They Say He's Sick, He's Obscene: Mental Health Stigma
Image: One Flew Over The Cuckoo's Nest (1975)
I’ve always been more open about my experience with Crohn’s Disease or physical illness than I have about my depression or social anxiety. I’ve been honest about a ruptured ovarian cyst, but not about feeling paralyzed with self-consciousness during a meeting. My goodness, I’ve shared that I’m having a colonoscopy more readily than sharing that I’m taking an antidepressant again. I know I’m not as forthcoming with these experiences because there are still dominant narratives that contribute to and maintain negative attitudes and biases about mental illness. I’m held back by this mental health stigma, both the awareness of public stigma and my own internalization of some beliefs.
These narratives range from viewing people with mental illness as weak or lazy, as incompetent or unfit, or as unstable or dangerous. These stories are so prevalent that calling someone “mentally ill!” can be used to insult, diminish, or disqualify them. For instance, we still haven’t found a way to discuss someone as awful as Trump without resorting to ableist language and weaponizing his cognitive and mental health status. The beliefs are also so ingrained that we can start to view ourselves as inferior or tainted in some way just for having a mental illness. The prejudice distorts understanding of mental illness, others, and ourselves.
It's stressful to disclose our mental illness(es) to others. We worry about being shamed for our feelings or symptoms. Of being reduced to our illness. Of having a friend or coworker look at us differently; with pity, bewilderment, nervousness, or guardedness. Or we worry about having our illness reduced. Of being told to "snap out of it" or that social anxiety is just being "too sensitive about what others think."
Sure, we’ve made great strides as a society when it comes to disclosure and conceptualization of mental illness, but we are still saturated with commentary and attitudes that are stigmatizing. I know I sometimes feel like ending this stigma is a Sisyphean task, but movement can come from unpacking and challenging these narratives to help dilute their potency. We need to be reminded that that’s all they are: narratives. Stories, right? Stories of fiction and of opinion. Myths. They might seem believable and feel constricting but they’re not actually real, and being cognizant of that can take away some of their strength.
So, let’s just get some of these false stories out there. Let’s explore the dominant myths about mental illness.
Myths About Mental Illness
Myth: mental illness isn’t real
One story is that mental illness isn’t real; it’s discredited as a real illness/disability. There is suspiciousness about its prevalence and skepticism about its existence. People seem to think it’s just a “millennial trend.”
Part of this story is that symptoms are not symptoms: it’s just your behaviour; it’s all in your head or all within your control; it’s just your disposition or outlook. Someone is referred to as weak, fragile, too sensitive, or selfish. They’re told they just need mental and emotional hardening, life skills, more gratitude, or a different perspective. These attitudes are apparent when we hear people say, “Depression is just a choice. Depression is a state of mind.” Or, “Suck it up. We all have problems. Some people actually have it worse.” Or, “Just get it together.”
Myth: mental illness implies weakness
If mental illness is acknowledged to exist, another false story is that you are weak because you have "allowed" yourself to develop it. As though strength means being invincible, that nothing can touch you. Therefore, the false story is that you’re not resilient enough or you haven’t persevered through adversity. Stories are part of culture, and in many parts of Westernized culture I think it’s fair to say that it’s still not okay to not be okay (no matter how many Pinterest quotes we put on Instagram). This culture is very results-driven. It values competition, achievement, and doing well for ourselves. So, poor health, of any kind, is viewed unfavorably, as an impediment to quality of life, to measuring up to certain standards. This is ableism. So, if you have a mental illness, you are viewed as having limitations, a deficit, and that maybe you are even infected or impure. There are other cultures or certain subcultures where extreme prejudice about mental illness may lead to someone being shunned, to being perceived as having brought embarrassment and shame upon the entire family or community.
Myth: mental illness implies instability or danger
So, we explain to people that having a mental illness doesn’t mean that individuals are weak, that they can’t help that they developed it or have it, that symptoms are symptoms and therefore some things are not always within their control. But when you say that, well that makes people nervous, doesn't it? Because what they can hear is that people with mental illness are "out of control" and then the false stories are about individuals being unstable, unable to self-regulate, or unpredictable.
There's also the story that if you’re unable to "self-regulate" well then you’re probably going to be needy, over-dependent, or a burden on others and society. Or maybe you're called creepy, psycho, a lunatic, crazy, nuts, insane, unhinged, or scary.
To richen these narratives, the way that media talks about or portrays mental illness can skew perceptions and contribute to heuristics. Because we don’t have CNN coverage of individuals with mental illness successfully going about their lives, do we? We have stories about acts of violence that have been committed by or suggested to have been committed by individuals with mental illness. Because what we’re hearing most of the time are stories where the automatic assumption is that the perpetrator must be "mentally ill." We have sensationalized movie or TV plot lines where someone with a mental illness or a likely mental illness poses a threat: they are deviant, violent, and a "danger to themselves and to others."
The false story becomes that of a causational relationship between mental illness and violence. We aren’t hearing the facts that people with mental illness are more at risk of experiencing violence, and are no more likely than the general population to engage in violent behaviour.
Myth: mental illness is just an excuse for certain behaviours
There are many false stories about certain mental illnesses. There are misconceptions about causal and maintaining factors, like in the case of addiction not being accepted as a disease (“These people are just unable and unwilling to control their urges."). In the case of eating disorders, the false story is that, “They’re to blame, they’ve brought it on themselves, they’re just doing it to themselves." There is significant misunderstanding about certain mental illnesses. The false story that someone with Body Dysmorphic Disorder is just too critical about their appearance. Or that a “schizophrenic” is someone with a split personality, and someone really dangerous. The false story of postpartum depression is that it is, “Just a bad mother, someone missing that maternal instinct, someone who is an unfit parent and a threat to their child.”
