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Paul Heroux

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Why Do We Stigmatize This?

Posted: 09/28/11 09:23 AM ET

On Sept. 20, 2011, the military policy known as Don't Ask Don't Tell became history. No longer would being openly gay prohibit someone from serving in the military.

But there is another form of don't ask, don't tell that is equally disturbing. This concerns mental health. In our society, the conventional attitude is don't ask anyone if they are suffering from a mental illness and don't tell anyone if you are. The taboo and stigma associated with mental illness is absurd.

A few months ago I blogged about depression in men, women and children. I received several emails regarding this. I ended up in a good discussion with someone who, after suffering from depression for a long time, asked me if they should go on antidepressants. I made it very clear that I am not a clinician, and that this person really should seek the help of a psychiatrist, but I did my best to have a casual conversation with this stranger seeking help.

This person explained to me how, after a series of stressful life events, he was not able to get back to a normal affective state. He described how he felt damaged by the stressful events. I explained that some illnesses are states, which are brief and don't last a long time; others are (and sometimes can even become) traits, which are persistent over time and across situations. When we talked about how antidepressants can be needed, the best analogy I could come up with is being permanently out of breath. Imagine that you put your body under a physically stressful situation -- it causes you a shortness of breath. Well, now imagine that you keep doing this to yourself, to the point that somehow, your body is permanently out of breath, even when you are no longer physically stressing yourself. That is basically what can happen to some people with some mental illnesses. The normal neurotransmitter level in your brain (i.e., serotonin) that partially regulates your mood is persistently off. Sometimes there is nothing that you can do about this on your own.

We see people being so seriously affected by stressful life events that some can't seem to get past the event. This is known as post-traumatic stress disorder (PTSD). We often hear about this with returning war veterans. The stress of war can have such an impact that it can essentially rewire someone's brain so they continue to relive that stressful event. The important thing that people need to know about PTSD is that it is not something that someone can just snap out of, and its not because they are weak.

There is this perception among some people that when you medicate a child who is hyperactive, you are doping that kid up, and they become a zombie. Over a span of seven years, I worked with 3,000 children, of which I personally knew of at least 50 who were served well by stimulants. I saw kids go from being troublemaking outcasts to fully integrated and functioning children. This is not to say that individual differences in children need to be medicated to make everyone the same; I completely disagree. And I've also seen on one occasion a parent not follow the recommended dosage of her child's medication, and that child did seem "doped up." The point is that sometimes people are born with different neurochemical levels that need to be regulated for the person to be able to achieve his or her full potential.

There is a perspective on medication that claims people don't need medication to heal or cope with mental illness. The argument goes that the human body can remedy its own ailments. Part of this perspective is that mental illness treated via psychiatric means is a disaster for the individual. I disagree. While the human body is remarkably resilient, and non-psychiatric means should be tried and exhausted first, sometimes the body's healing abilities just aren't enough. As to the disaster that psychiatry can cause, this may be true if a diagnosis and treatment is incorrect -- which happens, but is rare. But the point that opponents try to make is done by using isolated examples and/or errors made decades, even more than 100 years ago.

Mental illness can be especially complicated to understand because of a phenomenon that I call the etiology-maintenance-treatment confound: What causes a psychological problem isn't necessarily what maintains it, and the treatment might be unrelated to what caused it or what's maintaining it. For example, the thing that causes depression (a single event) might be unrelated to what keeps a person depressed (it can last for years), and the treatment might be unrelated to the cause or the thing that keeps someone depressed.

According to the National Institute of Mental Health website, over a 12 month period of time, more than 26 percent of people may have suffered from a mental illness at one point or another. What is perhaps even more shocking is that more than 46 percent of people have suffered from a mental illness at least at one point in their life.

Being different isn't a disorder; it is a virtue. The thing that makes a behavior pattern or thought pattern a disorder is that it substantially negatively affects someone's quality of life. Having a mental illness is not the fault of the person afflicted. This is the first and most important thing to understand.

But it is also important to understand that people who are suffering from an illness should not be expected to just snap out of it, to pray it away or to think it will go away by itself. Many mental illnesses have just as much of a physical basis as diabetes, cancer or heart disease. Each of these can be triggered or exacerbated by environmental circumstances, but they are all physical issues. It is the same for many mental illnesses.

In our society, we don't ask about mental illness, and we don't tell anyone about mental illness for fear of being thought of as weak or defective. The next time you hear of someone afflicted with a mental illness, remember to be compassionate -- they didn't ask to be afflicted with an illness. And not only do they have to cope with normal everyday life just as you or I, but they have to cope with the complexity caused by the illness, and the stigma that is wrongly and needlessly associated with illness.

PAUL HEROUX has a bachelor's in psychology and neuroscience from USC; he is not a clinician. He can be reached at PaulHeroux.MPA@gmail.com.