Post No.: 0313
A large proportion of individuals across the world with mental health illnesses still do not seek (professional) treatment or help, or seek it only after long delays, hence there’s a huge unmet need for mental health care. And the longer sufferers go without help, the even longer they’ll tend to go without help.
Generally, men are less likely to seek treatment than women. Young adults under 25 and older adults over 65 are less likely than those inbetween to seek treatment. Seeking treatment is also less common in ‘developing’ than ‘developed’ countries. In ‘Western’ countries at least, those from minority ethnic groups are less likely to seek treatment than those from majority ethnic groups.
Many hidden suffers in society may have something that’s enough to negatively affect their lives in important ways yet not severe enough to compel them to go see their doctors, and so they suffer in silence. They may also worry about the stigma or label of having a mental health problem and/or about the poor level of mental health care or treatment they see in their particular country.
All in all, reasons for the lack of treatment-seeking for depression include the perceived lack of a need i.e. a person isn’t aware that they’re depressed, or may believe they can and should deal with their symptoms alone and without professional help (this is more frequent with men, as they’ve been socialised to believe they should ‘man up’ and not make a fuss) i.e. there’s a stigma against seeking help. There are also negative attitudes towards mental health treatments, such as being hospitalised against one’s will, that they won’t work, or the fear that one might become dependent on any medications.
It’s ultimately an electrochemical problem in the brain yet some sufferers don’t want to take drugs like antidepressants because there are indeed some risks of side-effects that could be overall worse, and they worry that they might change the sides of their personalities they want to keep. The various drugs classed as ‘antidepressants’ on the whole and on average work to help patients though, although there is great variance between different drugs and their efficacy on different individuals.
They may have firsthand experience or have heard of some scare stories. And then there’s that stigma of being labelled as being treated for depression too, and the accompanying (perceived) risk of the impact on their reputation, being discredited for being labelled as ‘disordered’ (as if ‘he/she only talks nonsense now or cannot be a leader because he/she’s mentally disordered’), that people will start to behave differently around them (either by patronising or marginalising them) and will interpret every single little unusual thing they do as ‘disordered’, and the negative effect on their life or job prospects (as people may think they’ll be complaining excuse-makers, unreliable or even dangerous).
It can be like ‘if it’s kept private then it can be denied but if it’s made public then the condition becomes a label that I don’t want’ because no one really wants to be labelled as a ‘depressive’ or similar. Labels can be hard to remove even if a person recovers. But really, the labels shouldn’t matter.
Post No.: 0209 mentioned the difference between ‘social stigma’ and ‘self-stigma’. The prevalence of social stigma and self-stigma are culturally dependent, and the furry good news is that some cultures around the world are gradually becoming more understanding and tolerant of people with mental health issues. However, there’s still a long way to go in other parts of the world and there are still major unconscious biases against the mentally ill in all cultures currently.
Although not as high as for drug dependence, alcohol dependence or schizophrenia sufferers – many people would rather avoid marrying, working with, socialising with, making friends with or moving next door to a depression sufferer. ‘Sounding weird’ to some jury members is also synonymous with ‘psycho serial killer’, such is the state of some people’s naïve stereotypes(!) Fictional media frequently perpetuates these types of clichés through lazy writing, and this shows that not all clichés have a decent element of truth in them. That’s also why lots of real-life serial killers get away with their murders for so long – the general public tends to suspect the wrong people. Many serial killers or sexual harassers seem normal, even charming, and hide in plain sight in normal occupations – some sexual harassers even include celebrated media figures who were only eventually exposed when their brave victims finally spoke out.
Along with these attitudinal barriers, there can also be structural barriers, such as financial obstacles (e.g. having no medical insurance), a lack of availability of help, geographical access, not knowing where to go and/or not having the time, transportation and convenience regarding getting care – especially in more ‘developing’ world countries. For those of us in Western Europe or the ‘West’ in general, we often have to remember that the rest of the world isn’t always like it is here, both in terms of the level of cultural stigma and the available care when it comes to mental health. Not that these problems have been completely overcome here yet either.
Both attitudinal and structural barriers must be overcome so that people who need care will get care. Public awareness and informational campaigns, and perhaps laws, will help – people typically fear what they don’t understand, what they cannot easily ‘see’, so lots of educational anti-stigma campaigns will help. People need to understand that conditions like generalised anxiety disorder, depression, phobias and OCD are common, and that many sufferers have done and are doing incredible things in society. Some are very well known, kind-hearted, smart, talented, athletic, funny, successful and are deservedly loved and respected by many. They’ve not intentionally harmed anyone else and will never do.
