What you say matters.

So I’m 14 years old and it’s about 5 months since the suicide of my friend Katy Swann. It’s September, national suicide prevention awareness month. I’ve helped organize to get a speaker to come to my high school to talk about suicide prevention. I’ve introduced her and have returned to my seat in the auditorium. The speaker asks the audience the question, “What do you think keeps a suicidal person from seeking help?”

The girl sitting in the seat in front of me asks, “Why don’t they just go to God?”

Outside of the many problems with the assumptions behind this question, to use a well-overused phrase of the English language, if I had a nickel for every time that a conversation about my mental health started with the words “Why don’t you just -,” I would have enough money to pay off my college loans by now. At this stage of my life my typical response is, “Being a reasonably intelligent person, if it was just that simple, don’t you think I would have done that by now?”

Questions about my faith are particularly painful. I have actually had someone look me in the eye and say that I have anxiety and depression because I “don’t trust Jesus enough.” Coming out of an evangelical background I have read numerous testimonies since childhood about the seemingly immediate healing powers of salvation. People addicted to alcohol and other drugs that walk away cold turkey. People broken by years of abuse suddenly finding peace. And yes, people with severe mental illness, including testimonies of people that claimed to have had schizophrenia and bipolar depression, that were cured immediately by the power of belief. As an adolescent, reading and listening to these testimonies cut deeply. I always wondered what was wrong with me, why God hadn’t healed me. Especially since my mental health issues started after I joined the Church. This experience forms a large part of why I eventually walked away from the Church (but that’s another story for another day).

I’ve learned since all this that my experience is far from unique. It fits the pattern of stigma and discrimination that people living with mental illness often experience. A research study in 2004 by Patrick Watson and Amy Corrigan found that there are three main attitudes in the United States about mental illness: 1) people with mental illness are violent and should be feared; 2) people with mental illness are irresponsible and their decisions should be made for them; and 3) people with mental illness are childlike and need to be cared for. All of these attitudes are harmful to people living with mental illness because they erase our agency and limit our existence to that of a patient that must be cared for or a societal burden that must be carried. I can speak from experience when I say that they are felt deeply and keep many from seeking treatment.

Stigma and discrimination show up in all aspects of life including social and cultural interactions and political and economic policy. In this two-part series, I will break down how discrimination shows up in these areas and why it is problematic and harmful. In part one I will focus on social and cultural interactions, focusing on language and public visibility of mental illness. In part two, I will focus on political and economic policy, including access to services and resources, gun control policy, and the impact of mental illness on special populations.

Part One: Social and Cultural Interactions

Our social and cultural interactions contain some of the most insidious forms of stigma and discrimination. Our language forms a feedback loop of stigmatization: revealing our underlying biases about mental illness while shaping how with think about the people living with the conditions. Public visibility, facilitated by media, is an extension of this feedback loop, shaping and reinforcing biases present in the language. Both are under our control.

Language

Look, I’m a suicide survivor and I still mess up and make ill-placed jokes about killing myself. Making a joke out of mental illness is a part of the English lexicon and it’s a difficult thing to stop because language is just part of us. Speaking seems so natural that we often don’t think to analyze what we’re saying. But we should.

What we say is a window into what our society feels and believes. Saying “that’s so retarded” might seem like another way of saying that something is stupid or unfair, but at the deepest level we are making clear our lack of empathy for those with intellectual and developmental disabilities. This is because by making this statement we are equating the worth of a person living with one of these conditions to the value we place on a situation or object that we dislike which, in translation, is not all that much. We are saying that we value them so little that we throw around a word that is meant to insult their condition as another form of an insult. (I know where the word retarded came from, but that doesn’t change the fact that in the twenty-first century it is another word for stupid.)

