Mental illness is not deliberate

‘Covering it up’ is a far bigger problem than ‘making it up’…

It is still all too common to see reports or hear suggestions that people with mental illness are not trying hard enough to help themselves, give up too easily etc. etc.

It should go without saying that mental illness is not a matter of choice, nor the sufferers fault. Nobody wants to be psychotic, depressed, anxious or addicted to drugs. Mental illness, like physical illness, is caused by a combination of genetic and environmental factors, with biological, psychological and social components, that may develop and shift over years. One thing it is not is a choice. People cannot just ‘snap out of it’ because they did not snap into it. If it were simply a matter of ‘pulling their socks up’ or ‘trying a bit harder’ people would do so. If it was a matter of choice, then people would choose to be well.

The deliberate exaggeration or fabrication of complaints for financial incentives (malingering) or for no obvious reason (factitious disorder) is rare. Given that subjective ‘mental’ complaints like depression are no more easily falsifiable than ‘physical’ symptoms of pain, one has to ask why would anyone exaggerate or fabricate symptoms of mental illness when they would be likely to face prejudice and discrimination? Why feign mental illness, when these conditions are stigmatised?

Indeed, professionals versed in these issues generally reckon that patients are more likely to exaggerate or fabricate physical symptoms – such as when complaining of the effects of concussion or chronic pain.[1] People with mental illness are in fact unlikely to present for treatment, partly for fear of stigma and discrimination.[2-5]

In other words, when it comes to mental illness, ‘covering it up’ is a far bigger problem than ‘making it up’.

REFERENCES

1. Mittenberg, W., Patton, C., Canyock, E.M. & Condit, D.C. J Clin Exp Neuropsychol 24, 1094-1102 (2002).
2. Kessler, R.C. et al. Arch Gen Psychiatry 62, 617-27 (2005).
3. Wittchen, H.U. et al. Eur Neuropsychopharmacol 21, 655-79 (2011).
4. Bloom, D.E., et al. The global economic burden of non-communicable diseases (World Economic Forum, 2011).The Centre for Economic Performance’s Mental Health Policy Group. How mental illness loses out in the NHS (London School of Economics and Political Science, 2012).
5. Chief Medical Officer (CMO) annual report: public mental health. (DOH, London 2014).