What’s the Worst Mental Illness?
I, as a good little webmistress, keep an eye on my web analytics. So yes, I know some things about my audience, and one of the things I know is what people are searching for when they find me. This sometimes influences what I write about, like today: What is the worst mental illness?
What is the Worst Mental Illness?
That depends on how you judge it. You could judge it by suicide rate, in which case:
- Anorexia is the worst with about a 20-25% suicide rate*
- Bipolar is second worst with about a 15% suicide rate^
- Schizophrenia is third worst with about a 10% suicide rate**
You could judge the worst mental illness based on disability rates in which case you would probably get:
- Schizophrenia as the worst
- Bipolar as second worst
- Depression as third worst (although more people with depression are on disability overall)
Perhaps schizophrenia is the worst as it’s associated with more psychosis (delusions and hallucination). Perhaps major depression is worst because of the number of treatment-resistant cases.
Or perhaps the answer is simply this: The worst mental illness is the one you have.
Psychological / Psychiatric Pain Scale
I’ve had doctors want me to put my mood on a pain scale of 0 – 10 where 0 is practically dead and 10 is no pain. And I have done that appointment after appointment, as requested. I’d imagine many people have done this exercise.
But even if you consider yourself a “3” and I consider myself a “4” that doesn’t indicate that one disease is worse than another. It doesn’t even indicate who is in more pain. It just means that in our own heads that is our experience. Once you learn you can experience more pain than you ever thought possible, the scale shifts. Trust me.
But what does that matter. If half as much pain as you experience drives me to commit suicide, who the heck cares how we compared?
Mental Illnesses are Individual
What I’m saying is that my struggle with bipolar disorder is mine and unique to me. I have a unique set of symptoms, a unique set of challenges and a unique set of techniques that I find helpful. Bipolar disorder and all mental illness are heterogeneous that way.
But believe me when I tell you, no matter what the diagnosis, no matter what the illness, no matter what the pain scale, no matter what the statistics say, it doesn’t matter. Because when you’re on the floor of your kitchen with a razor blade in your hand, you know one thing for sure – your mental illness is surely the worst in the world for you at that moment. And you’re absolutely right.
* FYI, that’s a contentious number people argue over there. I suspect it includes all manner of anorexia-related death.
^ This is also a contentious number with some experts saying it’s closer to 6-10%.
** The number here may be lower than commonly accepted too at around 6%.
25 Responses to “What’s the Worst Mental Illness?”
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Schizophrenia is probably the worst. Almost nothing good comes from schizophrenics. I’m xchizo and I can tell I’m annoying, I don’t try to be but we are socially inept. We are robotic in conversation and have no self identity. It’s a tough job but some of us gotta do it
Hi MarrInde,
Well, I don’t have schizophrenia, so I don’t speak with the same experience that you are, but I know that people with schizophrenia have made all sorts of wonderful contributions to society, and of course, the lives of individuals.
Social interaction isn’t everything and many people can see beyond rough social edges.
Believe me, you have a lot to give, even if you can’t see it.
- Natasha Tracy
I agree with much of what you said, however, I do feel like one key disorder is missing – borderline.
Hi Ree,
Are you saying that borderline personality disorder is somehow worse than every other mental illness?
- Natasha Tracy
I’ll never forget what Edgar Rivera said. He was pushed in front of an oncoming subway train by Julio Perez who had untreated schizophrenia. Edgar survived. When he woke up he said, “I lost both my legs. Julio lost his mind. I think I’m luckier.”
Hi DJ Jaffe,
What a kind and generous comment. I can only pray I could show such compassion in such a situation. Stunning.
- Natasha Tracy
[...] The blogger Natasha Tracy, who has bipolar disorder, wisely recognized the delicacy of this issue in a recent post on what the “worst” mental disorder is. She writes: [...]
Thankfully for the web I could say I felt like whatever bipolar was I had it the worst. Now, I know others have suffered as I have and probably tipped the scales in delusinal thinking more than I khave. Not saying that I look to find others worse off than me but I feel more okay with myself knowing in my worst moments of rage or deepest depths of pain daydreaming of a way to end the torment there is someone out there who can sympathise.
I honestly thought I was alone and after twenty seven years I still have not met anyone (in person) who has as many issues as me functioning or trying to live a normal life. Perhaps one day, I think I would cry I would be so happy.
Oh look it we have matching scars, wow, lets hang out…..heh…..that was meant to be totally literal.
Hi Samantha,
I’m so glad to hear that you know you’re not alone. This can help so many people reframe their illness and feel more connected with others.
It’s not frequent that any of us meets others just like us in real life. I hadn’t either until recently. But keep in mind that most people don’t wear their illness on their sleeve and you may have met people just like you but not known about it.
