It was World Mental Health Awareness Day this week. And today is International Day of the Girl. And it was the anniversary of Maria De Villota’s passing. And it was American Coming Out Day. I’m sorry that I didn’t have spoons to make a big deal about any of it on social media, because work stress was/is giving me mental health symptoms.
Believe it or not, mental health is an issue in motorsport. The MSA currently has a ban preventing anyone with a mental illness from getting a racing license, and they’re not the only ones with that kind of attitude towards mental health. For a long time, the flying fraternity wouldn’t let anyone on antidepressants fly with passengers, in case they attempted suicide with people on board the plane.
This kind of policy is ableist. There are people who, through no fault of their own, have illnesses that make people afraid and distrustful of them. It’s like having a facial deformity that people find repulsive, except they can only see it when you’ve formed a bond with them and taken off the mask of being ‘okay.’ Having formed a bond before they see the truth under the façade makes it hurt more when they reject you.
This ableism is probably because we have very limited vocabularies for mental illness. Crazy. Mad. Demented. All mental illnesses lumped together under a handful of umbrella terms, dehumanised, and pushed to the margins of society where our diseases can’t infect the ‘mentally well.’
Mental illness affects marginalised groups more, not because the incidence is necessarily higher in those groups, but because it adds an intersecting layer of oppression on top of what they’re already dealing with. Also, they are more likely to go undiagnosed, because of stereotyping. Black people are just angry. Women are just emotional. Are you on your period…is that why you’re moody?
Studies have shown that women are more likely than men to have a physician ignore their symptoms and not provide a diagnosis. Doctors think women have lower pain tolerance, so are more likely to ignore the pain-related symptoms of congestive heart failure. Bipolar disorder often goes under the guise of PMT until the girl is old enough to be hospitalisably symptomatic. I spent years being told to ‘be less of a bitch’ while premenstrual, until I was twenty-five years old and someone finally noticed that it was a symptom in a larger pattern of behaviours. The population of the women’s prison in my town features a subset of about fifty percent of inmates who are in prison for killing their babies in a fit of postpartum psychosis, because doctors in Zimbabwe don’t give mental healthcare or preventative medications to new mothers. It’s systemic, and the result of unconscious biases.
In truth, there are the common illnesses that are treatable with non-invasive therapies like Vagus nerve-stimulating meditation, psychotherapy and hypnotherapy, antidepressants or antianxiety drugs, trans-cranial magnetic stimulation, or limited-dose drugs like psilocin/psilocybin (the active ingredients in magic mushrooms) and MDMA (methyline-3-4-dioxymethamphetamine, aka molly or ecstasy). The last two drugs are controversial, but mainstream researchers like Johns Hopkins Medical School, Imperial College London, and the US Army are having success with their trials. (They are to be taken seriously and under medical supervision only! Dropping a few tabs of molly at a rave isn’t going to make a difference to long-term mental health.)
These illnesses affect huge swathes of the population – including the segment who work 60+ hours per week in motorsport – and are on the rise. Illnesses like depression, anxiety, and PTSD fall into this category. It is important to remember that, while common, these illnesses can be fatal if left untreated for long periods of time. However, with diagnosis comes treatment, and most cases of these illnesses respond to the therapies listed above. For the ones that don’t, Jaak Panksepp and colleagues are working on a neural implant for drug-resistant depression. While at an elevated risk of suicide, these people are not generally reaching for a shotgun every five minutes, certainly not enough for the MSA to worry that they might kill themselves and others on track.
Chronic depression increases the risk of heart attack, as does chronic anxiety. Our bodies literally cannot handle being that sad/afraid for that long, and the ticker is the first thing to give out. The mind-body connection is poorly understood, but all the disorders listed in this post have physical symptoms and carry elevated risk of death from causes other than suicide.
Men are especially likely to die of depression or PTSD. There is a societal norm that states that boys don’t cry. Several men have spoken about how the only emotion they feel allowed to have is anger. When they feel fear or depression, they are taught to suppress those emotions. Men often don’t feel able to ask for help, because admitting to depression makes them seem weak.
I’ll lump my illness in with the discussion of several others, because they’re treated with the same drugs and therapies. Bipolar mood disorder (what I have), unipolar mood disorder (like bipolar, except without one end of the spectrum), epilepsy, and temporal lobe epilepsy are all treated with a small collection of antiseizure mood-stabilisers and regular talk therapy. Schizophrenia – which is sometimes under-diagnosed because of its similarity to bipolar disorder in the presentation of auditory hallucinations and psychotic symptoms – is very effectively treated with antipsychotics and talk therapy.