The same is true when we throw around words like OCD or depression or phrases like “I could have killed myself.” At the heart of the matter, when we throw around words like this what we are really saying is that we don’t take these conditions or situations seriously. Obsessive Compulsive Disorder and depression are real and, sometimes, disabling conditions that millions of people experience. Suicide is the second leading cause of death for 18-34 year olds and the first leading cause of death for 45-65 year olds. They should be taken very seriously.

Think about it this way: we would never make a joke about cancer, type 1 diabetes, or dying in a drunk-driving accident. We would say that the jokes were inappropriate because these are legitimate, life-threatening illnesses and situations. Use that same logic when talking about mental illness.

An additional problem to consider about language is that the way we talk and joke about mental illness is highly gendered. Women are far more likely to be called crazy or emotional. In general, women’s emotions and complaints are not taken as seriously, but women face a particularly nasty catch-22 when it comes to their mental health. Women are far more likely to be diagnosed with a mental illness while at the same time having their symptoms taken less seriously. Read the flip side of this: men tend to be less diagnosed when they should be and their symptoms are often ignored or missed. Once again, misogyny hurts everyone.

In short, check your language. Ask yourself before you speak: “Would I say this about another health condition?” “Would I say this about another way of dying?” “Would I say this about a man if the situation was the same?” Language sets the tone for how we will perceive something. If the tone is hostile, people are far less likely to engage, especially if a person fears that they will be seen in a less respectful or empathetic way for engaging honestly. If all else fails, remember what Thumper says: “If you don’t have nothin’ nice to say, don’t say nothin’ at all.”

Public Visibility

I can only speak for myself in this situation, but every time someone reports another mass shooting my first thought is, Please don’t let this person have a diagnosed mental health condition. As sick as it seems, I would much rather the person just be evil. It’s because every time something like this happens, it drives the conversation about mental health that much farther away from the public consciousness.

People living with mental illness have a similar problem to the Muslim and African American communities; the only times we tend to make the news is after a violent incident. This feeds directly into the mistaken belief that most people with mental illness are dangerous. Because of the stigma that exists around mental illness, people living with these conditions tend not to make their conditions known. This frequently means that most peoples’ only contact with someone living with mental illness is what they learn on the news. In reality, a person living with mental illness is far more likely to be the victim of violent crime than the perpetrator.

But fear and the perception of danger, real or imagined, are powerful. This is where public representation is problematic. A person having a mental health crisis is more likely to encounter the police than a healthcare worker. If the perception of a police officer is that a person with mental illness is dangerous, they are far more likely to resort to violence than nonviolent, conflict resolution techniques.

In addition to prejudicial media coverage, people living with mental illness are also affected by prejudice in consumer media (think movies, television shows, books, etc.). When characters with mental illness are included, they are almost exclusively white, heterosexual, and male. This erases the experiences of mental illness of people of color, the LGBTQIA community, and women. At the time of writing this blog, I can only think of two movies that feature (straight) women with mental illness and one that features a homeless black man as protagonists off the top of my head: Silver Linings Playbook, The Forest, and The Soloist. The Soloist is the only of these movies that is based on the life of a real person living with mental illness, cellist Nathaniel Ayers.

Additionally, scripts about people living with mental illness are typically limited to the horror, science fiction, and thriller genres. Think about these titles: Legion (An FX Original Series), Split, The Visit, Fight Club, Shutter Island, Psycho, The Silence of the Lambs, Bates Motel, American Horror Story, The Machinist, The Accountant, An American Psycho, Donnie Darko . With the exception of The Visit, all exclusively feature a straight white male as their protagonist. All fall under the three genres listed above. What is problematic about the use of these genres to depict the stories of mental illness is that these genres tend to rely on violence and unrealistic (read: not based on evidence) portrayals of mental illness, feeding the fears and misconceptions that most Americans have about people living with mental illness.

