Why are people uncomfortable talking about mental health?

Long Term Care Columnist / Guide · May 12, 2013

What a fascinating question........and how few real answers!

Personally, I think a lot of the stigma surrounding mental illness stems from the way-back days, when demonic possession was pretty much the only reasonable explanation for it in the eyes of a society that was very primitive, especially when compared with ours. (And ours isn't a whole lot better when it comes to understanding the human brain.) The hallucinations, wild gesticulations, demented ramblings and other behaviors seen in psychosis were often 'treated' by brutalizing the 'possessed' individual, often in unspeakable ways.

Now we're a little bit kinder about how we manage mental illness, but still a long way from recognizing psychiatric patients as having the same rights as everyone else to seek and obtain good jobs, utilize their health insurance, even own firearms. An individual also does NOT give up his/her right to privacy when diagnosed with one of these disorders, although there is no shortage of employers and professional licensing boards which believe otherwise.

In the meantime, what we can do as healthcare providers---some of whom suffer from MI ourselves---is to educate each other as well as the public about what psychiatric illness actually is and isn't. Contrary to popular opinion, most of us are not wild-eyed maniacs with an Uzi and a voice telling us to kill the _____s (insert target of rage here); we're everyday folks who just happen to struggle with a brain disorder. People don't need to be scared of us, for we live next door to them, work alongside them, even make life-or-death decisions for them sometimes. In other words: "we" are "you". :yes:

DoGoodThenGo · May 12, 2013

For much of recent history including the United States not being in one's right mind was grounds for being committed. The bar for such action in many times and areas was often quite "low", that is to say you could have all your rights taken away and be locked away merely at someone's say so. That *someone* could be your father, husband, parent or other family member for a whole host of reasons ranging from legitimate mental illness to you wouldn't "behave".

There has always also been a huge stigma attached to mental illness as being "feeble" in both mind and blood. When the Eugenics movement took hold it was felt in some quarters that forced sterilization was the answer to keep those with "bad blood" from reproducing further. As one elected official or judge at the time put it "three generations of idiots was enough".

For these and a whole host of other reasons people do not like to admit they aren't feeling mentally "well" and or are willing to acknowledge someone in their family might be so as well. No one wants themselves or a loved one treated the way the mentally ill often are in this country and elsewhere.

kbrn2002, ADN, RN · May 12, 2013

A nurse I used to work with has a son with paranoid schizophrenia. Watching her struggle to help him find treatment options and safe housing as well as the daily struggle to encourage his med compliance was terrifying and awe inspiring. Her biggest fear has been what will happen to him when she passes away as he has no one else to advocate for him and ensure his safety. I haven't seen her for a few years now but still think of her and her son now and then. Hoping them and all others in that sad situation the best.

DoGoodThenGo · May 13, 2013

A nurse I used to work with has a son with paranoid schizophrenia. Watching her struggle to help him find treatment options and safe housing as well as the daily struggle to encourage his med compliance was terrifying and awe inspiring. Her biggest fear has been what will happen to him when she passes away as he has no one else to advocate for him and ensure his safety. I haven't seen her for a few years now but still think of her and her son now and then. Hoping them and all others in that sad situation the best.

You have no idea how often that scenario is played out all over the United States. In a more recent and tragic case you have the Newton incident as a reminder of just how difficult things are even for families with means.

My best friend from school suffers from paranoid schizophrenia (as indeed does several of his siblings) and over the years it has been tragic watching him sink deeper into the abyss. As the years have passed his bad days are out weighed by the good, indeed since the post college years it has been a slow decline.

Sadly it is as you say, with proper treatment including med compliance he is fine (for the most part), but as middle class parents had no choice after awhile but to turn to the City and that was when the nightmares started.

Despite all the promises made when mental hospitals were shuttered and their residents along with future persons suffering from mental illness were supposed to have adequate community resources, that simply has not happened. Sadly what has become the new "mental facilities" are prisons and jails.

buckeyecass08 · May 13, 2013

I have worked in mental health for 7 years. I am currently a case manager for adults with severe mental illness. I am trying to get into a nursing program to become a psychiatric nurse. I agree with the people above...it's the stigma. Once you are diagnosed with something it follows you forever. Insurance companies are to blame for this. Your insurance won't cover your slight feelings of depression without a DSM diagnosis, so in order for the facility to bill they say well you have Major Depression and you will have this for years. There are also the socio-economic issues as well. Many of people who suffer with mental illness are unable to hold jobs, have burnt bridges with family because of their behavior, and can end up homeless. People assume the worst of someone with a mental illness. However, I have many consumers who, as long as they are taking their medications, are contributing members of society. No one wants to labeled as having a mental illness because of the recent shootings, bombings, and downright violent behavior against people. However, I think mental illness can also be a cop-out for getting a lesser sentence. Many people who commit crimes know exactly what they are doing when they do it. Some consumers I work with are willing to talk about their struggle, while others want help with paperwork for benefits, but will no talk about their difficulty with symptoms. Everyone is different, but I believe the stigma from people who do work with, live with, or know someone with a mental illness will continue to keep people quite.

wish_me_luck, BSN, RN · May 13, 2013

buckeye, I have noticed that many people with a mental health diagnosis do best when given PRN or part time work. It has worked out that way for me, as well. However, I personally plan on working full time if I have to move (to make ends meet) for a job.

