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Fitting into a box

(Stigma Part 2)



I was at an educational event the other day and an individual in the audience brought up an interesting point. She shared that mental illness is not black and white. She noted that people struggle on a spectrum and inquired at what point do we decide that this is an illness? She expressed concerns about the idea of waiting until someone has a "mental illness” to offer services and also that there is a clear stigma of having a mental illness. She wondered what could be done, not only about the terminology sounding so severe but also about the need to wait to help.

It was an interesting an idea and very well stated. The person leading the session did her best to offer an idea and asked for my input. I shared the following comparison:


When you go to a primary care provider for a checkup, and they see something is awry, say elevated blood sugar, they call it prediabetes. They may or may not offer medication, but certainly there is a discussion of what to do. The individual is recommended to diet and exercise and make other lifestyle changes in order to try and prevent the progression to diabetes. They are given a closer than usual follow up and monitored for the need for additional intervention.


In a similar vein, there are federal requirements set by the US preventative health taskforce with recommendations for primary care providers to screen for mental health issues, especially depression. The screening questionnaire often used is a PHQ-2 or a PHQ-9, a series of questions which seek to identify depression and the need for intervention. Depending on the answers, it is designed to be an opener for further discussion with the patient.


So to answer the question as to whether or not there is something that can be done to offer help to an individual with a presentation concerning for mental illness, the answer is an absolute YES with the caveat that the questions must be asked or information must be shared and then something must come from this. 

Now what about someone who doesn’t see a doctor or get the screening questionnaire? That is where family and friends, teachers, and even coworkers can be in a position to offer help. I am not at all suggesting anyone begin diagnosing and treating their friends and loved ones, nor am I suggesting that anyone try and do anything outside their comfort zone. But one could presumably tell that individual – “You don’t seem like yourself, you seem down, sad, etc. You seem like you aren’t feeling the way you deserve to feel. Maybe talking to someone would help.”

There you go, with those little words, you can offer hope and support, show someone you care. It is an invitation to remind a person that they matter and that they deserve more, deserve to feel differently.

Ok, so what about the term “mental illness.” Is this a stigmatizing term? Some would say yes. The point made by the presenter was that to not call it an illness might minimize that individual’s suffering, in my opinion a point well made. The truth is though, that there is stigma surrounding all kinds of mental illness or mental health issues (both, I feel are acceptable phrases when used in a nonjudgmental caring scenario). For that reason, I would argue that we change our mindset, not the terms. We don’t generally consider physical illness to be stigmatizing. We don’t say someone with diabetes is “weak because they can’t effectively process and absorb sugar”. We acknowledge they have a chronic condition requiring chronic treatment, and do just that, offer treatment. Without judgement or disdain. I would request we put other illnesses in the same light. If someone has major depressive disorder or generalized anxiety disorder, it doesn’t mean they are weak or just need to snap out of it. It means they are suffering from an illness and need nonjudgmental treatment. As a society, can we accept this idea? Knowing how many acknowledge their suffering, and understanding that this may just be a fraction of individuals in need, how can we not?

As always, if you or a loved one is struggling with depression, or any other mental health issue, please seek treatment. There are a lot of good and effective ways to achieve this, so please contact myself (or someone else local to you) and get help. If you need treatment from a psychiatrist, please contact me at 954-755-2885. My office is located at 5551 North University Drive, Suite 202, Coral Springs, Florida 33067, part of Kimmel Psychology. I have evening hours available.

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