What is Madness?

Someone asked why the name of this blog is Madness 101. Shouldn’t I call it Mental Illness 101? Isn’t mental illness the proper, politically correct term?

It is, but it’s not really mental illness that I’m writing about. I’m writing about the related subject of madness.

Illness is something that happens to you beyond your control. Some diseases are inherited, like Huntington’s; others are transmitted, like Ebola. Mental illness is thought to involve a multi-factor genesis called the Diathesis-Stress Hypothesis. (I love saying that. Try it yourself. Once you learn how to say it, you’ll love it, too. Diathesis-Stress Hypothesis.)

The Diathesis-Stress Hypothesis states that people are born with a genetic predisposition which is then activated by stress. You may have schizophrenia written into your genetic code, for instance, but it is not until you encounter the peculiar stress of adolescence or early adulthood that the symptoms of schizophrenia emerge. You may tend towards depression, on one hand, or anxiety, on the other. Most of the time you are fine, but when that decisive straw lands on your camel’s back, the camel falls one way or the other.

Other conditions are normal reactions to abnormal experiences. Almost anyone who smokes enough tobacco will become addicted to it. Addiction is the result of ordinary physiological processes whereby the body changes as a result of the substance ingested. All addictions are just as inevitable if you use the substance enough, although studies suggest that the path towards addiction may be speeded up or slowed, depending on genetics.

Post Traumatic Stress is another normal reaction to abnormal experience. It is true that not everyone who experiences a particular horrible event develops post traumatic stress over that event. However, we do believe that the accumulation of stressful events, or experiencing a single event in early childhood, when you are particularly vulnerable, will lead to the development of the condition.

The Diathesis-Stress Hypothesis is a powerful theory, but it leaves out one important factor: personal choice and responsibility. I’m not saying people choose to be schizophrenic; but the person with schizophrenia does choose whether or not to isolate himself, take his medication, and work with the people available to help him. The depressed person has a choice about whether to stay in bed all day or open the blinds to let the sun in. The anxious person can decide whether to avoid or face that which makes her anxious. The alcoholic chooses whether or not to drink.

When an alcoholic doesn’t drink, he is still an alcoholic, but he is not adding, through his own actions, to the condition. Similarly, the depressed, anxious, or psychotic person can do a lot towards addressing their conditions. They do not have to simply be passive victims.

I am aware that people with mental illness are subject to extreme social prejudice. I know that they often get blamed and blame themselves for things that are out of control. I work with them intimately on a daily basis. However, I am a counselor and it is my business to help people identify the ways that they contribute to the problems they face and the things they can do about them. It does them no good to tell them that they are the unlucky recipients of flawed genes or a chemical imbalance or have too much stress in their lives if they do not also address how they unnecessarily add to that stress.

Madness is my word for the things ill people do to make themselves more ill.

Having alcoholism is not madness, but drinking when you know you have alcoholism is madness.

Being depressed is not madness, but not getting up to start the day is madness.

Having anxieties is not madness. It’s very normal, and even may be desirable, to have anxieties; but, letting your fears control you is madness.

You are not responsible for having an illness, but when illness takes over your life and controls you and the people around you, that is madness.

In this series, I will describe the ways of madness and the things you can do about it.

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