The Therapist Is In: Changing The Culture Around Seeking Treatment

There is a stigma around seeking mental health treatment. The origins of this stigma are hard to decipher, being wrapped up with the larger stigma surrounding mental illness in general, but there are several historical and sociological facts that stand to be explored.

The fields of psychology and psychotherapy have been treated using a “medical model” for quite some time. When categorizing one’s relationship to a diagnosis, this may be somewhat beneficial, making sense of a mental illness the same way we would a physical illness. (Indeed, one could argue that a mental illness is a physical illness).

I think an inherent conflict exists, however, between how we treat a sickness, an infection, a disease, and how we treat a mental affliction. We want to find an antibiotic, but all we have are antipsychotics and antidepressants, while you can’t cure a cold with therapy. Further, we still struggle to separate “An individual who is schizophrenic” from “An individual who has schizophrenia.” We as a culture continue to identify individuals by their diagnosis once they are given such a “label.” This is not reflected in the fields of medicine. Who ever heard someone address themselves as “I’m cancerous”?

Here is my personal theory on the foundations of this societal stigma: We still adhere to the medieval belief that equates mind with soul.

If one’s mental state is unstable, their soul – the crux of who they are, their spirit, and everything that makes them them – we presume must likewise be off kilter. We see this in the portrayals of mental illness in entertainment: Film, television, and fiction. I am reminded of characters such as The Joker, Dr. Jekyll and Mr. Hyde, John “Scottie” Ferguson, Boo Radley, and the like. Indeed, even in reality, news agencies continuously refer to people in the media who have committed crimes while mentally unwell, such as the contemporary James Holmes, as “evil,” a term which hardly seems appropriate in a “medical model,” as if they were possessed by demons.

I find this fact ironic given the history of psychology, its progenitor in humorism and “black bile,” which seems far more medical in contrast, though this was certainly diluted by philosophy of mind. Alas, given the success of psychoanalysis, Sigmund Freud was concerned specifically with understanding the inner workings of the soul, a fact which has been lost in the english translations of his texts. (Freud used the term “die seele,” which means “the soul” in German, but became “the mind” in English localizations). Freud believed that the Id, the Ego, and the Super-Ego (in German, “the It, the I, and the Above-I”) were the actual components of one’s psyche or soul. This, I believe, continues to influence our current culture, feeding our demands for their negative portrayals in entertainment. We have not yet developed a better way of making sense of mental illness and are, instead, fascinated or, better yet, infatuated by it.

This stigma goes in the opposite direction as well. If this represents our baseline understanding of mental health – how society at large makes sense of a “sick mind” – than someone who has been given a diagnosis may begin to view themselves, make sense of themselves, and ultimately identify themselves with that understanding and the negative portrayals that emerge from it. Stigma becomes both external and internal, created a compounded cycle.

I am reminded of an ex girlfriend who told me her biggest fear was being deemed crazy and not being able to prove that she wasn’t…

Rather than face these external and internal pressures, we avoid treatment all together, hide away our struggles, in the hope that we can handle them on our own. We are social creatures, after all. Anything that might jeopardize our assimilation into society, therefore, must be avoided. Unfortunately, sometimes hope runs out.

Now how do we break this cycle?

In my opinion, it starts with public education, comprehensive programs that undermine these negative stereotypes and confront our warped understanding of what mental illness actually is. We have to change the culture; illustrate that depression and wanting to end one’s life is nothing to be ashamed of, but something to be discussed, explored, and listened to. Like a scientific hypothesis, we want to find evidence that ultimately proves it wrong.

There is worth in mental health and wellness, and mental illness can teach us a lot about ourselves, offering perspectives that change how we make sense of the world around us. The goal, however, is not to over-romanticize mental illness, but to make mental health as mundane as a doctor’s visit; to say “I feel suicidal… I think I’ll go to my therapist” with the same monotony as “I don’t feel well… I think I’ll go to the doctor.”

Unfortunately, the lack of funds for mental health treatment programs, their difficulty of access, the nature of suicidality itself, and the marked differences in treatment make this an onerous goal to achieve, but one that, I believe, an inevitable change in culture can provide.