Why are some people dismayed to learn that a friend takes medication for a mental illness, saying, "It's all in your head?" The expression is disdainful, because it implies a lack of willpower or toughness. The question that should be asked is not whether the illness is real, but what is the most effective combination of willpower, therapy, and medication for treating it.

The volume of debate over how to deal with mental illness depends on how severe and exotic the symptoms are.

Debate is less intense intense when symptoms are exotic, meaning of a type that most people never experience. Hallucinations, for example, are understood by most to stem from abnormalities in the brain. Whether the patient can cope with such symptoms well enough without medication is something that depends on their severity, but there is a general understanding that one cannot make hallucinations vanish through willpower or talk therapy.

Debate is more intense when the symptoms sound familiar. Someone who suffers from depression or mania can describe his symptoms in terms that seem familiar. Everyone can relate to "feeling sad" or "feeling hyper," so there is a natural tendency for the listener to assume that he understands how the other person feels. This belief can lead to thoughts such as, "Hey, I feel like that sometimes, and I don't take drugs. If I can deal with it, he should be able to deal with it. He shouldn't need drugs."

What the listener in this example does not realize is this: It is impossible to imagine an emotional state that you cannot experience.

Let me repeat that: It is impossible to imagine an emotional state that you cannot experience.

That simple statement is profoundly important. We understand another person's emotions by comparing them to our own. We have a "gut feel" about what it means to be happy or sad, which works well enough in most situations. Yet the reality is that Major Depressive Disorder and Bipolar Disorder produce emotional states that do not exist in normal human experience. Someone who does not suffer from such an illness truly cannot understand what it is like.

So here is the answer to the question I posed above: People who treat mental illness dismissively do so because

A) They are not capable of understanding it in terms of their own experience
B) They are not willing to put aside their prejudices and transcend the limitations of their "gut feel" by studying the subject

Sadly, the belief that the skeptical listener does understand what the sufferer feels can have a serious impact. The impact can range from friction, to the destruction of friendships, to creating insurmountable barriers to treatment.

The moral to this story is that people who suffer from serious mental illness bear the burden of coping with disbelief and obstruction from friends, family, and employers, as well as the illness itself. They are well advised to exercise discretion in disclosing the details of their illness, to educate themselves about their needs, and to refuse to let ignorance and prejudice interfere with their treatment.

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Kevin Thompson, Ph.D. is the author of "Medicines for Mental Health: The Ultimate Guide to Psychiatric Medication." You can find information about treatments for depression, bipolar disorder, schizophrenia, and sexual problems on his Web site at www.Mentalmeds.org