Expectations vs. reality: Breaking down stereotypes of mental illness

“You’re always so positive!”

“You’re the last person I’d expect to have depression!”

I’ve mentioned this a few times already, but I don’t fit the bill for mental illness. Part of the reason people don’t see the Man Behind the Curtain is because I don’t always choose to show it, but another reason is what people come to expect regarding what mental illness “looks like”. I looked at this issue from the perspective of therapy, but not entirely from the perspective of depression, and mental illness, as a whole. How exactly does mental illness appear to others, and how does that differ from reality?

  • Expectation: Mental illness is mental – it’s all in the person’s head! They just need to stay positive!

I’m going to go ahead and assume that, if you’re reading my blog, you don’t agree with the above statement. It’s an important assumption to tackle, though, so here it is.

Over the past couple of years with my depression, I’ve developed a personal theory about the assumption that people with mental illness can will themselves out of it: the language we use can skew people’s perceptions. I’m not just talking about using a diagnosis as an insult, though that is a factor. In this case, I’m thinking more along the lines of depression being a stage of grief, and anxiety being an emotion that most people will feel at different points in time.

When the layperson hears about depression, or being depressed, they are likely to think of the feeling of having lost a loved one. It’s a natural reaction, a stage of grief, and can be overcome over time and by coming to peace with the loss. Major Depressive Disorder is almost always shortened to “depression” in conversation, so it’s honestly a understandable why people can get confused. To them, it’s unlikely that they’re heartless people; they truly think, “I was depressed for a little while after ____ died, but I got over it, and so will you! Just stay positive/ pray/ exercise/ remember the good times”. Those individuals are trying to relate and empathize, but are misinformed about what a diagnosis of MDD truly means, and equate it with a brief stage of grief.

A similar problem happens when it comes to anxiety; you’d be hard pressed to find a person who has never felt anxious before. Whether it’s because of a job interview, a final exam, or getting married, anxiety is a fairly common emotion. Much like depression vs. MDD, though, feeling anxious in a situation is entirely different from being diagnosed with an anxiety disorder. Equating an emotion with a diagnosis is comparable to equating a bruise with a fracture – relating to something only on a surface level, with no true knowledge of the pain underneath.

  • Going forward: Instead of making assumptions about someone’s situation, ask them about it!

Not everyone will want to go into details about what they’re going through, but knowing that someone cares enough to ask can go a long way. If they do share with you, actively listen, and offer to help in whatever ways they may need. Asking these questions and offering support will dispel the idea that they can just “power through”, and can help you learn more about your loved ones in the process.


 

  • Expectation: Mentally ill people are dangerous! They’re unpredictable, and likely to harm you!

 

There is an abundance of research available that points to the negative impact media representation has on perception of mental illness. In fact, two fellow graduate students and I have researched this very topic, receiving an award for Best Poster Presentation in the process.

award

Humblebrags aside, the results showed a significant negative correlation between the amount of crime television participants viewed and their perception of mental health. For the non-nerds out there, this means that higher crime television viewing rates correlated with lower opinions on people with mental illness. The golden rule of research is that correlation does not imply causation, so we can’t shout “J’ACCUSE” at the media just yet, but there is a connection.

One of the articles I found while researching the subject reported that, in a two week span, prime time television shows portrayed people with mental illnesses as “nearly 10 times more violent than the general population… and 10 to 20 times more violent…than the mentally ill in the U.S. population” (full abstract and article can be found here). If people’s main source of information about mental illness comes from television, it’s no surprise that they will assume people with mental illness are more violent when, in fact, they’re much more likely to be the victim of violent crime than the perpetrator. 

This stereotype is never more sadly prevalent than in the aftermath of mass shootings. Perpetrators of minority races are labeled as terrorists or “thugs”, while white perpetrators are often deemed “mentally ill”. Much like the examples above for general violent crime, the majority of perpetrators of mass murder are likewise not persons with mental illnesses.

  • Going forward: Check your sources!

It’s always a good habit to verify where your information is coming from before taking it to heart. Every single one of us is susceptible to accepting things as true if we see it often enough! For instance, while 99.9% of dramatic depictions of defibrillators show the doctor using it when the patient “flat lines”, you would never use a defibrillator in that circumstance. Since we see it so often, though, almost everybody believes it to be accurate until we’re told otherwise. Television and film need drama to keep the stakes high; don’t believe dramatic depictions of mental illness without checking the facts.


 

  • Expectation: Treatment facilities are rundown nightmares! 

One of the seemingly infinite areas in which mental illness is stigmatized surrounds inpatient treatment. People seem to think that treatment facilities are exclusively haunted asylums with flickering lights, filled with patients who will frighten or attack you at the drop of a dime. Not only do I see this attitude in pretty much any given TV channel and major film release, I have seen it plenty of times even in healthcare settings.

I have worked in hospitals for almost four years, between two different cities and three facilities, and every single one of them has employees who are wary of patients with mental illness. I’ve had coworkers who prefer not to go to the behavioral health units, and even heard direct patient care staff talk derogatorily to and/ or about patients with mental illnesses, including referring to a patient as “crazy”, full stop. Not even a crazy person, just “a crazy”.

While it’s true that inpatient facilities are generally reserved for people with more severe cases of mental illness, they still receive treatment in modern facilities. The sixth floor of the hospital where I work is dedicated to behavioral health treatment, and contains a full staff, individual patient rooms, and common areas to sit, play games, or watch television. Giving people the perception that treatment facilities are nightmarish Victorian asylums just adds to the list of reasons why they don’t want to seek help if they develop a mental illness. The patients in these units are people who need treatment, just like the patients on any other floor of the hospital.

  • Going forward: Combine the first two tips – ask someone who you know has been to a treatment facility, and/ or check where your information is coming from before taking it to heart!

While you’re highly unlikely to run into violent criminals during casual conversation, there is a decent chance you already know someone who has been to an inpatient treatment facility for a mental illness. Again, they may not want to go into detail, but it never hurts to respectfully ask someone if they’re willing to share their experience with you. On top of that, as I said before, make sure you’re aware of where your information is coming from. If the only source you have is the Saw franchise, you can almost certainly disregard whatever information you’ve learned about mental health facilities… and you can most definitely find a better film franchise to watch.


There are almost certainly a number of stereotypes that I didn’t touch on in this post, but these three are a start. Stereotypes and stigma go together in a horrible way, and breaking down one can help break down the other. If we’re more open to hearing others’ experiences, and more conscious of where we get our information, we can help normalize the daily lives of the 42 million Americans living with mental illness.

 

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