People struggling with mental illness, from the mildest and most routine to the intractable and utterly devastating, are also burdened by the stereotypes and prejudices of stigmatization. The stigma of mental illness interferes with getting needed care and causes social isolation and alienation. This is not how things should be. Instead, people with emotional, cognitive and behavioral problems, regardless of whether the causes are external traumas or circumstances, internal events, or some combination, should be given the same respect and access to treatment as someone dealing with a mild sprain, a flu, or a life-threatening cancer. Healthcare should be healthcare. But it’s not. And stigmatization is largely to blame.
Everyone has a stake in fighting stigmatization. With around 1 in 5 Americans suffering from a mental illness over the course of a year, chances are pretty good you either are, have been, or are close to someone bearing the burden by stigma. The fight to reduce that burden really should involve everyone. So, after some context, I want to talk about three ways anyone can join the fight.
The context of stigma
Regardless of good intentions, people tend to perceive anyone whose psychological problems are worse than one’s own as “them” and not “us.” They are “other.” For the really serious problems there tends to be a perception of people as dangerous and deserving social isolation; we should “lock ‘em up!” People with milder conditions often confront a “weak-not-sick” attitude; they should “just get over it.”
These stereotypes help create social and emotional distance between the stigmatizing and the stigmatized. By creating this distance people can nurture the comforting fiction that instead of a fine line there’s a large gap between the mentally ill (them!) and the mentally well (us, whew!!). But that’s a myth. The line is very fine. They is us.
Sure, people differ in how psychologically resilient they may be, just like how people differ in how physically resilient they may be. But the fundamental reality about mental illness is that it can, and often does, happen to anyone. The social and emotional distance people create is just a way to avoid the anxious-making reality that things like depression, anxiety, emotional dysregulation, behavioral disorders, and the rest can strike anyone. Just like with physical illnesses where a wayward cell or pathogen can strike anyone, mental illness can strike anyone anywhere. We take illusory comfort from the distance stigma creates.
Stigma is insidious. A recent experience from my clinical practice illustrates the burden of stigmatization people with a mental illness must carry. A young man shows up at the ER complaining of an unusual set of symptoms: nausea, trembling, tingling in his legs, numbness around his mouth, and weakness in his hands. He also had an extensive history of mental illness, although he was psychiatrically asymptomatic at the time of this visit and doing very well.
But after the ER doc learned of this history, he quickly sent the patient home with a vague reassurance not worry since it was probably just a panic attack. Of course, it wasn’t. Happily he’s now under the care of an excellent neurologist and making progress. But this episode shows stigma’s insidious influence in stark relief.
Stigmatization is also pervasive. It has a broad social reach. Just consider the marketing campaigns of companies like Talkspace and Betterhelp who broke into the mental health marketplace with promises of anonymous therapy. Leaving aside the problem that anonymous therapy violates various codes of professional ethics, the promise of anonymity as an initial marketing ploy both builds on and enhances the stigmatization against which we should all be fighting.
It cynically trades on the pervasiveness of stigmatization, otherwise it wouldn’t work. What they did is like confronting racial bigotry by saying people should just try to pass or telling a gay person they should stay in the closet. Anonymity validates the prejudice that one should keep secret one’s struggles with mental health.
The fact that this marketing ploy appealed to so many, and it did, also highlights what’s called in the literature “self-stigma.” That’s the term used to refer to the fact that people internalize stigmatization so that it functions as an obstacle to seeking help and therefore as a magnifier of suffering. For example, one study of college students showed that the more people perceive stigma operating in the world the more they blame themselves for having problems and the more they resist seeking care. Other people’s prejudices about mental illness became their attitudes toward their own suffering and towards seeking help.
There’s actually lots more to say about stigma. There’s even an official APA journal specifically on the topic: Stigma and Health. But hopefully this has been enough to activate interest and maybe motivate at last some action. At least I hope you agree the fight against stigma is worth some attention. Here are three things anyone can do to join the fight.
Support an organization
There are lots of organizations taking the fight to stigma, both generally and for specific communities, like groups fighting the stigma on mental health care that exists in Asian American communities.. A great way to lessen the burden stigma imposes is by finding an organization that resonates with you and then supporting it.
But be careful, you don’t want to get caught in the paradox of choice so you end up doing nothing. Don’t over think. Instead, dive in and be helpful. Whether you donate money or time, or express support in some way, find an organization that speaks to you and support it.
