Mental illness stigma and barriers to breaking the silence

Many aspects of having a mental illness have changed since I was a college student. There are many more psychiatric medications now, they are advertised on TV, and many more people take them. There are also many mental health awareness and advocacy groups (which didn’t used to exist), and the use of social media encourages sharing of personal stories. Yet research shows that while the last two decades have brought greater public understanding of mental disorders being associated with biological factors, and greater awareness of available treatment – there have been no improvements in attitudes about people with these disorders (Schomerus, et al., 2012).

My own anecdotal experiences are similarly disheartening. A few years ago I conducted an anonymous survey of psych 101 students, asking what they would think about having a professor who was being treated for a psychiatric disorder. The one who mentioned Abraham Lincoln to illustrate that it is possible to have a disorder and still be an effective leader was far outnumbered by much more judgmental responses. The pervasive concern seemed to be that professors with psychiatric disorders could not be trusted to give students fair grades, since their evaluations of students may be irrational or unduly influenced by personal issues.

The attitudes of psychologists and psychology graduate students can be just as bad, if not worse. Clinical psychology graduate students are a hyper-competitive bunch, eager to believe that their admission to a highly selective doctoral training program implies that they are of superior mental health. When I tentatively revealed some aspects of my treatment during college and ongoing use of medication, several of my classmates’ reactions to my mere presence in their doctoral program were shockingly hostile. You also wouldn’t believe some of the stigmatizing things that the senior faculty said to us about people with various psychiatric conditions, allegedly as part of teaching us about mental disorders…. Far more than I ever would have expected, my experience as a person with mental illness pursuing graduate training in clinical psychology was defined by exclusion, perpetuation of stereotypes, and exceptionally high self-doubt. Admittedly this was a while ago and perhaps psychologists’ attitudes have improved, but I wouldn’t count on it.

Barriers to breaking the silence

I fully support appropriate sharing of one’s own mental health issues as a way of reducing stigma and helping others feel less alone. Nobody likes living a double life where so much of your experience, and especially your suffering, has to be hidden like a shameful secret. There is even research evidence that disabilities and stigmatized conditions that are invisible (as opposed to visible) are particularly detrimental for people’s well-being. So there are plenty of well-intentioned and healthy reasons to want to open up.

Yet, I am greatly concerned that the brave and articulate voices ubiquitous on campuses and social media may face unanticipated repercussions for their openness — particularly if they want to pursue careers in leadership, academia, or professional psychology (just to name a few). The stigma is just still so powerful.

One readily available compromise is to share having had some time-limited mental health problem in the relatively distant past – indeed many celebrities who open up about psychiatric conditions do this, describing their conditions as 100% behind them. I do this myself (while also dramatically under-emphasizing the severity of what I’ve been through) because it does help some students to realize that having been treated for depression in college decades ago didn’t stop me from being their professor today.

While I see sharing a past illness as better than nothing, it does promote a rather quick-fix attitude toward mental illness that is only rarely accurate and therefore unhelpful. Most of us with mental illness need to work to manage it in some ongoing or recurrent way — for a little while or much longer — while also trying to go on living our lives. Though in remission now, my mental illness is a very present aspect of my life — not a thing of the past as my casual references to having visited a college counseling center might lead my students to believe. Actively living with mental illness — while working, having relationships, and so on  — is what we all need to be talking about, but for many of us, stigma still makes this too costly a choice.

So this is my long-winded justification for why I need to blog anonymously about living with mental illness — rather than expressing myself more openly, directly, and personally with the students who would most benefit from such a conversation. Simply opening up such a conversation risks having students and colleagues constantly doubt the credibility of my authority, and that could easily cost me my job. Let’s not forget that when Dr. Marsha Linehan started revealing her own history of mental illness, she was already at the absolute top of her field, and had relatively little to lose. (And needless to say, I’m no Dr. Linehan.)

Getting where I am professionally was a longer, more painful process for me than for others as a result of my illness, and not letting my illness undo all that I have accomplished is already a difficult task (e.g., trying to meet expectations for nearly super-human productivity and unfailing health while pursuing tenure). I am certainly not going to risk the chance that just TALKING about my illness could undo all those years of effort, not even for what I truly believe is a good cause. What else can I say? I’m sorry.

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