I know you’re not kidding about the matching scars. But don’t forget, many people keep their scars inside.
I know what it’s like to want to be able to touch someone you can identify with that much. I can’t promise that it’s coming, but I can say that we connect with people on all levels and you might be surprised at who can identify with you, even if they don’t have the exact same illness or challenges.
Until then, you have us.
(As an aside, have you ever tried an in-person support group? You’d have a lot better chance of meeting someone like you in that kind of environment and you might find all sort of benefits to being in one.)
- Natasha Tracy
Brilliant article. You are fabulous!
On the internet I see a lot of people that appear to be trying to suggest they have the most severe case and that others can’t empathise because they have no idea how bad it is etc. In reality, none of us can experience another persons experience. That’s why I love your conclusion!
Hi Bipolar Project,
Yes, sometimes we are our own worst enemy as we try to prove how “bad” we have it as if there is some soft of mental illness prize pack or something. When in reality, we’re all in the same boat. Maybe just with different oars.
- Natasha Tracy
Yes Natasha ! you are right on… great article girl!!!…whatever each one of us is experiencing at in that particular moment of your own particular illness…is the worst…have said that in my head over & over many times.
thanks for this article. it said exactly what i was thinking:)
Hi Judie,
Thanks so much. I’m glad it resonated.
- Natasha Tracy
A friend send me this today because she’s pretty keen to what my diagnoses are and I think got a bit of a shock about the rates of suicide in Anorexia Nervosa. Just a few days ago I read (no, I don’t remember where, sorry) that Anorexic patients have a higher pain tolerance as side effect of self starvation. That makes sense to me for many reasons. The point was that because of this Anorexic patients use more lethal means to commit suicide. USUALLY, there is comorbidity with Depression though some say that the A.N. tends to decrease symptoms of depression and/or anxiety disorders. To me it seems kind of obvious, having lived with all of these, that if I’m in starvation mode I don’t really give a crap about anything. No, I don’t feel more pain. I can’t say for sure if I am actually more depressed or *feeling* more depressed but I’m certainly not feeling LESS depressed. I am pretty convinced I’m not as anxiety ridden. Why? I don’t have the energy for it. There is research out there on this as well.
I wrote an article for Veteran Cargiver about PTSD and the taboo of suicide. It will also be published this Saturday in Veteran Journal. Though the PTSD I refer to in that article is about war, there are several levels of Hell that I am familiar with in PTSD that have NOTHING to do with war. If you’d like to read it here’s the link.
http://veterancaregiver.blogspot.com/2012/01/suicide-transforming-taboo-to-hope.html
I agree the worst mental illness is the one you sit with and agonize over or the one that takes you and puts you down for days or maybe the one that is flat out ignored because nobody wants to talk about it. Pain is pain. When we share our pain we have hope.
Thank you for what looks like an exceptional blog and for being vulnerable with your heart. I know that isn’t easy. I wish you well and continued blogging success. :)
Hi Temet,
Yes, the numbers on anorexia are shocking and frightening. You are correct, anorexia patients are known to sometimes have a higher pain tolerance. And you’re also correct that depression is often comorbid with anorexia which is why I think the numbers on their fatality rate are so contentious to some.
Thanks for your link to the piece on veterans and PTSD. If you’re interested in that subject, I recommend checking out http://www.mybacktothewall.com which is a site for an amazing book on the subject (which, full disclosure, I edited, but trust me, that’s not why I think it’s good).
Thank-you for the compliments on the blog.
- Natasha Tracy
Hi Natasha,
The same friend directed me both to the book and the same website and perhaps that is how she came to know your blog as I know she’s conversed with Rev. Parker. I live with PTSD as well so resources are good, though I’ve found a little caution on the information overload to be a good idea. Researching suicide is painful enough but unless we change something up we’re damning ourselves to more of what we’ve seen. I appreciate your bravery.
With Care,
Temet
Hi Temet,
Well, it’s such a small world :) Nice to hear their name is getting out there and people are finding it useful.
Thanks for your comment and compliment.
- Natasha Tracy
I think your question is very relevant to spending priorities. True, everyone would vote “the one they have” as the worst and therefore most entitled to public expenditures. But I would disagree. Some might argue public funds should go to the highest functioning, since they are the ones perhaps most likely to live ‘normal’ lives and ‘recover’ and work. But I would disagree. I think we should be funding treatments and research designed to help the most severely ill which I would say is schizophrenia followed by treatment-resistant bipolar disorder. I personally believe they are worst based on homelessness rates, incarceration rates, forensic rates, liklihood to be stuck “imprisoned by their psychosis”. NIMH has a definition of ‘serious mental illness’ that encompasses no more than 8% of population. I think federal and state governments should adopt that definition as their priority population and require the lions share of all mental ‘health’ expenditures be spent helping this population.
