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Monster or Human?

The demonization of mental illness discourages help-seeking.

There has been a great deal of soul-searching in my hometown of New York City recently, as the city has witnessed an alarming nine suicides from police officers so far this year. Leaders within the police department have responded by pleading for officers in distress to seek help, emphasizing that seeking help for a mental health problem is nothing to be ashamed of: “Please reach out for help — you're never alone. There's people out there that love you and want to help you.”

Unfortunately, the above pleas, though sincere, ring hollow in the context of other pronouncements from leaders in recent weeks. Despite no evidence for a relationship between mental illness and recent incidents of mass violence in the US, the current US President has repeatedly linked them to mental illness, branding people with mental illness “monsters” and suggested that large-scale institutionalization would solve the problem of violence that has gripped the country. Although many have condemned these pronouncements as scapegoating, and a distraction from other causal factors that may be less politically palatable, there is no way around the fact that the US’s national leader has demonized an entire segment of the American population (25%, if defined broadly, and roughly 5-7%, if restricted to "severe" disorders). Some might be inclined to dismiss the effects of these statements given that the President frequently makes inflammatory remarks when speaking off-the-cuff. These statements, however, were made repeatedly, both in the context of a formal address and in less formal comments.

What does this have to do with seeking help? I believe that these types of statements have a potentially powerful effect on the willingness of many, particularly those who admire the President, to seek help for distress. As I’ve previously discussed, Bruce Link’s modified labeling theory of mental health stigma predicts that negative stereotypes about mental illness (dangerousness, incompetence, inability to recovery) are absorbed during the socialization process and take on “personalized relevance” when one is diagnosed. Awareness of widely-held negative stereotypes about social categories (acquired during formative years of the socialization process, and periodically reinforced later on) can have a powerful impact on self-esteem. This process was powerfully illustrated by Dan Berstein (director of MHMediate) speaking at a TEDx event:

Before I ever got sick with bipolar disorder I took an Abnormal Psychology class. One person in my group of friends made fun of every single mental health diagnosis that came up, and every single treatment. And that person was me…. And I remember sitting in the hospital after I was diagnosed, wondering if other people were thinking the same things about me.

This state of affairs presents a significant problem for those who have been diagnosed, which I have discussed at length elsewhere. A related issue, however, concerns those who have yet to be diagnosed but may be experiencing significant distress (whether depression or psychosis) and are considering seeking help, and potentially many members of New York City’s police force. On the one hand, the desire to reduce distress motivates one to seek help, but, on the other, knowledge of how help-seeking can lead one to be labelled as “mentally ill,” with its associated connotations, can lead people to delay seeking help for as long as possible, with potentially negative consequences. A recent study I conducted with Sara Soomro found support for this tension. Police officers were surveyed nationally and were given measures of both PTSD symptoms and mental health stigma. Interestingly, and alarmingly, officers who met criteria for PTSD endorsed more pessimism about the ability of someone with a mental illness to recover and greater perceptions that seeking help for mental health problems would be a sign of “weakness” than other officers. These findings suggest that those most in need of services may be most likely to endorse negative stereotypes about seeking them.

This brings us back to the President’s statements. I am not suggesting a causal relationship between them and a reluctance to seek help among the officers who died by suicide, but they may certainly have an impact on others in the future. Mental health problems are part of the human experience and can occur to anyone, regardless of political affiliation or profession. However, awareness of these types of statements communicates the message: if you get diagnosed with a mental illness, then you are no longer one of us, you are one of "them": a monster. You may be locked up for life, or you will at least deserve to be. From this perspective, it makes complete sense that one would avoid seeking help so as not to become lumped in with “monsters.”

 Photo by @ashleyjacklyn.c/schizophrenic(dot)nyc, used with permission.
Protesters in New York City challenge the demonization of mental illness.
Source: Photo by @ashleyjacklyn.c/schizophrenic(dot)nyc, used with permission.

Efforts to increase help-seeking need to begin with the stance that mental health problems are part of the human experience. Mental health differences can be normalized and even celebrated. Some countries have national anti-stigma campaigns that incorporate this type of messaging on a large-scale, with positive effects on willingness to seek help. Sadly, this is a far cry from what is currently occurring in the United States. This increases the chances that much help-seeking will continue to occur only when problems have reached a crisis level, or too often not at all.

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