by Emily Durbin
& Sherry Walling
In honor of Mental Health Awareness month KRL will be publishing several related articles on the subject of mental health in October.
The ideas inherent in psychology have been around for thousands of years. In around 400 BCE, Socrates was concerned with the health and nature of the soul. The field of counseling emerged more recently, gaining traction in the 1940’s and 50’s and gaining national recognition by the creation of Division 17 by the American Psychological Association which focused on the practice and practicality of counseling psychology.
With such a long history, the field of psychology is still seen by some as a voodoo science. Stereotypes about the field of mental health include images of men in white coats playing with rats, bearded doctors listening while their patients lie on a couch, or the existence of a pill to cure anything that ails you.
While all of these images do have a place in psychology’s long history, to reduce the field to such generalities would be rash. Practitioners and patients alike know the benefits of working on mental hygiene. Unfortunately, the many misconceptions about the field still contribute to the stigma attached to mental illness.
Former U.S. Surgeon General, Dr. David Satcher, once remarked that the stigma surrounding mental illness “deprives people of their dignity and interferes with their full participation in society.” This stigmatization stems from a general bias of mistrust and fear about people with mental illness. Those living with mental illness may face anger, confusion, wrongful stereotypes and even ostracism due to a lack of understanding and acceptance. Discrimination based on mental status too often follows from this misconception of ‘us’ and ‘them’. When it comes to mental illness, there is no ‘them’. Epidemiological studies indicate that the lifetime prevalence of mental illness is 46.4% among adults living in the United States (NIMH, 2011). And one in four women suffers from depression during their adult lives. This means that it is highly likely that you, or someone you love, will meet criteria for a mental illness at some point during your life.
In Ronald J. Comer’s 2010 book on abnormal psychology, three characteristics of mental illness were outlined. Mental illness, in the simplest terms, includes 1) disruption (a person experiences an extreme or unusual cognitive, behavioral, emotional or personality pattern that is generally viewed as abnormal in their cultural context), 2) distress (the disruption must be perceived as unpleasant or unwanted to the individual or those who love them), and 3) dysfunction (the disruption interferes with a person’s ability to go about their normal daily activities). Categories of mental illness encompass a variety of disruptions that stem from a range of causes. Mental illness can co-occur with stressful events such as having a baby or retiring from work. A mental illness can begin in childhood or adulthood and can be chronic (lasting throughout life), episodic (come and go throughout life), or acute (occur for a short period of time without reoccurrence).
A cornerstone in the understanding of mental illness is recognizing that a mental health diagnosis is made through rigorous testing, reporting and evaluating just as a diagnosis of a traditional medical ailment would be from your family doctor. Mental illnesses like depression, general anxiety, or an eating disorder stem from a combination of interactions between genetics and circumstances. A person who suffers from one of these diagnoses should know their rights as a patient, be able to seek out quality care, and have the financial support of their insurance company.
Misinformation and misperception about mental illness can lead to the stigmatization of our selves, our parents, our children, our spouses and others that we care about. The consequences of stigma range from social isolation to poverty to barriers to quality treatment and care. Stigma perpetrated on a grand scale can result in a system that reinforces the idea that people diagnosed with mental illnesses are unimportant and therefore are unworthy of access to quality and affordable care.
National, state, and local governments are responsible for research allocation. Morton Hunt, in The Story of Psychology (2007), outlines the distribution of mental health spending in America. According to Hunt, the national healthcare budget exceeds $1.4 trillion annually, however, just over $100 billion of that is spent in the mental health sector. This comes out to about 7% of the total health care budget. When considering that almost half of Americans experience a mental illness during their lifetime and given that suicide is among the top five causes of death, a question about whether stigma may contribute to allocation amounts should be asked.
The National Institute of Mental Health estimates that only 36% of individuals diagnosed with a mental illness actually receive help. Availability of services and the quality of care can vary widely even within the same State. Educating the public about the right to mental health services is often underfunded and the individual is left to navigate the system alone. In addition, insurance companies have a long history of disparities in care between physical and mental health coverage. Even today, many major insurance companies have larger deductibles and higher co-pays for mental health services than for medical or surgical services. Also, many mental health care plans have lifetime spending caps and limits on the number of visits an individual can have in a calendar year.
Some media outlets (films and television) serve to perpetuate negative stereotypes and reinforce stigma. Although relatively few people with mental illness act out in violence, we have all seen caricatures of mental illness that are overtly violent, explosively unstable, or incapable of accomplishing the simplest of tasks. While these portrayals might contain elements of truth, they are far too extreme and two-dimensional. In a 1998 study published in the Archives of General Psychiatry, recently released mental health patients had a rate of violence no different than others in the community (provided there was no history of drug or alcohol abuse). To assume that all individuals with schizophrenia are dangerous or all sufferers of anxiety cry at the drop of a hat is a simplistic view of humanity.
Work Place Stigma
Challenges abound for someone openly diagnosed with a mental illness in the work place. Individuals might divulge their diagnosis to create an environment of understanding, yet they may be met with inaccurate assumptions, harassment, and an environment where co-workers shift between ignoring and overcompensating for the diagnosis.
Due to a general misconception about mental illness, many are assumed to be incapable, too fragile, or a liability. Projects or responsibilities may be given to other co-workers or they might be overlooked for a promotion. Even if these accommodations don’t come from a place of malice, the effect is the same, from misunderstanding: resentment, harassment and discrimination can grow.
The harm of a mental illness can be compounded if the individual comes to blame himself or herself. Shame, doubt and isolation born from discrimination in the community can delay or even prevent someone from seeking help, worsening the illness the whole time.
In this way, discrimination doesn’t only come from the outside. If you constantly hear that you are wrong, you are the problem, it won’t be too long before it seems like the truth. The embarrassment experienced after a diagnosis or even in thinking that you might need to seek help stems from the false belief in the stigma. Some choose to live with the symptoms rather than the label of a mental illness.
But something like a diagnosis of bipolar disorder shouldn’t define you. No one is bipolar; there are only people with bipolar disorder. We wouldn’t say that someone is cancer, only that they have cancer. Understanding these errors, fighting discrimination and getting at the root of mental illness stigma will lead to a better mental health system and a better quality of life for those living with mental illness
How to Fight Stigma
The stigma that surrounds mental illness can trap sufferers in an unending sea of isolation—afraid to ask for help because they don’t know who they can trust. Finding support is an imperative part of recovery. This support can be with fellow sufferers or just a sympathetic ear that understands that going through a difficult period does not negate one’s worth as a human being.
It is also important to know that seeking treatment does not make someone less-than. A diagnosis and individualized treatment plan can be the best way to help an individual thrive again. If we could all go through life and never need help from anyone else we would all be expert farmers, builders and doctors. One of the hallmarks of a civilization is that we can become specialists in only a few aspects of life and then have our fellow man to rely on for help with the rest. This doesn’t make us weak—it makes us human.
And finally, in order to fight stigma on a systemic scale, community advocacy and education is key. As with all other fights to end discrimination, a group of people must be acknowledged as a distinct and worthy community before being fully absorbed into society. The mental health system is improving, but the negative attitudes of individuals that serve to perpetuate the stigma need to be changed too.
A Final Note
Mental health care is not only for the treatment of formal mental illnesses. A growing trend in the last forty years is the use of mental health services as a short term exercise in mental upkeep. We all experience the pain of loss, stagnant feelings found in routine, periods of unrest, or times when we struggle with unanswerable questions. The idea of ‘tune-up’ psychotherapy can be less scary to people, carry a smaller stigma in society and still be very beneficial.
If you would like to learn more about bipolar disorder check out an earlier KRL article.