Untangling Mental Illness – Understanding, Stigma, and the Path Forward
- Brainz Magazine
- Jul 29
- 7 min read
Written by Sandi James, Psychologist
Sandi James is a psychologist who finds ways to help people with individualised and person-centred care. She is also a PhD candidate in Australia. Her specialties include long-standing eating disorders, addiction, and trauma and she is researching the harms that can happen during treatment for mental health challenges.
Mental illness is a complex issue, encompassing biological, psychological, social, and cultural factors. Untangling it all involves understanding and addressing clinical symptoms, misunderstandings, stigma, and systemic challenges.
Defining mental illness
Mental illness refers to health conditions that alter a person's thinking, feelings, or behaviour, often causing distress and functional difficulties. These conditions range from depression and anxiety to substance use disorders, eating disorders, schizophrenia, bipolar disorder, and obsessive-compulsive disorder. Symptoms vary widely, with some individuals showing overt signs and others struggling silently and in isolation. Shame and stigma also frequently prevent people from disclosing their struggles or seeking treatment.
The entanglement of causes
The roots of mental illness are deeply intertwined and represent a complex interplay of factors. Biological factors, like genetics and brain chemistry, interact with psychological vulnerabilities and environmental stressors. Trauma, neurodiversity, or hardships of all kinds are often interconnected with mental illness, complicating diagnosis and treatment. Therapists and clinicians increasingly recognize the need to address trauma as a distinct factor, rather than solely as a psychiatric symptom. Holistic approaches that consider trauma, social context, and individual experience are vital for effective care.
Culture, society, and the psychiatric lens
Increasing numbers of people are experiencing mental illness. Ongoing cultural changes have influenced how mental illness is perceived, with 24-hour access to mobile phones, the internet, and social media, as well as detailed information about worldwide events. The increase in "influencers" and the spread of misinformation have also contributed to this shift. Change has been great in many ways, but equally harmful in life-threatening ways.
Some people tell us that we are the problem. If we simply think differently about things, change our behaviour, find a better-paying job, or make friends, we will become better people. They suggest that a culture hyper-focused on harm and vulnerability may lead individuals to interpret everyday struggles through a psychiatric lens, potentially pathologizing normal life challenges. Others contend that systemic issues, like social inequality, economic instability, and ecological crises, are the root causes of rising mental health problems, suggesting that macro-level societal changes are needed to adequately address the crisis.
What if it is both, and the whole space between?
The challenge of stigma
Stigma is a persistent and incredibly harmful barrier to recognising, understanding, and treating mental illness. It manifests in negative and judgmental attitudes, discriminatory language and policy, and difficulty accessing appropriate care. People with mental illness often face discrimination, social exclusion, and violations of their rights. Stigma reduction requires more than just awareness campaigns; it demands systemic change, including equitable access to services, education, and employment, as well as challenging power structures that perpetuate discrimination. Real fears exist that a person’s identity, strengths, or livelihood could be taken away at any moment by the groundless suspicions of others.
Treatment and recovery: Beyond the medical model
Effective treatment for mental illness must integrate psychotherapy, medication, and social support, depending on the individual needs of each person (1). Psychotherapy helps individuals understand their experiences, change harmful patterns, and develop coping skills. For severe and persistent mental illnesses, community-based models like Assertive Community Treatment (ACT) can offer multidisciplinary, continuous support to prevent repeated hospitalizations and foster autonomy. Recovery extends beyond symptom management; it involves reclaiming identity, building relationships, and finding meaning and purpose in life. Individuals with lived experience emphasise that their conditions are only one part of who they are. Accepting and integrating this aspect of identity without letting it define the whole person is a lifelong process.
Breaking the cycle: Toward inclusion and justice
Untangling mental illness and finding compassion means confronting and challenging personal, cultural, environmental, and social suffering, stigma, and discrimination, alongside addressing systemic neglect and mistreatment.
This calls for all of us to (because this impacts and benefits us all!):
Recognising the diverse causes and expressions of mental illness, including neurodivergence, trauma, and cultural context.
Challenging stigma through rights-based, justice-oriented approaches that prioritise inclusion, equity, and dignity.
Understanding and acknowledging privilege and our own mental health, and making space for lived experience voices to lead the conversations around healthcare.
Supporting and elevating robust, person-centred care systems that address both clinical needs, social determinants of health, and quality of life.
Empowering individuals to define themselves beyond their diagnoses, fostering hope and resilience.
