• Jacob Buttry

5 Recommendations for Proactively Addressing Mental Illness Without Increasing Stigma

Over the last week or so, many members of American society have been struggling to grapple with the tragic events in El Paso, TX, and Dayton, OH. The tragedy has affected almost all of us in a profoundly emotional and psychological way, and most of us end up frustrated because we feel like we are left with more questions than answers.

In the hopefully well-intentioned efforts of many to address the underlying issues behind these attacks, some individuals have brought up the issue of mental illness as a primary explanation for and/or cause of these tragedies. I, as well as many others close to the issues of mental health and mental illness, have found the manner in which this is typically done to be quite problematic. Not only are there numerous examples of mass shootings where mental illness has not played a role, but this form of rhetoric also poses a serious threat to positive social and educational developments in the area of mental illness. When people in positions of power and influence only discuss mental illness in response to mass shootings, it associates the topic of mental health with images of violence, crime, and tragedy. This counteracts the efforts of many who seek to decrease stigma around this issue so that more people feel comfortable seeking treatment. In response to this, I have compiled a list of some of my personal recommendations about how we as a society can address mental illness in a way that does not increase stigma. While I am no professional, I hope that my insight from personal experience and research can prove beneficial:

Increased education on mental illness. While many Americans have a very rudimentary understanding of some of the major psychological disorders included in the DSM, very few Americans could accurately describe the essential components of many of the most common psychological disorders among the US population. Furthermore, comments that loosely use these illnesses in colloquial conversation are quite common—people describe themselves as “schizophrenic” when they act a bit scattered, as “OCD” when they want things to be neat and tidy, as “bipolar” when they are a bit moody, or as “depressed” when they are feeling a little sad. While these comments are largely playful and innocuous in themselves, they reveal a bigger issue that most people simply do not comprehend the true nature or gravity of many mental disorders. This is a problem because a lack of basic understanding of these issues can delay diagnosis or treatment for many people who are simply unaware of how most mental illnesses typically look or must be treated (often in different ways from one another). For example, the International OCD Foundation cites that, on average, it takes a person with OCD 14-17 yearsto find a correct diagnosis, in part because of the numerous misconceptions about the way this disorder typically manifests. Furthermore, therapy not specifically aimed at addressing OCD often exacerbates the problem because it seeks to address the wrong issue, and this indicates the importance of accurate and swift diagnosis for people struggling with all kinds of mental illness.

Better understanding of the term “mental health.” (This point is inherently somewhat hypocritical, but I think it is important nonetheless.) If you were to ask a sample of people on the street to define “mental health” (or even “mental illness”), you would likely get a large number of varying responses for what these topics specifically refer to. The ill-defined nature of these terms poses two different problems: In the first sense, it increases the potential for using these terms (and the groups associated with them) as a scapegoat for other ills in society, just as many have done in response to the epidemic of mass shootings. What we as a society consider to be a “mental illness” has historically been known to shift and change depending on who holds power and what the dominant cultural lens is at the time. For example, drapetomania—or the desire of enslaved African Americans to run away from their masters—was absurdly recognized as a mental illness in the US in the 1800s. Moreover, homosexuality has historically been viewed as a mental illness until recent decades. These examples thus show how the label of “mental illness” can be used as a potent tool by those in power to suppress certain groups of people, characterize them as crazy, or remove social and rhetorical power from them. In this sense, having better and more widespread understanding of mental illness while also more specifically defining the term could prove to be beneficial to stakeholders in the issue of mental illness.

Secondly, the hazy nature of the terms “mental health” and “mental illness” can also pose a problem by slowing and confusing the efforts of well-intentioned but ill-defined grassroots movements that rally around the ever-changing and no-one-really-knows-exactly-what-we’re-referring-to topic of “mental health.” One of the simplest ways we can begin to better address mental illness is by being less vague and getting more specific about who exactly we are referring to, what exactly we want to fix, and how exactly we want to fix it. And one of the best ways to allow people to be more specific is to increase their abilities to be knowledgeable about the topic so that they can move beyond vague generalities and instead focus on real, possible change.