It’s sometimes down to insufficient education – depressed people may not be able to recognise their own symptoms and understand that they’re ill, and PTSD sufferers may not be able to make the link between a PTSD-causing event and their PTSD. Depression can sometimes creep up so slowly upon a person that no one (neither the sufferer nor those close to them) realises unless they look back and work out ‘I/they didn’t use to be like this’. It’s a bit like gaining weight, except gaining weight should be more obvious because of the external signs. Depression isn’t just the normal ‘sadness’ or ‘a lack of energy’ healthy people experience now and again. Sufferers will likely know the difference once they look back on their own feelings and behaviours from the past. They will know the difference because they likely haven’t always been that way. It’s not their intrinsic personality or inevitability to be depressed; just like it’s not someone’s intrinsic or inevitable physical state to be shot in the kneecaps(!) It doesn’t have to be that way and it can be treated. Woof!
But someone may want to avoid talking about their distressing thoughts and feelings to others because they think it’ll make them feel even more anxious and depressed. And being stoic is seen as being ‘strong’, but ‘putting on a brave face’, being silent, trying to sort one’s problems out by oneself all of the time and this kind of stoicism has obvious risks for sufferers because they not only make themselves lonely but beat themselves up. For (still) striving for a ‘perfect life’ – the ‘perfect solution’, in their mind, could be to tackle their mental issues alone so that a label is never placed on them; but this will mean that they won’t get the external support they likely need. And there’s the risk that disclosure won’t get them the support they need anyway and they receive stigma from others instead. The people sufferers directly disclose their feelings or condition to may not stigmatise them, but gossip tends to spread, and spread far and wide, and people in the outer circles or trolls might start to treat them with inappropriate discrimination.
The fact that some sufferers don’t wish to talk about their depression is partly a symptom of depression itself. It then becomes a vicious circle, hence the need for everyone to be clued-up about depression and how to best handle and support (suspected or diagnosed) sufferers. Expecting them to comfortably speak up if they have a problem can be like telling a person with both their arms chopped off to stick their hands up if they have a problem(!) Some sufferers wish other people could just read their minds. They don’t want to tell other people that they’re depressed. They just wish they knew – wish they could just know without explicitly telling these people their inner feelings.
And despite learning about the potential steps for achieving one’s recovery, one can still find it difficult to force oneself to ask for help or change one’s thoughts via willpower alone. It’s arguably as fundamental as homosexual people trying to force themselves to be heterosexual, or indeed heterosexual people trying to force themselves to be homosexual. It isn’t always this severe an analogous feeling but it can be for anybody who finds it difficult to change – whatever they find hard to change. One could theoretically physically do it easily (just like one technically has the physical capability to have homosexual sex if one is categorically heterosexual, or vice-versa, thus one apparently ‘has no excuses not to just do it’(!)) but the mind finds it difficult to go through with it. One might simply not have the desire and the mind refuses to seek help because of the (perceived) stigma and self-stigma.
For those who sought help but felt let down – longer doctor’s appointments might help some. Some sufferers can feel that the system doesn’t really care because they feel like they’re given very short shrift and curt treatment when they finally manage to go see their doctor (which might’ve been a big effort for them itself). They’re sometimes given some pills and are virtually told to go away, and so if those pills don’t work or aren’t properly explained then they might not go to see their doctor again (and if they don’t go back then their doctor may assume they’re now okay). Most doctors would agree that longer, or at least more flexible, appointment durations would help; albeit, with limited resources, it’s a difficult balance to achieve to see as many patients as possible and providing a top quality service to every single patient.
Sufferers of all kinds often think they’re a lonely and powerless voice against a powerful figure or overwhelming culture of stigma, but many other people may be thinking and feeling the exact same way (e.g. victims of domestic abuse in private), and if only all of these ‘lonely’ people spoke out and united together, they’d realise that they’re in fact not alone and are actually very powerful together! It’s like certain crimes are vastly under-reported because of the perceived shame of being a victim of that crime, but it’d help other people for one to speak out because it would help prevent other people from falling for or accepting the same situation, and it’d also show that it’s not embarrassing because they’re hardly the only ones. (Plus when there are so many sufferers or victims of something, it highlights that the problem is systemic rather than, or not just, because of the individual.)
So to quash the stigma against mental health sufferers – it takes more and more voices making a noise and being heard! For fearful people to learn that mental health sufferers are simply people like anyone else, it takes both experience, via more exposure to people who are known to have mental health conditions, and more education that mental health conditions are not contagious or by themselves dangerous.
Woof! And so if you want to be heard here then you’re welcome to reply to the tweet linked in the Twitter comment button below!