One of my bicycle mechanic friends told me that every single person who brings their bicycle into the bike shop talks about JRA. I was “Just Ridin’ Along…. and my brakes suddenly stopped working.”  OR I was “Just Ridin’ Along, and my tire just went flat….” Out of the blue. The mechanics hear it so often that they just use the acronym JRA.  Never mind, for instance, the brakes needed maintenance, or the tire had 1500 miles on it and was so thin that flats started being very predictable.

So the disease model, or biological mental illness, says the illness “comes out of the blue.” Yet almost every one that I’ve asked talks about a series of biographical stressors that predated their entry into The System. For me, it was a marriage that was a poor match for my energy level, an existential crisis about my career, pot use, and a spiritual emergency all at the same time. No one worked with that stuff, though, they started talking biological mental illness and genetics and diagnoses right away.

The question is, “Is there any evidence that people who end up with mental health labels, but who are no longer symptomatic, have any different chemical or structural or genetic differences?” And the answer is no, this has never been proven.

Don’t Try Harder, Try Differently….

Lael Ewy Does a repetitive stress injury to a joint or a bone come “out of the blue”? It sure seems like it, until we look at the conditions that caused it.

And the chronicity of emotional distress is the same: if the conditions aren’t dealt with or better techniques for dealing with the situation aren’t adopted, you’ll keep having the same pain.

I realize that the “disease” model is flawed, but it’s falling out of favor in the physical health field too, for the reason that people aren’t “sick” in a vacuum; their problems occur within a biological, emotional, and cultural context. You can treat the lead poisoning, but if the kid still lives in substandard housing, you haven’t treated the problem, and he’s just going to get sick again.

And the joint, say, an ankle, will still have the repetitive stress injury until we learn to walk a different way or get different shoes. Just as we might need to find different ways to manage stress, or different people to spend time with, or different ways to move beyond past traumas than we have been using.

Why Even “Perfect” Lives can have Biographical and not Biological Mental Illness

Often times people point out that college is the age of onset for emotional distress for many people. This would make sense, since many people go through some kind of existential crisis in college as they put more academic or athletic pressure on themselves at the same time that they try to decide a future career.

Sooner or later we’ll put together a research article that includes people’s stories about how they entered into mental health care. When I tell some people this idea, that none of this stuff just comes “out of the blue,” often I hear that people thought their life was just fine. Well, it was for me, too, but the hardest part was my own expectations of my own achievement. I didn’t have a biological mental illness, I felt a conflict in my goals to be a great mom, a great scientist, and do good in the world all at the same time. I starting thinking that all three things wouldn’t be possible simultaneously.

And Dan Fisher explained this to me the other day when I was helping him to prepare the Statement of Psychiatric Survivors at the Carter Center symposium. We were sitting in the copy room of the hotel comparing our recovery stories, how we both got labeled during grad school as we were working on science degrees.

“There are many people out there that say it seems like biological mental illness because it came out of the blue. But this happened to me, too, and it sounds like your story, too. It seems like we were perfect people and we had to find a flaw in ourselves in order to become real. It’s like many Asian artists will leave a flaw in their art so they know it’s made by a human. We were too focused, too goal oriented to allow ourselves to feel humanity.”

 How about your experience, was it biographical or biological mental illness?