Mental Illness and Cognitive Dissonance

It’s no secret that the spectrums of mental illness come fraught with confusion, anxiety and fear, whether it be depression, bipolar disorder or schizophrenia. In some cases, the illness is the anxiety and confusion itself – a deep-set emotional displacement that has no reasonable cause behind it. There exists an endless number of factors that influence, weave in and out of, and cause mental illness, and it can take decades of therapy and medication to root out the reasons behind it, never mind help resolve it.

One of the biggest pain points for me – and for many people I know – is that there exists a discrepancy between what they see and what they feel, or between what they believe and what they’re told to believe. It can be as simple as feeling worthless when everyone around you tells you how great you are; it can be as complex as believing that you don’t physically exist, despite being able to touch and feel your own body.

Cognitive Dissonance Theory

The concept of cognitive dissonance dates back over sixty years, when psychologist Leon Festinger proposed that humans need a kind of internal consistency between belief and perception in order to function mentally. The basis of his work came from a phenomenon in the 1930s after a severe earthquake in India. People who felt the earthquake but suffered no damage began to believe that worse disasters were yet to come – not because there was evidence to justify their fear, but because they needed a belief to justify their fear.

This is something that can be seen throughout the world today; perhaps the most obvious example is theology. People believe in the existence of a deity or deities not because there is evidence to make them believe, but rather because the existence of those deities is necessary to support their beliefs.

The thing is, when there is a contradiction between belief and perception – or simply between two beliefs – people will go to extreme lengths to justify both beliefs. Historically, the geocentric model of the solar system is another example. Despite evidence to the contrary (the motion of planets, stars, etc.), astronomers came up with increasingly complex systems to keep the earth at the center of the universe, because it was necessary to support their belief.

Subjective Dissonance

One of the greatest challenges to psychology is the subjectiveness of the field; whilst chemical and behavioral studies can help, and large data sets balance things out for clinical trials, when treating individual patients it can be difficult to isolate a particular illness for the purpose of a diagnosis, simply because the treating psychologist is reliant on the subjective description of the symptoms by the patient. Observationally a person may appear depressed, but internally they may feel content or happy.

This disconnect between objective fact (what a person does or says) and subjective reality (how the person really feels) is often at the heart of many mental illnesses. For myself, a day in bed might be genuine exhaustion from a hard week at work, or perhaps a low-level illness; to my family, who’ve seen me like that frequently, it’s just depression. And of course, the behavior often begets the emotion – the longer I stay in bed, typically the worse I feel.

For someone in the manic phase of bipolar disorder, it can be even worse: to the sufferer, the world is on their side, everything is going amazingly, and nothing can bring them down. To the observer, they are erratic, nonsensical and in some cases outright dangerous.

Belief in Treatment

The key to surviving with mental illness is to get help; to find treatment. It can be in the form of therapy, medication, meditation … all these things are proven to help balance an unbalanced mind. But dissonance can be a challenge here, as well. To start with, it can be difficult to admit you need help – you don’t want to believe you have a problem, despite observable evidence to the contrary. Alcoholics suffer from this; the pile of empty bottles in the garbage simply don’t equate to a drinking problem. They find ways to justify the drinking – even in the most absurd ways – because they don’t believe they have a problem.

On the flip side, someone in the throes of depression may not believe they can be any help – that there is no point seeking treatment, because it won’t make any difference. I’ve suffered this for most of my life.

And then, of course, there’s the behavior changes associated with treatment itself. The classic example is the schizophrenic patient who goes off their medication, because on the medication they feel fine and believe they don’t need medication. Another is when I stop taking my own medications because I’m running low and I don’t want to run out.

Logical Fallacies

To anyone on the outside, this simply doesn’t make sense; it isn’t logical. But logic is the enemy of cognitive dissonance (or perhaps the other way around). In my mind, it all adds up: if I run out of medication I will feel worse; therefore if I stop taking medication, I won’t run out.

My friend at work was talking to me the other day and mentioned a similar experience; he suffers from extreme anxiety, and is on medication to help cope. But once he was on the medication he didn’t feel anxious, and when you don’t feel anxious, you don’t need medication. So he stopped.

