When First Impressions are the Worst Impressions
The first time you ever heard the term “mental illness”, what did you think of? I can tell you what I thought of……. I was in the beginning of high school the first time I recall hearing this term. At the time, associated it with people who were unstable. I thought of people who were violent or adults who had tantrums or isolated old women who never left the house. I thought of mental illness as something that was permanent, something that individuals “had” and couldn’t recover from. Even though de-institutionalization was prevalent by that point, I still thought of people who have long stays at psychiatric wards and pictured them mumbling to themselves in a straight jacket.
Ironically, I was going through my own struggles with mental illness at the time. I didn’t call it mental illness then. I would go back and forth between feeling anxious and depressed, but I thought it was teen angst and aloofness. But was I mentally ill? My 16-year-old self would say “No way. I’m not crazy.” (Whatever “crazy” means…)
My teenage image of what an adult living with a mental illness might look like.
As I learned more about mental illness, my view of it changed substantially. By the time I was halfway through college, I realized that my anxiety and mood disorder had a significant impact on my functioning and that mental health existed on a much wider spectrum than I thought. My lived experience with mental illness was one of several factors that influenced me to study human behavior. But what about people who do not have the desire to learn about this topic? Are their impressions as biased, extreme, and inaccurate as the examples I mentioned above?
My teenage reactions to the term “mental illness” were similar to the negative stereotypes that exist in the public sphere. One of the most egregious stereotypes of people who live with mental illness is that they are more likely to be violent than the general population. The truth is that people who have a mental health diagnosis are about 10 times more likely to be the victim of a crime than the perpetrator.
A mannequin represents a victim of crime on the street. Despite certain stereotypes, individuals with a mental illness are 10 times more likely to be the victim of a crime than the perpetrator.
Perhaps the stereotypical images discussed above are the first to come to people’s minds because they are the most extreme interpretations of what mental illness might look like. The hard truth is that the majority of mental illnesses are subtle. Somebody could be diagnosed with conditions such as schizophrenia, bipolar disorder, depression or anxiety and the rest of us would have no idea. In fact, over 40 million adults in the United States have a mental health condition. That is equal to nearly 1 in 5 people. And contrary to my 14-year-old imagination, the majority of adults with a mental illness are not violent, institutionalized, or home bound.
Mental illness affects children, adolescents, and adults from all walks of life, but this is not often talked about due to stigma. Although efforts to reduce stigma have made recent progress, it is not uncommon for the people who I have worked with to experience guilt and shame as reactions to a mental health diagnosis. I have heard story after story about their worries and projections. Would a mental health diagnosis alter their life in a frightening way? Would they have to take medication forever? Would they be able to work at a level that would allow them to meet their goals?
A man expressing worry and sadness, reactions that many people may have when diagnosed with a mental illness.
When new symptoms arise, it is reasonable to be concerned about how they may impact our quality of life. Yet, forecasting defeat can make symptoms of almost any mental health condition even worse. In fact, if is possible to utilize the information gathered about your diagnosis to make informed decisions about how to take care of yourself moving forward.
Something Doesn’t Feel Right?
I think it is safe to say that we can all relate to having a physical illness or ailment. We have had upset stomachs, scratchy throats, or aches or pains that seemingly came from nowhere. All of us can relate to the feelings of helplessness and annoyance that arise when we want the condition to go away, but we have no control over when it will because we are unsure of what caused it and how to fix it. Some of us may have even been informed that there is no way to “fix” the ailment because we have something chronic, but that we can learn to live with it by managing the symptoms.
Now imagine that you are having symptoms, but they are emotional instead of physical. Picture struggling with a relentless sense of hopelessness, prolonged sadness, sudden episodes of panic, recurring flashbacks to a traumatic incident, or intense fear that others might be out to harm you. Like having an upset stomach or a mysterious pain, there could be a variety of reasons why you are having these symptoms and they are not always clear. And when we see a doctor for the weird stomach ache or sore throat that won’t go away, what does the doctor do? Ask questions: How long have the symptoms been occurring? Do they happen at specific times of the day? Do they happen after you eat? Then they will probably examine your throat or press on your stomach to examine your body further.
An experience that many of us are familiar with at the doctor’s office.
A similar process occurs when you seek consultation about a mental health condition. You tell a therapist, social worker, or psychiatrist the symptoms and life events that you have been experiencing, and they will ask a series of questions to help find the nature of your condition. The questions that these professionals ask are typically called bio-psychosocial assessments and tend to be quite comprehensive. Similar to when you visit a medical doctor, the treatment plan may not be clear after one session (in fact, in many cases it is not!) but it can offer a roadmap about what to do nest.
