Did you know that 4 in 5 Americans’ mental health has been impacted by COVID-19? That is 80% of the population! Since there is a strong connection to physical and mental health, it is important to take care of both. Now is a great time to take charge of your mental health.
I was sitting alone in the hallway of the Carter Center conference area in Atlanta during the 2012 Rosalynn Carter Symposium on Mental Health Policy. I had just finished being a panelist and talking about how employment and education helped me overcome the stigma associated with my depression. The conference was still in session, so I had the hallway to myself. I sat quietly, reflecting on the fact that I had been invited to speak here as both a clinician working in community mental health and a person living with depression.
Two scenes flashed through my mind highlighting two very different points in my life: getting offered a job as a therapist at the mental health center where I completed my internship for my Master’s in social work, and sitting in a psych ward on the eve of my 18thbirthday, wondering if I would graduate from high school.
Persevering Through Depression
It took many years of perseverance for me to become that professional sitting on a panel at a national conference. Though I managed to graduate from high school, I dropped out of college at 19 as my depression worsened. I was unemployed, and my only income was Social Security disability. Years of failed depression treatments included medication and talk therapy.
I spent most of my time alone doing what I refer to as “stewing in my own depressive juices.” This lasted for 10 years. During that time, I was challenged by the symptoms of mental illness— insomnia, loss of appetite, lack of concentration, suicidal thoughts. After a decade of being unemployed and living on Social Security, I decided that for my own survival, I had to return to school and complete my social work degree. Of course, my depression was against this:
“You can’t go back to school; you will fail.”
“You won’t be able to concentrate enough to complete your assignments.”
“You’re too stupid to get a college degree.”
Somehow, I decided to talk back to these negative thoughts. My response was simple: “I’m just going to do the best I can.”
And I did. I got myself back to school and finished my degree in social work. Around that time, I also tried a different treatment for my depression, and it worked. Things got easier.
Today, I feel incredibly lucky to say that I am doing exactly what I want to be doing. But really, luck had little to do with it. Besides my symptoms of depression, I faced an additional barrier to school, employment and inclusion in general: unhelpful attitudes from well intentionedhealth professionals—in other words, stigma.
Learning To Reject Stigma
One mental health professional once told me, “Maybe you’re not getting better because you’re not trying hard enough.” Another warned me, “You might not be ready to go back to school full time. Shouldn’t you just take one class and see how that goes?” A psychiatrist decided, without asking for my opinion, that I should be sent to live in a group home for people with mental illness. (That did not happen, and that treatment relationship ended that day.)
These scenarios were fueled by the stigma associated with mental illness—stigma that ultimately serves to limit and exclude rather than encourage and include. Had I listened to those professionals, I might never have returned to school or entered the workforce.
So how did I overcome the stigma that I faced? I rejected it. Rejecting—or overcoming—stigma, whether it be self-stigma, public stigma or structural stigma, is one of the keys for those of us living with mental illness. This is not an easy task, to be sure, but it is becoming more possible and a bit easier as more and more of us of speak out about our mental health conditions.
After working as a therapist and witnessing the negative effects of stigma on clients and their family members, I decided to develop a stigma-reduction training curriculum called “Overcoming Stigma.” I spent several months reading every scientific article I could find about stigma research. Most of it simply documented that stigma exists (in hospitals, in psychiatry, in substanceusetreatment centers, in pharmacies, universities, employment, housing, etc.) and that levels of stigma have not changed over the last decade.
According to many studies, effectively reducing stigma pointed to one intervention: contact with someone successfully managing a mental illness. One shining example of this is NAMI’s In Our Own Voice (IOOV) program. People with mental health conditions share their powerful personal stories in this free 60- or 90-minute presentation. I decided to integrate elements of IOOV into the beginning of my trainings by briefly disclosing my own depression and giving a few examples of my experiences with stigma. The rest of the training includes a description of the seven most common types of stigma experienced by people with mental illness and substance-use disorders, research about the effects of these stigmas, ways to reduce stigma, and the clinical and agency assessment tools I developed.
I have presented Overcoming Stigma trainings in many different health care settings, and the curriculum continues to evolve, always guided by the latest stigma research. Recent research shows that stigma training needs to be ongoing instead of a one-time thing and, it likely needs to address many stigmas all at once.
My trainings get everyone involved in the discussion; I like to ask for anecdotes from attendees. Here are some real-life examples of stigma shared by health care professionals who have attended my trainings over the past several years:
• A cardiac surgeon said he would not do surgery on a person with schizophrenia because he didn’t think the person would be able to do the required follow-up care.
• A therapist shared that as a Ph.D. student, he was told he would lose his scholarship if he left for “depression” treatment but could keep it if he left for “medical” treatment.
• A mother puts off making an appointment for her daughter to see a therapist despite her daughter experiencing severe symptoms of anxiety because she doesn’t want her daughter to be labeled as “crazy.”
• A physician attendee said it was well known in her neighborhood that her son had been hospitalized with bipolar disorder and no one acknowledged this fact (much less offered any type of support).
• A mental health clinician working in an emergency room said doctors and nurses often referred to patients in the ER with mental illness as “her patients,” rather than “our patients.”
If I do my job well, attendees leave with the understanding that we all have a role to play in reducing these harmful kinds of stigma. Personally, I still experience stigma, but I am no longer limited by it. I sometimes even chuckle when I hear someone say something particularly stigmatizing because I immediately think, “Well, that’s going to be part of my next training.” That’s not to say it isn’t still discouraging to see or hear things that continue to perpetuate stigma, but for me, there is a feeling of freedom and power in being able to turn a potential lost opportunity into one that is gained.
