The Free Press, Mankato, MN

May 27, 2012

Suffering in Silence, Part 2: Denial, wishful thinking fuel stigma

By Mark Fischenich
Free Press Staff Writer

ST PETER —

Stigma can be described as a bloodless abstraction, a thing pondered intellectually rather than felt as rejection in the pit of your gut.

Julie Jones knows different. She can dread meeting people. Even small talk isn’t safe.

Where do you work?”

Explaining that you receive government assistance is not exactly a great conversation starter.

And it doesn’t help that Jones looks and dresses normally. It can be hard for people to accept that she is unable to work.

I didn’t plan to live my life this way,” the North Mankato woman said.

Mental illness can range from mild to crippling, and it’s those people in the middle who often have the worst time of it, said Kirsten Berg of rural New Ulm.

There are individuals like me who have an illness, and no one would know.”

And those who need a friendly shoulder the most often get it the least.

At the hospital, no one visits. It’s all hush; we don’t talk about it,” said Julie Soper, head of the Mankato chapter of the National Alliance on Mental Illness.

She figures they’re thinking, “If someone finds out it’s in my family, people will think I’m nuts.”

Another perspective is that the stigma is essentially a result of denial, and of wishful thinking.

It’s like a superstition,” Irvin Schaefer of St. Peter said. “People want to think it can’t happen to them.”

This slight regard for mental illness betrays itself at a societal level, as people decide what sufferers are due and what accommodations should be made for them.

An ‘extra’

Dr. Michael Farnsworth, a Blue Earth County psychiatrist, said the county’s reimbursement from medical assistance doesn’t even meet their overhead costs.

So that’s a lack of parity,” he said. Mental health is often seen as an extra, and can be the first to get cut in times like this.

Kathy Sheran, a state senator with a long history in the field, said the Legislature was considering a 17 percent cut to adult mental health services last year. The cut was eventually lowered to 10 percent.

Why the double standard? If mental and physical illness are the same, why are different standards applied to each?

To prick, then bleed

The word stigma comes from the Greek word for “to prick” and it originally referred to a mark cut or burned into the flesh to signify some lesser person, like a slave or criminal.

The word is more open-handed today, and others get a share of this now-invisible mark of shame.

The truth is that our national culture is one of rugged individualism,” said Farnsworth, the psychiatrist who works for Blue Earth County. “You pull yourself up by the bootstrap; you don’t admit to weakness.”

If you break your leg or get the flu, sympathy comes free. But there are no outward signs and, perhaps more importantly, no test for mental illness.

More and more, we do see biochemical markers,” said Farnsworth, formerly the medical director at the Regional Treatment Center. “They’re subtle.”

Even so, he’s skeptical, bordering on cynical, about most people’s ability to believe in a difference between laziness and mental illness.

Most of society’s happy if they’re locked up and put away until it’s one of their loved ones,” he said. “I still think personal stigma is pretty high.”

This rejection plays a unique role in sustaining mental illness.

The sense of shame people have, thinking that they’re weak,” Farnsworth said, compounds the illness.

And many illnesses come with a lack of insight, so that sufferers are already in a self-loathing mood. When you’re already facing imaginary slights to your person, real-life insults hit harder.

In general, there is now more public acceptance for many types of mental illness and people are more ready to accept help, said Gregory Nelson, a Mankato Clinic psychologist.

Hoping for zebras

When Mankato Clinic physician assistant Todd Leech first sees a patient, he typically tries to rule out a physical diagnosis before settling on a psychological one. That’s a typical method in medicine — make a list of the possibilities and investigate the most common, dangerous or easily treatable ones first.

Leech often tries to rule out physical diagnoses first. Thyroid disorder, for example, can mimic mental disorders, but it’s very rare, he said.

The aphorism is: “When you hear hoofbeats, look for horses, not zebras.”

Patients are sometimes the ones looking for zebras.

Soper said, “A lot of people want it to be something more physical. Something easier to explain and accept. A brain tumor.”

This inclination is natural, given the stigma. A physical cause can be cured. But “mental illness” means something is wrong with your brain, your seat of perception, not with your kidneys or your small intestine.

One of the sources of stigma is the fact everyone has some control over their own mental state. If I can pull myself out of the dumps, the thinking goes, then someone who can’t is simply being mentally lazy.

For Schaefer and others, though, it’s work to even stay healthy, knowing you’ll never be cured.

For a lot of us, it’s like climbing a mountain,” Schaefer said. “You still make that effort.”

Schaefer once saw some children knocking down birds’ nests. He didn’t do anything and later decided he had to work on being less passive. It’s the quest for self-improvement everyone faces, Schaefer included.

Everyone has self-pity open to them,” he said.

Language probably plays a role, too.

Mental illness. Such stigmatizing words,” Soper said.

It seems like a lot of responsibility to heap on two words in the English language, but some doctors, too, avoid labels. Nelson is one of them.

I would like to see less pathologizing, more hope in the picture, more encouragement,” he said.

Even so, the diagnosis can be its own medicine, or at least was in Schaefer’s case.

It’s an illness. It’s not the Matrix,” he said, referring to the sci-fi movie in which reality as we perceive it is an artificial fiction.

More hope

There are reasons to suspect attitudes are changing.

Leech said patients tend to be more comfortable with dealing with mental illness like a medical problem. The introduction of Prozac in the early ’90s did much to cement that association in the public’s mind, he said. After all, if a condition has a physical treatment, it seems likely to have a physical cause.

While depression in particular has received more acceptance, other illnesses remain off limits socially.

Schizophrenics still suffer from a myth that paints them as intrinsically violent, Leech said. That diagnosis also gets thrown around a lot, probably more than it should, he said. Its sufferers experience delusions, hallucinations, disorganized speech and catatonia, during which the victim can appear unconscious and devoid of feeling.

A large 2005 study conducted by the MacArthur Foundation asked whether those with mental illness are more violent than their neighbors.

It found that people with a major mental disorder who did not abuse drugs or alcohol were no more violent than the people who lived around them. But those with both a substance abuse disorder and a mental illness were found to be much more violent than normal.

Also, it found delusions were not associated with violence, even those delusions that cause someone to think that someone else is trying to harm them or control their thoughts.

Schaefer doesn’t relish acknowledging that he hears voices but was willing to discuss it to help people understand that it does not mean he is violent or out of control.

When he hears them, he tries to think: “Today is their day; tomorrow will be mine.”

In his seminal book, “The Road Less Traveled,” author and psychiatrist M. Scott Peck explains why he believes seeing a therapist is a sign of strength, not weakness.

It is worth quoting at length.

No act is more unnatural, and hence more human, than the act of entering psychotherapy. For by this act we deliberately lay ourselves open to the deepest challenge from another human being, and even pay the other for the service of scrutiny and discernment. ... It is because they possess this courage, on the other hand, that many psychoanalytic patients, even at the outset of therapy and contrary to their stereotypical image, are people who are basically much stronger and healthier than average.”