Could the pain and distress of mental health problems be less than the damage done by the stigma and silence that follows?
At any one time, one in four people have mental health problems. With a global population of 8.25 billion (at time of writing) that means around 2 billion people are directly impacted, and perhaps twice as many again, who are close relatives, are indirectly impacted.
That means almost everyone on the planet is directly or indirectly impacted by mental health problems.
Yet, most people find it difficult to talk about their mental health. Why? They know, from a lifetime of experience that there is severe stigma, and prejudice still attached to mental health problem being diagnosed, or even shared.
They have seen how their friends, relatives and co-workers have been treated when suffering mental health challenges. The culture of how to treat people with mental health problems is internalised, inside all of us. Silence is the norm. The silence is imposed from within and without.
Societies across the globe have created a taboo: mental health struggles are crises to be concealed.
As a psychologist, with decades of experience, I have witnessed this silencing firsthand, over and over again. Silencing takes place at both ends of the mental health spectrum.
Psychiatric clients fear reporting any symptom to the “professionals” who are supposedly trying to help them. Why? They know the symptom will be dismissed as “part of their illness.”
The worried well with minor challenges, in a coaching session, will say things such as: “You won’t tell the Chair that I have this problem, will you?”
Why is it important to break the silence?
If people cannot speak freely about the mental health challenges, they can and do go underground, and become progressively worse. That, is harmful to everyone.
People who could have given a lifetime of noble contribution to their community are thrown on the scrap heap because they could not talk about what was an easy to deal with challenge, which, as result of the silence, degenerated into complete dysfunctionality.
By normalising mental health conversations, we can heal individuals, and rebuild communities. Imagine a world where we could reduce the numbers having mental health challenges each year from one in four to one in eight. Think of the vast improvements in so many areas of life that would bring.
Instead, it is going in the other direction. Since 1945 the incidence of mental health problems has increased by 60%.
Silence and stigma certainly have made things worse. How?
The roots of mental health stigma have a long and twisted history. The mentally unwell have been (are?) thought of as mad, unreliable, or morally deficient. They are subjected to prejudice, discrimination and exclusion.
The prejudice is not consistent. In the Victorian era, “melancholia” was the cliched euphemism for what we would now call depression. Alas, it was not consistently applied. The elite were melancholic, but for the masses, their mental health challenges were lunacy, deserving of asylums and chains. Would you speak-up about your mental health challenges if that cruelty awaited you?
Is such class-based +barbarity a thing of the distant past? Far from it. In more recent times the language to describe mental health problems was equally class driven.
Freud’s couch became a symbol of neurosis for the neurotic rich, while the working class were dismissed as “hysterical” or “feeble-minded.”
Surely no such stigma exists today. Yes, it does and it impacts vastly more people. The World Health Organisation estimates that over 970 million people, globally, live with an ongoing mental disorder, yet stigma prevents one in three from seeking help.
Public support for physical problems is huge. We have marathons for cancer survivors, ribbons for heart disease… but mental health? That invites whispers and suspicion.
In collectivist cultures, such as many in Asia and Africa, mental health is often seen as a matter of family honour. Admitting vulnerability risks tarnishing the entire family and the wider clan.
In Japan 62% of mental health sufferers conceal their symptoms to avoid “burdening” relatives. In cultures that value individualism, (most countries in ‘the west’) the expectation of the self-made person makes speaking up about mental health challenges difficult. Success is about being tough, being strong, “not letting anything get to you.”
Any mental health challenge, in such cultures, signals personal inadequacy. Oriental and occidental cultures drive mental health silence, for different reasons.
Gender, too, plays a part, a dangerous part. Men who grew up hearing that “boys don’t cry” or the equivalent, feel that they can’t speak-up. They suffer in silence, at a huge cost to themselves, their families and their countries. UK data shows that male suicide rates is four times higher than women’s, largely due to unexpressed despair: silence.
Race also plays a horrible part in mental health problems. Marginalised communities face stigma that is compounded. Well placed, historically based mistrust of healthcare systems, coming from such scandals as the disgusting Tuskegee experiments, breeds silence and reluctance to seek help.
A person of minority skin colour who discloses anxiety might be met not with empathy, but with accusations of “playing the race card” or weakness. That encourages silence.
Such racial prejudice is not theoretical. People of a different skin colour to the majority in the UK are 350% more likely to be sectioned under the mental health act. Does that act as a barrier to speaking up about mental health challenges? Of course it does.
Here is another barrier to speaking up. If anyone expresses suicidal intent to any medical or mental health professional, certainly in the UK, that helper must report the suicidal ideation to the authorities.
Almost certainly the person expressing suicidal thoughts will be detained under the mental health act. Why is that a barrier to speaking up? Because those who are merely expressing the depths of their despair, can find themselves confined to a locked psychiatric ward, surrounded by severely mentally ill people, and their ability to control their own destiny will be removed.
Rather than reducing the suicide rate, is seems likely that by making it smart for people NOT to talk about their depth of despair, they are more likely to deteriorate to the point of ending their lives. The figures support that: men who feel they can’t speak-up are four times more likely to kill themselves.
People remain silent about their mental health challenges for many reasons. For some, they feel ashamed because admitting vulnerability invites judgement.
