I have been attending professional conferences for more than 30 years, so they have become rather predictable to me. Plenary sessions, research paper presentations, skills workshops: Sessions are generally informative, though sometimes deadly dull.

suicide preventionThat said, my experience at the 2014 conference of the American Association of Suicidology in Los Angeles a few weeks ago was anything but dull or predictable. At this meeting, it was announced that a movement to establish a new AAS division for members with lived experience – people who had made suicide attempts and survived – had been successful.*

I write because I recently expressed concerns here about this movement.

Stories of suicide-attempt survival

A session I attended on the topic was, well, atypical. One audience member compared it to a Grateful Dead concert – perhaps a bit of stretch, but, to be sure, one does not commonly experience whistles, whoops and multiple standing ovations at a professional conference (see above).

This particular session consisted of four brave individuals, one after another, telling stories of adversity, despair, desperate acts and recovery. The stories were wrenching, heartrending and triumphant. Resisting any urge to evoke pity or idealize their recovery, the speakers delivered a remarkably consistent message: I’m not out of the woods yet; I sometimes still have suicidal thoughts, but I am hopeful and committed to pursuing the meaningful and joyful life that all human beings should have. The implicit message:

“You can do this, too. I went into that dark place and came out the other side, not only alive, but stronger for having been through it.”

Lasting impression

It is this latter message that impressed me most.

I realized that in expressing the unease that I and many mental health professionals have about giving up privacy regarding one’s history of suicidal thoughts and attempts, I was not fully appreciating the fact that this “coming out” was about much more than just shedding the burden of stigma (sufficient motivation in and of itself); more, it was about the therapeutic impact that the communality so evident in this packed room had on the participants and potentially to anyone in the audience, whether physical or virtual.

Which brings us to the issue of coming out digitally.

In my prior post, I noted that fighting stigma by posting one’s private information on the Internet, whether about suicide attempts, HIV status or any other protected health information, is a quantum leap compared to other forms of disclosure, in that it reaches a worldwide audience and is “out there” essentially forever, available to future employers or potential romantic partners, who might not be as open-minded as one would hope.

So here’s the trade-off for the loss of privacy: The collective nature of this coming-out – potentially large numbers of kindred spirits as well as potentially huge numbers of struggling individuals desperate for a ray of hope – adds up to a potential bonanza of therapeutic benefit that has heretofore not existed. Translated, this means many lives potentially saved.

Goodness knows, we mental health professionals can use the help on this sacred mission.

Does this mean I’m totally OK with people coming out about suicide attempts online? Let’s just say I will still advise my patients and anyone else who asks to put a lot of thought into the decision, carefully weighing advantages against disadvantages. The thing is, while the column listing disadvantages remains, the advantages column just grew considerably, as a result of the whistling and whooping at that otherwise predictable conference.

*AAS already had divisions for clinicians, researchers, prevention specialists, crisis workers and survivors (those who have lost a loved one, friend or patient to suicide).

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National Mental Health MonthAs a staunch advocate for eliminating the stigma surrounding mental illness and brain disorders, Menninger encourages conversation in our homes, our communities and our media outlets.

So let me begin this conversation by offering kudos to the Houston Chronicle editorial writers for the May 19 admonishment “Low Blow” that said the tactic of leaking a political candidate’s treatment for depression by the opponent’s camp went too far.

Politics and mental illness

An outgoing politician aligned with Lt. Gov. David Dewhurst released documents revealing Sen. Dan Patrick’s voluntary mental health treatment.

Mental health history, like a history of diabetes or even recovery from alcoholism or other addiction, doesn’t belong on resumes. Neither does skin color. Neither does where you grew up.

Sen. Patrick used the situation as an opportunity to right a wrong.  He issued a statement that said he had indeed received “treatment decades ago for depression and exhaustion.” And today he’s arguably a successful Texas businessman, regardless of your views about his politics.

It’s up to all of us to capitalize on such newsmakers and promote the facts about brain disorders such as depression, anxiety (the most common category of all brain disorders) and other conditions. It’s up to each of us to let our family, friends, co-workers and others who care for us know that brain disorders happen to many people, treatment works and speak up when we need support or attention from professionals for help.

