Thoughts on Mental Health Stigma

Yesterday I went to pick up my repeat prescription for fluoxetine (Prozac by a more generic name). I usually block out the world with some very loud music on such trips but I’d forgotten my headphones, so on the walk back I found myself thinking about the stigma that still surrounds mental health issues and the use of medication to deal with those issues.

First, a bit of personal context. I first had treatment for depression and anxiety just over ten years ago. I had lost myself in a relationship that ended slowly and badly, and by the time it was finally done and I had deleted all trace of him from my phone and my life, I didn’t really know who I was. I didn’t ask for help, rather I was taken to get help and I accepted it. I was very lucky that I was able to be treated privately, with a combination of CBT and other slightly more random therapies (including some sort of intuitive role play group, or something like that) and medication.

CBT was one of the best things I have ever done. It wasn’t a cure, and wasn’t meant to be, but it armed me with an array of coping tools that I still regularly use. It wasn’t easy, and there were times when I sat in my car outside the hospital just seconds away from bailing on a particular session, but I always made myself walk through the hospital doors. I did the work, and I’m so glad that I did. (It’s worth mentioning here that I think one of the reasons I still struggle with BDD and related issues is that I didn’t really talk about it during therapy sessions. CBT requires shining an uncompromising light on those dark corners of the mind that harbour the seeds of our depression, anxiety or whatever, and I did not want to shine that light on why I felt the way I did about my own body. As a result, I’ve never received any real guidance as to how to apply CBT techniques to those particular issues.)

I was prescribed fluoxetine after I had been attending CBT sessions for a while. It had been hoped that the CBT alone would be sufficient, but it wasn’t. I’ve been taking it on and off ever since. The “off” periods were times when I decided that I didn’t need the medication anymore and so just stopped taking it. Without fail, some time later I would find myself going back to the doctor for another prescription. The problem was that I didn’t think I needed the medication anymore because of the medication. For me, fluoxetine doesn’t provide a miracle cure for depressive or anxious periods, and I’ve been through various stages of both whilst taking it, but it smoothes off the rough edges and lifts my mood sufficiently to enable me to deal with those periods.

Personally, I have only experienced mental health stigma to the extent that it informs attitudes in our society, rather than having been on the receiving end of anything more specific. Having said that, there are times when I have not been entirely honest about those issues. If I had been, maybe the stigma would have reared its head more directly. There have been times, for example, when going to work has been an epic struggle. Days when I could pull the duvet over my head, stare blankly at the inside of the covers and let the day just drift past because even making the decision to get out of bed was just too damn hard. Days when I felt so uncomfortable being out of the house that I would be repressing a panic attack whilst waiting for my train. On some of those days, I would push through. On others, I would call in sick, but I would always give a physical reason – a stomach bug, a migraine or something like that. Taking a day off work because you need to take care of your mental health is just not on a par with taking time off to care for your physical health.

It’s those pervasive attitudes that need to change, but that’s easier said than done. How do we move away from seeing mental health issues as a flaw or a weakness, to seeing them as health issues that are treated and managed just like any other? In my own personal experience, someone who is dealing with mental health issues is the exact opposite of weak. Every single person I know who deals with such things (and it is often something that requires work day in day out, not just on those particularly dark days) is strong, courageous and tenacious. It takes strength and courage to manage symptoms, to face down the negative voices in your head and to ask for or accept help when you need it.

Awareness is absolutely key to ending stigma, and I think this is generally recognised, or at least it is getting to that point. More and more people are being honest and open about their own mental health experiences through social media, articles and blog posts, and initiatives like Mental Health Awareness Week help to bring awareness to as many people as possible. As well as awareness, I think there has to be a real understanding of how mental health can affect people’s lives and what can be done to assist by, for example, employers. In an employment context, for example, an HR policy that reflects awareness of mental health issues will have very little positive impact if employees, particularly managers and those in positions of authority, do not have a genuine understanding of those issues such that they are able to treat the person in question in an appropriate and compassionate way. Dealing with mental health issues does not automatically mean that someone is less able to do their job or any less ambitious. There might be times when a person’s particular problems mean that they are less able to do their job, but that should be treated no differently to a situation where physical incapacitation renders someone temporarily unable to work.

It’s also important to tackle the spread of misinformation about mental health issues and the use of medication. Careful and thoughtful reporting is required. The following headline, for example, appeared in the Daily Mail recently:

“Could antidepressants really cause brain damage? Experts reveal the pills don’t work for most people and could even cause PERMANENT harm”. [The caps are theirs, not mine.]

That is, frankly, sensationalist and unnecessary. There has also been a lot of reporting recently about the apparent risks of taking antidepressants during pregnancy (Google “antidepressants and pregnancy” and look at the news results). The vast majority of people reading these articles are not experts, and so have no knowledge or experience to draw on to be able to verify or counter the information provided. Take that DM article. I have absolutely no way of knowing whether what it says is correct, or whether it correctly reports the results of any studies it cites. The same goes for the myriad of articles out there which report the “results of scientific studies” or the “views of experts”. I would, however, recommend that everyone watch the segment from a relatively recent Last Week Tonight about science reporting, which makes it impossible not to question such pieces. Sensationalist and incomplete reporting, together with clickbait headlines, can be dangerous on any subject. Where mental health issues are concerned, they prevent the dissemination of accurate information, which is essential to increasing both awareness and understanding.

Deeply embedded attitudes take time to change. Society is, I think, definitely moving in the right direction as far as attitudes towards mental health are concerned. If as many people as possible can keep talking about it, including people with platforms big enough to be heard by a lot of people (Carrie Fisher, you are missed), then hopefully we can keep moving in that direction. I will continue to do my very small part by being entirely unashamed about any past or present issues that I had or have and by refusing to be embarrassed about taking the medication I need to be a functional human being.

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