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The stigma of mental illness: What it looks like and how it's being shattered in Colorado
Gazette - 9/25/2022
Sep. 25—"What have you got to be depressed about?"
"Stop drinking so much. Have some willpower."
"I thought you were doing well last month. NOW, what's wrong?"
"Have you tried yoga, changing your diet, taking Vitamin D?"
People struggling with psychological, emotional and social difficulties hear insensitive comments from family, friends, co-workers and even the critical voice inside themselves.
Such misunderstanding doesn't help the black hole that consumes someone's life when they're suffering mental imbalance and even can be part of the prodding and poking that widens it, experts say.
"As a society, we still make moral judgments about those who live with mental health issues and the challenges they face in managing their illnesses," said Lori Jarvis-Steinwert, executive director of the Colorado Springs office of NAMI, the National Alliance on Mental Illness.
The negative bias — or stigma — surrounding mental health often is seen as an individual failing and something that can be controlled, said Jenna Glover, Ph.D., director of psychology training at the Pediatric Mental Health Institute at Children's Hospital Colorado in Aurora.
"There's a perceived weakness," she said, in the individual who is having mental problems.
Falsehoods and incorrect images are pervasive, but professionals in recent decades have been challenging misconceptions to improve public attitude.
Entertainment-industry portrayals of people with mental problems being out of control, dangerous and needing to be locked away have contributed to the stereotype, Glover said.
For example, 97% of video games analyzed for a study published in 2019 in the Journal of Medical Internet Research depicted mental illness in "negative, misleading and problematic ways," the study concluded. Games associated mental illness with "violence, fear, insanity, hopelessness."
"The common terms that people are psycho, psychotic, crazy — we've used them in a pejorative way throughout history," Glover said. "That's completely inaccurate but has exacerbated the problems with the stigma and of people supporting those who have mental health concerns."
Social and institutional judgment stems not only from a lack of understanding but also an unwillingness to treat mental illness as a true illness, Jarvis-Steinwert said.
Think about how you'd act toward a friend with diabetes, rheumatoid arthritis, a physical disability or other chronic health situation, she said.
"We would support them, encourage their health and well-being," Jarvis-Steinwert said. "Why can't we do this for people who live with mental illness? It would make a world of difference if we did."
While everyone encounters bouts of depression, anxiety, worry, agitation or being out-of-sorts at times in their lives, extraordinary stress can turn mental fragility into mental illness, Glover said.
Like physical conditions, mental conditions can be temporary, along the lines of mending a broken leg for instance, or they can be chronic, like diabetes, and need to be continually treated and managed — or they'll worsen.
"People don't necessarily view chronic mental health conditions the same way as physical health conditions, but they're just as severe and impairing," Glover said.
In her work, Glover finds that it's common for families not to tell relatives that their child is in therapy because the knowledge can affect how family members view the child and the adults as parents.
"If a child had cancer and you were taking them for treatment, that's not something you'd hide," she said.
In that case, well-wishers would rally around the family and volunteer to help with transportation to doctors' appointments, picking up prescriptions, cooking meals or babysitting other children.
The same kind of aid usually doesn't materialize for parents who have a child who's chronically depressed, though, Glover said.
Mental illness is "not something to be ashamed of but something to show up for," she said.
Simply using the word 'stigma' can be bad
Harold Maio, a retired mental health editor who lives in Florida, has been campaigning to remove the word "stigma" in relation to mental health.
It's an insulting term, he said, one that society eradicated use of at least three notable times.
In Nazi Germany, Adolf Hitler declared European Jews carried a stigma. The Nazis killed 6 million Jews during the Holocaust. In the 1970s, women said they refused to do further harm to women who had been raped by calling them stigmatized. And in the 1980s, many people were stigmatized after developing AIDS, an autoimmune disease that particularly infects gay men and drug users who share needles.
"The proper reference is prejudice," Maio said. "When we argued there was a stigma to rape, our intent was to show prejudice to anyone who had survived rape." Or the Holocaust or HIV/AIDS.