I have to agree on the last part of your post--I think mental illness gets a bad rap from the media and all these high profile cases. I also agree that some people use it as a cop out for doing bad things. I have always felt that unless a person had a diagnosis before they committed the crime, they should not be able to use mental illness or any insanity plea as a defense for their actions.

dirtyhippiegirl, BSN, RN · May 13, 2013

I'm curious as to why this is a continuous, recurring theme with your posts? From your OP, I assume that you're PRN somewhere.

NurseDirtyBird · May 13, 2013

Mental illness is unpredictable. Unpredictability is scary. People as a whole like familiarity and conformity. For people who are used to things a certain way, and have every expectation of it remaining the same, safe, comfortable way, it's very unsettling. From the beginning, society has attempted to control the uncontrollable, and this includes mental illness. They attempted to force conformity (e.g.: exorcism or lobotomies), and if that didn't work, they were swept under the rug, hidden away in institutions to live the rest of their lives in what were essentially prisons. The stigma stems from fear, plain and simple.

I second the notion that those with mental health dx usually do best working PRN. Works great for me!

Long Term Care Columnist / Guide · May 13, 2013

I wish I could afford to work PRN/casual. Unfortunately, I need health insurance, and could never afford it on my own even if I were insurable.....which I'm not.

The other day I was researching health insurance plans online to see if I could purchase even a short-term policy to tide me over until my next job, and what I found was: a) one plan said "NO WAY" when I inputted my height/weight; b) another let me get as far as my HTN and diabetes before it, too, said "fugeddaboudit"; c) still another let me get through that but said "Nix!" when I got to bipolar; and then d) there was the plan that let me get ALL THE WAY THROUGH the application---including details on every diagnosis and every medication---before it said "We're sorry, but we cannot offer you health insurance at this time." GAAAAAAAAAAAHHHHH!!!!

Marshall1 · May 13, 2013

I agree with the PRN status being best if possible..I struggle a lot with anxiety and depression. I see jobs often that I would "love" to have but in reality (which I have learned the hard way) would not work in the long term. It is unfair to myself, the employer and other job seekers for me to apply/interview and if hired, only have a set back and leave within a few months. This has happened for me many times in the past few years and it's only been recently that I realize this is how I am and as much as I would LOVE to be normal (able to work FT, go out without feeling anxiety ridden, etc) that is just not who I turned out to be. For me, self acceptance of having these conditions has been the real obstacle and I think sometimes it is for many others which is why mental health isn't talked about as much as it should be. The thought being "if I ignore it it will go away" or thinking a certain food or exercising or herb will be the cure all..certainly there are transient times in a person's life of anxiety or depression but what myself and others on here struggle with is a day to day sometimes hour to hour minute by minute fight that may ease up but does not stop. The stigma, lack of understanding and difficult access to healthcare all play a part in many people - myself included - not seeking treatment on a consistent basis or trying to keep things inside because unless one has walked the path there is no way for them to understand that sometimes I don't have a logical reason I can't just get in the car & take off to the mountains for the day or go to a restaurant that is more than an short drive from my house. I can't think of anyone I know, myself included, that would choose these chains - they are life limiting in many ways. That's what I wish people - health care providers included - understood - mental health is not a weakness, in many regards it takes a tremendous amount of strength and resilience to cope and function on a daily basis - even at a lower than expected by others level.

wish_me_luck, BSN, RN · May 13, 2013

dirtyhippiegirl, recurring theme? Mental health? That theme? Because I have a mental health issue that was made public (I did put the thread in the forum Nurses with Disabilities). I can't really hide it since that point (especially from employers--the people who matter most in my job quest), so I would rather tell people on my terms. In my openness, I have realized that even mental health (everyone has mental health even if they don't have a mental illness) is a very taboo subject. But, when I mention having a mental health condition, I get the look of fear. Healthcare professionals are the worst, actually. Lay people do better with it. Go figure.

I don't have a nursing job; however, I work in another capacity and I have more of a flexible/not entirely set schedule. It's the same in any field, nursing or non-nursing for the PRN (all that means is as needed) or part time work comment. But, like I said, if I have to move for a job, then it would have to be full time as I would incur more expenses.