentric, maybe even a little bizarre, for whom it is not clear whether a psychiatric diagnosis of psychotic illness is necessary. I am thinking especially of people who may have strange beliefs about ghosts or vaccines or encroaching government, leading to odd behaviours, but who do not fit tightly into psychiatric categories. Or people in highly agitated states of inspired creativity or happiness or sadness, but not necessarily in need of a diagnosis of bipolar 1 or 2. Or someone who is having a hard time dealing with recurrent thoughts or problematic behaviours but whom is not best treated as having a personality disorder.
Indeed, there is a very fine line between thoughts and feelings and behaviours that are eccentric, and thoughts and feelings and behaviours that are best thought of as mentally ill and best treated by the psychiatric system.
But where do we draw this line?
The obvious answer is that someone is best treated psychiatrically when they are a risk to themselves or others.
But I feel this is not enough. There are still people who society find strange or eccentric, but for whom a full-fledged psychiatric diagnosis and heavy medication or therapy may not be the best response. There are people, I believe, whom we can accept as a bit odd but whom are best regarded as sharing humanity with us. People who might behave a bit strangely, but who still need love and support and companionship and social networks more than they need psychiatric intervention. And perhaps, our better response as a society is not to pathologies but to accept – accept that people can be odd! People can be strange! People can be bizarre!
And, perhaps it is through such acceptance that our peculiar little planet can find a path from less suffering towards tolerance, and towards a recognition of shared humanity that can benefit us all.
Dr Richard Schweizer, Policy Officer at One Door Mental Health richard.schweizer@onedoor.org.au.