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Mary Walker Baron

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Calling in Crazy: Why We Must Normalize Mental Illness

Posted: 02/27/2012 5:49 pm

It's tough to admit that we are all from time to time a little mentally ill. We don't want to acknowledge our intermittent mental illness because we would then become part of a stigmatized population -- a population that we ourselves have perhaps at times helped to stigmatize.

Throughout our lives, we travel a health-to-illness continuum, always seeking a return to wellbeing. While we acknowledge the physical realities of this continuum, it's harder to accept the emotional, cognitive and behavioral aspects.

If I comment to a friend that I'm sneezing, my joints ache, my temperature is slightly elevated, my throat hurts and I feel nauseous, my friend will very likely reply with something like, "Sounds like you're coming down with a cold or the flu." My friend might also suggest a remedy. "Don't forget to drink plenty of fluids and get a lot of rest. Eat some chicken soup. That always helps me." The conclusion might be that I'm a little physically ill. The assumption is that with proper, time-tested care, I will recover. Should my symptoms get worse, it is understood and expected that I will seek professional care, which might include a visit to my doctor, medications and even hospitalization.

It's not so easy for me to say to a friend that I'm feeling kind of hopeless, I'm not sleeping well, nothing seems to interest me and I've lost my appetite. However, wouldn't it be great if I could comfortably say those things? And wouldn't it be even greater if my friend could reply with something like, "Sounds like you're coming down with a touch of depression." And wouldn't it be greater still if my friend reminded me of possible remedies such as, "Don't forget to utilize your positive coping skills like talking to friends, exercising and restructuring negative thoughts. Remember that these episodes pass. Stay hopeful. I'm here for you." The conclusion might be that I'm a little mentally ill. The assumption might be that with proper, time-tested care, I will recover. But should my symptoms worsen, I would know to seek professional care, which might include a visit to my doctor, medications and even hospitalization. I would know that because with the normalization of mental illness, there would be no more stigma attached to my depression than is currently attached to my cold or touch of the flu.

According to the National Alliance on Mental Illness (NAMI), one in four (close to 58 million) American adults experiences symptoms of a mental illness at some time during the year. I suspect that the one in four is fluid and interchangeable. Today I am the one in four. Tomorrow you might be the one.

These symptoms of mental illness that you and I experience in the one in four exchange are generally about as inconvenient as experiencing the symptoms of a cold or the flu. They pass, often without much effort or attention from us. Nevertheless, though, in the best of all possible worlds we would acknowledge that for the few hours or days of discomfort, we were suffering from a mild mental illness.

Of course, on that continuum of health-to-illness and back again to wellbeing, NAMI goes on to tell us that one in 17 American adults experiences and lives with symptoms of severe mental illness such as schizophrenia, bipolar disorder or major depression. Just as we acknowledge the impact of chronic physical conditions, a chronic mental illness can profoundly impair functioning and, yes, kill us. Suicide, according to NAMI, is the 11th-leading cause of death in this country. And all of these symptoms and behaviors exist in stigma.

Living with stigma not only damages. It silences. Silence in turn informs greater stigma. The intention of normalizing mental illness is not to minimize or trivialize its impact, but instead to openly acknowledge its existence.

As a first step in this normalization process, let's acknowledge that we are all, at one time or another, number one in the NAMI one in four who throughout the year experience symptoms of mental illness. Having accomplished that, it may be easier for us to look at the one in 17 among us suffering from severe mental illness not as separate, but as companions traveling with us on the continuum of wellbeing.

Since there's no such thing as a stigmatized majority, we could begin eliminating the stigma of mental illness simply by talking about our own symptoms however minor and fleeting they may be.

Yesterday I was a little mentally ill. Today I'm okay. Let's talk.

For more by Mary Walker Baron, click here.

For more on mental health, click here.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

 
 
 

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10:04 AM on 03/15/2012
Mary,

