The limits of destigmatisation: against awareness

This time a year ago, I was trying to educate everyone I could about the illness I'd been diagnosed with several months earlier: borderline personality disorder (BPD). I wrote this blog post, which I think is a useful resource for explaining what happens inside my brain (I still sometimes refer to it when I can't figure out what's going on). But this Mental Health Awareness Month, I've been grappling with the question of whether awareness and destigmatisation are worthwhile goals or whether they have the capacity to hurt more than they help.

Searching for resources to help me cope with my illness, especially its impact on my relationships, always lands me reading some article targeted at the partner of a borderline telling them to run. When someone comes to me having been newly diagnosed, my first advice is always to never google it. I've read so many articles about how we are manipulative, abusive, and incapable of love. Things are changing, slowly: many articles and books emphasise the availability of successful therapies, and BPD is increasingly becoming conceptualised more as a mental illness in the vein of mood disorders than as a fundamental character flaw or a broken personality (I have no doubt that this is about its relative curability compared to other personality disorders). You could trace this through the appearance of sympathetic articles about BPD in Vice, Buzzfeed, even the Telegraph. BPD is the cause célèbre of personality disorders.

Narcissistic and anti-social personality disorders are not benefiting from this process. These disorders, associated with "psychopathy", occupy a particular space in our minds and in culture as states of pure and irredeemable evil. They are always viewed from the corner of the eye, reviled but never understood. Neither "psychopath" nor "sociopath" have fixed meanings; there is no clear delineation between them, no accurate usage. The ease with which these terms are thrown around reveals how hesitant we are to look at their content. Conceptually, this is a black hole: an empty space where we can project all the badness we can't and don't want to understand.

The Mind website lists BPD separately from other personality disorders, reflecting its increasing assimilation into the popular understanding of mental illness.
Mass murder, abuse and other acts of immense violence are frequently explained (and explained away) by mental illness. The treatment of white murderers and terrorists by the Western media are the clearest example of this. In the wake of massacres at Isla Vista, Charleston and San Bernardino, mental illness was immediately on everyone's lips. Throughout the US primaries, Donald Trump has been repeatedly assessed as a "sociopath" and "diagnosed" with narcissistic personality disorder by real psychiatrists who have never spent a minute with him. On Twitter, he is assessed by those less familiar with diagnostic models as having dissociative identity disorder or schizophrenia. These, among others, are the mental illnesses commonly referred to as highly stigmatised or scary, because they are in particular associated with violence, horror and threat to the social order.

Labelling fascists, murderers and anyone thought to be evil with these diagnoses does the dual injustice of hurting real mentally ill people (in very literal ways - people with these diagnoses are often subject to forced medication, hospitalisation and psychiatric abuse) and allowing us not to think too closely about problems. Madness allows ideology to get away scot-free. It allows us to explain abuse without looking at the social conditions which produce abusers. It allows us to see the most horrible violence as anomalous and exceptional: the result of a broken brain, not something which can exist in ourselves and in the people we love and trust most. Distancing oneself from evil is one of the oldest and most important ways of dealing with the horror that humans are capable of doing to each other. It's not going to go away.

Most mental health awareness activism works by normalising mental illness. The mad are "just like you". We're 1 in 4. But as more people are assimilated into the new normal, as depression and anxiety and other illnesses become understood and empathised with, the place of fear remains. Destigmatisation functions, necessarily, by shifting the stigma to someone else. How many times have you heard "I'm not crazy" or "I'm not a psycho" from a mentally ill person? This saying retains the negative associations of "crazy" and holds it at a distance. It says pick on them instead.

An important part of this is that certain symptoms can be understood more easily than others. One may not understand depression without lived experience, but a vague grasp of it can be extrapolated from experience of the low moods that everyone occasionally experiences. These symptoms don't vastly threaten one's understanding of what it is to be human. Psychosis, personality disorders, dissociative identity disorder, all entail symptoms which are so far beyond the realm of neurotypical experience as to be incomprehensible. They are the Other, the horrifying inversions of the lies our societies are structured around. Real liberation for people with these illnesses would mean more than assimilating them into the neurotypical world; it would mean deconstructing the notion that humans are fundamentally rational, logical and objective. Normalising these illnesses will never work because they are not normal.

I wonder if raising awareness about this sort of illness does the opposite of what it intends, bringing us greater violence and mistreatment as more people learn about our disorders. Because no matter how many statistics you spout about how mentally ill people are more likely to be victims rather than perpetrators of violence, there will always be the role of the disturbed, axe-murdering psycho lurking in the imagination. That role is central to us being able to move through the world without being overcome by the horror of it all, the capacity for horror we carry inside ourselves. Somebody has to fill it. And in a belief system which privileges rationality, the scapegoats will always be those for whom irrationality is a constant companion.

A solution to this problem is scarcely imaginable, requiring the overturning of Western political thought stretching back to Ancient Greece. Methodologies which threaten the hegemony of rationality are barely taken seriously even when forwarded by respected academics with huge stores of cultural capital. Meanwhile, the impulse to destigmatise, to explain over and over again that you're not violent, dangerous and abusive is understandable, and has implications for day-to-day and long-term survival. Awareness gives us pressure on policy-makers to fund services and research. Awareness makes it easier for us to be open about our mental health at school, university or work, giving us access to vital accommodations. But crucially, this work should always be accompanied by an understanding that normalising mental illness will not destroy stigma. Talking about depression or anxiety and eating disorders or even personality disorders will not make things better for all mentally ill people. There will always be someone scarier. There will always be experiences which destabilise and disturb the foundational cultural beliefs which govern our lives. And most of the time, by normalising our illnesses and symptoms we are shifting the worst stigma onto the most vulnerable people, people who perhaps don't have the power to fight their own corners.