I read a Twitter thread recently about an individual in the UK who had their disability benefits revoked because the assessor said that they “looked too glamorous” to be mentally ill.
Now, this may sound silly to you if you’re not disabled or chronically ill, but I would submit that a) chronically ill/disabled people don’t think it’s silly, because they have to deal with biases and struggles such as this (getting disability reinstated) all the time; and b) this is one example of common biases and myths about mental and physical illness. Let’s talk about them.
Myth #1: Sick people LOOK sick.
Crew Dog, onesickvet.com
Having been told many, many times that I “don’t look sick” or “but you look good” (even from doctors), I must assume that people’s perception of illness is stuck in the Middle Ages: If someone is carrying a dangerous contagion like the Black Plague, they will have obvious external symptoms, and healthy people will easily be able to avoid them and stay healthy.
The flip side, that people who look healthy must be healthy, is part of a cognitive bias known as physical attractiveness stereotype.
Myth #2: People who look healthy ARE healthy.
Crew Dog, onesickvet.com
This myth is pervasive – and dangerous. Especially when combined with body dysmorphia. I know chronically ill women who look malnourished – because they *are* malnourished, due to their health conditions. But, thanks to the pervasive lie in Western society that women can never be too thin, these malnourished, ill women are told they look great, and even are the objects of envy from other women. And many people with eating disorders are praised for the way they look – until they have lost so much weight that their health (and lives) are in severe danger. So, “looks healthy” does not equal “is actually healthy,” and skewed perceptions of what “looks healthy” may not actually align with what a truly healthy person looks like (if there is such a thing).
Other examples of looking healthy not equating to actually being healthy include Jim Fixx, the runner who helped spearhead the running/jogging fitness movement but who dropped dead of a heart attack at 52. Or Catherine Zeta-Jones, who looks fabulous but has bipolar disorder. Or Selma Blair, who also looks fabulous, but has MS (multiple sclerosis). [Can we just pause a moment and appreciate all of the celebrities who are “coming out” about their health problems? I am so glad they are joining the conversation, raising its profile, and “normalizing” health problems, chronic illnesses, and disabilities.]
Additionally, most people with cancer don’t look any different from people without cancer (at least, before they receive treatments that can make their hair fall out and such). So why does the myth that people who look certain ways are healthy persist?
Myth #3: “Crazy” people look obviously crazy.
Crew Dog, onesickvet.com
Again, the myth persists that “crazy” people look crazy, like Michael Keaton in Beetlejuice, or any actor who played The Joker in the Batman series, or like Bertha Rochester (the crazy wife in the attic) in Jane Eyre, or perhaps even Bellatrix Lestrange, from the Harry Potter books. I can only assume that, like with the Black Plague analogy for physical illnesses, this myth persists because people would like to believe that they can perceive and avoid mental illnesses and the people who have them (instead of haplessly marrying them, like Mr. Rochester did).
But believing that “crazy” people look crazy is harmful in so many ways. One example of which being the original Twitter thread that started this rant blog post: the harm that comes when people are judged to “look too good” to have a mental illness.
First of all, mental illness covers a broad spectrum, and most mentally ill people (or people with mental illness, if you prefer that language) are no harm to others.
Second, as scientists and medical professionals (slowly) learn more about mental illnesses, they are developing more effective treatments. Perhaps much of the lingering fear of mental illness persists from the days when there were few effective treatments, and patients were simply locked away in asylums to deteriorate with no effective treatments.
Third, “average” is a mathematical construct. “Normal” is a statistical artifice that makes data easier to manipulate and understand by forcing it into a distribution (see Bell curve). And many neurodiverse folks (who I am not calling crazy) would argue that being average isn’t necessarily “better” than being an outlier. You may be of average intelligence, of average health, or have an average balance of brain chemistry. All this means is that, based on current measurement devices, techniques, and practices, you seem to align with a majority of the sampled population. Supermodels, world class athletes, and geniuses are examples of people who are not average – they are exceptional – outliers in respective areas (appearance, physical abilities, mental abilities, or creative perspectives). So, in effect, by seeking to discern who is “normal” and only associate yourself with them, you are excluding anyone who is exceptional – anyone who does not easily fit in with the (perceived) majority.
Myth #4: If you have mental illness or cognitive difficulties, you can’t accomplish goals. A.K.A., if you’re high-functioning, you have no mental or physical illnesses.