I have a serious bone of contention with you only in the sense of I can be FORCED and that is the huge issue. To align this with the flu is understandable but if I have the flu I have the right to refuse treatment in a psychiatric ward I do not. I may be taking to court to be proven I am NOT mentally competent to make my own decisions and ergo will be medicated against my will. I identify as a psychiatric survivor for several reasons one of them being the FORCE used within the mental health system. I believe until we begin to ignore people like DJ Jaffe and E. Fuller Torrey and we recognize that NAMI has lost sight of its original mission. In its infancy NAMI was in the trenches with us fighting for better services and believing the system needed to be held accountable and then it changed its tune. E. Fuller Torrey's group preaches we aren't competent to make our own decisions to take or NOT take medication By the way, that is also DJ Jaffe's line of non-sense so for my two cents until we begin to recognize that ONLY the person having the crisis knows what they need and ONLY they know what they need to recover; then and ONLY then we will be able to put an assigned psychiatric label on par with a diagnosis of the flu.
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Mary Walker Baron
01:42 AM on 03/16/2012
I really appreciate your reply. As I said in my original post my goal in comparing mild symptoms of mental illness to a physical condition such as the flu was to begin an exploration of methods of normalizing mental illness and removing stigma. While I am not that familiar with the processes in other states, I do know that in California in patient psychiatric facilities must hold a Riese hearing before psychotropic medications can be given without consent. Depending on the outcome of that hearing the person can be forced to take medications. I also know all too well that in California a person meeting the criteria outlined in the LPS legislation can be forced to be hospitalized up to seventy-two hours. Oddly enough, these laws were designed to protect people experiencing psychiatric crisis. Nevertheless, that same person can be, under the protection of those laws, forced into hospitalization and forced to take medications. As mental health treatment moves toward the Recovery Model in which the person receiving the mental health services is the primary architect of those services I sincerely hope that issues of forced treatment will disappear. As mental health services are guided more and more by those receiving them we can also sincerely hope that the stigma of mental illness will disappear. Early in the creation of California's Mental Health Services Act (Prop. 63) the guiding message was, "Nothing about us without us." Again, thank you so much for your response and for this conversation.
04:40 PM on 03/21/2012
If you have a serious disease, like the plague, the same thing happens. You will be quarantined and treated whether or not the doctors have your consent. This is to keep you from harming yourself and others. It's the same for mental illness.
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Mary Walker Baron
12:24 AM on 03/22/2012
The plague, of course, is contagious and mental illness is not. However, the treatment intent of preventing harm to self or others seems an accurate match to issues related to the treatment of mental illness. These are essential discussions and I thank you for participating.
10:33 AM on 03/12/2012
Thank you Mary. I think your article was quite clear both in content and intent. And your replies very thoughtful and respectful.

The social stigma is still strong. In that sense the leper and the mentally ill share the dangers of rejection, though on a different scale.

In our society, the mentally ill may be committed against their will to an institution (sometimes for their own good, and that of others). When a child sees that occur to a loved one, s/he may grow up with a deep fear of being 'locked up", and so it would be terrifying to be ill and for others to know.

Your observations are accurate. I would be embarrassed to say to even a friend (let alone an employer), 'yes, my mother was hospitalized for being highly neurotic/psychotic', or even to admit to depression. It would make me (I fear) seem less in others' eyes and might embarrass or mystify my friend as well.

We might be able to say things like, "I'm a bit down today" But, as our illness level increases we may not even be able to recognize that we are ill. Having recovered, however, we ought not to be ashamed that we had been ill.

So, thank you for urging us to realize that a. we are all vulnerable and b. the boundary between mental and physical illness is somewhat illusory. I agree we need to start somewhere.
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Mary Walker Baron
12:06 AM on 03/14/2012
Thank you for your feedback and reflections. Part of the normalizing of mental illness challenge is the lack of language for such a thing. And so we begin by saying things like, "I'm a bit down today," if that's the case. Even that vulnerability can be terrifying because we are so socialized to forge ahead regardless of the damage the forward motion inflicts on us. I think the more we acknowledge 'being a bit down' (for example) the more likely we are to create a proper/appropriate language for stating the state (whether positive or negative) of our mental health. Thanks, again, for your comment.
08:41 AM on 03/14/2012
Thanks, Mary. I would like to understand why mental illness is more stigmatized than physical illness. Any insights?
08:52 AM on 03/03/2012
I see your point but I don't think your comparison is exactly on target.

Because I certainly don't want to offend anyone, I'm sitting here trying to think of a sensitive way to state this but the easiest way to state this is just to come right out and say it. I come from a long line of crazy people. I'm pretty sure that those who've read my comments here over the years have pretty much suspected that all along! :)

Substance abuse and deep depression have been common in my family historically and we've had many hospitalizations, attempted suicides and several successful suicides over the decades.

Also there are a couple of folks in my family who are bipolar and when they spiral out of control they are convinced that they are fine and the rest of the world needs help.

Perhaps because of the stigma, my family members did not recognize their symptoms had worsened and they needed professional help. Or in some instances perhaps they did recognize there was a problem but they entered deep denial for so long that eventually they were unable to seek professional care for themselves. All of the hospitalizations were involuntary commitments or were a result of suicide attempts.

Those are the reasons that I don't think the mention of being a little mentally ill is on par with the mention of having the cold or flu.
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Mary Walker Baron
11:43 AM on 03/03/2012
I believe that it takes courage to tell our stories so, first of all, thank you for telling yours. As I said in my article, seeing mental health/mental illness on a spectrum was in no way intended to negate the horrific effects of severe mental illness not only on the person experiencing those symptoms but on the families and communities of those who are suffering. However, I do believe that the conversation must start somewhere if we are to somehow normalize mental illness enough for people to be comfortable not only talking about it but doing something about it in the forms of seeking help, obtaining resources for treatment, or treating. Because of the stigma on mental illness and especially on severe mental illness a good place to start the discussion might be in areas we all experience from time to time. Again, thank you for you comments. Critical thought and discussion are building blocks for social change.
09:40 PM on 03/03/2012
Thanks for your thoughtful reply.

