The Hierarchy of Mental Illness
Which diagnosis is the least debilitating?
Vanessa Ferney
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There was a time when people were reluctant to disclose that they were depressed. It was considered a weakness by society at large. Seeing a therapist meant a person was unstable and a misfit. Today, that is still true in many parts of America. In New York City, however, depression and therapy reflect metropolitan lifestyle, as if life in the Big Apple mirrors a Woody Allen movie.

In the arts, it is normal to be depressed and in therapy. Prozac is consumed like candy in the eyes of the public, and it is almost unfashionable not to be depressed from time to time.

Being manic-depressive is now becoming acceptable in various communities as well. Robin Williams fans can attest to the fact that he is at his best and funniest when he reduces his Lithium. Mania has a reputation for being exciting and fun very often, with the negative aspects of bipolar occurring when depressed. Mania is considered equivalent to acting like a caffeine addict who drinks 15 cups of coffee per day. Anyone with serious manic depression, however, knows that mania can be quite horrific, involving paranoia, delusions, or even hallucinations, which are symptoms rarely discussed by the public. Yet, if someone says they are bipolar, it is still somewhat acceptable.

Next on the food chain of mental illness comes schizoaffective disorder, which cannot be fully understood without being familiar with full-blown schizophrenia. Schizoaffective disorder combines the symptoms of schizophrenia with those of a mood disorder. If you are schizoaffective, you are either unipolar or bipolar type, which means that you either suffer from symptoms of depression, or manic depression while also experiencing the more flavorful and prevalent schizophrenic symptoms. Schizoaffectives are considered to have a "better" prognosis than schizophrenia, but a "worse" prognosis than either mood disorder alone. This, however, is not always the case.

There are many people with depression or bipolar disorder that may at some point be less functional than someone with schizoaffective disorder, than with schizophrenia. Every individual must be considered unique with symptoms that affect their level of functioning differently. According to the public, however, being schizophrenic is ALWAYS considered worse than being bipolar, which is ALWAYS considered worse than being depressed. As far as schizoaffective disorder is concerned, most people have never even heard of it. It might as well be some new kind of dance craze or type of breakfast cereal. On my computer, the word schizoaffective is underlined in red because the computer does not recognize it as a real word. Those few who are remotely knowledgeable about schizoaffective disorder, tend to consider it nearly as "bad" as schizophrenia. It can even be argued that it is in fact a kind of schizophrenia, though it still has a different make-up of symptoms and is listed as a separate category in the DSM (Diagnostic and Statistical Manual).

Some schizoaffectives are actually "worse" off than schizophrenics, because they have symptoms from not one, but two diseases. Again, every individual is different.

Ironically, the same impression of various mental illnesses exists among people who are mentally ill, as within the public at large. The mentally ill tend to stigmatize themselves as much as others stigmatize them, otherwise known as self stigma. Many mentally ill people are afraid to disclose not just to society, but to EACH OTHER, and sometimes with good reason.

Manic depressives are considered "crazier" than depressed people, especially BY depressed people. That goes double, triple, quadruple for schizoaffectives and schizophrenics.

For example, suppose you were in a support group of people with mood disorders. It is perfectly acceptable to discuss your depression, how hard it is to get out of bed, your medication regimen, your therapy, and so on. A bipolar person discusses these things as well, but adds information on mania which includes delusions of grandeur, singing to people in the street, and buying a large plot of land in the South Pacific. The added manic symptoms are foreign to the depressed person and often considered "crazier."

A schizoaffective in such a group may have depression or mania as well, but then adds something about how their phone is being bugged or how difficult it is for them to learn how to fax a letter. All the more "bizarre" to the depressed person, and even to the bipolar, not because it is truly "crazy," per se, but because it is something someone who suffers from depression or mania alone has not experienced.

You, the reader, are probably thinking that the schizoaffective is certainly less functional than the depressive because he or she is paranoid or is having cognitive problems. Schizophrenics supposedly drop in IQ once they exhibit symptoms, and everyone thinks of this when considering the state of a schizophrenic or schizoaffective as well. But what about the depressive who stares at the cracks in the ceiling and cannot get out of bed, compared to the high functioning schizoaffective who writes great works of fiction. Or the schizophrenic who is effectively medicated, has a relatively high IQ, and thus very articulate, though still somewhat afraid of the police? Who is "lower" or "higher" on the food chain in this case?

The truth is that you cannot judge a person by his or her diagnosis, and we mental health consumers should know better than that. If we judge each other, then you cannot blame the public for judging us as a group. We mental health consumers need to make a positive impression upon everyone we encounter, mentally ill or not, and prove our abilities. This would be much easier if we would begin by giving each other a chance, so
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