SPOILER WARNING! Let’s break down Psycho, Alfred Hitchcock’s famous 1960 film, as an example. Let me say that Psycho is one of my favorite films and a great work of art, but that doesn’t mean that it isn’t a problematic work. of its portrayal of mental illness. To begin, the protagonist and murderer, Norman Bates, is a white, heterosexual male. He is also afflicted with what, at the time, would be called multiple or split personality disorder. Today it would be called dissociative identity disorder.

Dissociative identity disorder (DID) is a common trope in horror films, television shows, and novels, but it is rare in the “real” world: only 2% of the population experience any kind of dissociate disorder. DID only affects around 1% of the population. Ironically, women are more likely to experience a dissociative disorder. The disorder is identified by the Diagnostic and Statistical Manual of Mental Disorders by a person alternating between personalities. The personalities often have unique names, characteristics, mannerisms, and voices. The person experiencing the disorder often feels like the voices are trying to take control of them. The disorder often develops as a way to cope with trauma and abuse.

Norman Bates, whose alternate personality is that of his mother, is explained to have been abused by her as a child which aligns with the experience of many of those living with DID. However, what is atypical about Norman’s behavior is his violence. In general, people living with mental illness are rarely violent. This includes people living with DID. They are more likely to harm themselves than others.

In addition, while it is common for people experiencing DID to experience periods of lost memory and time when another personality, sometimes called an alter, when the alter is in control, there is little evidence to suggest that a person living with mental illness can be “lost” to the control of another personality, as Norman Bates is at the end of the film. In the vast majority of people living with DID, alters exist to hold onto the traumatic memories of abuse. The theory of most scientists is that abuse or trauma causes the mind to reconfigure into divided personalities that can manage stress and anxiety. Alters switch with the person experiencing DID in situations that trigger the past trauma, allowing a means of escape.

In this way, Hitchcock’s portrayal of DID is inaccurate. Norman Bates’ murderous rampage is not a typical of a person with DID, nor any person in general living with mental illness. In addition, Bates’ total transformation into his mother’s personality at the end of the film is not based on evidence of actual people living with the disorder or scientific study of the condition.

To summarize, check your media consumption. Are you exclusively consuming media that portrays people as violent or helpless? Are you exclusively consuming media that erases the experiences of women, people of color, and the LGBTQIA community? Do your research and seek out research that debunks myths about mental illness. Follow websites for organizations like NAMI (National Alliance on Mental Illness) and the NIMH (National Institute of Mental Health) that frequently publish a broad range of news about mental health. Seek out media that portrays mental illness realistically. Here’s a great article from NAMI about film portrayals of mental illness: http://www.nami.org/Blogs/NAMI-Blog/December-2015/7-of-the-Best-Movies-About-Mental-Health. Your media consumption is really one of the simplest ways that you can change the public portrayal of people living with mental illness. Money talks.

What can you do?

While the stigma and discrimination of our social and cultural interactions seem overwhelming, this is one of the parts of our lives over which we can exercise the most direct control. Here are ways that you can change the way you use language and consume media in order to reduce stigma and discrimination:

  1. Check your assumptions. First of all, just because you have never had an experience does not mean that someone else’s experience isn’t real. As evidenced by our use of language and consumption of media, Americans hold many skewed ideas about mental illness and mental health. The only assumption that you can make safely is that you don’t have all the information.
  2. People that have had a particular experience get to control the narrative about that experience. The best way to get more information about the experience of mental illness is to listen to the people who have actually that experience. Seek out blogs, novels, and media that accurately portray the experience of those living with mental illness. Better yet, consume media that is actually written and created by the people that have had these experiences.
  3. Practice empathy. It is easy to assume (see point number 1) that the reason skewed ideas about mental illness exist is because the people that experience it don’t tell their stories. Recognize that there are many reasons why people living with mental illness don’t talk about their experience. Forcing someone to speak is just as oppressive as forcing them, directly or indirectly, to remain silent.
  4. Get informed. It is not the responsibility of people living with mental illness to be your sole source of information about mental illness. Take responsibility and educate yourself. There are numerous resources that can help you understand the experience of mental illness. At the end of this blog I will relink last week’s blog post which contains a short list of some of these resources.
  5. Check your language. Take the time to analyze how you speak about mental illness. If your language is problematic, change it. Note humor is a great way to change peoples’ hearts and minds. Many people ask me, “Isn’t making jokes and using humor a way to make mental illness more acceptable.” Yes and no. Yes, if the humor is created by a person who has had the experience or a person that is extremely familiar with mental illness (example, the parent or friend of a person living with mental illness) and that humor moves the conversation about mental health forward. No, if mental illness just serves as an insult to a person or group of people or is based on erroneous assumptions about mental illness.
  6. In case you missed it the first time, consume media that accurately portrays mental illness as well as media that is written and created by people that experience mental illness. Seek out broader news media on sites such as NAMI and the NIMH. Don’t assume that the headlines tell the whole story. Don’t assume that you know the whole story. Be open to allow a person who has experienced mental illness to correct you if you are wrong.