These sorts of logical fallacies are the loophole for cognitive dissonance. I can use a kind of “When A is true then B is true; B is true so A must also be true” reasoning to connect the disparity between my thoughts and my perceptions. The subjective truth is that I meed medication to keep a constant chemical balance in my brain, but the objective truth is that I simply feel better.

In the end, cognitive dissonance isn’t going anywhere, and nor is mental illness. But an awareness of this problem can help a lot of people – it certainly helps me – to push through with something that might not immediately make sense, because in the long run it will help. Keep taking the meds, even when you feel fine, because the meds are the reason you feel fine.

And if the problem is that you simply can’t believe in your own worth, use this to look around you. The people who still talk to you, who live with you, who put up with you – they wouldn’t, if they believed what you do. You might not be able to change your belief, but you can change your behavior – and that’s sometimes the first step towards changing yourself.

A New Kind of Stigma

My writer’s ink has literally dried up in the last few weeks.  At first it was a “I’m too busy” thing, then it was a “people are helping me access treatment” thing, then it was a “I’m too happy” thing and then, believe it or not, it was a “I am accepted” thing.  And like the things that are peculiar and do everything in the opposite in Cat in the Hat by Dr Seuss, I do not know how to speak or write happy, treatment access, acceptance stuff.  No.  I can write volumes about what is wrong with mental health services, how people are not accessing the life-saving support they need, how discrimination and stigma crush and damage the people who are living with a chronic illness that changes the course of their lives forever.

Yes.  I can describe depression, psychiatric wards and healthworkers who are as sensitive as I am after taking my Serraquel and heading for bed (that’s not very).  And I think I have done that within this very space on The Bipolar Writer.  Amazingly, many of you wrote back and said what can we do, how can we help.  My response a few weeks ago, was that people with mental illness globally should stand up, talk, talk, talk, take action, scream and shout, document and show what’s really happening EVERYWHERE until we see the changes that need to happen.  And we are assured that those changes would be sustained.  I still think that needs to happen.  But my experience – and these niggly things I’ve come across – make me want to add a lot more.

Not only do we need to highlight the darkness, the human rights transgressions and anything that fundamentally affects mental health – we also need to celebrate, and shout loudly about people, organisations, companies, communities that are accepting, that help, that accommodate, that assist people with mental illness.  We need to show that it can be done.  And that the results are awesome where it works.  That we can “function” just as well as our environment allows us to.  No, I don’t believe functioning is on a scale of 1-10 – but rather what is best for a particular person at a particular time, and BUT a lot of that depends on how they’re treated and received.  What they are provided access to.

One example of the acceptance I received was in a job interview.  After a great discussion (which is generally how it goes) I decided after a heave ho in my mind that I needed to disclose that Bipolar lives with me.  For the first time since I was diagnosed a good long decade ago.  That I would only be prepared to work in an environment that was accepting of that.  And that Bipolar wasn’t a matter of running between two poles of sadness and happiness, as I’m built for comfort not for speed (and that would be exhausting).  More seriously, I said that my wellness at work was dependent on the relationship with the employer, and not “special allowances” but rather an understanding of where I am, what I need, and what would contribute to wellness going forward.  That my treatment team could participate (obviously without disclosing anything) in analysing and assessing what contributes and detracts from staying well.  That it was possible.  And even more importantly, that I was so, so, so worth it.  I have never believed that a day in my life.  Never.  Until now.

I don’t know if I got the job yet.  Maybe they were just being nice… I am, based on experience, skeptical.  But they have given me something I could not pay for already.  The belief that that a world where I – and people like me – can be accepted, loved, happy.  What can we do?  What can we change?  Our minds, our behaviour, our reception of people who are vulnerable, of people who need help, no matter what affects or ails them.  And, maybe, just maybe, we can do that with a smile on our faces.  I’m going to.   Be part of those who support us as opposed to those don’t.  I am 4M’s Bipolar Mom.

Olena Sergienko