The stigma of mental illness is a significant problem in our society that may be killing us silently. I cannot count the times that a new client shook their head no while saying “I’m not crazy” or a family member pointed their finger exclaiming “I’m not crazy, they’re the problem.” I also witnessed many times pedestrians on the street, commuters on a bus, or shoppers at a supermarket ridiculing someone because of a perceived mental illness. Not surprisingly, the feelings of shame and embarrassment come to mind among others that would hinder one’s ability to seek treatment in the first place and take full advantage of treatments available for mental illness.
Unfortunately, that mentality is a commonly held societal belief that is problematic and detrimental to treatment. Consider some of the harmful effects of the stigma of mental illness as outlined by the Mayo Clinic:
Stigma of mental illness is also a major barrier to psychological treatment because it prevents some people from seeking treatment in the first place. This is a major problem because according to the National Institute of Mental Health about 10% of adults in U.S. suffer from a mood disorder and another 18% from an anxiety disorder in any 12 month period. Only 51% of those experiencing a mood disorder and 37% of those experiencing an anxiety disorder are receiving treatment. To make matters worse, there is an overwhelming amount of research linking mental illness to suicide. The American Association of Suicidology reported that “in 2006, suicide was the eleventh leading cause of death in the U.S., claiming 33,300 lives per year” and “the risk of suicide in people with major depression is about 20 times that of the general population.” That same report cited research by Isacsson and others (2000) adding that “the suicide risk among treated patients is 141/100,000,” which is significantly lower than 20% for untreated depression.
Stigma also prevents others from fully engaging or benefiting from the therapeutic process. Let me illustrate how stigma associated with seeking services can hinder effective treatment with an example from my clinical experience:
About a year ago, I began treating an adolescent client who was experiencing several symptoms of depression, including sadness, isolation, irritability, thoughts of worthlessness, and thoughts of death, as well as attention-seeking behaviors. After a couple of months of weekly meetings with the youth, it became clear that she felt ignored by one withdrawn parent. She responded to that parent’s withdrawal by engaging in problematic behaviors intended to gain attention. I made numerous attempts to engage that parent into family therapy with little success. During one brief individual meeting, that parent stated “I’m not crazy, my child has the problem” and refused to participate in family therapy. Although it was beneficial for that youth to learn to cope and express her feelings appropriately, including her parent in sessions would have expedited therapeutic progress if the parent would have been willing to take a look at what their role in the ongoing problems were and make some changes. Moreover, it could have been fruitful for that parent also, as it could have provided some insight into their daughter’s problematic behavior and possibly lead to an improved and more satisfying relationship. This client went on to make substantial progress, seeing decreases in many symptoms especially thoughts of death, but it took many more months than if her parent had attended and participated in therapy sessions. Sadly, the youth’s relationship with her parent was not repaired.
It could be extremely productive for children and adolescents to involve parents or guardians into family therapy, as this approach can improve dysfunctional interactions and poor communications that plague the family. Below are a few strategies that clinicians, physicians, or anyone else who wants to eliminate the stigma of mental illness might consider utilizing.
Strategies for Overcoming Mental Illness Stigma
Motivate. Many people will not engage fully into any activity they do not see a value in or worthwhile. The same is true for psychotherapy. Explain how counseling will benefit them, but be specific providing examples of how exactly therapy would make their life easier, happier, more fulfilling, etc.
Redefine. Many people still consider people who are homicidal or psychotic to be “crazy” and the only ones receiving mental health care. In actuality, people seek treatment for all types of issues including behavioral problems, depression, and marital conflict just to name a few.
Engage, engage, engage! Do not give up after your first attempt to encourage someone to begin treatment. Be persistent. I have found that it is useful to “trouble shoot” and find solutions to obstacles preventing them from participating in treatment.
Educate. Information helps people make informed decisions. If you are informed about mental illness, its consequences, and its treatment, share your knowledge.
Be Patient. Many people hold on to long-held beliefs due to societal or cultural influences. Be aware that it takes time to make change, especially one that involves reframing our worldview. Be patient and do not give up or blame the individual.
Recruit. There is strength in numbers. Recruit allies such as family members, friends, service providers or others to help overcome the stigma of mental illness.
Advocate. There are many local and national organizations that are fighting the stigma of mental illness by educating the public about mental health issues, lobbying congress for mental health parity and to prevent discrimination towards people with mental illness, conducting research, and offering support. Get involved! There are many ways one can take action and help end the stigma of mental illness. The National Alliance on Mental Illness (NAMI) is one such organization worth looking into if you are interested in advocacy.
Author: Dr. Yoendry Torres, Clinical Psychologist