Gretchen Grappone, LICSW is a trainer and consultant with Atlas Research in Washington, D.C. Her work includes projects with VA medical centers, community mental health centers and other health care settings around the country. She lives in New York City.
As I was entering medical school, I found out that my mother had made a postpartum suicide attempt. I did not find out from her; it was shared with me in hushed tones by another family member who thought I should know, “now that I was going to be a doctor.” I was quite surprised by this information. And it made me sad to think that this wasn’t a topic she felt she could openly discuss.
Suicide is a challenging issue for all of us. Secrecy surrounds the topic, with shame as a common co-traveler. That’s why it’s an honor for me to be a small part of NAMI’s movement to make seeking help and support more acceptable. I’ve met many resilient people in the NAMI community who have overcome suicidal thoughts or actions. Often because there was a person who stood by them during a crisis or a new treatment approach that made a difference in their life. Some found sobriety for a co-occurring substance use disorder. Others found clozapine or lithium, which have been shown to reduce suicidal thinking. Some learned coping skills through a psychotherapy like cognitive behavioral therapy or dialectical behavioral therapy. Many found relief in the community of NAMI. Regardless of how, their suicidal thoughts or actions were talked about and changed.
My field sorely needs similar conversation and change. Doctors also have high rates of suicide and it’s a major issue that some of the doctors we turn to for care are often not taking care of themselves. We need to teach help-seeking behaviors in the medical and psychiatric fields. Doctors need the same support and encouragement to get help as their patients.
I lost a patient to suicide early in my psychiatric residency. This was a person with many strengths, who was also in tremendous psychological pain. I worried about him during off-hours and felt powerless to help at times. After I learned of his tragic outcome, I was upset, slept poorly and struggled at work for months. I was worried I had said the wrong thing or had failed in some way as an inexperienced psychiatrist. I seriously considered leaving the field and entering another specialty. I was lucky to receive support and empathy from my colleagues and supervisors as they encouraged me to seek therapy. I did my best to carry on, but I never forgot about this patient and his suffering.
Last year, at an American Psychiatric Association (APA) event, I was impressed that even doctors are wondering if they worry, struggle and stress too much. APA president Anita Everett reviewed the stresses that commonly consume doctors and announced that psychiatric wellness would be a core feature of her leadership. Dr. Everett’s thoughtfulness and openness on the stresses doctors face and her emphasis on help-seeking was powerful; her efforts have started many overdue conversations across the entire field of medicine. Unfortunately, the same shame that led to the secrecy around my mother’s postpartum suicide attempt is alive and well in the medical field.
Doctors don’t have all the answers for stress, mental illness and suicide—our most challenging aspects of being human. Medical culture needs to continually evolve and learn from the remarkable and resilient people like those I have met at NAMI. Facing your mental health challenges head-on and working to get help with a supportive community behind you is a key piece of NAMI culture. It’s a culture we can all learn from.
Ken Duckworth is medical director at NAMI.
Depression can be hard to talk about—so hard that a lot of men end up silently struggling for years, only to reach out when they’ve hit rock bottom. Others, sadly, don’t reach out at all. This is one of the reasons why men account for 3.5 times the number of suicides as women.And depression is one of the leading causes of suicide.
Fighting depression is difficult. Not only do you have to fight the illness but you also fight the stigma attached to it. For men, the fear of looking weak or unmanly adds to this strain. Anger, shame and other defenses can kick in as a means of self-protection but may ultimately prevent men from seeking treatment.
Here are some common myths that stand between men and recovery from depression:
Depression = Weakness
It cannot be emphasized enough that depression has nothing to do with personal weakness. It is a serious health condition that millions of men contend with every year. It’s no different than if you develop diabetes or high blood pressure—it can happen to anyone. We show our strength by working and building supports to get better.
A Man Should Be Able To Control His Feelings
Depression is a mood disorder, which means it can make us feel down when there is absolutely nothing to feel down about. We can’t always control what we feel, but we can do our best to control how we react. And that includes choosing whether to ignore our problems or face them before they get out of hand.
Real Men Don’t Ask For Help
Sometimes we need an outside perspective on what might be contributing to our depression. Consulting a professional who has more knowledge of depression and treatment options is the smartest thing to do. Trying to battle a mental health condition on your own is like trying to push a boulder up a mountain by yourself—without a team to back you up, it’s going to be a lot harder.
Talking About Depression Won’t Help
Ignoring depression won’t make it go away. Sometimes we think we know all the answers and that talking can’t help a situation. This couldn’t be further from the truth. Often, things that seem like a huge deal in our minds aren’t as stressful when we talk about them more openly with a friend or mental health professional. Talk therapy (or psychotherapy) is a proven treatment for depression. It’s useful for gaining new perspectives and developing new coping skills.
Depression Will Make You A Burden To Others
Being unhealthy and refusing to seek treatment can put pressure and stress on those that care about you, but asking for help does not make you a burden. It makes people feel good to help a loved one, so don’t try to hide what you’re going through from them. What’s most frustrating is when someone needs help, but they refuse to ask for it.
If you (or a man you know) think you might be living with depression, HeadsUpGuys is a website specifically designed to help men fight depression. The site features practical tips, information about professional services and stories of recovery. It also has a self-check that can help determine whether or not depression may be affecting you. Check it out today.
Since recovering from experiences with depression and a suicide attempt in 2010, Joshua R. Beharry has become a passionate advocate for mental health. Josh is currently the project coordinator forHeadsUpGuys, a resource for men in pursuit of better mental health.