As our knowledge and understanding of the nuances of mental illness evolve, so too must the willingness to listen, adapt, and take action to improve systems of care, supporting accessible and relevant care. By untangling these biological, psychological, social, and cultural threads, a future where mental health is truly accepted and all people are supported to live full, meaningful lives can be achieved.
Untangling your own mental illness: A metaphor for personal growth
Imagine your mind as a ball of yarn, tangled by life experiences, stresses, and traumas. Untangling your own mental illness is like gently working through those knots, requiring patience, self-compassion, and a willingness to explore what’s hidden beneath layers of social expectation and ‘norms’.
1. Notice the tangle
The first step is recognising distress, which might appear as persistent sadness, anxiety, procrastination, or confusion. Notice and name the distress without judgment or shame.
2. Finding the ends
Identify the things that lead to distress by reflecting on recent events, past experiences, or behavioural and thought patterns. Journaling, creating, mindfulness, talking with a trusted friend, or working with a therapist can help.
3. Working through the knots
Untangling is a gentle exploration, not a forced separation. This means practising self-compassion, breaking down overwhelming problems, and using coping strategies like mindfulness or creative outlets to ease emotional tension. Seek help or support when the knots feel too tight to manage alone.
4. Accepting imperfection
Some tangles or knots may never fully come undone, and that’s okay. The goal is a mind that feels lighter and more manageable, accepting some uncertainty while still moving forward.
5. Weaving something new
As you untangle, you gain insight, resilience, and self-understanding. The yarn, once knotted, can be woven into a new sense of identity, purpose, or connection. Each knot worked through becomes part of your unique story, your tapestry, shaping growth and compassion.
Untangling your own mental health is an ongoing adventure, a journey like no other. Approaching your mind with curiosity, kindness, and perseverance can slowly loosen knots and create space for healing, hope, and fresh beginnings.
Steps to untangle the complex thoughts
Untangling the complexity of the thoughts happening in our minds can be incredibly challenging and overwhelming, but intentional strategies can provide clarity and a sense of control.
1. Recognise and label your thoughts
Notice difficult or intrusive thoughts and label them as just a "thought" or a "story" to create distance and reduce emotional impact. Remind yourself that such thoughts are common and do not define who you are.
2. Practice acceptance and mindful observation
Instead of trying to make thoughts go away, acknowledge their presence, observing them without judgment. Focus on your surroundings, your breath, or your bodily sensations to stay present.
3. Notice the story
Notice if you are creating stories or deciding exactly what a thought means about you or your future. Gently separate from this narrative and focus on the present moment. Writing down overwhelming stories can help externalise and gain a little distance from them.
4. Question the validity of unhelpful thoughts
What is the evidence for and against your thought? "How likely is this outcome?" or "What evidence supports or contradicts this thought?" Reframe the thought in a more balanced or helpful way.
5. Redirect and refocus
If thoughts get stuck, shift your attention to something grounding or comforting, such as a pleasant memory, a sensory experience like a favourite smell or soothing texture, or an activity that you enjoy. Visualization techniques, like picturing thoughts as passing clouds, can help you feel less entangled.
6. Try self-compassion
Remind yourself that everyone experiences difficult thoughts and that struggling does not make you weak or broken. Treat yourself with gentle kindness and calming words, just like you would a close friend.
7. Seek support
If thoughts are overwhelming, reach out to a mental health professional. Therapies like cognitive-behavioural therapy (CBT) and acceptance and commitment therapy (ACT) have been proven to help untangle complex and sticky thought patterns. Connecting with supportive friends, family, or peer groups can also provide new perspectives and encouragement.
8. Be persistent
Untangling complex thoughts is a slow and gradual process; some knots loosen quickly, while others require time and repeated effort. Experiment with strategies and remember that progress is rarely linear.
By approaching your thoughts with curiosity, patience, and compassion, you can gradually loosen their grip and gain greater clarity and peace of mind.
Read more from Sandi James
Sandi James, Psychologist
Sandi James is a psychologist who finds ways to help people with individualised and person-centred care. She is also a PhD candidate in Australia. Her specialties include long-standing eating disorders, addiction, and trauma. She is currently doing her PhD researching harms and adverse events that can happen during treatment for mental health challenges.
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Koegel, P. Through a different lens: An anthropological perspective on the homeless mentally ill. Cult Med Psych 16, 1–22 (1992). https://doi.org/10.1007/BF00054437