Check in next week for part-two: Political and Economic policy and mental health.

As always, love and respect.

As promised, here’s the link to last week’s blog post, People Matter:

https://nicoledance.net/2017/03/2014/people-matter

People Matter

In order to support individuals that experience mental illness, it is important to understand how mental illness affects our communities. Below are statistics about how mental illness affects the general population of the United States as well individual communities within the general population. In addition, I have also included a list of useful resources for further research. I hope that this post gives everyone a better understanding of how mental illness affects our communities. Its far more common than one might think…

As always, love and respect!

General Population:

  • 43 million adults experienced any mental illness in 2015.
  • 8 million adults experienced serious mental illness in 2015 (severe impairment).
  • 1% of children 13 to 18 years old will experience a mental illness in their lifetime, 13.1% during a 12 month period.
  • Roughly half (58.7%) of people experiencing a serious mental illness will seek treatment.
  • Roughly half (50.7%) of children 8 to 15 years old will seek treatment.
  • 57% of state prisoners, 45% of federal prisoners, and 67% of local prisoners experience a mental illness during a 12 month period. Fewer than half will receive treatment.

Men:

  • Mental illnesses affect both men and women, but men are less likely to seek treatment.
  • Alcohol and substance abuse is most common in men, affecting 1 in 5.
  • Men are three as likely as women to be diagnosed with antisocial personality disorder.
  • White males have the highest rate of suicide in the United States, with firearms being the most common method.
  • A man is 10 times more likely than a woman to succeed in taking his own life.

Women:

  • Anxiety and Depression are the predominant mental illnesses that affect women.
  • Depression is twice as common in women as in men and tends to be more persistent.
  • Risk factors impacting women’s mental health include: violence, social and economic inequality, poverty, and stresses related to gender roles, such as childcare.
  • Women are impacted by prejudicial diagnoses. They are more likely to be diagnosed with a mental illness and more likely to be prescribed psychiatric medication.
  • Women are twice as likely as men to attempt suicide, with overdose being the most common method.

People of Color:

African Americans –

  • The prevalence of mental illnesses among African Americans is similar to the general population, although rates of treatment seeking are lower.
  • They are 20% more likely to experience a severe mental illness (schizophrenia, bipolar depression) largely due to more limited access to mental health resources and greater exposure to violence and poverty.
  • Misunderstanding about mental illness, such as a belief that an illness is a punishment from God, is common in African American communities, especially communities affected by poverty.

Latinxs –

  • The prevalence of mental illness is similar in this community to the general population.
  • The latinx community is 20% less likely to seek treatment for mental illness. Some contributing factors include misdiagnosis, language barriers, legal status, and lack of access to health insurance, and the tendency of some communities to rely on traditional methods of healing.
  • In general, the latinx community does not talk about mental health. A common saying is “La ropa sucia se lava in casa,” (don’t air your dirty laundry in public). This is often compounded by a misunderstanding of mental health similar to that of the African American community.

