I always feel that when a celebrity, valedictorian, or writer discloses that they experienced a mental health struggle and recovered through therapy, they help at least 20 people in their audience. Their disclosure reassures the people listening that they are not alone if they struggle with depression, anxiety, or other psychological issues. It also normalizes the practice of seeking help from a counselor when it is needed. It is another step toward easing the stigma of mental illness. But why is there a stigma around mental illness in the first place?
Invalidating mental illness
Unfortunately, according to the American Psychological Association, more than half of people with psychiatric issues don’t get help because they fear that the stigma of mental health treatment will result in them being treated differently or losing their jobs.
I’m not Crazy! Our culture seems to view pejorative terms for mental health issues as OK. We have evolved to have more sensitivity around other forms of shaming. For example, we acknowledge that shaming people for their skin color, body size, and sexuality is wrong, but many people still ignore the truth that most of us casually use stigmatizing language about mental health all the time. Words like “crazy, sicko, psycho, nuts, and loony” are still part of popular speech. These disrespectful and dismissive words imply that psychiatric disability is funny and OK to mock.
Movies and television have also created the false impression that people with mental health problems are clownish, dangerous, or out of control. The truth is that people being treated for mental health problems are statistically no more violent than anyone else in the community. These portrayals imply that asking for help with mental health issues means that you are ridiculous or dangerous. These negative beliefs about mental illness are perpetuated by the repeated stigmatizing language and negative media portrayals.
Psychological problems are not real?
On top of the disrespectful language and media imagery used around mental illness, there is a pervasive myth in the US that validates medical treatment but invalidates mental health care.
Frequently, mental health struggles are regarded as much less “real” than physical illnesses such as cancer or heart disease. Mental illness is a medical problem, just as valid as a heart attack or a stroke. Despite decades of research verifying genetic and environmental causes, symptoms of mental illness, and effective treatment, some people (even public figures) irrationally state that they don’t believe in mental health issues. These figures say that it is “fake,” or a sign of being spoiled or weak. They say that people should “toughen up,” “trust Jesus more,” or “snap out of it on their own.”
Unfortunately, repeated expression of this myth has kept many from seeking professional help to address mental and emotional challenges when they need to.
Cultural stigma
Research shows that some particular cultural groups in the US hesitate to seek help for mental health concerns, compared to the general population.
People of Color. Because of the racist history of mental health treatment, many People of Color are understandably hesitant to seek therapy. Historically the field has been tainted with racism, abuse, discrimination, and cultural illiteracy among medical and mental health providers. There is little diversity in mental health providers. According to the APA, in 2019, the mental health workforce consisted of 83% White and only 17% racial/ethnic minority psychologists.
It is much harder for People of Color to find a therapist who looks like them and shares their cultural values. Many prefer to solve mental health issues on their own or in the community, or turn to the church for help. Although these alternatives can be perfectly valid and helpful, a blanket rejection of all psychological services can keep people with more severe and dangerous issues of emotional distress, such as trauma, schizophrenia, or suicidal ideation from receiving a needed higher level of care.
Immigrant communities. In some immigrant communities, there is great pressure to uphold the family reputation within the community. A family is culturally obliged to project the appearance of accomplishment and success in their community to maintain social status and respect. They may be judged as letting down the community or being selfish if they reveal weakness or infirmity. Unfortunately, this is often accompanied by the impression that seeking mental health treatment will bring shame and dishonor to the family by revealing that someone in the family is flawed and pitiable. This can lead some families to avoid social censure by concealing and denying family members’ mental health symptoms instead of seeking treatment to alleviate their suffering. Another factor that can keep immigrant communities from taking advantage of mental health care are language barriers. The information that would normalize the identification and treatment of mental health issues is not provided through bilingual outreach.
Generational stigma
Statistically, there is a difference in the US between generations and their use of mental health services. The good news is that mental health stigma seems to have decreased over the last ten years. The statistics seem to support this hypothesis. Generation Z and Millennials are 37% more likely than previous generations to report that they have received mental health treatment. This compares to Gen X at 26%, Boomers at 22%, and The Silent Generation at 15%. Improvement in the quality of mental health services and public campaigns to reduce the stigma seem to have been successful.
The change in the attitudes of Millenials and Generation Z has often been attributed to the rise of social media. Social media is thought to have promoted interconnectedness, information, and social support that was not available to previous generations.
Talking about mental health problems and asking for help has been normalized by the internet more than for the previous generations, and seeking help seems to have been generally reframed as a strength rather than a weakness.
On the Fence?
If you are struggling with fear of stigma but would like to have the support of a mental health professional to talk to, here are some things to consider.
Common Worries dispelled. Don’t worry too much about having a diagnosis. It is not a label that defines you. It is not set in stone and doesn’t remain relevant forever. Diagnoses are based on statistics of symptoms of people who have felt similarly to the way you do. A diagnosis is used to help a therapist find the evidence-based treatments that have worked well and helped other people with struggles similar to yours recover. You don’t have to worry that information about seeing a therapist or diagnostic information will be made public. Mental health professionals are not allowed to talk about their patients in public. Records are confidential, and information will never be released to your family members or employers without your permission.
Concerns that your issues are not bad enough to be treated by a therapist or, conversely, that your problems are too strange for a therapist to help with, are completely unfounded. Therapists are trained to be supportive, relatable, and non-judgmental. We have learned about numerous mental health issues and have seen people with concerns similar to yours many times.
Therapy is not about judgment. No ethical therapist would ever mock or demean your problems or say that you did not deserve therapy or are too much trouble to treat. Therapists are not here to judge you, we are dedicated to helping you lead more productive, functional, and happier lives. Don’t let fears about being weak or not self-sufficient stop you from seeking professional help. It is not weak but extremely brave to walk through a therapist’s door and reveal experiences that are causing you emotional pain to a stranger. Your therapist will not be a stranger forever. Humans are social beings that thrive on being heard and understood. Getting things out in the open will be helpful. Worries about being brainwashed, controlled by your therapist, or forever trapped in therapy are also unrealistic.
You are always in control. You are ultimately in control of the session, not your therapist. You set the pace and decide what you feel comfortable talking about and when the time is right. You are free to quit and find another therapist if anything they do makes you uncomfortable. Think of your first appointment as an audition for the therapist. If you don’t feel safety, warmth, and connection, don’t return and find someone else to see.
Your therapist doesn’t want you to become dependent on them and in therapy forever. Our goal is to get you to the point as soon as possible where you don’t need us and have the tools to manage on your own and live your life. The topic of terminating sessions will come up as soon as you are ready, or you can bring it up yourself.
Stigma against mental illness lives in media, language, myths, cultural beliefs, and generational attitudes. It can lead to harm and suffering when it interferes with professional treatment.
Finally, it seems that efforts to address and eradicate mental health stigma are helping people with mental health symptoms choose empowerment over shame.