"The line between healthy and sick is fluid"

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Whether depression, schizophrenia or addiction: people with mental illnesses are often confronted with rejection, distrust and prejudice. The boundaries between healthy and sick are much more porous than most people believe, says Dr. Georg Schomerus from the Greifswald University Hospital in conversation with

Dr. Georg Schomerus

Dr. Georg Schomerus is head of the Department of Social Psychiatry and Outpatient Care, Clinic and Polyclinic for Psychiatry at the University Medical Center Greifswald. One of his main areas of research is public attitudes towards mental illness.

Dr. Schomerus, mentally healthy, mentally ill - is there a clear limit at all?

That is the central question! As medical professionals, of course, we have to draw such a line because we have to determine who needs treatment and who doesn't. In fact, the dividing line between healthy and sick is always artificial. And very different things come into play here - the scientific consensus, but also societal ideas. That is why the limits are there, but not given by nature.

And they are constantly changing.

Right. Some diseases even disappear again, such as homosexuality, which was officially considered a disease in our country until 1973. Now that seems absurd to us.

It is interesting that a great many people even experience symptoms of a mental illness themselves in the course of their lives.

That's correct. The vast majority of people at some point have experiences that also occur with a mental illness. In difficult phases of life in which one has to deal with stressful experiences, psychiatric symptoms often appear. For me as a psychiatrist, it is very exciting that you can understand so many experiences of mentally ill people. And notices: This is not fundamentally something else, it is often just more extreme.

For example, that everyone knows irrational fears, but not everyone develops an anxiety disorder?

Exactly. When such conditions occur sporadically, they are part of normal life. Only when they become very massive do we classify them as symptoms of a mental illness.

That is why psychiatric illnesses should not be played down. One must have respect for the size and severity of the extreme experiences some patients have to go through. But that doesn’t mean that you cannot begin to understand and comprehend this.

In fact, many more people become mentally ill than is commonly assumed.

25 to 30 percent of all people meet the criteria of a mental illness for at least some time in the course of their life. So every third to fourth!

If mental illness is so common, why are people still so stigmatized?

The main problem is the perceived otherness. Many people think that there is a fundamental difference between healthy and sick. People with mental illness are often seen as unpredictable, even dangerous. That unsettles and scares you. You don't really know how to deal with them.

Some of the most stigmatized sufferers are people with schizophrenia.

In schizophrenia, it is the extreme otherness that catches your eye in the acute phases of the disease and makes you cringe. Even here, the psychiatric symptoms are much more common than you might think. For example, certain forms of magical thinking are very typical of schizophrenia - but they are also common in healthy people. Thoughts of conspiracy and persecution can also be found in a weakened form in healthy people. Of course, such symptoms are much more extreme in acute schizophrenia, but these phases in particular are temporary and can now be treated very well.

What about hallucinations?

Such experiences are also made by people who are mentally healthy - on the one hand intoxicated or with severe physical illnesses, but also as a very everyday phenomenon: There are mentally perfectly stable people who have heard voices all their lives. As long as they can handle it well and don't find it stressful, that's not a problem. Such people do not need any help.

The threat of stigmatization makes it difficult for the sick and those around them to openly surround themselves with mental illness.

This is really a big problem. Anyone who is acutely affected by a mental illness is already very troubled by the symptoms. At the same time, patients also have to worry about whether they will be rejected, how their personal environment or how the employer will react. They are confronted with the question of whether and to whom they will disclose their disease. Anyone who talks about it can sometimes actually run into difficulties, but unfortunately that is still tricky. That is why you have to think carefully about such a step and find an individual strategy. Very often, however, an open deal is a relief, because you don't have to hide anything anymore, others show you more understanding than expected and you also get support.

Is an open approach also a way of countering stigmatization?

When mentally ill people have the courage to deal openly with their illness, the others suddenly notice: He's not that different from me. That helps a lot to break down prejudices. In the case of depression, this has already been achieved to a certain extent. Many celebrities have also committed themselves to this, which helped a lot. You could also see from them that mentally ill people can be fine again at some point. Mental illness is not a trap that will snap shut forever.

Once sick, always sick, is that not true?

Everyone goes through difficult phases. Some - even many! - have the bad luck that they then slide far in the direction of illness. But you can even come out of an extreme phase of illness and be on the healthy side again. The important thing is: We have to get away from stereotyping and see mental health in transitions. This not only helps to reduce stigmatization. If we become more open, we will all win.

You don't necessarily stay a cancer patient forever.

Just. The line between sick and healthy is permeable. Nobody is always 100 percent fit and healthy, happy and mentally stable - that wouldn't be normal either. It is normal for it to fluctuate. And that's a good thing.

What do you mean?

100 percent fitness would lead to a totally flat, colorless life. Anyone who experiences every deficit as a minus and wants only ones on their life testimony is on the hunt for total perfection. Not only is this doomed, it is also unhealthy and joyless.

The crisis as an opportunity?

Crises are certainly something that one does not wish for, but that is absolutely part of it. These are phases in which you learn a lot about yourself, in which you come into contact with yourself and with those around you on completely different levels. They offer the chance to mature. This also applies to mental illnesses. People who manage to cope with these often become very special personalities. Mental crises, as bad as they are, give life its depth.

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