Why Having a Mental Illness Is Not Like Having Diabetes

A number of times during the course of my illness I have been told by health professionals that it is useful to think of having a mental illness (in my case schizoaffective disorder) as having a lifelong disease that requires lifelong management and drug treatment—in fact, just like diabetes, a well-known disease affecting a large proportion of the population. Diabetics, so the story goes, need to accept that they have an illness that will require treatment for the rest of their lives; and if they continue the treatment, they will maintain their health insofar as this is possible, while if they discontinue treatment, they will suffer dire consequences, including blindness, loss of limbs, diabetic coma, and so on. Looked at in this light, treatment of a mental illness is just the same; if medication and other treatments are continued, the prospects are relatively good, and if not, the prospects are dire. This story is common among health professionals who treat those with mental illness, but it also occurs in some medical research in which schizoaffective patients have been explicitly compared with diabetes patients. In a series of studies a team based in Lund, Sweden, took schizoaffective patients and compared their social networks and background factors. The rationale for making a comparison between schizoaffectives and diabetics is as follows: ‘‘From a medical and psychological point of view there are similarities between diabetes and schizoaffective disorder. In both diseases youmay prevent a relapse by taking medication (insulin or lithium) and the risks of pregnancy and delivery are greater than for healthy women. Further, the chances that a child to a parent with diabetes or schizoaffective disorder will subsequently develop a diabetes or a schizoaffective disorder are considerable. Thus, the medical and mental strain caused by diabetes and schizoaffective disorder to some extent may be the same. I would like to spend the rest of this article showing why this parallel, so frequently made, is ill conceived and unhelpful. Hospital Experience