Asian Americans –

  • The prevalence of mental illness in this community is similar to that of the general population although treatment seeking behavior is significantly lower in this community than the general population.
  • The experience and perception of unfair/discriminatory treatment can increase the likelihood of individuals in this community experiencing mental illness. Additionally family and cultural stress related to assimilation into the mainstream culture are associated with increased exposure to domestic violence, increasing the risk of mental illness.
  • Like other groups, language, access of health insurance, and education also impact the likelihood of Asian Americans to seek mental health treatment.

Native Americans –

  • Native Americans have a higher rate of mental illness than the general population, although they account of 1.2% of the population, they have 21% prevalence rate of mental illness or 830,000 people affected.
  • Contributing factors include higher rates of crime victimization (twice that of African Americans), increase poverty and unemployment, and higher rates of drug and alcohol abuse.
  • Although mental illness is recognized within the community, lack of access of health insurance, lack of understanding of available resources, and misdiagnosis by mainstream healthcare workers all contribute to lower rates of treatment.

LGBTQIA Community:

  • This community experiences mental illness at 3 times the rate of the general population. Common conditions include major depression, posttraumatic stress disorder (PTSD), suicide, and drug and alcohol abuse.
  • The experience of mental illness in this community is impacted by prejudice, discrimination, and stigma experienced in the mainstream culture.
  • Members of this community frequently do not talk about their mental health conditions and routinely hide them from family, friends, and healthcare works to avoid ridicule.
  • In addition to prejudice and stigma, denial of civil and human rights, higher rates of criminal victimization, higher rates of drug and alcohol abuse, social exclusion, social isolation, and familial rejection all impact experiences of mental and treatment seeking behavior.
  • LGBTQIA individuals are 3 to 4 times more likely to attempt suicide than the general population.

Income Disadvantaged:

  • The overwhelming majority of people living with mental health disorders experience poverty, poor physical health, and civil rights abuses. Common mental health disorders are twice as common among the poor than among the wealthy.
  • People living in poverty are 8 times as likely as the general population to experience schizophrenia.
  • Food insecurity, large debts, lower education, higher rates of unemployment, and poor and overcrowded housing situations all contribute to higher rates of mental illness.
  • The relationship between poverty and mental illness appears to be cyclical: poverty increases the risk for mental illness while mental illness increases risk factors for poverty such as unemployment and divorce.
  • Although the poor are more likely to experience mental illness, mental health care is largely ignored in the services and budgets of the development groups and government organizations that are supposed to care for them.

Prison Population:

  • Approximately half of all local, state, and federal prison inmates experience some type of mental illness within a given 12 month period.
  • The experience of homelessness and foster care common among prisoners that experience mental illnesses.
  • Additionally, inmates with mental illness are more likely to have experienced physical or sexual abuse.
  • Once in prison, most inmates do not get the mental healthcare that they need. After leaving prison, a criminal record makes it more difficult to find employment or housing, increasing the risk factors for poverty and, therefore, increasing the risk for more severe mental illness.
  • Inmates with mental illness, on average, serve 4 months longer than inmates without mental illness.

 

For more information, see these resources:

National Institute of Mental Health, https://www.nimh.nih.gov/index.shtml

Centers for Disease Control, https://www.cdc.gov/mentalhealth/

National Alliance on Mental Illness, http://www.nami.org/

Substance Abuse and Mental Health Services Administration, https://www.samhsa.gov/

Anxiety and Depression Association of America, https://www.adaa.org/

World Health Organization, http://www.who.int/mental_health/

Mental Health America, http://www.mentalhealthamerica.net

 

 

Stories Matter

There are 43.3 million adults living with mental illness in the United States (NIMH 2015). I’m one of them. For an illness that can make you feel like Will Smith from I Am Legend, it is nice to be reminded that you’re in good company. Especially when there are limited examples of people like you thriving in “real life.”

