Note: I am not a mental health professional in practice, but psychology was the focus of my college major, I have a Master’s Degree in Clinical Psychology, and have worked in the mental health field.
By now, the world knows designer Kate Spade committed suicide and battled depression, Dutch Queen Maxima’s sister battled mental health issues and committed suicude, and Anthony Bourdain’s death followed not long after. Many articles and blog posts have been dedicated to these tragedies and the number for the suicide hotlines have probably gone around the world.
But it won’t stop suicide. It might help some, but it will never help everyone. Why?
The stigma that prevents people from reaching out for help. The stigma that prevents people from realizing they need help. The stigma that prevents people from being open with the world about their battles. The stigma that the mental health field has fought to tear down to no avail. The stigma that stops mental health professionals and their clients from working forward together towards positive change.
I never had a class devoted to stigma. Instead, it wove its way through everything I did during my education and training. Often, we were helpless. We could watch people who needed someone to listen to them, but, unless they reached out, our hands were tied.
What Does Stigma Look Like?
“Oh my God, you’re crazy! Go see a therapist!”
“There’s something wrong with you. You should go talk to someone.”
“You sound depressed. Maybe you need to take some pills.”
“So you’re seeing a shrink, huh?”
“Don’t be so dramatic!”
“Shrinks won’t help. They only push pills!” (We don’t. Unless psychologists receive extra training, they cannot prescribe medication. Medical doctors and psychiatrists prescribe. Most psychiatrists these days only prescribe without providing therapeutic services.)
Do you see where I’m going here? People do one thing that seems out of character and everyone around them thinks they’re crazy and should be diagnosed with a dozen different things. For the record, every diagnosis has a laundry list of criteria that must be met before diagnosis can occur, but anyone and everyone can and will exist on the spectrum for any number of diagnoses (yes, even you!) without meeting diagnostic criteria.
People have preconceived notions about the mental health field. They think mental health professionals push pills and sit around while you talk. First of all, there are many psychological techniques and lying on a couch while you spill your guts is only one. Mental health professionals need you to open up to them, need you to trust them and develop a relationship with them before the actual work can happen (which can and does take years) where clients can receive the guidance and tools they need to function without a mental health professional to guide them. Second of all, change cannot occur after one session, and maybe not even after ten. It takes work. Third, mental health professionals can only help when you’re ready for help. They cannot help those who do not believe they need help and are not willing to receive help.
The Two Sides of Stigma
The Individual with Mental Health Issues
The person sitting next to you, living two doors down, or who drops off their kids at the same time you do might have a psychiatric disorder and you will never know it.
People are not comfortable with sharing their mental health struggles. It’s taboo to be open about it. The thing to do is hide and pretend it doesn’t exist.
But that’s painful. Suffering alone hurts, but people are afraid of opening up, afraid of admitting they have a problem and need help, afraid of the rapid fire questions and the “why didn’t you say so sooner?”
The stigma lies here. People will think they’re crazy or wanting to call attention to themselves or it’ll overshadow everything they do and have done. They’re afraid of being called crazy.
So they hide. They don’t talk openly, or even at all, about their struggles. They put on a happy face and say everything is fine. Even when it’s a lie.
The Mental Health Professional
Mental health professionals want to help. They see someone who could use their education and training, but can’t offer much because HIPPA restricts them from approaching them for the purpose of openly discussing mental health issues.
Instead, they wait. And hope.
But stigma surrounds their work. People think they don’t help, that they’re quacks. They think they’re just paying someone to listen to them. They think everything should be better after one session and get angry when nothing has changed after an hour of talking.
Most of all, people think they’re being weak for seeking out help, when, in reality, they’re doing the strong thing.
Some Truth About the Mental Health Field
Unless a psychologist is licensed to prescribe medication, they won’t. If they think it might help, they will refer clients to a psychiatrist. Psychiatrists prescribe medication and most these days do not provide therapy.
For most disorders, medication is only one step. It helps manage symptoms so non-medicinal tools and practices can be put in place. Many people think meds will fix you. They don’t always. Therapy provides the long-term management skills that enables people to stop or decrease medication. And medications can and do stop working.
Effective therapy relies on something called the working relationship/alliance, also called rapport. The mental health professional and client must develop a relationship based on trust and understanding before any real work can be done. This takes time. Many people think they can go in once and be cured. Mental health does not work this way. It takes work and it takes time.
There are many treatment modalities. We’ve all seen those cute cartoons with someone lying on a couch and a huge speech bubble floating above them while a balding man sits back, takes notes, and says “And how does that make you feel?” Not all therapy is like this. Actually, this is psychoanalysis (think Freud), which has come a long way from this. There is also Cognitive-Behavior Therapy (CBT), Acceptance and Commitment Therapy (ACT), the very effective Dialectical Behavior Therapy aimed at clients with Borderline Personality Disorder, Relational Therapy, group therapy, family therapy, etc. All of these are different in their approach and what they ask of the client.
