In our society, the stigma of mental illness is very real. While lowering cholesterol is something people discuss openly, seeking mental health treatment is something many view as a secret. As a psychiatrist, it is disappointing to see that negative perceptions are a major barrier to patients receiving the medical care they need. Where do these perceptions come from? And how can they be changed?
Influence of media
It is easy to blame television and film for portraying mental health patients and treatment in a negative light. If you saw “One Flew Over the Cuckoo’s Nest,” the image of Jack Nicholson with his wild eyes and hair askew as a stereotypical patient facing involuntary confinement and forced shock treatment is a scary one. Some TV shows that feature mental health treatment depict providers who are unprofessional, inappropriate and even unethical. These shows may be entertaining, but they do little to help educate their audience about what brings someone to treatment and what providers do to help.
The news also features mental illness regularly. The recent acts of mass violence that involved perpetrators who had mental health problems have inspired some to focus on the link between mental illness and violence. While perpetrators of violence at Virginia Tech and in Tuscon, AZ were suspected to have major mental illness, the truth is most acts of violence are not committed by people who have mental illness. People with major mental illness are actually estimated to be 11 times more likely to be the victims of violence than the general population, and most acts of violence committed are self-injury.
Twisting words
But we cannot just fault the arts and media for contributing to the stigma around mental health treatment. Many people feel reluctant to seek treatment because of how popular culture addresses mental health. It is embedded in our very language, with demeaning use of terms like “schizophrenic,” “psychotic,” and “delusional.” There is rampant overuse of terms like “depressed,” “panicked,” and “anxious” to describe normal variation in mood. Somehow, mental health terms have morphed into insults or casual phrases. Some view the need for help as a “weakness” or a sign they “cannot manage things” on their own.
With so many negative associations, it is not surprising that in 2010, only a little over a third of adults with mental illness reported receiving mental health services in the past year.
Worry about judgment
With society using this biased lens to view mental health, it is common for people to feel ashamed or embarrassed to discuss seeking help for problems with their mood. Some worry they will be judged or criticized for starting treatment. A 2010 CDC study showed that 90% of Massachusetts residents surveyed believe that treatment can help people with mental illness lead normal lives, but 39% do not believe that people are caring and sympathetic to people with mental illness. This suggests a disconnect between what people believe will help and what they are motivated to do.
Celebrity spotlight
On occasion, Hollywood addresses the stigma of mental health problems. Celebrities that have acknowledged having depression include Sheryl Crow, Marlon Brando, Billy Joel, Ashley Judd, and J.K. Rowling. Historical figures with depression include Abraham Lincoln, and Tennessee Williams. In 1998 Janet Jackson told the Washington Post of her depression “it hits a lot of people – and a lot of artists – and I didn’t know that. Nobody ever talked about that in my family – I still haven’t talked to anybody in my family about it.”
Brooke Shields, Courtney Cox, and Gwyneth Paltrow, were vocal about struggling with postpartum depression.
Celebrities who have discussed their OCD include Donald Trump, Howie Mandel, Leonardo DiCaprio, Cameron Diaz, Charlize Theron, Megan Fox, Justin Timberlake, Howard Stern, and David Beckham.
Jane Pauley, Jean-Claude Van Damme, Patty Duke, and Carrie Fisher have discussed their struggles with bipolar disorder. Vincent van Gogh, Virginia Wolff, Ludwig van Beethoven, and Winston Churchill also had bipolar disorder.
But even with outspoken celebrities, there is still a fear that treatment for mental illness will interfere with having a happy, successful life. There is a need to change this perception, as recognizing mental health problems, as with any medical problem, is the first step to feeling better.
So, what can we do? The journey to change society may not be a short one, but we can each contribute a step. Challenge the stigma of mental health treatment by starting with – and acting upon – your own beliefs.
Starting the conversation
I often encourage people to consider opening up to someone in their life about what they have been going through, either as a first step or as they are receiving treatment. Problems like depression, anxiety, ADHD, bipolar disorder and addiction tend to run in families, so talking to a family member may give you insight into how other people in the family have managed treatment. Usually conversations leave people quite surprised to learn that they know many people who have also sought help. Talking to a friend, coworker, or family member can help you feel less alone in your treatment. You may even help someone else who is also struggling to engage in their own treatment.
The role of treatment and providers
I remind my patients that the treatment itself is the solution to the problem with which they are struggling, and should be seen as the thing that improves how they feel. Treatment should be looked at as a tool which people can use to help themselves.
Mental health treatment involves medical interventions for biological conditions. People cannot use willpower to make symptoms like depression or anxiety disappear any more than people can use willpower to make high blood pressure or diabetes disappear. Unfortunately, not everyone sees it this way. It is rare to hear people say “I didn’t want treatment for my high blood pressure because of the stigma.”
Providers can serve to educate patients about available treatment options and guide them to choose the one that is right for them. There is a great deal of room for improvement on public education and destigmatization of mental health treatment, and I feel providers should be at the forefront of this charge.
Until we see the change in the world we want, I encourage everyone to explore their own biases and not deprive yourself of necessary treatment. Everyone deserves to enjoy their lives.