Using the word "stigma" means, "I am discriminating against a group of people by assigning them that word, rather than acknowledging my personal prejudice," Maio said.
But the 85-year-old Maio has garnered little support for eliminating the word from mental health dialogue.
"Our culture at every level now, including government and higher education, is insisting that term is acceptable," he said. "We've stopped insisting AIDS carries a stigma, but we're still being told mental health issues carry a stigma."
Leaders from the United States surgeon general to former First Lady Michelle Obama have publicly stated there is a stigma around mental illness, Maio noted.
"That term does everything it can to avoid reviewing our prejudice and the actions of discrimination that result from our prejudice," he argues.
But Glover says all negativity regarding mental illness needs to be recognized.
"We need to call stigma out," she said. "This is a part of the day-to-day world we're in."
In Colorado, new legislation has increased mental health care funding, formed an administration to oversee behavioral health and created a system to fix what has long been considered a broken network for psychiatric treatment.
Educating society at-large about mental illness, advocating for insurance parity, promoting workplace acceptance and encouraging compassion also have developed to round out improvements.
And while the COVID-19 pandemic caused premature deaths, lasting physical ailments, grief, isolation, fear and other problems, it also shed light on the importance of mental health care.
"The pandemic 'leveled the playing field' as far as our understanding of what it means to struggle — certainly with the depression and anxiety associated with isolation and loss," Jarvis-Steinwert said. "More of us have had these types of symptoms and, in general, have greater insight and empathy for those who struggle than we did prior to the pandemic."
Glover agrees, saying she doesn't think anybody went through the pandemic without some type of mental health symptom. "We're finally acknowledging that it impacts everybody at-large and are putting money towards it."
Normalizing mental health care
Public realization from the pandemic was significant because normalizing mental health care helps overcome stigma, said Charlotte Whitney, spokeswoman for the Colorado Behavioral Health Administration.
"We know that stigma is one of the leading causes of why folks aren't seeking treatment," she said.
Whitney defines stigma as the fear or shame that people feel in association with pursuing treatment for conditions such as substance-use disorder, a mental illness that affects a person's brain and behavior to the point they are unable to control their use of drugs, medications or alcohol.
Research also shows that sharing stories of successful recovery journeys is effective, she said.
Whitney oversees the behavioral health administration's public-awareness campaign called Lift The Label, created in 2018 to eliminate stigma surrounding opioid addiction, an increasing problem statewide.
She also heads the Recovery Cards Project, an initiative of Lift The Label that started in 2019 to produce greeting cards from Colorado and national artists with messages aimed at recipients who are fighting addiction or in recovery.
More than 70,000 cards have been sold in stores and online, Whitney said. They are available online at https://recoverycardsproject.com. Some are free to order.
Messages of celebration, encouragement, grief, gratitude and support are available and include Colorado Springs' artist Lauren "Lo" Gomez's card, "It's OK to Ask for Help." She made it this year for the annual September observance of National Recovery Month.
Gomez's boyfriend overdosed on opioids, partly because of the stigma he felt about his drug habit, Gomez said in a video about the card design.
Keith Hayes of Denver, who's featured in the anti-stigma promotion, was addicted to drug and alcohol for 20 years but said he resisted reaching out because of the culture of stigma.
"You feel people might look at you differently," Hayes said. "People don't understand it's a disease."
Growing up a Black man, Hayes said trying to figure out how to get clean and sober on his own didn't work for him.
After Hayes became "sick and tired of being sick and tired," and was given the choice of going to jail for three years or quitting using substances, he entered a treatment program.
"I didn't have any insurance, so I went to the Salvation Army, and they showed me how to live, how to be responsible," Hayes said. "I lost my dignity, I lost my humanity."
Now, at age 40, he's regained a sense of self-worth and well-being, and more.
"There is life in recovery, there are people who understand the place you've been in," Hayes said. "There is hope."
Anyone needing assistance for mental health problems can call the free, confidential Colorado Crisis Services line at 1-844-493-8255 or text "TALK" to 38255. Dialing the new nationwide 988 hotline also is available.
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