Changing the ‘No Casserole’ Response to Mental Illness

It's time to look at mental illness in a new light

Posted Mar 27, 2015

Photo purchased from iStock, used with permission.
Source: Photo purchased from iStock, used with permission.

A mother of two who is active in the International Bipolar Foundation shared a story the other day. When her youngest daughter was diagnosed with diabetes, friends called, sent cards and flowers, brought food, and posted encouraging Facebook messages.

When her eldest daughter was diagnosed with bipolar disorder a few years earlier, however, the family got a different response: silence. “It’s known as the ‘no casserole’ illness,” she explained.

With that anecdote, we get to the heart of what’s wrong with our reaction to mental illness. When someone is diagnosed with a “physical” ailment, we offer our support and encouragement. When the illness is mental, however, we all too often turn away, just when we’re needed most.

It’s a response that has its roots in the stigma surrounding mental illness – stigma that’s been fed by fear and ignorance that few of us take pains to overcome unless we’re personally affected. As a result, those suffering with issues such as bipolar disorder, depression, anxiety, obsessive-compulsive disorder, schizophrenia and PTSD – tens of millions of us, according to National Institute of Mental Health statistics – often find themselves struggling not just with their illness but also with a sense of shame and abandonment.

A presidential commission on mental health once summed up the problem this way: “Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders. ... It leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking and wanting to pay for care. Responding to stigma, people with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment.”

As a society, we have taken some steps toward counteracting stigma. The Americans With Disabilities Act, for example, includes provisions to prevent discrimination against the mentally ill in the workplace, education, housing and health care – although the reality doesn’t always live up to the hope. And recent changes to health care laws require coverage of mental health at the same level as traditional medical care for many policyholders.

Also encouraging are the support groups that have proliferated through the years, such as the International Bipolar Foundation, which proved to be an invaluable resource to the family mentioned above. Other organizations that offer a helping hand include the National Alliance on Mental Illness, the Depression and Bipolar Support Alliance, the Anxiety and Depression Association of America, the National Federation of Families for Children’s Mental Health, and the National Institute of Mental Health, to name just a few.

Still, such groups often find themselves preaching to the choir – spreading the word about stigma to those who are already aware of its existence. What’s needed to truly end stigma is something called for in virtually every policy paper on the issue: contact between those who aren’t directly affected by mental illness and those who are. In this way, important truths are disseminated, such as:

  • Those dealing with mental health challenges aren’t just nameless statistics; they are our friends, our neighbors, our coworkers, and they may well be us. They are also among society’s greatest leaders and most creative members: Winston Churchill, Abraham Lincoln, Mohandas Gandhi, Vincent Van Gogh, Beethoven, Isaac Newton and Michelangelo. Among contemporary names are J.K. Rowling, Carrie Fisher, Catherine Zeta Jones, Sting, Lady Gaga and Ben Stiller.
  • Mental illness is not a moral weakness or a failing. It’s a disorder of the brain thought to be the result of interlinking causes – for example, genetics, brain structure, biochemical processes and trauma. The good news is it can be treated, most commonly through therapy and medication. Many reclaim full and productive lives.
  • Despite what is perceived as a link between violence and the mentally ill, the reality is that those with psychiatric disabilities are much more likely to be victims of violence than perpetrators, research shows.
  • Just as with other health issues, mental illness is one aspect of a person’s life; it does not define them.
  • Those in need are much more likely to reach out for help and to have a successful recovery – an outcome that’s good for all of us – if they know they can count on the compassion and support of those around them.

If you’ve only viewed mental health issues from afar, I urge you to take that crucial step toward ending stigma: Make contact. Consider volunteering with a mental health support organization. Get to know the people involved and the issues they face. Most important, get educated about the realities of mental illness. Thanks to the Internet, information is at your fingertips. It’s knowledge you can use to help a friend in distress, or perhaps even yourself.

Those dealing with mental health issues, in turn, can help find the support they need by letting others know what they’re dealing with and that a helping hand is welcome. And be open about what form of assistance is best. You may not require a casserole, but perhaps you’d appreciate an occasional ride to your therapist or being kept in the loop about social events, even though you may not always be able to accept an invitation.

Remember that friends may be more eager to lend a hand than you realize. Often, people hold back out of worry they’ll say something that may accidentally offend or cause pain. And the reality is, they probably will say something at some point that makes you wince. But you can set a positive tone if you let them know that it’s not perfect words that you value most; it’s their presence in your life.


Dr. David Sack is board certified in psychiatry, addiction psychiatry and addiction medicine. As CEO of Elements Behavioral Health, he oversees mental health treatment programs at Lucida Treatment Center in Florida, The Ranch in Tennessee, and Malibu Vista in California.