National Mental Health Month

There’s no better time to have that discussion than in May, which is National Mental Health Month.

Speaking of speaking up and out, I’m reminded of a conversation I witnessed earlier this month. In front of more than 800 guests at Menninger’s annual signature luncheon, which raises funds for research, training and patient care, University of Houston’s Brené Brown, PhD, LMSW, and Academy Award-nominated actress Mariel Hemingway chatted about mental illness.

With the stage set as close to a living room as a ballroom’s stage can be, the women opened up about the realities of coping with a brain disorder. Mariel said she realized that in creating her documentary, Running from Crazy, the idea of telling her story was more scary than actually telling it.

The lesson learned: “We all need to tell our story,” said Mariel. Before she did, she equated it to trying to hold a ball under water. “When you tell the truth, it is freedom like nothing else.”

Our life’s picture includes our parents, our children and pets, our friends. It also includes our work and hobbies as well as our ups and downs, our sickness and health.

It’s time to place our mental health in our personal portrait and be willing to share it. Clearly, Mariel and Sen. Patrick do not view their portrait as less than whole for sharing that part of their story.

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labels addictionLabels play a large part in defining our experiences; they also play a role in stigmatization.

Webster’s Dictionary defines stigma as “a mark of disgrace associated with a particular circumstance, quality, or person.” Just take the word “addict,” a common label for people who use substances. The mark of disgrace here is the label.

Many thoughts associated with the term “addict” are negative. Historically, the term suggested someone who was weak, couldn’t handle themselves, was morally bankrupt or just a bad person altogether. Today, when doing a Google search for “addicts are…,” the search engine auto populates this search term with “Addicts are … weak, selfish, manipulative, liars, narcissistic, losers …” and the list goes on. These words place emphasis on morals and personality judgments.

Neurobiology of addiction

Though persons with chemical dependence often seem selfish or weak or manipulative, there seems to be an underlying process going on. That process is often thought of as the neurobiology of addiction – where thought, reason and morality are hijacked to support the survival function of the brain; where substances are used as rewards to sustaining life. Addiction is when the neurobiology of substance use is considered to dominate life choices.

Many times we label people based on the choices – good vs. bad – we see them make. After all, labeling someone’s behavior has given us good indication about how to protect ourselves; so labeling is not always bad. But it’s important to consider when the label becomes harmful and we start to qualify someone’s inherent worth because of it.

When I think about worth I start to think about worthiness; stigma and labeling are attached to this through shame. Shame touches that part of us that feels worthy or not. The transitive verb form of shame makes this connection and means: “to cause (someone) to feel ashamed.”

The feeling of shame denotes pain regarding shortcomings. Shame created by labeling someone introduces the blame factor. In addiction, this can keep people from seeking treatment and thinking they are not worthy of getting better or are incapable of doing so. Most importantly shame and stigma keep us from knowing the person and their experience.

Even in addiction? Especially in addiction.  

Personal responsibility

You may be wondering about all the harm addiction has caused you and your family. Does this mean the person using substances isn’t responsible? Not exactly.

The nature of addiction does not absolve the individual from personal responsibilities in recovery. Active addiction and recovery look very different. In the Narcotics Anonymous basic text there is a passage that says, “The time has come when that tired old lie, ‘Once an addict, always an addict,’ will no longer be tolerated by either society or the addict himself. We do recover.” This means that people suffering from addiction can and do recover. There is hope in letting go of that ‘tired old lie’ or label.

We all know someone affected by substance use whether it be a family member, friend, coworker, neighbor … the list goes on. This is significant because it means addiction runs through life as a common thread.

Tips on changing stigma

But how do we face it? How do we change stigma? Maybe we start by building authentic connection, recognizing that we too are human vulnerable to suffering with a desire for love and acceptance, just like someone who is facing addiction.

