Friday August 4, 2017

Soldier On?

When Senator John McCain’s office announced last week that he has brain cancer, politicians on both sides of the aisle cheered him on with battle cries extolling his fighting spirit and hailing his prospects for winning the war against his disease. Personal agency certainly influences healing. But as Jean Hannah Edelstein argues, the ‘warrior metaphor’ can be trouble when it comes to health.

Obama tweet

This is especially true when it comes to mental health. We often talk about promoting resilience as a life skill,  the same way we’d talk about learning to swim or to ride a bike. But while developing internal strength to face adversity is important and good – indeed it’s an essential component of psychotherapy – there is a darker side to the “resilience rhetoric.” It promotes the deep-seated but grossly misinformed idea that you can “kick depression” or “just calm down” if you rally your will and muster up the strength. And this simply is not the way recovery from mental illness works.

1.

Why do we urge people to fight to win their battles with ill health?  Surely we have the best of intentions when we tell people they can “kick cancer” or “beat depression.” We naturally want to cheer people on, empower them, and encourage a sense of their own agency. And in fact, it does matter what we do when we are ill: our coping strategies can impact the course of our illness, our quality of life, and our recovery.

2.

So what’s the problem with cajoling loved ones to soldier on?  The trouble with the warrior narrative is that it promotes a logical fallacy that someone suffering from a mental illness, particularly a chronic one, must not have tried hard enough to beat it. They must have “lost their battle” because they were weak, because they had a bad attitude, because of some deeper moral failing.

3.

Someone with depression is no more to blame than Senator McCain is to blame for brain cancer. Although our diagnostic system identifies the problem as residing within the individual, we know that wellness and ill-health are the result of an extraordinarily complex interplay of social, environmental, and biological factors. The rugged individualism of American society inadvertently promotes the idea that ill health is somehow uniquely the result of bad decisions and weak moral character – that ill health can somehow be beat by the individual alone. Not true.

4.

The politics of the warrior narrative.  The fighting metaphor is one of personal responsibility and individual agency. It also has real political implications. If responsibility lies solely with the individual and not with the larger society, it takes the collective off the hook. There’s no need to improve communities, no need to invest in social services; people just need to be stronger. And there’s is the rub: of course we want to promote strength and courage and resilience, but we also need to recognize that societal factors like poverty and violence and education are enormously influential when it comes to risk and recovery for many health conditions, especially mental health.

5.

What can we do and say to Senator McCain and what can we do and say to those with enduring mental illness?  We can balance our messages. We can encourage and empower. We can offer kindness, compassion and understanding. We can promote agency and acceptance. We can empathize and support. We can remember that ill health – whether it is a brain tumor or major depression – reflects a particular intersection of biological, environmental and social factors; some things are in our control and some things will never be.

We can remember that we are each born into a larger story, and our personal journeys belong to us as individuals within the collective. We can remember that societies as well as individuals shape health and healing. And as we grapple with healthcare reform in the USA, we need to marry our rugged individualism with collective responsibility and stewardship to maximize health and healing.

 

Senator McCain, I am sorry that you are ill. I hope you find strength during this chapter of your journey and a community that supports you. I wish the same for individuals who struggle with mental illness every day.

Kathleen M. Pike, PhD - Is Professor of Psychology & Director of the Mental Health Program at CUMC kmp2@cumc.columbia.edu