Mental Health, Social Stigma and the Well Mentally Ill

People with mental health issues are still stigmatized. The media portrays most people with mental illness as violent or flat out crazy. Yet, that is not an accurate portrait of a person with mental health concerns. First, if we were to remove all the mentally ill people from the population: violence would only decrease by 3% according to Dr. Phillip Resnick, M.D. psychiatrist (served as an expert on the Unabomber and other criminal cases).

Secondly our picture of mental illness is at the peak of symptoms. When most people think of mental illness they think of: 1) The person with anxiety who can’t leave the house or attend social situations; 2) The person who is depressed who can’t get out of bed, can’t go to work or school and who is suicidal; 3) The person with bipolar disorder or schizophrenia who is floridly psychotic, hallucinates, hears voices and has delusions; 4) The veteran with PTSD who can’t function in public, has an extreme response to a car backfiring and who can’t sleep for days; or 5) The person with any kind of mental illness who self-medicates with alcohol, street drugs and perhaps is homeless.

This portrait of mental illness would be like believing people who have cancer are all bald, weak, bedridden, vomiting, and ill. Yet people, who have had cancer treatment, hold jobs, are parents, are siblings, run races for the cure and get to celebrate another year of recovery.

The person with mental illness, who is in treatment generally looks and is very well! They too hold jobs, go to school, get married, parent, have goals and friendships. Frankly you run into people every day that are among the healthy, with mental illness. It could be your doctor, a salesperson, dentist, school teacher, banker, lawyer, engineer, carpenter, or banker, boss, coworker or friend. However, we rarely see the functioning mentally ill because of the stigma. They don’t announce another year without psychosis, being afraid to leave their home, or not being bed ridden or suicidal. So, we have a skewed view of mental illness.

We do know that most mental illness, which really is a neurological brain function illness, is a combination of genetics and luck of the draw. Shake the family tree of someone with mental illness and you’ll generally find a variety of family members with anxiety, depression, “strange behavior or eccentric behavior’, hospitalizations, suicides, and addictions. Only a small percentage of mental illness is totally environmentally caused by extreme neglect, abuse or trauma. The rest of the folks with mental illness had a “normal” childhood.

What does good treatment look like to produce the highest level of functioning? Let’s look at the top 4 supports to insure the best outcome:

• A loving, supportive family who is supported themselves. Family members must go to their own counselor or to a support group. This is to help them get through the grief of lost potential, fear and help them know how best to help and not enable.

• A great psychiatrist AND continuous individual counseling for the patient. Medical management is essential and hospitalization needs to be available in the acute phase. Counseling is essential too. It’s in the counseling session that the patient learns skills, is supported, problem solves, develops a relationship and learns about their illness.

• Medication compliance. Again because of stigma most first time – fourth time patients resist medication. When the patient’s life falls apart, sometimes several times, they finally accept that medication is necessary for treatment. I know of one psychiatrist who medically supervises her patients’ titration down from medication. When the psychosis or depression or anxiety returns, it’s in a safe environment and the patients then can admit they have an illness.

• The patient’s desire and hero’s journey to get well. Mental Illness is a chronic, relapsing, and sometimes debilitating condition where residual problems occur with each episode. It is not easy to be well and hopeful when you’ve lived through such a soul robbing experience. Others can assist by simple kindness and acknowledging the sheer strength, stamina and courage it takes to get well and stay well.

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