I have to admit that there are two things that I listen for when I watch the news: the first is that the violent incident being reported doesn’t involve a person living with mental illness; the second is that the death being reported isn’t the result of suicide. When you’re a person living with a mental health issue, most of the time no news is good news. It’s frustrating that most peoples’ perception of people living with mental illness is still Split or Bates Motel instead of Silver Linings Playbook (seriously, check it out).

It is true, a significant number of the homeless and prison inmates have mental illness, sometimes severe. And this should be of great concern to everyone. These people need treatment, not imprisonment. However, the majority of us are working our way through life, managing as best we can, kind of like everyone else. The difference is that Buzzfeed doesn’t really make listicles for lifehacks when living with mental illness. And no one else is either. And I think that is why I have recently started talking more openly about my experiences.

True story: I started talking Lexapro, an anti-depressant, at the start of my junior year of college. I had never really known anyone taking this kind of medication and had no idea what to expect. Going onto psychiatric medication isn’t one of the easiest decisions to make. I was afraid that I would no longer be myself, that I could become some kind of zombie. It was also difficult because I grew up in a part of North Carolina was seen as the “easy way out.” Psychiatric drugs are seen as taking a pill to fix yourself rather than “dealing with your problems.”

I found several internet forums with people posting about their experiences, and while it was helpful, it wasn’t as comforting as sitting down with a friend and talking intimately. And then a friend that had graduated recently messaged me over Facebook to ask me how I was doing. This friend had spoken with me before about my experiences with anxiety and depression. I told her that I had just started on the medication. She said, “Oh yeah, I was on that once. It’s not so bad.”

It is impossible to describe the relief that I felt as my friend shared her experiences with me. I suddenly felt a lot less alone. My symptoms, my fears, and my hopes for improvement were no longer a burden that I had to carry; they were a part of the fabric of experience of everyone that lives with mental illness. I had nothing to be ashamed of.

Her openness with me also had another effect: it gave me permission to continue seeking health care and to feel okay about myself and the choice that I had made about my health. As odd as it seems, my friend’s honesty was an affirmation of me and my experience and gave me the confidence to continue moving forward in my help seeking.

This experience has been affirmed numerous times since this conversation. A fellow dancer relieved to finally meet someone else that lived with anxiety when I candidly mentioned taking an anti-depressant during a forum. An audience member that saw one of my works about living with mental illness that saw hope in his recent diagnosis. People who shared with me the stories of loved ones lost to suicide after seeing a work that I made about losing one of my own friends to suicide. I believe that there is immense healing power in empathy and honesty. So I try to talk openly and honestly about my experiences.

I also share my experiences to make space. Many people living with mental illness are afraid to talk about their experiences because of the stigma that is still attached our conditions. (If you don’t believe me, check your language. When is the last time you called someone “OCD” as a joke?) The problem is that our silence means that other people are telling our stories. And their narratives are often hurtful. (Have you noticed that one of the only times we discuss mental health is during a gun control debate after another mass shooting?)

In spite of my mental illness, I am a person of immense privilege. As a white, middle class, college-educated person, I have access to insurance and health care that many do not. I am also granted a certain amount of “tolerance” from others for my quirks. This tolerance also gives me space to talk about how I live with mental illness in ways that other people find difficult. I want to use my privilege to make space for others – people from lower socio-economic classes, people of color, members of the LGBTQIA community – to tell their stories so that they can be seen, heard, supported, and accepted.

Over the next few weeks, I’ll be sharing information about mental illness: who it affects, how it affects those who live with it, how it is treated, how it is stigmatized, how you can help.

If you are a person living with a mental illness: share you stories. We will listen. You are loved. Please feel free to post in the comments, on Facebook or Instagram.

To those who do not live with mental illness: listen. You have no idea how much your support matters. Please feel free to post your support.

I look forward to hearing from you and sharing with you. Love and respect, always.