Thinking About Thinking About Mental Illness
In a recent article published in Aeon, clinical psych PhD student Kristopher Nielsen describes a way of thinking about mental disorders as “sticky tendencies” within the framework of embodied enactivism—which is, in turn, a framework to help with trying to understand how we humans function.
I quite like Nielsen’s description. He offered a sensory analogy:
To understand this concept a little more, imagine holding a kitty-litter sized container with both hands. The floor of this container is shaped like a little landscape with hills and valleys. Now imagine placing a marble in the container and moving your hands so that the marble rolls over the landscape. Notice how the marble gets stuck in the valleys and bounces off the hills; how sometimes it falls into patterns or particular tracks across the landscape.Kristopher Nielsen
He goes on to suggest that we might understand mental disorders as places where the marble has trouble getting out of a given spot in the floor—where it gets stuck, so to speak.
This makes a lot of sense to me—it dovetails nicely with the idea of mental disorders as points along a spectrum (for example: we all experience anxiety from time to time, some for frequently than others; it isn’t generalized anxiety disorder unless it reaches a point at which anxiety disrupts and impairs our lives), while perhaps offering a way to help people understand how the near-universal experience of a passing depression might need to be handled differently than the less-common experience of a persistent one.
It also tracks well with my experiential sense that my mood disturbances are very much cases of getting stuck. (Of course, I acknowledge here that confirmation bias is a thing.)
It has also, in a way, helped to clarify a point I’ve had trouble expressing, because it was difficult to translate from my weird, non-verbal way of thinking about abstract things into words, which are pretty darned important to communicating abstract ideas most of the time, which is this:
Outside of the formal field of psychology, we tend to lump all mental “disorders” into one big collection. We unconsciously think of them as functioning the same way—they’re pieces of the machine that have got out of whack somehow.
This can make it very difficult for people to understand things like related and unrelated comorbidities and why a pinpointed therapy or medication might work for one class of disorders, but might not for another.
In the formal field of psychology, on the other hand, we break out groups of disorders based on the idea that they’re somehow related, though we don’t always quite have a sense of how, and sometimes we’re completely wrong have have to move things around, because brains are complicated, yo.
This distinction is often lost in efforts to communicate about mental disorders with the world at large, first because it’s fundamentally kind of a challenging idea to communicate; second because it’s easy and natural and normal to just lose sight of one’s acquired framework. We get so used to seeing things through a certain set of lenses that we forget they’re there, and we fail to include them with our description of the moon (this can also make it much harder for us to see and accept our own errors as new evidence emerges).
Nielsen’s analogy could be immensely helpful, here, if extended just a little further.
For example, we might think of autism as something that changes the substrate and makes the marble roll differently everywhere.
No two substrates will be exactly the same, but on average, NT substrates will be more similar to one-another than to autistic substrates, and vice-versa (there are, of course, other ways of being neurodivergent, and I can think of ways to further layer the analogy that should still work when they overlap).
Perhaps the neurotypical base is smoother, or rougher, or has wider or narrower grooves overall on average, than the autistic one. Regardless, the ball rolls a bit differently on the autistic base than it does on the neurotypical base.
In both cases, however, it’s still possible for the marble to get stuck.
In both cases, the place where the marble gets stuck is real, and once the marble is stuck there, its entire experience is colored by that stuckness. In both cases, the marble might need extra input to get unstuck, though that input might need to look different for a marble in an allistic track than it does for one in an autistic track.
Regardless, as long as we don’t overinvest in the analogy, the ideas of the track, the variations in the topography of the track, and the marble might be really useful in helping people both at large and within the formal field of psychology imagine mental disorders.
This doesn’t directly address the possibility, of course, of many mental disorders being less actual malfunctions than the result of an infinite diversity of minds being force-fitted into a narrowly-defined set of life options—but Nielsen’s model does acknowledge the role of culture and experiences in shaping the tracks in which our mental marbles run, and doesn’t regard the tracks as fixed, changeless entities.
Likewise, as with any model, this one might not be universally useful. For me, it’s a helpful framework; someone else might find it less than useful or even the opposite of useful.
This is why it’s important to offer models, but not to treat them as holy writ. We’re still far from really understanding the human mind, and our failure to acknowledge that can harm both people (who suffer when we try to force-fit them into inaccurate models) and progress (which is stymied when we let ourselves get stuck in our existing models and when we can’t see beyond them).
It’s encouraging to see that researchers and people at large are taking the question of how to think about mental illness seriously. When we think about our thinking, we make room for change.
This kind of change—change that questions assumptions and tries to meet people where they are—has done a lot of good for those of us living with mental illness and those of us who are neurodivergent in ways that might not fight the traditional idea of “mental illness.”
We’ve still got a long way to go, but it’s good to know that people are making the journey.