Mental Health in America: Why Some People Can’t Pull Themselves Up by Their Bootstraps
By Julie Gebhart
Several months ago, I received a text message from my older brother: “Nick died” was all it said. True to form, I wasn’t able to reach my brother until a few hours later to find out what happened.
Now, for a little back-story: Nick was my first crush (my first crush who was not Luke Skywalker). He was one of my brother’s only friends who saw me as a person, not just “Brian’s little sister”. He was genuinely nice to everyone. He was a varsity athlete who grew up in a middle class home in the suburbs. Nick died in an inpatient psychiatric facility. He was being treated for paranoid schizophrenia and developed a toxicity to his medication. He died in his sleep; he was 35.
Our culture is one that values work ethic, willpower, and independence. My father drove this into our heads at a very young age. My brother and I could be throwing up with a 103 fever and my dad’s response would be “get up, get moving, get a shower, and see how you feel.” In our household, a shower and a glass of juice were remedies for anything that ailed you.
So, this whole concept of overcoming an obstacle using nothing but sheer will seems particularly true with mental illness. Comments such as “What do you have to be sad about?,” “Stop worrying so much,” or “Just make yourself get out of bed and get going,” while possibly said with good intentions, are ultimately dismissive and unhelpful. It begs the question: What if we viewed physical health issues the same way we view mental health issues?
Physical vs. mental health in America
I stumbled across this cartoon (which I think popped up on my Facebook feed at some point) and it really struck me. Now, this first one regarding food poisoning—I remember on my 20th birthday, I got the worst food poisoning of my life, resulting in a popped blood vessel in my eye and a sizable cut because the toilet seat cracked my right across the bridge of my nose (you’re welcome for that image.)
If someone had told me that I just wasn’t even making an effort to get over it, I would have likely punched them in the throat. So why is it okay to tell someone with ADHD to just calm down? Would you ever really tell someone to just try harder to stop a wound from bleeding (in all fairness, my dad might have…)?
The stigma surrounding mental illness
In my research, I found a video clip that was part of Canada’s anti-stigma campaign that really touched on how we view/approach “physical health” vs. “mental health” and had some shock value, which is often a good wake up call.
This really resonated with me. Would we ever encourage someone to simply will themselves produce more insulin or chastise them for “not trying hard enough” to beat cancer?
We have increased knowledge now about contributing factors that lead to mental illness: variance in typical levels of neurotransmitters, structural differences in the brain, genetics, and environment. To give you some frame of reference, here are a few brain scans of individuals with mental health disorders:
A little disclaimer: I am not a neurologist, so I have a very basic understanding of the images on the screen. If you ask questions beyond what I have prepared, I will politely pretend to ignore you, as I will likely not know the answer.
I will be the first to admit that I think ADHD is over diagnosed and that we have pathologized typical childhood behaviors… it’s kind of a clinical pet peeve of mine. However, I will also be the first to tell you that children with true ADHD really do struggle socially and academically. We now know that children with ADHD have certain neural pathways that are slower to develop and mature, decreased grey matter and cortical thickness, and imbalances in dopamine and noradrenaline (both of which have been implicated in influencing inattention and impulsivity). Knowing this, is it fair to say that a child with ADHD just isn’t trying hard enough to sit still and pay attention?
The other brain scans are equally as compelling. Trauma impacts the brain in a profound way. The brains of individuals with PTSD show long-term dysregulation of norepinephrine and Cortisol systems, which impacts an individual’s stress response. Additionally, the hippocampus (which is responsible for emotions and memory), amygdala (which is linked to the fear response), and medial prefrontal cortex (which is thought to impact memory and decision making) are all affected by trauma. With that in mind, is it fair to ask someone who has experienced trauma to suck it up and move on?
The last two scans are of individuals with mood disorders, either depression or bipolar disorder. Let’s start by taking a look at the image of the brain of an individual with depression. People with untreated depression have fewer serotonin and opioid receptors. Additionally, the hippocampus and pre-frontal cortex may shrink or weaken during depressive episodes, whereas the amygdala becomes more active.
In contrast, the brain scan of an individual with bipolar disorder shows some shrinking of grey matter in the prefrontal and temporal regions of the brain, as well as differences in the limbic system, which controls emotion, motivation, memory and fear. With all those things in mind, is it fair to say that a person with depression just isn’t trying, or to tell an individual in the midst of a manic episode to calm down and get it together?
So, enough with the dry, academic stuff, let’s move on to a story that I am going to do my best to get through without getting emotional. Public displays of emotion make me wildly uncomfortable, so if I flee, just talk amongst yourselves.