Others fear repercussions such as the loss of promotion, broken relationships, or even social exile. Yes, people do shun those who have had a mental illness diagnosis.
That lesson is learned early in life: children who are different are bullied for “being weird.” Most children internalise that lesson: emotional vulnerability is a liability. Silence is wiser. The rates of untreated adolescent depression have seen a 40% increase in recent years.
New mothers silently hide post-natal depression so that they can carry on the façade of the “perfect mum.”
Older adults keep quiet about their mental fog or dismiss it as “just old age,” fearing a diagnosis of some form of dementia.
Most pernicious of all, when it comes to silence about mental health challenges is the workplace.
76% of employees conceal their mental health issues fearing that being honest is career suicide. When being silent about mental health problems is a matter of self-preservation, that leads to worsening mental health problems. That reveals a toxic, hidden truth about the state of society.
With the spread of remote working, people are feeling a bit safer about their ability to remain silent. That apparent safety is a poisoned chalice; mental health problems, for most people, are amplified by isolation.
Even brilliant minds are impacted by silence.
You may have come across a type of brilliant leader, the kind people would follow into battle, who cannot fight their own mental health demons. Some opt for self-medication by way of alcohol or drugs. Others for comfort eating. Both lead to illnesses and premature death… all because they do not feel safe to speak-up about their mental health challenges. The loss of these great people to society carries a huge cost.
Humans evolved as a cooperative species. We thrive when we bring out the best in each other. History surely teaches us that when groups do not support each other, when they turn on each other, the society collapses with horrible consequences.
For us to function well in groups we must be able to support those who need it, when they need it, knowing that when we need support they are there for us in return. When that cooperative trust breaks down, when the depth of connection that can only come from honest connection is severed, we all suffer.
What can we do to break the silence?
- It starts with coming out to ourselves. When we admit that we are struggling to stay mentally healthy, we take the first step towards action to regain our mental health.
- Team-up with supportive others. Reach out to those who are prepared to admit that they, too, are on a journey to recover their mental health. There are many mutual support groups for all sorts of mental health challenges, in the online and real world.
- Be cautious about professional help. Many mental health practitioners will seek to make you as dependant on them as possible, as quickly as possible. They will get you to sign up for months or years of therapy, and will keep you in therapy for as long as it takes to pay off their mortgage. Competent therapists empower you to solve your own problems, quickly, and the best can do so in one long session; just one.
- Challenge your inner critic. Reasonable, rational people have self-doubt. Self-questioning is what sane people do. They seek to learn from their experiences. If you are feeling destabilised by events in your life, that is normal. The more major life changes you have at one time, the more likely you are to have mental and physical health problems. So, when you are being hard on yourself, take a mental step back, and remind yourself of the ancient wisdom: “This too shall pass.” That is not to say you go into denial about the reality of the problem, it is to say that you will find a way to deal with it. If you are reading or hearing this message, you have already solved all the previous problems in your life; you will deal with this one, too.
- Be careful of labels. Many people seek a diagnosis for their challenge; anxiety, depression, ADHD, or whatever is the fashionable diagnosis of the day. Once received, they cling to their diagnosis like a safety blanket. It becomes their identity; their tool of abdication: “I can’t because I have XYZ.” For the vast majority of people, needing help, they have a short-term mental injury, from which they will recover. If they label it as a ‘disorder’ or a ‘syndrome,’ they make a permanent state out of a temporary problem. Do not make the mistake of going from one extreme to the other; going from silence (I have no problem) to identity (I have an incurable problem).
- Reframe your challenge. Having provided therapy for 40 years, allow me to share this. Many people who come to therapy have framed a normal reaction as a problem, and that reaction has become a habit, and that habit, developed in one context has been generalised to many other contexts, and has, therefore become a problem. When they see that they have unknowingly created a problem by turning a normal reaction into a destructive habit, they can usually solve it quickly, themselves. Once they have reframed what they thought was an enduring problem as a habit that is being misapplied, they make a dramatic recovery. By being silent about their challenge, they, unknowingly, created the conditions where a disempowering habit could be formed, and perpetuated.
- Create a mental health friendship. Most people have a confidante; someone with whom they can share almost anything. We know that people who have a confidante are much healthier mentally. If you don’t have a mental health confidante, create such a friendship. Ideally, it is a two-way confidante arrangement, where you both share your mental health challenges, and solutions. Many people have physical health buddies, with whom they can discuss all matters to do with health and fitness. Find or create a mental health buddy. I have several, and we each benefit.
What to do if you can’t break the silence?
There are vast numbers of videos, podcasts, articles, and other materials online that you can use to get support. Every library, online and paper-based, has huge numbers of books and journals that are available to you to seek knowledge, understanding, and either solutions, or ways of coping with every conceivable mental health problem.
In summary, silence about mental health problems can and does perpetuate a culture of denial, and prevents society from moving towards mutual support and care. Silence about mental health challenges is harming billions of people, directly or indirectly.
When it comes to mental health, silence kills. Don’t be one of them. Reach out, speak-up, and be part of the movement that makes honesty about mental health the healthy norm.
Professor Nigel MacLennan runs the performance coaching practice PsyPerform.
