Monday, April 02, 2018

Stop Stigmatizing Psychiatric Treatment!

Stigma is a sticky, two-sided issue, one that we talk about often in our field of psychiatry.  Many things are stigmatized. While mental illness is an obvious one --and I'll come back to this-- many other things are stigmatized as well.  To name just a few: drug use, smoking, being a criminal, going to jail, behaving in a disruptive way, smelling badly and being physically unkempt in certain settings, begging for money in public, being on public assistance (in certain circles), beating your children (again, in certain circles), incest (in all cultures), being morbidly obese (especially when it happens in someone who makes poor food choices, as opposed to being the result of an illness), suicide, behaving badly after drinking alcohol,  sexually harassing your colleagues in certain circles, and I could go on and on.  

Stigma, as you can tell by my short list, is a bit diffuse and subject to individual consideration, pertains to lots of troublesome behaviors, and depends almost wholly on the environment and consideration of others, and what is stigmatized  changes over time.  While stigma is troublesome in that it causes people to feel shame and self-loathing, it also has a role in society.  Stigma inspires some people to change  or avoid certain behaviors.  People certainly smoke less since it's become highly stigmatized and those who want to smoke at work are sent out into the cold to stand in little boxed off smoking areas.  There is a stigma to going to prison and being labeled a criminal and this is part of the deterrent to crime.  While suicide rates are rising, many people still don't end their lives for fear of stigmatizing their family, and as much as I see suicidal thoughts as a symptom of an illness, I do imagine that more people would choose to end their own lives if it left a legacy with no stigma whatsoever.  While it may have once been cool to be a "player," it's no longer okay to grope your co-workers.

But what about mental illness?  Mental illness is not a behavior and it's not a choice, it's a constellation of uncomfortable psychic events, or symptoms, and sometimes having a mental illness leads people to behave in stigmatized ways.  But the illness itself?  Yes, it's mostly still stigmatized, despite our best efforts, but some conditions certainly more so than others.  We have not really clarified exactly what mental illness even is, but the reaction you'll get to saying you've had panic attacks in the past may be a bit different to the one you'll get if you announce that during manic episodes you run through the streets naked and max out your credit cards.  

So I don't want to talk about the stigma of mental illness and substance abuse today,  I want to talk about the continued stigma of getting treatment for these issues.  Because one of the problems with stigma is that it discourages people from admitting to themselves or others that they have these problems and getting help, and so the treatment itself is stigmatized.

This is the funny thing: most things that are stigmatized are unpleasant or have unpleasant consequences.  Jail is uncomfortable and leaves you with a bad mark.  Getting psychiatric treatment is not usually unpleasant, and it often leads to very GOOD things.  Being in therapy is stigmatized in many circles, but once over the hurdle, people ENJOY coming to therapy.  You talk to someone who cares about you about the difficult things in your life, you have a safe place to process what goes on in your head, and often just talking is a relief.  Most people like their therapists and look forward to sessions.  If things are not going well, the session is a place to process what's going on, to have someone who listens with concern, who may or may not offer helpful suggestions, who carries your history and story.  This can be a great relief and a tremendous comfort.  But people don't just come in when the world is crashing, often they are happy to come to a session and announce that things are going well!  They want their therapist to be pleased for them.  And therapy is about the same things for everyone: talking about the stuff you can't talk to everyone else in your life about, often talking about issues with interpersonal relationships, and the obstacles to getting what you want out of life.  It's the same for those with serious mental illness as it is for those who function well.  So why do we stigmatize something that people enjoy, that helps them?  This I find perplexing.

And what psych meds?  The stigma that comes with taking them is huge and there is even a culture of what some have called "pill shaming."  Granted, some medications have side effects or cause weight gain or sexual dysfunction, it's not all good.  But many people take psych meds and feel so much better.  They become more functional, they feel less misery, they stop hearing voices, they stop behaving in those ways that are associate with mental illness and they gain a resilience and reserve that is helpful.   Yet most people don't proudly announce that they get monthly antipsychotic injections or that lithium has been a live saver that allows them to have their highly functional life.  At one point, it was probably fine to say you popped a Xanax for anxiety, but now even appropriate benzodiezapine use use gets lumped in with addictive issues.  

And rehab?  Oh, my, outside of Recovery circles, most people don't advertise that they have been to detox or rehab.  Why not?  Good rehab is a wonderful thing.  It takes people out of the foxhole of addictive misery and gets them back into a place where they can love and function.  

We're never going to stop stigmatizing mental health problems, especially if we continue to insist that they are the cause of people becoming mass murderers.  But let's work hard on it: mental illness does not explain many things that the American public thinks it does.  And let's try very hard not to stigmatize treatment!  Treatment is good, it gives people their lives back, it helps them shed oppressive symptoms,  it feels good and it's nothing to be ashamed of.

1 comment:

Joel Hassman, MD said...

People want to lessen the stigma of mental illness? People with mental health disorders need to vote consistently and in majority numbers, force politicians to take public positions on mental health care needs, and those losers in public office who either dismiss the mental health voters or give superficial and lame positions, well, then vote them out of office!

Because, most politicians love the scapegoat, the mentally ill especially the chronically ill are easy targets, and most important to politicians, if you don't vote, then the politician has no interest in this citizen. Not a constituent, then not a concern.

But, that requires time, energy, and sometimes money for these voters to act. The mentally ill are always the first if not the top three on the list to demean, disdain, and dismiss.

Sorry for the Nazi analogy, but the mentally ill were the first to be exterminated. It is there to learn, for those who want to dismiss this point...

One source if interested:

Joel H