The suicide rate among patients of these disorders is markedly higher than the category listed above. Nobody knows the exact number, but bipolar and unipolar mood disorders have a fatality rate of around two thirds of sufferers. That is, two out of every three patients will eventually kill themselves in a moment of abject misery.
Temporal lobe epilepsy seems to be a response to environmental factors, whereas epilepsy that causes TC (previously called grand mal) seizures seems to be caused by a variety of factors, including repeated MTBI (minor traumatic brain injuries, also known as concussion). In places where medicine is a largely spiritual practice (including communities of white Christians, just in case you thought this was something only brown people did), temporal lobe epilepsy is often mistaken for demon possession and be left untreated other than regular exorcisms.
These illnesses – the epilepsies I’ve mentioned, as well as the bipolar/schizophrenia group – develop noticeable symptoms in late teenhood or early adulthood. There is plenty of time for someone to start karting, fall in love with the sport, and make progress through the ranks before becoming symptomatic. This makes the MSA’s ban and regulations like it in other countries very distressing for people with these illnesses. They have been known to hide their symptoms and detox from their meds for a few weeks before their license medicals, neither of which are healthy things to do in the long term.
The challenge of these chronic diseases is keeping people on medication. Medication has side-effects. The things we use to self-medicate, while less effective than the official drugs, produce more manageable side-effects. You can go ahead and add “I feel fine today, so I don’t need to take my pills,” to the list of challenges faced by doctors treating people with many of these illnesses. Non-observance of drug regimens is a problem to the extent that there is a research paper called “the best drug for bipolar disorder” that concludes the best drug is the one the patient is willing to take daily. Giving people a reason to stay on their meds is vital in the long-term success of these illnesses.
Letting mental illness patients do favourite activities or things that give them joy and allow them to enter flow is a very good way to motivate them to stay present. Our minds are easy places to get stuck – for neuronormative as well as neurodivergent people – and, without something keeping us in the present, disappearing into the thought realm is a great way to avoid reality. If a kid holds racing as a favourite thing, and develops a mental illness, having racing taken away from them for being ill is emotionally distressing, and can raise their risk of suicide.
Personality disorders are pertinent to our discussion, for two reasons. Firstly, Millennials are constantly being accused of being narcissists in the media. Narcissistic personality disorder is fairly rare and has very clear diagnostic criteria. Millennials are not pathological narcissists; we simply don’t want to work for people whose values don’t align with ours, and therefore seem self-serving when we quit to ‘find ourselves.’ There may also be some influence from what Simon Sinek calls ‘failed parenting strategies’ in this group of people due to dominant child-rearing philosophies in the eighties and nineties.
Secondly, sadistic personality disorder is positively correlated with trolling behaviour. If someone seems to be being mean to you online for the sake of being mean, they may not be able to help themselves. It may be a personality disorder shining through, but know that this illness affects less than 1% of the population. Psychopathy and Machiavellianism are in this group.
The four are collectively known as the Dark Tetrad of personality. All of them go untreated for the most part, because they make the people who have them unpleasant to be around. There’s often nobody left to ask for help when the patient realises they need it.
The final group I will address is ADD/ADHD (another one on the list of things I’m chronically ill with) and the autism spectrum, which are poorly understood. This group of illnesses seems to be caused by any one of several possible factors, and ranges in severity from mild social impairment – for example, Sheldon Cooper’s inability to detect sarcasm, or a person with ADHD blurting out something inappropriate to the context – to being completely unable to communicate verbally. Many cases are mild, and can evade detection by medical professionals for years. Symptoms for these disorders develop in infancy and early childhood, and some doctors tell the parents of these children that their offspring are ‘just being difficult’ or ‘just responding to your parenting style.’
Development workers say that girls in developing countries skip school because the menstruation facilities aren’t sufficient. The same trend of absenteeism is true of people with mental illness. The collective impact of these illnesses is only possible to estimate, but some figures suggest that the global economic benefit of destigmatising and treating depression would be in the order of magnitude of the GDP of a reasonably-sized European country.
A good starting point would be to stop shaming men for feeling emotions other than rage, and stop dismissing women as ‘emotional’ when they report mental illness symptoms. We need to accept that as social animals, we all have feelings. Only when we listen to negative emotions and get curious about their causes can we have a meaningful conversation about mental healthcare. We can’t do that as long as we’re gendering basic human emotions.