Many of these stories contribute to attribution bias, where the person's behaviour is seen as indicative of their traits/personality whereas the state they're in/mental illness is not taken into account. This is consistent with the very stigmatizing way people can talk about individuals with Borderline Personality Disorder. It’s the false story that they’re all just looking for attention, manipulative, self-involved, highly unstable, difficult to manage and draining, and maybe even a dangerous person waiting to snap. This is also a common storyline in film.
Sometimes even helping professionals seem to have subconsciously bought into false narratives that their patients/clients are just being dramatic, seeking attention, malingering, or "manipulating the system to get time off work." It can be painful and a breach of professional trust when you do get up the courage to ask for help, maybe even specific help, and the doctor minimizes the severity of your problem, or dismisses your need for medication, or only wants to throw a prescription at you, because they're not hearing your actual story.
Myth: mental illness is just certain behaviours
False stories also continue because certain labels are thrown around flippantly, which can lead to the minimization and misrepresentation of the complexity and debilitating nature of these mental illnesses. You might hear, “I wish I could be anorexic for like a month.” These labels are usually erroneously related and reduced to it all just being about an undesirable quirk, state, or experience. So, someone who is moody might be called "bipolar." Some who is acting a bit scattered might be told they are acting "schizo." Someone who is a self-proclaimed perfectionist might say, “I’m so OCD." And someone who has experienced something uncomfortable and mildly stressful might say, “I’m going to have PTSD from working on that group project.”
Myth: illness is identity
“Sam is bipolar.” “She’s just an addict, a crackhead.” “I hate working with borderlines.” “He’s bulimic.”
Individuals are often reduced to a diagnostic label, and the person becomes the problem. I know clinical labels have value and are helpful for assessment and treatment consistency and efficacy. However, it's also surreal and disempowering to have our experiences pathologized, summarized, and classified in this way. We can feel like we lose our unique identity by becoming another statistic of the disease, or that everything we do is seen through the lens of our illness. For instance, any tiny display of emotion may lead to someone asking, "Are you taking your meds?"
Unfortunately this is reinforced by the way we can be treated within the mental health/medical community. There can be pervasive paternalistic attitudes held by professionals that may devalue our experiences, thoughts, and choices. I've built off the term mansplaining with my term medsplaining: when a medical/helping professional talks at us and provides a patronizing and dismissive explanation of our mental health experience. We can feel like we lose ownership of our experiences and ultimately lose our sense of identity and trust in our self-awareness and self-efficacy.
Myth: mental illness treatment tells the whole story
False stories about medication include it being just an easy fix, toxic, or completely unnecessary. Some believe that taking medication or "needing therapy" must demonstrate someone's instability. There are stories that psychotherapy is unwarranted, a luxury, ineffective, a waste of time, or even pseudoscience. Some believe it is too invasive, while others think it is just a form of coddling or dependence. The same way you seemingly can insult someone by referring to them as "mentally ill!" you can say "you need therapy!" There is also significant stigma surrounding more intensive support options like electroconvulsive therapy or inpatient hospitalization.
Myth: I've been there, I totally get it
Our own personal experience with mental illness can predispose us to either minimizing or magnifying what it must be like for others. Just as people often give me unsolicited diet tips for my Crohn's disease because they know someone with Irritable Bowel Syndrome, so have individuals touted how simple it is to just exercise to manage depression. Even if we've experienced depression and anxiety, or have a cousin with anorexia, or lived with a partner with a dissociative disorder, we will never know how it impacts someone personally.
Our own experience may also bias our understanding of stigma and what it takes to get help. Various factors contribute to different experiences with public and self-stigma. As discussed, certain mental illnesses have more stigma than others. Someone’s experience with both homelessness and addiction seems to be more demonized and criminalized than that of a celebrity struggling with substance abuse. Other factors that influence stigma include socioeconomic status, race, culture, age, sexual orientation, gender identity, and location. My experience with stigma may be nothing compared to that of an Indigenous male living in a rural community. Men are very aware of society's expectations for them to "tough it out," and talking about emotions is not readily encouraged. Social and structural stigma also influences how mental illness is conceptualized by and responded to in certain subcultures, institutions, and workforces: the trades, the military, helping professions. This often makes it harder for these individuals to open up and get help, my own story of which I will share in an upcoming post. It's ignorant to deny the potential real consequences someone may experience when they disclose their illness and we need to be sensitive to this. We can normalize both their mental illness and hesitancy to accept a diagnosis and seek support.
The Real Story
The real story of mental illness is that it is real: it is not an excuse, it’s not someone just being dramatic or doing things for attention, it’s not just all in someone’s head. Mental illness can be acute or chronic, it can be episodic. Mental illness can have significant impact on functioning and the symptoms are symptoms of an illness. Most individuals pose no threat to others. There’s a myriad of individualized contributing and maintaining biopsychosocial factors, including genetics, brain chemistry, and psychological and environmental stressors. These possible factors categorically do not include: weakness; lacking gratitude or a certain frame of mind; lacking willpower, resilience, or perseverance. It is not something someone brought on themselves. It is not someone exaggerating their experience or trying to manipulate the system. And it's that Sam has Bipolar Disorder, not "is bipolar" or "crazy."
The person is not the problem, the problem is the problem. The person is not their illness. We may be ill but we are not defective or tainted, or a lesser human being, and we are worthy of people hearing and respecting our individual stories.
Title lyric: No More Mr. Nice Guy (Alice Cooper)