A quick search of ‘Mental Health Stigma‘ illustrates that it has been publicized back into the 1980s – so why does it still seem like an emerging topic, and where are we going wrong?
In some ways, when considering a modern representation of mental health, we have come far – yet our lexicon can be regressive, insensitive, and quick to label difference as dangerous. We shy away from the unfamiliar, not because it is a uniquely natural reaction (curiosity in the sciences illustrates otherwise) but we do so because we are culturally scripted to reject otherness – the associated and imposed shame of mental illness has not yet fully transformed into an open dialogue about mental health and diversity. The recent suicide of Robin Williams polarized reactions, demonstrating just how little is understood about the complexity of depression, and how entitled others feel to control what they fear.
Mental health touches so many lives, it is churlish to imagine that we wouldn’t have thoughts and feelings relating to its presence in our society – but imagining that experience is the same as knowledge, or that knowledge is the same as understanding is like claiming to be a professional tennis player simply because you’ve read a book or watched a lot of games. Those within the field understand that we are all still learning, and that compassion should come 1st, 2nd, and 3rd, before judgment or opinion.
Here are 4 points to a formula for increasing the dialogue of mental health within our (largely western) culture:
Don’t rationalize in an attempt to normalize; it detracts from the complexity of mental health, and it minimizes the narrative.
View it as a continuum, as something uniquely experiential and subjective to each individual condition, the human condition. Not everyone returns to or achieves a level of functioning that fits into a normalization paradigm; the community-based model of care should promote that truth, and work towards acceptance and compassion of difference, unifying us through that shared experience. Diversity is the constant, not uniformity.
Try not to speak in terms of deficit, but also try not to romanticize mental health.
We lead largely mundane lives, and we can all experience struggles; yet we collectively fantasize about our meaning. We wish for more. Attaching a savant label, or sophomoric and new-age ideals relating the benefit of mental illness for society is oppressive, and it is insulting to a whole population that does not wish to be marketed as such. We stigmatize through generalization, and isolate those who don’t fit into the ‘creative gift’ paradigm – not everyone with a mental health issue (or a disorder of some kind) are tortured geniuses, creative leaders, shamans, or whatever else may be touted by Hollywood or social myth as a compress to reality. That is just a deeper layer of the effort to rationalize an experience, and to centralize the person into a mainstream paradigm – think about it, we risk creating a sub-class of citizens that don’t fit based upon unrealistic and oppressive values.
Consider about how you perpetuate myth or stereotype.
We share responsibility for addressing stigma if we are to support and maintain efficacious change. Mental health seems to have fallen behind issues such as: gender equality, race, and sexual identity when it comes to addressing language and to campaigning. With that responsibility comes the necessity to challenge prejudice as well as ignorance or misunderstanding, because both are harmful to the narrative, both obscure real dialogue and undermine social advocacy.
I often see variations of the following motivational poster: 
This may give meaning, and a voice – but in truth it misrepresents, it doesn’t even make sense. The reality of mental health is complex; it is an amalgamation of presenting issues and experiential angst, culminating in a variety of symptoms. On the surface there is little wrong with attempting to change the conception of depression away from pity and weakness, but it is obtuse – active depression is a sign of many things: an event in ones narrative, a change in neurochemistry, an affect of neurobiology, a lack of coping skills, medication, or a non-supportive environment. Maintaining a binary perspective of strong vs. weak undermines progression; it also serves to perpetuate the cure vs. treatment dynamic.
Don’t give up hope.
There is great meaning in searching for cures (and in reducing overt systemic dependence upon pharmacology), but we are not quite there yet, there are no universally observable cures – but there are holistic and person centered treatments that can dramatically improve the lives of many clients. That isn’t to detract from the importance of hope, it is incredibly necessary – it is the foundation of the therapeutic relationship. Changing societal reactions to mental health can have far reaching implications into our culture, effecting: education, family health, employment, and the criminal justice system.
As a clinician, I can tell you that we take the diagnosis and labeling of conditions very seriously. Often a diagnosis will change over the therapeutic relationship – that isn’t a sign that we are guessing, it is an indication of the complexity and transitory nature of the human condition. We need labels to be able to communicate with/about and to treat people; but it is understood that diagnosis represents the knowable symptoms, not the individual. This should be discussed more openly with clients – keeping momentum away from the ‘I am / you are’ narrative, and into the ‘I have / you experience’.
Often times I hear people complain of how quickly a clinician comes to a diagnosis – the truth of it is that if you are skilled, observant, and well-trained, the presenting symptoms are quite easily categorized, and that should be a good thing, because it demonstrates the commonality of the experience, and it illustrates the efficacy of the profession. Again, we see the symptoms fit a diagnosis, not the person limited into a label, and we shouldn’t be afraid to explore that diagnosis with a client.
Below are a number of great documentaries, shorts, and talks on mental health, as well as some links to organizations that excellently address the issue of labels and of stigma- because this is really what undermines the treatment of mental health issues, across the board.
A great documentary, both upsetting and insightful, that illustrates how we have changed much of our views, language, and intervention, over time.