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A Contextual Path to De-Stigmatizing Mental Illness

By June 5, 2017May 18th, 2019No Comments

Are there really separate mental and physical illnesses?

There has been a fair amount of talk lately about de-stigmatizing mental illness and providing appropriate treatment and care for the many diagnosed and undiagnosed cases in this country. This includes many habitués of prisons and of the street. In some cities, our sidewalks are reminiscent of another century when madness was treated as cruelly and cavalierly as is being done in the contemporary world.

Many of us agree that mental illness should be de-stigmatized. For some, the solution is to consider it on a par with physical illness for treatment and insurance purposes. Making the two equivalent in these ways would alter their reflected image in the eyes of the public, the ultimate outcome hopefully could transform the sense of shame felt by sufferers and scorn by those who do not understand.

No one should feel defective or ashamed to be suffering from a condition over which they have no control. That is one of the most important distinctions that is often made between so-called psychological and physical conditions. They should “shape up, have a better attitude and stop wallowing in their own misery.” Should they and can they?

We all suffer from the ups and downs of ordinary life from ordinary stresses, and there are more and more of them as cultures become more complex and more global and threats to our well-being appear on our ubiquitous telephones every moment of the day. Are there, in fact, separate physical and psychological illnesses?

I want to suggest another and totally different solution to this problem. I want to skip right over the notion of separateness and of equal concern for this proposed parallelism. That is, that we abandon old-fashioned categories from another century and that we consider a completely different paradigm that does not separate illness and injury, which have been shown to be intertwined by many research projects. Within that paradigm there is not only NOT a distinction between the physical and the mental, but neither is there a separation between illness and injury, or trauma.

These experiences are more complex than we once understood. I suggest that there is no biological illness without the intertwined environmental influences, as epigenetics is showing every day. There is no “mental illness” separate from the physical or from exacerbating and traumatic experiences.

Secondly, I want to call to your attention that what we now call “mental illnesses” are not just located in a designated area of the brain, but are being shown to have contributions from multiple areas of the brain itself. Just as important are the discoveries that the brain is part of a complex system that includes the vagus nerve, the gastro-intestinal system and what we currently refer to as the immune system. The causes and effects of these mental illnesses, so-called, are not discrete or linear, as we once thought. Now stir in any number of environmental influences and you have a much more complex recipe for what ails many of us. We must think much more holistically to solve psychological/physical/contextual problems.

There may well turn out to be some “pure” illnesses or separate traumas, but that is a question for science, not for conjecture. I cannot imagine them not involving the entire physical/familial and cultural contexts, including gender, ethnicity, class and many other significant influences.[1] There is nothing more important than changing perspectives from the intimate personal to the broad cultural to put together the pieces of this puzzle.[2]


[1] Kaschak, E. (2013) The Mattering Map: Confluence and Influence, Psychology of Women Quarterly, 37:4.

[2] Kaschak, E. (2014). Feminist Approaches to Psychotherapy, Wiley-Blackwell Encyclopedia of Gender and Sexuality Studies,London: Wiley-Blackwell.

This article was originally published in Psychology Today.

Ellyn Kaschak

Ellyn Kaschak

Ellyn Kaschak, Ph.D. is an internationally acclaimed and award-winning psychologist, author and teacher. She is well-known as a speaker, workshop leader, human rights advocate and a public intellectual.