And you're right...we've got to start somewhere.

But it sure is a scary step to say those things right out loud to people instead of from the comfort of the semi-anonymity of our computers isn't it?

Thanks for listening!
04:30 PM on 03/02/2012
Plato said it best (also the opening to one of my favorite books, Flowers for Algernon):

"Any one who has common sense will remember that the bewilderments of the eye are of two kinds, and arise from two causes, either from coming out of the light or from going into the light, which is true of the mind's eye, quite as much as of the bodily eye."
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Mary Walker Baron
11:21 PM on 03/02/2012
And oh that common sense was much more common that is!
02:39 PM on 03/02/2012
A friend and I were just discussing this very thing. Why is it that if anything goes wrong below your eyebrows it is socially acceptable to most (and that in itself is quite scary), but let it be above the brows and between your ears and most people are quick to withdraw from you. Education is the key, but I have also met people who refuse to believe that mental illnesses are REAL diseases, and that many have REAL treatments. Frustrating, to say the least.
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Mary Walker Baron
11:16 PM on 03/02/2012
Great comment! Part of the problem, it seem to me, is that much of what goes on above the brows and between the ears related to mental illness is invisible until the symptoms become behaviors. Also, fear plays a large part in the stigma. With enough education people hopefully will understand that mental illness is real. Thanks for taking the time to respond.
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June Conway Beeby
08:25 PM on 02/29/2012
This article must be only directed to the lesser mental illnesses. That's the problem with the recent incorrect statistics about mental illness--statistics which do not differentiate among less disabling afflictions and the chronic biological diseases of the brain, like schizophenia, manic depression and other psychoses.

There is too little knowledge of this different in symptoms and seriousness among mental illnesses. They are not alike in their needs and disabilities. By ignoring this unique difference, services for the most ill have been abandoned . For example, their need for hospitalization. during times of crises, is ignored by closing psychiatric hospital beds.

It is important to learn more explicit information about the most ill,so they will have an equal chance to receive the care that includes their unique treatment plans and the hospital service they need when their normal relapses occur. It is disgraceful that current systems abandon the most sick and only cares for the less ill and the easiest to serve.

History will remember this era and notice how alike we were to those who did not take appropriate care of lepers.



Ask any families of the seriously mentally ill, they will confirm this.
12:44 AM on 03/01/2012
You are mistating it by saying it makes the the statistics incorrect. They are still correct; the recent discussion has been that there needs to be more discussion in breaking down the statistics in recognizing severe and presistant mental illness from those that cause disruption but people are able to maintain a level of functioning in their life. So its not incorrect just not a clear picture. This statistics is meant to increase awareness around mental health symptoms and increase normalization in hopes that more people will reach out for help.

You completely ignored what her article was talking about in encouraging people to have a more open dialogue about mental health and went on to your own agenda. In no way does encouraging people to be more open in discussing and accessing and using supports when experiencing struggles detract from services from those experiencing more severe mental illnesses.

It is a misdirection of the problem. It is largely up to where ever you live to decide how they want to structure their mental health services so it is hard to make a larger change as well as everyone also has a different idea on how things should be handled as I am sure I have a much different idea than you. The fact that you refer to people with a sever mental illness as lepers is perturbing.
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Mary Walker Baron
11:23 PM on 03/02/2012
Stigma is fed by silence. My hope is that discussions of mental illness will become comfortable for everyone everywhere. Thanks for the discussion.
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Mary Walker Baron
12:50 AM on 03/01/2012
June, thanks for much for your comment. Of course severe mental illness can cause profound impairments and, yes, far more resources need to be devoted to the care and treatment of such disorders as bipolar disorder and the psychotic disorders. These resources are far more likely if we work together to decrease the stigma of mental illness. One way to do that is to acknowledge the broad spectrum of mental illness -- from mild to catastrophic -- while working toward not only treatment but also prevention. Again, thanks for taking the time to comment.
01:03 PM on 02/29/2012
This message is so important! Mental health issues affect everybody and we need to increase public awareness on it's pervasiveness within our culture. The very nature of mental illness is covert and highly stigmatized. Agents of health care reform, health care systems and community health providers must give a voice to those who suffer and create policies and programs that sympathize and support various degrees of mental health. Kevin, writer (www.thoughtsunearthed.com)
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Mary Walker Baron
12:44 AM on 03/01/2012
I agree, Kevin. The more voices raised the less the stigma and the more likely policy and programs are to receive the attention and funding for necessary expansion. Thanks for the comment.