Seeing beyond the ‘dysfunction’ paradigm: Challenging the stigma around mental ‘ill health’

What if the idea of mental 'ill health' had never been coined? 

what if we never perceived a standard of optimal mental health as being a norm we should aspire and strive towards?

While we have made significant strides in the conversation surrounding mental health in recent

years, there is still much stigma surrounding it. As part of world mental health month, I thought it

would be interesting to consider how we may begin crafting a different dialogue around how we

view mental ‘ill health’, by turning to evolutionary psychology and existential psychotherapy.

Some evolutionary psychologists suggest that mental ‘disorders’ may be a designed and learned

response to the problems of life, rather than a malfunction of the mind. Considering mental ill health

in this light, these evolutionary psychologists make sense of mental ‘disorders’ as designed coping

mechanisms and responses, rather than inherent ‘diseases’ or ‘malfunctions’ of the mind.

If we take one of the most well-known, and often most stigmatized mental illnesses, Borderline

Personality Disorder (BPD), and consider it instead as a coherent response to unstable patterns of

early attachment, we can view it rather than a ‘disorder’ but more as a designed response to certain

problems, often linked to early development.

Borrowing from Bowlby’s account of attachment theory, borderline personality disorder, a diagnosis

characterised by intense, unstable relationships and difficulty regulating emotions and impulses, can

be seen as a natural response to a certain image of the world adopted in early childhood. BPD is

characterised by danger, unpredictability, insecurity and hostility and has a strong correlation with

childhood trauma, neglect or abuse. According to Bowlby, dysfunctional childhoods can lead to

children developing an “internal working model” of the world characterised by danger,

unpredictability, insecurity and hostility. As opposed to children with ‘healthy’ attachment styles,

who often grow up to nurture healthy relationships, children with compromised attachments,

according to Bowlby, could go on to be ‘hypervigilant to signals of rejection and abandonment’. In

other words, those with dysfunctional childhoods can go on to exhibit dysfunctional attachments

later in life, much like those that characterise BPD; the result of learned behaviours adopted from

certain environments.

Evolutionary Psychologists who identify certain mental illnesses as having adaptive qualities, draw

evidence from the large number of the general population that still possess these patterns of

behaviour: ‘As a rule, if a condition is widespread in humans and has a strong genetic risk factor,

there’s a good chance it’s helping us in some way. Otherwise, natural selection would likely have

eliminated it from the population’ (Source: Psychology Today). Given that BPD alone affects over 6%

of the population, these Evolutionary Psychologists suggest that there may be an adaptive basis to it,

even if it may become maladaptive further down the line. Similarly, these Evolutionary Psychologists

view depression as an evolved adaptation, and a way of our minds telling us that something in our

lives is not going well, particularly in social interactions, or the threat of exclusion, or perceived

failure. While there are a multitude of factors at play to cause mental discomfort, I think it is

interesting to consider mental struggles as very human, and often rational, responses. Viewing

mental ‘ill health’ in a way of responses to life problems, rather than an inherent disease, has been

noted to lead to better treatment outcomes, and may help to reduce the stigma around how we

view those diagnosed with such mental illnesses.

There are parallels to this approach with the work of existential psychotherapist Irvin D. Yalom,

who’s therapeutic theory centers around the fundamental belief that mental health problems are

frequently caused by struggles with existence, of which four core themes were the most pertinent:

isolation, meaningless, mortality, and freedom. These fundamental concerns that form the basis of

what makes us human, makes many mental struggles formed around ultimate concerns of the human condition a natural outcome. Although these, in turn, will need to be addressed, I think it is

useful to consider the normalcy of mental turmoil, since it is an inevitable and very human aspect of

our lives. When we start to look at mental illness in this way, we see that the stigma surrounding

these mental ‘illness’ is very much misinformed, as it is a something we will likely all deal with on a

very fundamental level at some point in our lives. When we considered previous ‘disorders’ as

‘designed responses’, this can open the door to a broader paradigm shift away from mental illness as

a dysfunction, to a strategy.

‘Yet disorders come in all sorts of forms, are so global, that to believe in only one idea of what makes

people ill or well means to ignore other influences that might contribute to a person’s outlook on life.

Those influences could have been thousands of years in the making and a part of our genomic code,

or could have been as recent as some environmental stressors. Taking this view can tip the standard

of care to instead of trying to make everyone logical, rational and orderly, to simply helping someone

regain a sense of balance and in particular, helping those who are living with mental disorders regain

a sense of purpose.’ (Source: Psychology Today)