Crew Dog, onesickvet.com
To add to the Twitter example, in my own case, when I applied for VA disability, the interviewer told me I could not possibly have any cognitive impairment because I was in a doctoral program. End of story. He had made up his mind when he read in my application that I was in grad school. During the interview, he asked if I was still in grad school, and despite me listing the ways in which I was having difficulties, as soon as I affirmed that I was still (technically) in school (though making no progress), his mind was made up. (I subsequently had to withdraw from grad school due to cognitive difficulties.)
This misperception that high-achieving individuals, also known as high-performing or high-functioning, cannot also have mental or physical illnesses is patently false and absurd. See this article: “Now, at age 26, Claire manages to hold down a high-stress job as a legal office manager for a multimillion-dollar law firm despite battling not only a depressive disorder but also type 1 diabetes and kidney disease.”
High-functioning individuals face stresses just like less high-functioning individuals do, and either type can be prone to anxiety, depression, perfectionism, eating disorders or other illnesses, or unhealthy coping mechanisms such as substance abuse. (See this article, or this one.)
I am in no way implying that high-functioning individuals with mental illnesses are better than lower-functioning ones. I am simply pointing out that if you’re able to disguise your mental or physical disabilities, people choose to believe that they do not and cannot exist. Particularly if you are coping with a mental or physical disability and achieving as much as or more than your evaluator has, they refuse to believe you could possibly be ill.
Myth #5: Health (whether mental or physical) is static – it stays the same over time.
Crew Dog, onesickvet.com
People act as if healthy people will always be healthy and sick people will always be sick. While it’s true that chronically ill and permanently disabled people are highly likely to remain that way (barring new medical advances), it is also true that most humans are only temporarily abled. Additionally, it is also true that some chronic illnesses have periods of remission, and that chronic illness symptoms may come and go, or be stronger on one day but less impairing on another. And some people’s symptoms improve or disappear when they’re on the correct medications.
Even healthy people occasionally suffer from illnesses such as colds or the flu, and injuries such as sprains or broken bones. Health is not binary. No one is 100% healthy 100% of the time, and almost no one is 100% impaired. Health is a spectrum. And one’s position on the spectrum fluctuates. It is not static. You could even argue that we are all “health-fluid.”
Myth #6: People can completely control their physical and mental health.
Crew Dog, onesickvet.com
Most people, whether or not they are aware of them, operate under the influence of cognitive biases such as the Illusion of Control (“the tendency for people to overestimate their ability to control events”), or the Just-World Hypothesis (“the tendency for people to want to believe that the world is fundamentally just, causing them to rationalize an otherwise inexplicable injustice as deserved by the victim(s)”) to explain to themselves why some people (but not others) are ill or disabled, or to (falsely) reassure themselves that such things will not happen to them.
Acting according to, and in order to reinforce these biases, people will often blame chronically ill or disabled folks for their conditions, or (rudely) ask how their condition came about, hoping to confirm their biases. In the descriptive and powerful words of Elizabeth at Owning the Stars, what these people are, in effect, saying when they ask such questions is, “Please confirm for me that this was in some way your fault and not a horrible random piece of chance so that I can comfort myself by believing that this could never happen to me or someone I love.”
Unfortunately, this is not how life works. People get hit by trucks (like Elizabeth did). Spouses get cancer and die. Healthy people who “do everything right” get Alzheimers. Bipolar disorder can be brought on by stress. Deteriorating health is pretty much a part of aging. And, to paraphrase Ecclesiastes, “Time and chance happen to [us] all.” Even if you’re physically and mentally “normal” now, it probably won’t stay that way. You are, at best, temporarily abled.
BOTTOMLINE: Instead of acting like people with chronic illnesses, disabilities, neurodiversity, or mental illnesses are abnormal and probably to blame for their conditions, instead of denying invisible illnesses or disabilities, consider the truth that nearly everyone is only temporarily abled. And just because someone became disabled more quickly than average doesn’t mean they’re lazy, faking, or inferior, or that they did something to deserve it. Consider how you’d like to be treated when you become chronically ill or disabled (typical conditions the elderly cope with include diabetes, failing eyesight, failing hearing, arthritis, and dementia). But don’t assume other people would want to be treated the same way you would – Ask chronically ill/disabled/neurodiverse/mentally ill people how they’d like to be treated.
Treat chronically ill/disabled people of all ages like people – because they are.