On to Hedi’s story. Hedi and I crossed paths when she was working as a school psychologist and I was working as a counselor. We shared the same sense of humor, same political leanings, and same taste in music…all things crucial for a successful friendship. We were able to maintain contact after we parted ways professionally, which is something I suck at by the way. July 10, 2013, was the last time I saw Hedi. We had dinner at Bru River and shared this weird watermelon pale ale.
On July 21, Hedi ended her life with a gunshot. Her husband found her when he returned from his morning run. I got the phone call when I was pulling into the parking lot at work. I remember where I parked, what I was wearing. I remember yelling “I just saw her, she was fine” over and over. It didn’t add up. On the surface, Hedi had a great life: friends and family who supported her, a husband who loved her, 2 graduate degrees. I couldn’t make sense of it and I was angry and I needed answers.
And so, I started Googling her name and incessantly checking her Facebook page, because obviously, I would find some magical answer from the internet. What I did find was a sermon that was given at the Cincinnati Friends Meeting in Hedi’s honor and I found some solace in it.
Donne Hayden stated:
“From the outside, it seemed that Hedi had everything to live for—she was young, strong, bright, gifted. But because of her disease, in Hedi the will to live—the most necessary component of continued existence on planet earth—was defective. Life on earth is hard—if we weren’t programmed with an incredible capacity to seek life, most of us wouldn’t bother. The instinct for self-preservation, the essential force behind all life, the will to live, the ‘On’ switch for living—this is what keeps life alive against all odds. Depression, as I understand it, is a malfunction of the ‘on’ switch. For us to ask why and look for reasons she chose to end her life is normal, but we will find no answers in logic or reason, any more than we can find a logical explanation for why someone has heart disease or cancer.”
Shifting your point-of-view
Nick and Hedi’s stories had a huge impact on me both personally and professionally. To give you some background about me: I work as a counselor. I diagnose and treat mental health disorders for a living. I take people’s stories and symptoms and, as ethically and professionally as possible, I assign them a number: 309.81 for PTSD, 300.02 for Generalized Anxiety Disorder, 296.21 for Major Depressive Disorder.
Some of my professional experiences had left me jaded, skeptical of people’s true struggles, less empathetic than I once was, until two influential people in my life died before their time. I took pause and reflected on how I do my job. Was I guilty of doing the very thing I’m up here preaching against?
In all honesty, yes.
Stereotypes and stigma abound in this world, including the stigma associated with mental health issues, which can lead to devastating effects, including:
- Inadequate insurance coverage for mental health services
- Fear, mistrust, and violence against people living with mental illness and their families
- Family and friends turning their backs on people with mental illness
- Prejudice and discrimination
Are people with mental illness more likely to be violent?
In a world where mass shootings occur far too often, how frequently do we hear “the shooter was mentally ill” or “a mentally unstable gunman entered and began shooting”? Did these individuals have mental health issues? Most likely, yes, however this pervasive image of a crazed, dangerous, twisted individual is both damaging and inaccurate.
Despite decades of public information campaigns costing tens of millions of dollars, Americans may be as suspicious of people with mental illness as ever. Research published in the Journal of Health and Social Behavior, finds that 68 percent of Americans do not want someone with a mental illness marrying into their family and 58 percent do not want people with mental illness in their workplaces.
Some attitudes have gotten worse over time: For instance, people are twice as likely today than they were in 1950 to believe that mentally ill people tend to be violent.
The truth is that the vast majority of people with mental illness are not violent, however according to a 2001 study in the International Journal of Law and Psychiatry, individuals with a mental illness are 2.5 times more likely to be victims of violence than members of the general population. And a study, published in February 2009 in the Archives of General Psychiatry (Vol. 66, No. 2) finds that mental illness alone does not increase the chances that a person will become violent.
Changing the conversation
So, what do we need to do to combat this stigma? It seems that the whole “mental illness is just like any other illness” thing isn’t as effective as people had hoped. Scotland, and subsequently Canada, have both started anti-stigma campaigns focusing on the contributions of individuals with mental health issues. What a novel idea? Individuals with a mental illness can and do contribute to society on a regular basis, so why not focus on that?
I have a short video I want to show you that really summarizes what I’ve been talking about.
I urge you, the next time you see someone responding to something that you or I can’t see, the next time you hear about someone who can’t leave their house due to crippling anxiety, the next time a friend confides in you about just how down they’ve really been lately, take a moment to find some empathy. After all, they are someone’s son or daughter, they are someone’s husband or wife…they are someone.
It lies within each and every one of us to choose empathy and compassion over judgment and fear. I urge you to reflect on and challenge your own beliefs and biases about individuals with mental illness; create a dialogue within your family and friends if needed. Offer support, offer a shoulder, be there for someone, and mean it. Keep in mind the true face of mental health in America.
This article is based on a sermon by Harmony UU member Julie Gebhart, and is published here with permission from the author.