I’d like to be clear that not everybody who sees one of these professionals necessarily has a mental health condition that can be treated using the same biological model that applies to medical diagnoses. In many circumstances, the problem that brings someone to a therapist or social worker requires a treatment plan that has a higher emphasis on fixing social or environmental problems. Yet, these interventions are also based on best practices from previous research and can improve mental health outcomes. British author Johan Hari wrote excellent book named “Lost Connections” which gives several examples of what these interventions look like and how they can improve symptoms that were originally presented in a more clinical setting.
I have noticed that people have different reactions to mental health diagnoses than they do to medical ones. For example, when I was diagnosed with Panic Disorder it felt different from when I was diagnosed with Allergic Rhinitis. It was difficult for me not to view my diagnosis of Panic Disorder as some kind of moral shortcoming. Throughout the years, I have learned that viewing my diagnosis as a personality flaw would make it harder for me to come to peace with it and have the willingness to explore treatment options.
Creepy blurred photo of a person’s face and a furry hood. Panic attacks tend to escalate very quickly and sometimes the experience can feel very “blurry” as interpreted in this photo.
It is not useful, and not at all accurate, to attach guilt and to such conditions. I did not engage in any actions that resulted in me developing Panic Disorder. A combination of genetic predispositions in my DNA and social experiences I had early in life have influenced my brain to develop in such a way that I sometimes respond to situations with a disproportionate amount of fear and terror – often over a very short period of time. This is not a moral shortcoming, it is a combination science and learned behavior. I can learn to manage it though and work with therapists or peer groups to take steps to “unlearn” the behavior.
Now, let’s go back to that doctor’s visit we discussed earlier. Imagine how we might feel at the end of each of these visits. I can attest that after I receive a medical diagnosis, I am often relieved. Most of the time, I am informed of what the problem is, what medication to take, and what lifestyle choices I can make to relieve the symptoms of the condition. Even though the steps to treat it might be a nuisance, at least I leave knowing what to do and feeling a bit more empowered.
When treating mental illness, it is often difficult to make a diagnosis after one visit. Providers have to identify a diagnosis for insurance billing purposes, but after just one visit with a client that diagnosis is preliminary. It is inaccurate to stay that you will leave your first appointment with an explanation of how to vastly improve our symptoms, but the point that I am trying to make is that once an explanation is provided it can arm you with additional knowledge about how to manage your situation and put you in a position where you can make a choice.
Any time I needed to seek help for my mental health symptoms, I tried to view it as a learning opportunity. I would ask about the known causes, any research that has been done on it and what has been successful for others who have been living with it. I would also reflect on how the information that I obtained applied to my own situation and determined (sometimes with a provider and sometimes on my own) what the best next steps would be in my action plan.
For me, it was empowering and validating to be reminded that I was not alone. Like I said earlier, 40 million adults in the United States have a mental health condition. And there are forums on the internet, and sometimes in-person support groups, for many different mental health conditions where you can connect with other who are finding solutions. The more you know about the root of your distress, the more power you will have to manage the symptoms and make your own choice about the best next step. Mental health professionals can help with the evidence based guidance – but we are not experts on you – you are!
Challenges with This Process: And How to Stay Empowered Through Them
Mental health treatment isn’t always linear. If you need a medication to improve your mental health, you may need to try a few different drugs or different dosages before you find the right prescription that works for you. If you need to seek a therapist or support group, you may need to try different groups or providers before you find the right match. And you may go through mental health treatment, get better, and find that a month or a year or five years down the line, you need treatment again. There may not be a quick fix.
Sometimes treatment can feel like a bit of a puzzle. It can take several tries of piecing different approaches together before you feel whole again.
It is true that sometimes the dynamic between a therapist or psychiatrist and a help seeker can feel disempowering to the client. When working with clients, I have always tried the best I can to use the strengths perspective which focuses on a person’s assets and resilience, rather than their pathologies. It is important for practitioners to know that our communication style and view of the client as a non-expert of their own life can contribute to their feelings of disempowerment. Speaking from the experience of being on the consumer end of mental health treatment, I have always felt much more . empowered when I saw providers who used the strengths perspective.
