I was seeing a very depressed patient the other day and we were discussing how far he had fallen in his functioning since he had gotten ill. He said, “I used to be strong. I used to be able to provide for my family.” And yes, there was no doubt that he was unable to provide for his family now. Despite being relatively healthy physically, mental illness had made it so that he could not work, had difficulty leaving the house, or finding enjoyment in anything.
I try not to read too much into simple statements. But the phrase “I used to be strong” resonated with me because I think that it had something to do with why he waited until it was almost too late to seek treatment. While I think that he was trying to express the depths of his feelings of helplessness and need, his statement implied that he was now weak. Fatigue, lack of energy, and poor sleep from depression could make anybody weak. However, I don’t think that this is what he meant.
I often hear people stigmatizing mental illnesses like depression by saying that it only happens to “the weak”. One thing that I’ve learned from my experience practicing psychiatry is that it can affect anyone from CEOs to valedictorians to world-class athletes. Just like this patient indicated, it doesn’t matter how strong you are or think you are, mental illness can affect you if life and genetic predisposition put you in the wrong circumstances.
One of my main concerns with the stigmatization of mental illness is that if it is seen as a weakness, then the solution is often seen as needing to “be stronger”, deny a physiologic problem, and not seek help. As many mental illnesses are quite treatable with medications, psychosocial interventions, and therapy, this can often have tragic and unintended consequences such as loss of close relationships, occupations and careers, or even death.
The other concern is that if mental illness is seen as a fault of character and not as a group of illnesses, then appropriate and necessary resources and medical services won’t be available. In North Carolina, where I work, acknowledging that you need help is not the biggest barrier to treatment. Actually, it is trying to find a provider or an inpatient bed.
With the demand for inpatient psychiatric services skyrocketing in North Carolina, the number of psychiatric beds available has decreased and the outpatient mental health system, which was once a model nationally, has crumbled. It’s hard to imagine that with greatly increasing rates of kidney disease in this country that dialysis clinics or transplant services would be closing down. However, this is exactly what is happening to psychiatric services in North Carolina. It is a complex issue but is due to the national trend of closing state psychiatric hospitals as well as to the privatization and decentralization of outpatient mental health services.
Some people are taking notice of this disturbing trend, including the former First Lady of the United States, Rosalynn Carter. She has written a book on the mental health crisis in the United States and is encouraging people to be vigilant in taking care of their mental health, to overcome challenges, and to get involved.
May is Mental Health Month. So, please take this opportunity to join our former First Lady in advocating for mental illness treatment. Go to your local legislatures or call your congressional representatives and ask that they support funding for mental health services.
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