[Baltimore Sun] There’s still too much stigma around mental health struggles | GUEST COMMENTARY
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“Can I come in through the back door?” or, “Please schedule my appointments so I don’t run into anyone I know.” These requests were routine early in my 40-year private practice as a clinical psychologist. Teachers didn’t want to encounter their students or students’ parents. Doctors wanted to avoid their patients. Students were uneasy about seeing classmates in the parking lot or on the stairwell even though those classmates had just completed a psychotherapy session themselves with my officemates or me.
I understood my patients’ concerns about being stigmatized and outed, so to speak, for misperceived weaknesses. I did my best to accommodate their wishes for privacy. But, at the same time, I felt sad and wondered why struggles with depression, anxiety and bipolar disorder were wrongly characterized as self-indulgent or trivial complaints.
Coming to grips with a psychiatric diagnosis is daunting, especially when accompanied by feelings of shame. People with these diagnoses typically feel unworthy and hide their suffering from others. While shame results from internalized biases, for someone already fighting to get out of bed, leave the house when the world feels dangerous or whose moods fluctuate radically from out-of-control highs to the lowest lows, this unjust, added level of stigma is like a lead blanket, immobilizing.
A woman diagnosed with bipolar disorder shortly after her son was born explained, “When first diagnosed, I did not want to believe it. I had preconceived notions that people living with bipolar are scary, unstable, hyperactive, have split personalities, and are not able to function in society. How could I be diagnosed with something like this?” She struggled to accept it. She’d always been high-functioning and successful as a teacher, mother and partner. Her prior judgmental attitude toward people with mental illnesses thwarted her ability to accept her own. “I was ashamed of this disorder and wanted to hide it from others.”
Three types of stigma can impact people with mental health diagnoses, according to the American Psychiatric Association:
1) Public Stigma — Negative or discriminatory public attitudes about mental illness.
2) Self-stigma — Internalized shame.
3) Structural Stigma — Systemic, involving policies of government and private organizations that intentionally or unintentionally limit opportunities for people with mental illness.
Thankfully, times have changed for the better. While people with psychiatric diagnoses are still reluctant to disclose their mental health history on job applications and in new social situations, they’ve become more comfortable sharing their mental health struggles with friends and even with acquaintances. Not infrequently, by telling others they panic when driving over bridges or need to check and double-check that doors are locked before leaving home, they may learn that their friend feels intensely anxious, too, when in new social situations and is so overcome with anxiety on airplanes that she stopped flying.
Rates of depression, anxiety and substance abuse have increased significantly since the onset of the pandemic. Almost every family is affected by a mood disorder. According to Johns Hopkins University, “an estimated 26% of Americans ages 18 and older — about one in four adults — suffers from a diagnosable mental disorder in a given year.” Anxiety disorders affect 31.9% of adolescents between 13 and 18 years old.
These numbers tell a sad story: Americans are suffering in unprecedented numbers with afflictions that are invisible to others. However, not seeing how much your friend ruminates doesn’t mean she is not suffering. She may smile, albeit wanly, while thinking, “I’m worthless. I look so fat and old; no wonder no one likes me.” By not revealing this, she may not learn that her friend’s adolescent daughter trolls through sites on how to conceal anorexia from her parents. We don’t wear billboards advertising our woes.
However, the more we disclose our symptoms to friends, family and professionals, the more likely we’ll find support and receive appropriate treatment for these genuine maladies. Just as no one is to blame for medical conditions, no one should be blamed for anxiety or depression.
Happily, I saw a welcome change in my practice just before I retired in late 2021. When I asked a patient, a psychiatrist who treats many people in the community, if he’d like to be scheduled before or after my regular office hours, he said, “No, I have nothing to hide. I think it’s good for my patients to know I seek help, too.”
Patricia Steckler (pattisteckler@gmail.com) is a retired psychologist who was in private practice for 40 years. She lives in Bethesda and is a 2019 graduate of the Johns Hopkins science writing master’s degree program.
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