A family member is in a funk and hasn’t seemed like himself in a long time. Or you haven’t been able to get on a crowded train all week because you break into a sweat. Maybe a friend keeps canceling plans and hasn’t gotten out of bed in several days. It might be clear to some that there is a mental health problem at hand. But there’s something inside the person that fosters doubt and delays taking action.
These examples speak to the challenging process of accepting a mental health problem. In my book, I define acceptance as the process of recognizing and actively dealing with the symptoms and related challenges associated with a mental health problem.
In a previous post, I described the different facets of the acceptance process, and tips to accepting a mental health problem. Here, I highlight the common challenges to acceptance, based on my research, and how they can be overcome to bring a greater sense of recognition and self-care. These barriers can be internal (emotional, cognitive, behavioral, identity-related), relational, or cultural-systemic.
1. Feelings can get in the way of acceptance.
The first barrier to acceptance is at the emotional level. In my research with people with mental health problems, many people described difficult feelings like shame and despair that get in the way of accepting a mental health problem. On the other hand, feelings like hope, pride, or even fear could motivate recognition of a mental health problem.
2. Certain actions or inactions might block acceptance.
Another obstacle to acceptance can happen at a behavioral level. People I spoke with described avoidant and maladaptive behaviors that only led to greater denial. These inactions might include skipping appointments or social activities that bring a sense of wellness and connection. Scheduling positive activities and committing to them often helped with accepting and managing a mental health problem.
3. Thoughts and beliefs can pose barriers to acceptance.
Cognitive challenges in acceptance can include things like a lack of clarity or negative thinking. Other cognitive processes that promote acceptance might include a sense of awareness and self-reflection. One person I interviewed spoke to this experience, seeing acceptance as, “Just thinking about what’s going on with me. Just knowing my issues, just knowing my problems, just knowing how I act on a regular basis, [helps] accept it.”
4. Ideas about your identity or sense of self may interfere with acceptance.
I learned in my research that acceptance can be a process of identity development, involving integrating a new sense of oneself as a person with a mental health problem into one’s identity in a positive way. But if you have negative associations of people with mental health problems being inferior, this can be a challenge to overcome. However, having a mental health problem can also lead to positive identities, such as being a strong and resilient person for making it through, or serving as a role model or advocate for others.
5. Some relationships may not support acceptance.
A lack of acceptance and support from other people can be a key problem to accepting a mental health problem. “When other people don’t accept you as you are, it’s really hard to accept depression,” as one person described this experience to me. This relational obstacle to acceptance also speaks to the need of the broader society to promote acceptance and eliminate stigma as a community, rather than expecting people with mental health problems to do the work of acceptance on their own.
6. Cultural factors can inhibit acceptance.
Stigma can be particularly prominent depending on one's cultural values, beliefs, and practices. In American culture, for example, there's a common stereotype that people with mental health problems are violent. Or, given our individualistic, productivity-oriented culture, one may encounter prevailing beliefs that people with mental health problems are a “drain” on society. As one woman described this to me: “In America you’re not supposed to be depressed, and if you are, you’re supposed to snap out of it, pull yourself up by your bootstraps.” However, there might be other cultural supports or beliefs that offer resources and support that foster acceptance, like some biomedical treatments, or an emphasis on education and learning about mental health problems to spread awareness.
7. Religious beliefs might impede acceptance.
Depending on an individual's religious and spiritual backgrounds, they might feel they are being punished by God for their mental health problems, or believe that they could be cured through spiritual practices that might be ineffective or even harmful. In other cases, one’s religious community and practices might be a source of inclusion, encouragement, and healing that can be extraordinarily helpful to acceptance.
8. Institutional factors can also hinder acceptance.
Institutional factors at the systemic level can interfere with acceptance. People might be ostracized at work or school because of a mental health problem. They may be failed by the policies in health care or local politics in their region. Access to adequate resources can be transformative to boosting acceptance of a mental health problem and offering the right tools to do so.
The process of acceptance can be complex, involving a number of challenges that arise at different times for different people. But with each barrier can come an adjacent facilitator to the acceptance process, whether emotional, behavioral, relational, cultural, or otherwise.
See Acceptance of Mental Illness: Promoting Recovery Among Culturally Diverse Groups for more research and ideas about the nature of acceptance of a mental health problem.
Mizock, L., & Russinova, Z. (2016). Acceptance of mental illness: Promoting recovery among culturally diverse groups. Oxford University Press.