Hi DJ Jaffee,
An interesting perspective. I don’t know what the current rates of funding are, but in 1999 they looked like this, for the National Institute of Health:
Disease | Research $ | Prevalence | $/person affected
HIV (incl. AIDS) | $1,792,700,000 | 800,000 | $2,240.88
lung cancer | $163,100,000 | 342,457 | $476.26
cervical cancer | $75,200,000 | 231,064 | $325.45
multiple sclerosis | $96,300,000 | 350,000 | $275.14
breast cancer | $474,700,000 | 2,197,504 | $216.02
colorectal cancer | $175,900,000 | 1,041,499 | $168.89
Parkinson’s | $132,300,000 | 1,000,000 | $132.30
prostate cancer | $177,500,000 | 1,637,208 | $108.42
Alzheimer’s | $406,500,000 | 4,000,000 | $101.62
schizophrenia | $196,515,000 | 2,632,396 | $74.65
bipolar disorder | $57,805,000 | 2,227,412 | $25.95
depression | $199,600,000 | 10,732,076 | $18.60
panic disorder | $19,049,000 | 3,239,872 | $5.88
OCD | $12,693,000 | 4,859,808 | $2.61
(Numbers from here: http://www.schizophrenia.com/szfacts.htm )
So schizophrenia did get the most even if it did fall far beneath diseases like cervical cancer which affects 10% the number of people (!).
And I would tend to agree – helping the most severely ill is very important. Helping those people will help society at large as it will allow them to be _part_ of our society rather than an outsider, possibly homeless and jobless. They can add their valuable contributions – and I think we all want that.
- Natasha Tracy
Hi Natasha, It may be worth adding that the National Comorbidity Survey results indicated 28.5% (USA) Bipolar patients ATTEMPT suicide, while Journal of Clinical Psychology puts that statistic at between 25% to 50%. And as for the nay sayers against medication, International Consortium for Research on Bipolar Disorders; the Dept of Psychiatry at Harvard Medical School reported in 1999 that there is a 8-fold decrease in suicide risks when drug therapy is taken, thus supporting the point you have made in the past, I think, that one should not abandon meds. without serious thought beforehand.
But also I have a question for you: When you said, “Once you learn you can experience more pain than you ever thought possible, the scale shifts” do you mean that you feel more able to deal with the bad times? I ask because when it started, no one told me a) how long the worst depression I had would last or b) how bad that would be or, indeed, how bad would be my worst dysphoric hypomania. Knowing how bad it was, how do you feel about the possibility of having to go through it all over again? I’m not sure I could but – hopefully – that situation won’t arise now I have medication.
Hi Graham,
Good points. I do believe the rate of suicide attempt is closer to the 50% mark in bipolar, but that’s me.
“And as for the nay sayers against medication, International Consortium for Research on Bipolar Disorders; the Dept of Psychiatry at Harvard Medical School reported in 1999 that there is a 8-fold decrease in suicide risks when drug therapy is taken”
Another good point. Lithium appears to be particularly prophylactic against suicide.
As for your question, I suppose it is the case that you _are_ more capable of handling worse pain. That happens by default over time – you get better at handling whatever life throws at you (hopefully). But actually what I meant was that the new, greater amount of pain becomes the new low and this naturally shifts the scale as you realize you were wrong about the maximum amount of pain there was available before.
And, of course, no one can tell you how bad or how long your (or my, or anyone’s) episode will be and I have been through many. Looking forward, I never want to be in some of the places I have been, but the truth is, I likely will be. Because that’s the illness for you. And I say that as a treatment resistant person, so not everyone is going to have that experience. But for me, I know as bad as it has gotten, it will likely get that bad, or even worse, again. That’s just the way the cookie crumbles with the illness.
I try not to think about it. Really. That’s how I handle it. I just take one day as it comes and know that tomorrow will take care of itself. If I worry about future pain it will ruin any chance I have in the present.
- Natasha Tracy
Really thought this was a good read with a great conclusion. I didn’t realise the suicide statistics for anorexia were so high. It’s terrible.
Thank-you Elinor.
Most people have no idea how deadly anorexia is. The numbers include all those that die of the illness and suicides proper. But I think that’s understandable as anorexia really is just a very slow suicide.
- Natasha Tracy
Hi Natasha,
A girlfriend of Joyce and me stated a wonderful answer to us a number of years ago to a similar question to yours.
“The “worst illness” is the pain and suffering you’re currently experiencing.”
Warmly,
Herb
vnsdepression@gmail.com
http://www.vnstherapy-herb.blogspot.com
Herb,
Yup, my thoughts exactly.
- Natasha