Stigma and Sense: Behaviour or disorder?

'The Express Tribune’ explains the difference to help you understand mental health better

KARACHI: Society may be waking up to mental health but the confusion over seeking help remains pervasive. The concept of getting treated for mood swings, depression or anxiety is unfamiliar to most.

What comes naturally to us, instead, is to deny and repress emotions by embellishing it under the term "strength." To realise one needs help and then to reach out for it can perhaps be best described as taking a leaping of faith.



Researchers have found that individuals show a preference for self-reliance as one of the most important barriers to help-seeking. Other factors include hopelessness and hapless, confidentiality issues and stigma attached to it. All this, coupled with the inability to recognise symptoms and accept that you have a problem, needs as much introspection as it needs external intervention.

In our part of the world, a major barrier to seeking help is also the misconception, misinformation and disinformation surrounding psychological care. 'Stigma and Sense' is an initiative by The Express Tribune that aims to go over the basics of mental health and illnesses for a layperson.

Behaviour or disorder?

In the midst of mundane conversations, we often hear latent murmurs of disorders disguised as behaviours. Terms such as Obsessive-Compulsive Disorder (OCD), Anxiety and Depression, Bipolar Personality Disorder (BPD) and Narcissistic Personality Disorder have snuck into our lives.

Not much thought is given when pegging someone as "bipolar" or claiming to have "OCD" – all without a diagnosis. But do we really know the gravity of using these labels to describe behaviours? Probably not.

PHOTO: FILE

A frequent example would be that of Imran Khan, who has been "suspected" of narcissism and grandiosity. Miles away, Donald Trump is routinely diagnosed with narcissistic personality disorder.

In a New York Times op-ed, Dr Allen Frances observed that "most amateur diagnosticians have mislabelled President Trump with the diagnosis of Narcissistic Personality Disorder… He may be a world-class narcissist but this doesn't make him mentally ill because he does not suffer from the distress and impairment required to diagnose mental disorder."

Dr Frances was the chairman of the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV (D.S.M.-IV). He added, "Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy.”

Now Trump's example may be excessive, but it paints the picture. How many times have we mislabelled someone or gotten mislabelled as "bipolar" if showing signs of indecisiveness. How many times have we been called "OCD" for being unusually particular about cleanliness?



The confusion lies in the basic understanding of psychology – the difference between a behaviour and a disorder. The DSM-V defines mental disorder as "a syndrome characterised by clinically significant disturbance in an individual's cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.”

It further adds, “Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g. political, religious or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."

The key word here is disability. To put it simply, as long as behaviour does not hamper the ability to live a normal life, it is not a disorder.  On the other hand, a behaviour that may come across as "troublesome" but does not disrupt your life or lives of those around you, may just be that: a behaviour.

People with psychological disorders rarely behave "badly" – at least not on purpose. Impaired cognition and inability to control emotions is as much a struggle for them as it may be for those around them.

Let’s take a look at OCD. The DSM-V characterises it "by the presence of obsessions and/or compulsions. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviours or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly."

In simpler words, a person with OCD is unable to process thoughts or perform tasks without adhering to obsessions and compulsions. If you or someone you know has a difficult time concentrating if say the files are out of order, you may have an obsessive-compulsive behaviour but not a disorder.

Difficult behaviours can be stressful but using psychiatric labels is a misguided way of countering them and downplays the struggles of those who battle with mental illness on a daily basis. To quote Dr Frances, "It is a stigmatising insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Trump (who is neither)." We need to be sensitive to the struggles of those in agony.

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