Consider these tips:

  1. Stop labeling: First, you have to recognize when you use labels and stop doing so. Lose the blame factor. Put the person before the label.
  2. Cultivate curiosity: This is as simple as asking questions. Notice when you start to place judgments and start to let them go. Ask someone in recovery about their experience and be open with your concerns or ideas, too.
  3. Develop connection: Share stories – listening to someone’s story builds connection while telling your story builds acceptance of your experience. It’s likely you have more in common than you think!
  4. Learn about addiction: Get educated about the neurobiology of substance use.
  5. Pass it on and pay it forward: Participate in continuing the conversation; connect with and inform others. This could be as simple as letting others know why the “addict” label doesn’t work.

Even a very small step can make a big impact

Although labeling does a lot for us by giving us the ability to categorize and to try to make sense of facts, it can also lead to prejudice and discrimination. Labels have the ability to become harmful and dehumanize; we can’t expect to know someone based on just that.

The old adage “Never judges a book by its cover” or in this case, its title, can be applied. Using the term “addict” creates a barrier to understanding chemical dependency and those who are affected by it. It is true that some people in recovery chose to identify with the term, but they do so in a way that promotes their recovery. That is something we can all learn more about.

You may not want to stop using the “addict” label, but I bet there is a label you’ve faced yourself, one you’d like to see less of. Challenge that label in the same way and counter the stigma attached to it.

I wonder: What would you want someone to know about you? It’s probably not that you’re just another tired old label.

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Caring for the mentally ill & combatting stigma is the heart & soul of psychiatric nursing

by Marilyn Warnock, RN May 9, 2014

Every year during National Nurses Week I think back on the start of my career more than 20 years ago and how I always knew that my life’s passion was nursing.     On a search to discover which aspect of this care-giving profession would be most fulfilling to me, I started out working in […]

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A mother’s recollections of postpartum depression

by Ann Marie Buckley, LCSW May 9, 2014

Motherʼs Day always invites me to recall my early days as a new mother, more than 27 years ago. Among all the sweet baby-breath, bath time, first smile and first sleep-through-the-night memories that warm my heart, I also remember an afternoon when I was walking the floor with my new baby, trying to soothe her, […]

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Do you want fries with that? A provider’s view on “drive-thru” mental health treatment

by Hannah Szlyk, LMSW April 3, 2014

“Popular female celebrity has gone into rehab. She expects to make a full recovery and return to her tour and her fans by next month, says the publicist.” How many times have we read this in the news? As I write, I am thinking of Justin Bieber’s recent DUI arrest, and I can only help […]

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Marijuana: The modern-day trojan horse we need to talk about

by John O'Neill, LCSW, LCDC, CAS March 27, 2014

For the first time in history more than 50 percent of Americans support the legalization of marijuana. Those of us in the addiction field are faced with new attitudes about a substance that is not as innocent and harmless as many of its proponents would like us to believe. Contributing to the confusion about the […]

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Can public education decrease the stigma of mental illness?

by Jon G. Allen, PhD March 14, 2014

I do not know the answer to this question, but I have some thoughts about one aspect of it. A significant public education effort has been mounted to decrease the stigma associated with mental illnesses by emphasizing their neurobiological basis. We can rightly think of psychiatric conditions as brain disorders with a partly genetic basis. […]

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Is psychiatry’s drug addiction increasing the stigma of mental illness?

by Jon G. Allen, PhD March 11, 2014

I deliberately chose a tendentious title for this essay – misleadingly metaphorical rather than literal – to highlight, as one of my recent posts outlines, my alarm stemming from reading research on stigma. With many others, I had assumed that treating psychiatric disorders as “a disease like any other” (i.e., like any other general medical […]

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I’m a registered dietitian, and I don’t like “The Biggest Loser”

by Kim Morgan, RD March 7, 2014

Rachel Frederickson, (right), the most recent winner of The Biggest Loser, lost 60 percent of her body weight on the show. The “winner’s” initial weight of 260 pounds made her BMI a health risk at 44.2, while her new weight of 105 pounds also has her BMI a health risk at 18.1. Is she healthier […]

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