May is National Mental Health Awareness Month, a time when organizations and individuals around the country rally around anti-stigma campaigns and the notion that all you have to do is ask for help.
Many use the term “mental health” as an umbrella term for everything from stress and mild anxiety to depression, eating disorders and PTSD. It is even used to refer to schizophrenia and depression. For example, a proclamation by President Biden about Mental Health Awareness Month states:
“Millions of adults and children across America experience mental health conditions, including anxiety, depression, schizophrenia, bipolar disorder, and post-traumatic stress disorder. Nearly one in five Americans live with a mental health condition.”
Yet these are not “health conditions”—they are illnesses. Calling them health conditions only perpetuates stigma, the very thing these messages are trying to avoid. It implies that there is something shameful about having a mental illness.
Calling them health conditions instead of illnesses whitewashes mental illness. Having a “mental health condition” doesn’t sound so bad. Because it encompasses so much, mental health conditions can apply to just about everyone at some point or another. Feeling stressed out or having trouble coping with isolation from the pandemic? You have a mental health condition. You can fix it by reaching out for help, talking to someone, taking time for yourself and prioritizing self-care. It’s reassuring to know there are solutions.
But schizophrenia, bipolar disorder and depression are serious, debilitating illnesses that cannot be adequately treated with counseling, self-care or meditation. They are genetically based brain disorders that last a lifetime, so why the reluctance to call them illnesses?
Perhaps the biggest problem I have with “mental health awareness” is the misguided focus on anti-stigma campaigns instead of the fundamental issues people with mental illness face. Mental Health America’s message for this month is, “Now, more than ever, it is critical to reduce the stigma around mental health struggles, because that stigma often prevents individuals from seeking help.” It offers a toolkit with things like “adapting after trauma and stress,” “dealing with anger and frustration” and “taking time for yourself.”
Encouraging people to reach out for help is fine, but what this essentially says is that if you have an illness, you can fix it by talking about it. In other words, you are responsible for your illness, and if you are not getting better, you are not doing enough to address it. We wouldn’t expect someone to be able to control their epilepsy, so why are brain disorders like schizophrenia and bipolar disorder any different?
And what about the people who cannot get access to the treatment they need? There is a severe shortage of psychiatrists and hospital beds in the U.S. If you are experiencing signs of mental illness, you can expect a weeks-long wait to see a psychiatrist. Once you do find one, the best treatment they can offer is a trial and error of different medications with terrible side effects until you find the best ones, a process that takes weeks—if you’re lucky—and in some cases, years. Others remain treatment-resistant. Mental illnesses are chronic illnesses, like diabetes, that require life-long treatment. So telling people all they have to do is ask for help or call a hotline if they are suicidal is a false promise—and a cruel one.
For those with the most severe illnesses like schizophrenia and bipolar disorder, their symptoms may prevent them from realizing they need help in the first place. A lack of awareness of one’s illness, known as anosognosia, is pervasive in people with psychosis. If someone is not aware of their illness, how can we expect them to ask for help?
Yet, leading health organizations ignore these individuals with the most severe illnesses—the very people we should be focusing on the most. While NAMI can be a tremendous help for people with mental illness and their families, their “You are not alone” campaign ignores the true barriers to treatment for mental illness.
It’s OK to talk about mental health. But we also need to start acknowledging mental illness and the myriad issues people with these serious brain disorders face, including discrimination, housing, employment, criminalization and lack of treatment options.