Whenever I have felt disempowered, it has helped me to focus on what was immediately in front of me. When I have gone through episodes of worry and doomsday forecasts in my mind about things “never getting better,” I was able to get through it by putting thoughts of the future aside and engaging in a useful task that would give me an immediate sense of gratification. Enter….cleaning! It sounds a little silly, doesn’t it? Never in a million years did my feminist inspired brain think that domestic tasks would help me feel empowered. But in certain moments, they really did. I even tried some DIY cleaning ingredients which made it fun for me. It was kind of like a creative project. I would make something, use it to change the environment and feel a sense of accomplishment afterwards. Of course, recovery and wellness as a whole are not that simplistic. But there have been several times where a night of giving some TLC to my apartment helped ground me and remind me that my mind did not always have to be in the future and that I could enjoy simple tasks in front of me in the meantime.
Let’s Talk More About Empowerment
OK, so you were informed of your different treatment options and have made a decision about what you would like to do. How can the sense of empowerment you felt when you made that choice stick with you as you go through the process of recovery?
A Canadian study that was facilitated in 2001 explored factors in the lives of adults with a mental illness that influenced the degree of empowerment felt in their lives. Every participant was in some kind of mental health treatment (either therapy, medication management, a peer support group, or a combination of more than one treatment method). The study revealed that the two factors below had a significant influence on empowerment:
1.) Personal motivation: When consumers of mental health services were able to take more initiative in making choices, it resulted in improved confidence, skill development, and greater sense of control over their lives.
2.) Supportive Relationships: Consumers of mental health services reported feeling more empowered when their personal and professional relationships were supportive and fair. This resulted in increased participation and involvement in the community, particularly if they were able to connect with a community of peers who they saw on a regular basis.
I have actually witnessed the peer support models become increasingly common in the past decade and know of individuals who have discovered a sense of purpose once they become involved in peer support. These kinds of groups and relationships have the potential to offer mental health consumers a sense of connection that may be difficult to find elsewhere.
Giving and receiving mutual support to other with a mental illness can provide empowerment and a sense of purpose.
Another way that having a mental health diagnosis can result in empowerment is through resilience. Those of us who have lived with a mental illness have often been placed in positions where we have had to struggle to find new or different ways to cope with life’s stressors. It has been my experience that surviving through the moments where the mental illness is at its worst forces us to learn skills to help us persevere. Even though I felt hopeless and vulnerable in the midst of my worst mental health crises, I always came out of each of them feeling a little stronger and a bit more confident in my capacity to grow through adversity. And some coping skills I have learned as a result of struggling with anxiety have resulted in positive changes in my life that I otherwise may never have experienced.
For example, I had no interest whatsoever in meditation before my anxiety hit its peak in my early twenties. I tried meditation, with some skepticism, after some peers and providers had recommended it to me. Meditation ended up benefiting me so much that I continued to practice for long after my symptoms improved. As a result of practicing meditation, I have become more patient, more present, and more appreciative. Had struggling with mental illness not given me the motivation to try new coping skills, I may have never discovered this practice that has enriched my life.
I have heard others share similar feedback about exercise. Several of my peers specifically mentioned running as an activity that helped them with things such as “clearing their head” or “setting their perspective for the day. One challenge with exercise though, is that it can be hard to start particularly when you are having symptoms of depression. These symptoms can suck away your energy level and motivation.
When discussing the benefits of early morning exercise, Jen mentions a visualization activity that can help counteract some of the self-deprecating thoughts and beliefs that come with depression. Our thoughts can sometimes trap us into believing that certain things are not options. I have certainly gone through this before. It sounded a little bit like this “There is no way I can get up at 6 to hit the treadmill tomorrow. I’m not going to have the energy.” And then I literally pictured myself hitting the snooze button until 7:15.
Changing our narrative, and the way we visually see the narrative playing out, can be useful. Psychologists have found that the self-fulfilling prophecies that occur during depression can create a cycle that is difficult to get out of. Visualizing yourself overcoming challenges has the potential to break this cycle.
Meditation reduces stress, improves concentration and increases self-awareness, something that is particularly useful when managing a mental illness.
We are all familiar with the stereotypes of mental illness. Advocates, consumers, and providers have been fighting to challenge these stereotypes and provide correct information about mental health. Stigma against mental illness can often deter people from seeking treatment and may cause them to view mental illness as a personal weakness rather than a treatable condition. This perspective can be reframed by viewing a mental health diagnosis as a framework for establishing a treatment plan. Some mental health consumers may be able to shift this perspective on their own, but providers and the public need to also take accountability. Stigma is created by public opinion. If the public could have more empowering and empathetic views toward people who have a mental illness, it could lead to a paradigm shift that could help more people see diagnosis as a blueprint rather than a bombshell.
by Ashley Santangelo