Recently, I talked to a doctor who reminded me that patient-blaming in mental illness is alive and thriving. For those of you not familiar, patient-blaming is when you, the person with mental illness, i.e., the patient, are blamed for the lack of treatment success. Unfortunately, this idea is actually baked into medicine’s nomenclature. People say things like, “I failed that medication,” or even, “I failed chemotherapy.” People know the intended meaning, of course, they mean that those treatments failed to make those people better. But the idea that language even exists in medicine really sets the stage for patient-blaming in mental illness.

What Might Blaming the Patient in Mental Illness Look Like?

Recently, I was talking to a doctor of cybernetics (not a medical doctor). Let’s call him Joe. Now, Joe works with “students” (patients) and sells the idea that he can “reprogram” the brain to do anything from deal with dementia and brain trauma to help you live your dream. His sales pitch is quite extraordinary. He claims to have helped more than 1,600 people.

I asked him how many people with bipolar disorder he had helped, he said 20. I asked him what his success rate was and he said 70%.

So then I asked him the key question: Of those that weren’t helped, why do you think that is?

That’s when Joe said something like, “They were too attached to bipolar as an identity. They weren’t ready to be well.”

<Insert expletive here.>

There’s a lot to unpack from that little exchange.

First off, there’s no mention of bipolar at all on his website which makes me think he might have pulled that “20” from his ass. (He does mention depression.)

Secondly, if he was actually 70% successful at helping people with all the things he does list, like depression, chronic fatigue, “compulsive additions,” eating disorders and memory loss, to name a few, my guess is I would have heard of him before now. In fact, I’m guessing we all would have. While the internet is a wild and wacky place, I’ve been playing in this sector of it for 17 years and it says something that I have never heard of this guy.

But thirdly, and most relevantly to this article, he blamed the patients with mental illness when his magic fairy dust, or, sorry, I mean “treatment,” didn’t work. Because, naturally, the same treatment that helps a person “feeling trapped” is also going to help someone with a serious mental illness like bipolar disorder, and if it doesn’t work, it’s obviously the patient’s fault. And in the alternative sphere, you hear crap like this all the time.

Patient-blaming does happen throughout medicine, but it’s most common in mental health. No one would ever dream of saying, “That chemotherapy didn’t work because you’re too attached to being a cancer patient.”

No. Someone would, quite rightly, smack you for that. But say the same thing about a person with bipolar disorder? Then it’s considered acceptable.

Mental Illness Patient-Blaming

Nonetheless, some people feel every bit entitled to say that mental illness treatments only work when you want them to.

This brings me to two points:

  1. When a treatment actually works, it doesn’t require a magical halo, prayer or belief to do so.
  2. I (and pretty much all of us) always want the treatment to work.

1. When Treatments Actually Work

We know a treatment works because it goes through a series of tests. In fact, for pharmaceuticals and other treatments, it’s a double-blind, placebo-controlled study. This means that some people get the active treatment while others get the placebo (it does nothing) and the treating physician doesn’t know which is which. You’ll not that “belief” in the treatment is not required in any of the three groups and yet treatments are approved by the Food and Drug Administration every day. How are they doing it without ensuring that people aren’t too attached to an identity as a bipolar patient?

2. We Want Treatments that Work — Always

I have yet to meet a person who as actively participating in getting treatment who doesn’t want the treatment to work for psychological reasons of any sort. I have yet to see someone say, “Oh yes, I’m taking expensive, noxious psychopharmaceuticals every day but I do hope they don’t work.”

Just from my perspective as a mental illness patient, I can tell you this: I don’t have “belief” per se, in any of it working for me. The vast majority of my hope was wrung out long ago. That hasn’t stopped treatments from working on occasion, however.

Why Doctors Patient-Blame in Mental Illness

I think there are two main reasons we see patient-blaming in mental illness, particularly. One, it’s easy, and two, it covers up the practitioner’s own insecurities.

It’s Easy to Blame a Person with Mental Illness

Patient-blaming happens in medicine but patient-blaming in mental illness is even more common. But what is patient-blaming and why do doctors do it?

Patients with mental illness are written off all the time. And even people who don’t write us off can often write off our thoughts, feelings and opinions. And while I like to think that healthcare practitioners don’t write off the mentally ill simply due to illnesses we didn’t ask for and can’t control, I can’t say it never happens. It’s just too easy to not believe someone with a mental illness by just saying, “Well, she has bipolar, you know. Bipolars are treatment noncompliant.”

Covering Up a Practitioner’s Own Insecurities

I think it’s hard to treat people with serious mental illnesses because of the high failure rate. And when I say that, I don’t mean that the patient fails or that the doctor fails — it’s the inadequate treatments we have that fail. This can take a toll on a healthcare practitioner. It natural for a practitioner to believe that he’s doing his very best and so if it’s not working it has to be someone’s fault that isn’t him. It’s easy in this situation to assume the patient is doing something wrong if the doctor knows he’s been doing his very best.

In short, mental healthcare practitioners don’t want to admit to their own shortcomings, nor those of their treatments.

Don’t Believe in Patient-Blaming in Mental Illness

  • When people say you must believe in the treatment for it to work, that’s just mental illness patient-blaming.
  • When people say the treatment works if you really want it to, that’s just patient-blaming in mental illness.
  • When people say the treatment works if you’re ready for it, that’s just patient-blaming in mental illness too.

I promise, if you are out there, following the treatment protocol, working with your doctor and doing your best and the treatment fails, it’s not your fault. Don’t let anyone blame you — the sick party — for what comes down to genetics, neurochemistry, hormonal balance, many other things we can’t pin down, and, let’s face it, luck. The fact that treatment didn’t work wasn’t because you didn’t pray to the right god, turn around three times and spit before you peed or had premarital sex. Sometimes treatment doesn’t work and it isn’t anyone’s fault, least of all the mentally ill patient’s.

We Won’t Accept Mental Illness Patient-Blaming

So, the next time you work hard but a treatment doesn’t work, who are you going to blame — no one! The next time you see a doctor and after multiple tries, he doesn’t help you, who are you going to blame — no one! The next time a doctor says you’re not trying hard enough, who are you going to blame — no one!

And the next time some wackadoo selling electrified snake oil says it’s your fault, don’t believe him. You know better.