Increased research on pharmaceuticals, other forms of treatment, and the mind/body connection. There are certainly a large number of subtopics within the category of “mental health” on which research would prove to be highly beneficial, but some of the essential topics include psychotropic drugs, the effectiveness of other treatments, and the mind-body connection. Many psychiatric medications have not been able to develop significantly in the last several decades, and many forms of therapy and other kinds of treatment still need to be studied closely or compared with new ideas and new techniques. Genetic testing has provided a great deal of advancement in research and treatment, and even more is left to discover. Furthermore, there have been even more studies into the realm of psychoneuroimmunology and other interdisciplinary fields that have looked at the way that our physical and psychological health are very closely interconnected. Many autoimmune disorders and other “physical” diseases have psychological manifestations, and increasing research and expanding awareness among both physicians and psychiatrists about the interdependence of physical and mental health issues can be an important milestone in helping people to get the proper treatment they need.

Increased compassion, perception, and knowledge within the mental healthcare industry. While many mental healthcare professionals perform their jobs with a great amount of compassion, and while this is an area that has seen immense growth over the last several decades, this area can certainly still stand to improve.An extremely fascinating yet little-known publication called “On Being Sane in Insane Places” was published by David Rosenhan in 1973. It followed a group of eight patients who checked themselves into multiple mental hospitals, falsely claimed that they had been hearing voices, and then acted normally from that point onward, wondering how long it would take for the healthcare professionals to notice that they were not actually mentally ill in any way. The scary results: None of the patients were ever discovered to be faking at any of the dozen hospitals that they visited, and many were kept there for long periods of time (the average time being 19 days). What perhaps is more alarming, however, is the extremely low amount of eye contact, respect, and active listening that was given to these pseudopatients. 71% of psychiatrists and 88% of nurses and attendants did not even make eye contact with pseudopatients who tried to begin conversation with them in the psychiatric hospital—instead they simply looked away and walked off. This stands in stark contrast to the 0% of physicians who responded in a similar manner when patients tried to reach out in a normal medical center setting (Rosenhan, 1973). While many facilities and professionals have seen a great increase in compassion, perception, and knowledge over the decades since this study, it would be very difficult to argue that these issues have been totally resolved, and there might be more ground left to make up than has already been covered. Regardless, increasing perception and compassion skills, while also decreasing compassion fatigue and burnout among healthcare workers, is needed to properly address the issue of mental illness.

Increased access to important resources. Thankfully, over the years, researchers, doctors, and others invested in the healthcare professions have made remarkable advancements in addressing mental illness. However, many people are left unable to take advantage of these resources due to financial constraints, inability to see a doctor who uses these resources, or other obstacles that limit their access to these potentially life-altering technological advancements. A prime example of this is the use of genetic testing to assess which psychotropic medications might work best for a patient. Access to this kind of resource can be beneficial in many ways—not only can it decrease the time it takes to find effective treatment, but it can also decrease the possibility of encountering negative side effects from ineffective medications. For example, I chose not to take one of these genetic tests for the first 6 months of my own treatment with my psychiatrist, and, in retrospect, the first antidepressant that I took was likely the leading factor in the rapid progression of my condition from bad to dangerous. If I had access to my genetic results, my psychiatrist would never have prescribed me this medication because the science indicated that I would be highly susceptible to side effects but unlikely to reap the benefits of the drug. While these advancements have incredible potential, there is still a big issue here because many people do not have access to these kinds of resources because they are very expensive. This genetic test alone typically costs around $500, and many patients simply cannot overcome the financial hurdles to pay for this test that would allow them to receive better, faster treatment. Increasing access among patients to genetic tests and other technological resources would be a great way to address mental illness in a very practical and helpful way for the stakeholders involved.

At this point, this list has become very long, and while I do feel strongly about everything I have said, my intention in creating this long list of recommendations extends beyond each item in itself. The point is: there are many, MANY ways that we as a society can continue to improve our efforts in addressing the social issue of mental illness, but we cannot be effective if we are only bringing this topic into the public forum in response to massive acts of violence and tragedy. This increases fear, stigma, and frustration around this subject, and it does not lead to any positive change—it only distracts from solutions to both addressing mental illness and minimizing mass shootings. If we are serious about addressing mental illness, let’s look at how we can provide the best care for those affected, rather than simply using a vulnerable population as a scapegoat for a bigger issue.

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