Mental illness. Two words that cause people to cast judgment or turn away. It is, perhaps, the ultimate example of a stigma. Society probably spends more time trying to ignore mental illness than to understand it. And that's not easy to do given how many people mental illness affects.
- Of American adults, more than 25 percent (more than 57.5 million adults) experience a mental health disorder in a given year, but only 36 percent receive treatment.
- Of 13-18 year-olds, more than 46 percent have or currently experience a mental disorder. Strikingly, 20 percent of all 13-18 year-olds have or have had "a seriously debilitating mental disorder," and only 36 percent of them receive treatment.
But recently, it's been nearly impossible to turn a blind eye to it. Why?
There's been a rash of events that saw the words "mental health" and "mental illness" (terms that I've consistently seen elicit a visceral and negative reaction, which we need to change) in our daily lives and discussions.
Silver Linings Playbook, the Sandy Hook massacre, Christopher Dorner, and the gun control debate. The return of enlisted military personnel. Brain trauma and suicide in sports. Side Effects, a seeming outlier. Each is connected to mental illness, albeit in different ways. This swell of attention should help break down barriers and help de-stigmatize the issue, but we have to let it.
Here are six ways that our cultural and societal view of mental illness is unhealthy:
1. Silver Linings Playbook is a vivid and honest representation of someone struggling with bipolar disorder, from inpatient treatment to arguments about how many medications one person can take to prevent the recurrence of manic breaks. The movie conveys messages about mental health, but also more broadly as Harold Koplewicz Dr. observed, it shows that "it takes a lot of mutual support for people to be their best selves, whether or not mental illness is involved." Yet when Bradley Cooper travelled to Washington to discuss mental illness and mental health, we didn't hear about meetings with patients who suffer from bipolar disorder, but rather reports focused on a screening and meeting with veterans at Walter Reed Hospital. When he went onHardball, NPR, and on other shows, there seemed to be little talk about mental health. Instead discussions focused on football, Robert De Niro, Philadelphia, and so on. Bradley Cooper has spent time helping to understand mental illness and raise awareness of its prevalence. His intent is clear, as he's spoken about his hope that this movie will break down the stigma around mental illness. But there needs to be a more substantive, public discussion, not just in 30 second sound bites.
Cooper also participated in a panel discussion at the Center for American Progress, where he spoke about the need for increased public dialogue to remove the stigma and the importance of people coming to terms with the fact that mental illness is something that they can relate to and have more than likely experienced or witnessed. The event, however, also focused heavily on the "invisible wounds" of returning veterans. Again, the discussion was moved to a place beyond most people's everyday reality. Perhaps I am overly skeptical, but to me, focusing on a cause beyond our capacity to change -- invisible wounds -- is just one example of continuing the stigma when it comes to the majority of mental illnesses.
2. We gravitate towards issues beyond our grasp framing them in a manner that is easier to understand by providing a cause-and-effect lens, because it seems that society has an easier time "understanding" and "accepting" mental illness when it is about a specific group and mostly discussed around a specific issue. In this case, the group was veterans and active duty servicemen who suffer from Post Traumatic Stress Disorder (PTSD). Just from observing conversations and coverage of the issue, there appears to be greater acknowledgement and acceptance of PTSD, especially for veterans, than of mental illness more generally. Why? Yes, they are heroes, but perhaps also because of the clear causality. The public understands they faced hardships the likes of which the vast majority of people never see -- it is a foreign experience (evoking "that would never happen to me" thoughts), but also one with an identifiable origin. For example, confrontation by enemy combatants caused an identifiable trauma that has resulted in a tangible mental illness, PTSD. And, we have also seen and heard stories about how people have been "cured" of PTSD or have overcome it. Society does not see it as an incurable, chronic condition like so many other mental health diagnoses. This is just one example of how when engaging the public about mental illness, we gravitate toward topics that are more "user-friendly."
3. Chris Dorner and Adam Lanza are just two representatives of another take on mental illness. From reading reports and listening to the gun control debate, mental illness is seen as at least a contributory, if not the primary, factor for the horrific acts of murder they both committed. And in Lanza's case the first reports would have had you believe that Asperger's Syndrome makes people dangerous. Not only tragically wrong, but offensive. The conclusion: mental illnesses or disorders make people dangerous. Not the guns, but the unstable individuals who somehow gain access to them. This is naïve at best, but regardless is highly prejudicial and flawed. These men do not represent "mental illness" and should not be our frame of reference. Yes, they suffered from mental illness, but their problems and compounding factors make them the exception. They must not be what we think of when we think of mental illness.
4. As for the gun control debate, recall that more than 1 in 4 adults in America has suffered from mental illness over the past year alone. So do we preclude more than 25 percent of the population from owning guns because they suffer from mental illness? Those who are against comprehensive gun control may try to walk back their sweeping statements by saying those with mental illnesses should not own guns and calling that a compromise. To be clear, I strongly support comprehensive gun control legislation, but this is a timely example of the flawed logic that many are using to shift the burden of fatality from the weapon and the owner wholly to the owner's mental state. That reasoning is flawed. Beyond gun control, people with mental illness who are being or have been treated and whose diagnosis is under control, in principle should not be precluded from an activity solely because of their mental illness. The Americans with Disabilities Act has grappled with this issue more broadly.
5. From Junior Seau's suicide to the death of three NHL players in three and a half months in 2011, it is hard to turn a blind eye to the relation between mental illness and elite athletes. These tragedies have led to a lot of discussion of Traumatic Brain Injury (TBI) and mental illness. Often the suggestion is that the TBI leads to the mental illness, because if that were the case there would be a specific causal relationship, as with PTSD. A 2007 University of North Carolina study found a correlation between TBI and depression, but it showed no causality. There is some good news, throughout February, seven Canadian NHL teams have been working together to raise awareness about mental health. Hopefully next year American teams will take part. As Dr. Thelma Dye Holmes, Executive Director of Northside Center for Child Development, says in a great piece by William Rhoden, "Mental health has a stigma that is tied into weakness and is absolutely the antithesis of what athletes want to portray." This doesn't pertain just to sports. But, the real strength comes in seeking help. NFL player Brandon Marshall made this point writing, "In sports, those who show they are hurt or have mental weakness or pain are told: 'You're not tough. You're not a man. That's not how the players before you did it...' We must break the cycle, and that starts with prayer and by seeking help.'' We need to work together to promote the importance of seeking help.
6. And then most recently along comes Side Effects. (The film is an entertaining thriller and should be valued for those qualities.) Without spoiling the movie, in it depression, anxiety and dependence on psychopharmacology are seen as weaknesses. (Perhaps the drugs are not presented as beyond common experience. But then again the story is based in Manhattan where I've heard more than one discussion about what SSRIs someone has taken and how they have tried more than the other person -- as if it is a contest.) What is clear is that depression is seen as a burden and something that like any other ailment a pill can cure. An oversimplification of the issue, after all, people don't stop going to physical therapy because they can take Tylenol.
It is good to see discussion of mental health in the mainstream, and I hope this is just the beginning of a bigger discussion and growing awareness. I agree fully with Bradley Cooper and Brandon Marshall. We need a dialogue to de-stigmatize mental illness, and the best way to do that is to enable people to realize that it is something they literally face everyday. Perhaps if we come together and work together we can create a national conversation and further de-stigmatize mental illness.