Here are two stigma-fighting organizations I support.
The first is a group called “Phd Balance.” Graduate student mental health is their focus. Their mission is to show that students pursuing advanced academic degrees who are, quoting their mission statement, “dealing with mental health issues are NOT less capable, are NOT less intelligent, are NOT less creative, are NOT failures … [they] might just need support and a different set of tools.”
They pursue this mission by creating spaces where mental health issues can be openly and safely discussed and by curating resources that can be useful for those pursing both an advanced degree and a healthy balance in their lives. As a former graduate student myself, and someone who now treats and works with several people pursuing doctorates, this groups resonates with my interests and values. So, I want to help them achieve their goals. They have my support.
The other organization is The Ride for Mental Health. Started by an attorney, Malcom (“Mac”) Dorris who lost his son to an intractable and ultimately fatal mental illness, this event is a two day bike-ride through the Hudson Valley in New York. Its mission is both to raise funds for research (McLean Hospital’s research programs being the current beneficiary) and, quoting their mission statement, “to end the stigma surrounding mental illness through education and awareness.” I’ve ridden all three years of this growing event and am already looking forward, and spreading the work, about next year’s ride. Not only is it a wonderful ride on gorgeous roads, participation is a way to do good by having fun.
Tell your story
Stigma lives in darkness, in shame. Bringing stories of struggle into the light weakens it. The social distance and self-stigma that comes from the “them not us” myth can’t survive people telling the story of how they, or their loved ones, experienced emotional suffering. Truth destroys stigma.
Truth telling is actually how Phd Balance began. Its efforts to “increase visibility and awareness for students and to let those struggling know they are not alone” began with Susanna Harris, the founder and a graduate student in microbiology, telling her story of depression and anxiety in a moving video monologue. Sinking into a depression after an academic setback, she spoke up about the experience rather than hiding in silence. Phd Balance grew out of her courage and she has inspired many more to do the same.
I also had an email exchange with Mac Dorris from The Ride for Mental Health about this. He told me that after his son Eric died he “suddenly had a key to everyone else’s story or stories about mental illness.” He recounted being at a business dinner and telling Eric’s story to a new business associate who “responded by telling me that he lost his brother years earlier under very similar circumstances.”
He also shared a story about a colleague of his who had previously lost a son to what was called an unusual heart aliment. When he called Mac to express condolences for Eric’s death “I told him that I was sorry I had joined the club of having a kid pre-decease us. He then explained that his son didn’t die from the heart ailment but from an accidental overdose and that he suffered with mental illness.”
Stories brought to light reduce shame. And one person’s story really can be the key to unlock someone else’s story from the shackles of shame and stigma.
Stop perpetuating it
This one is simple; don’t make things worse. If you insult someone by saying they’re “crazy” or “nuts” you’re inadvertently perpetuating stigma. Same when you judge someone to be “less than” because you found out they’ve been in therapy of years and years. There’s even research showing that even benign, diagnostically accurate labels result in harsher, more negative judgements.
Unfortunately, mental illness is frequently used to explain bad behavior. Instead of describing a mass shooter as a murderer with too easy access to weapons of war, we make them into mental patients as though the illness explains the evil. It doesn’t, any more than one could say someone became a mass murderer because of their diabetes.
We have a particularly pernicious version of this these days. During the Trump presidency mental health professionals have unfortunately fallen into the stigma-supporting trap of explaining his bad behavior with a diagnosis. I firmly believe there are many things that make him unfit for the office such as his racism, history of sexual predation, constant dishonesty, science denial, invitations for Russian election interference and subsequent obstruction, family separations, and historical ignorance, especially about immigration, to name a few.
Just this week he stood in front of an audience of 9/11 first responders and lied about his participation. Of course, your politics may be such that you do not think such reasons disqualify him. OK, difference of opinion. But saying those qualities are symptoms of a mental illness will not convince anyone of his unfitness. I believe the reality is that a mental illness is not what is making him unfit for the office, anymore than someone with a mental illness is unfit to be a lawyer, a plumber, a teacher or any other job or profession. What makes him unfit is how he does what he does, a constellation of evil actions that spells the end of the American experiment. I believe we should not insult people with mental illness by implying it is illness rather than his dishonorable actions that make him unfit for his office. Doing so merely supports the stigma.
And always remember, they is us.
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