No mental health professional fits all. Mental health professionals are people, too. They have their own background, education, training, and experience. No one professional will work for everyone. It can and does take time to find the one professional with whom a client feels comfortable.
Therapy isn’t just for people with psychiatric disorders! Mental health professionals are there for anyone who needs guidance, support, and management skills for anger, self-regulation, non-clinical anxiety, etc. They can help with normal day-to-day problems. They can help bring things into a new light. They can help with life issues. Mental health is more than just depression, anxiety, schizophrenia, personality disorders, eating disorders, sleep disorders, etc. It’s about your emotional, mental, behavioral, and social well-being.
When I was in high school, I read a story about someone who was preparing to commit suicide. The house was empty, the mode of execution was in place. Then the phone rang and the caller left a message.
It was a friend. Someone calling to ask if everything was okay. Someone calling to say they were worried. Someone calling to say they cared and loved their friend.
The person who was about to kill themself lived. And called back to say their friend had just saved their life.
How You Can Help Bring Down Stigma
Yes, you can help the mental health field! It’s people who created and perpetuate the idea that mental health professionals are quacks and don’t do anything to help. So it’s people who can change this idea by changing the message.
- Listen and notice. Look at your family, friends, neighbors. If someone seems out of sorts, don’t assume there’s something wrong with them. Don’t suggest they “get help.” Instead, offer to listen. Offer to be non-judgmental and not ask questions. Or keep an eye on them and develop a relationship full of trust, kindness, and understanding.
- Parents, encourage your children to be open. Listen to them without judgment, without thinking there’s something wrong with them and they need help. Let them know it’s okay to experience the negative emotions (sadness, anger, jealousy, etc.). Create an atmosphere of trust and change how you talk about mental health professionals.
- Change your thoughts about mental health professionals. If you think they’re great and they’re there to help, you’re right! There are, of course, those who aren’t helpful. There are also those that you won’t click with. Not every mental health professional is a perfect fit with everyone. Sometimes it takes time and experiencing several professionals before you find one you’re comfortable with. But if you think they’re quacks who are unhelpful and only push pills, reconsider the message you’re giving yourself and others. Therapy takes time and working with the right person. Yes, sometimes medication will be strongly suggested, but it’s because sometimes mental health professionals cannot work effectively unless symptoms are temporarily managed by medication so that other tools can be put in place.
- Learn about the mental health field. Find out what it is and what it isn’t. There are so many preconceived notions about it, it makes me sad to think of them. Mental health professionals vary. Experiences vary. Treatment plans vary. Techniques vary. Just because one person had a bad experience doesn’t mean seeing a mental health professional can’t help. It just wasn’t a good fit for them.
- Be open. People who have been told there’s something wrong with them or people who have spent a decent amount of time in an atmosphere where mental illness was not okay are probably not likely to be open about their problems. They will carry the stigma, the negative messages about mental health and will have a much harder time admitting to themselves that something is wrong. This can and does happen even when they find themselves around those who support them because the message has been so pervasive. So don’t start that message. Instead, stay open. Listen. Be positive about mental health.
- Realize a psychiatric disorder is a part of the person, not who they are. They are suffering with it. They are not the disorder. By separating the person and the disorder, you can see the person for who they are and see the disorder as something that affects their life, but isn’t who the person is. A person with depression, anxiety, autism, bipolar disorder, schizophrenia, anorexia, etc. Not a person who is depressed, anxious, autistic, bipolar, schizophrenic, anorexic, etc.
The stigma around mental health is pervasive. It often feels unrelenting. Those in the field can work tirelessly to destroy it, but, in the end, it’s up to you to help. Think differently about it. Learn about it. Let people know it’s okay to not be okay and there’s nothing wrong with it. If you suspect something in someone you know, read up on it, look for the signs, and support in any way you can and that they allow. Don’t make them feel guilty for not speaking up sooner, being open about it, or for “trying to call attention to themselves.” If they say they need help, realize they’re taking a huge, scary step.
Yes, sometimes this still won’t help. Yes, sometimes bad things can and will happen. The stigma is pervasive. It feels permanent. It will take time to tear down. And people can be in denial until it’s too late.
Until people can feel open about discussing their mental health issues without shame, ridicule, and brush offs, people will continue to hide and suffer in silence and loneliness.
But you can start the message. You can say it’s okay to not be okay. You can help educate the people you know about what the mental health field is and what it aims to do. You can be open about it. You can be open to listening to the people around you without judgment. You can offer support and judgment-free love and friendship.
You can help destroy the stigma around mental health.