Sometimes the problem is…ME?

by Thomas Ellis, PsyD, ABPP on March 9, 2010 · 5 comments

in stigma,therapy

The good news and bad news about the fight against stigma is that we’ve come a long way but have a long way yet to go. The dark days of the Salem witch trails and huge, prison-like institutions for the “insane” are thankfully behind us, yet we continue to struggle with marginal insurance coverage for psychiatric disorders and soldiers who avoid seeking mental health services because they fear (not without some justification) that their military careers might be jeopardized if they do.

Where to start?

Such social forces often can seem beyond the reach of the average individual. Yet, as Roger Verdon humorously showed us in a prior post, there is a place where we all can make a difference, starting today:  ourselves. A renowned psychologist, the late Albert Ellis (no relation to me, but an esteemed mentor), authored an article years ago called “How to Deal with Your Most Difficult Patient: You.” Written for fellow therapists, it revolved around one of Ellis’ consistent messages:  that none of us—no human being—is without irrational beliefs, unrealistic demands and maladaptive behaviors.

To this, Ellis added a profound observation. As if these difficulties were not enough, we often compound the problem—two problems for the price of one!—by putting ourselves down for having them:  “You idiot. What’s the matter with you? Can’t you do anything right?”

Talk about stigma! And then we take it a step further and insist that it’s not OK to get help for these problems. “It’s a sign of weakness. I should be able to solve my own problems. Only crazy people go to therapists and counselors.”

Who says stigma is only about society?

As it turns out, stigma is not only something that’s inflicted on people by someone else or by impersonal social forces; it’s also about what we do to ourselves, day to day, moment to moment.

Ellis referred to this process as “symptom stress”:  being depressed about being depressed, anxious about being anxious, ashamed of being angry, even fearful of being happy. I recall, during my first days in training at his institute, being advised to always consider dealing with this issue first with a new therapy patient; failing to address (for example) the patient’s shame about needing therapy would leave in place a significant obstacle to working openly and effectively in that therapy. I find this to be sound advice to this day.

Ambivalence about therapy

It is interesting that we mental health professionals, while believing in the benefits of psychotherapy, remain ambivalent about our own relationship to it. Studies show that most therapists have at some point pursued their own therapy (one would hope so!), yet this is seldom a topic of discussion, either at professional gatherings or in less formal settings. One senses a lingering fear that fellow professionals might look askance, perhaps silently revising estimates of one’s competence, personal or professional.

On the other hand, in my experience, students and trainees are less likely to share this unease (might this be a generational difference that they will carry with them into later years?). My own graduate training program years ago actually required all doctoral psychology students to seek therapy (a rare scenario anymore), and I remember being pleased that I had an excuse to do so (hey, it’s a requirement—not that I actually need it).

Therapy as an educational prerequisite?

I have often wondered what it would be like if there were an expectation, if not a requirement, that everyone, whether in primary, secondary or post-secondary education, were asked to experience the process of talking with an objective and caring person, reflecting on thoughts and feelings and candidly exploring problem areas for healthy solutions. We all had health and p.e. classes, so why not p.e. for the mind?

Short of this utopian vision, are we as individuals willing to reconsider our own attitudes, if not to seek formal therapy, then at least reduce our self-stigmatization? Can we do away with expectations that we ought not to have problems or ever need to seek someone else’s help or support?

In a future post, we will explore strategies for shifting self-judgment and condemnation to attitudes that embody greater acceptance of imperfections and needs. Perhaps—just perhaps—if we can start treating ourselves better, we might begin to treat others better and thereby influence society after all.

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Think you’re stuck with self-stigma? Think again.
June 18, 2010 at 3:26 pm

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Mark March 15, 2010 at 7:54 am

When I received the email announcing this website, I immediately thought how can I use this at work (an urban community mental health clinic). So, to say that I am grateful such an esteemed institution would encourage practitioners to recognize stigma and to do something about it, would be an understatement.

Daily, I hear terms like “the schizophrenic”, “the borderline”, “the addict” and wonder why in this day in age, do we continue to use labels to define the people we work with. As a supervisor, I try to capture labeling and stigma as an opportunity to teach. I try to point our colleagues towards recovery centered research done right here in our community. This has typically been met with mixed reviews. Most common; “that sounds good, but it is not very practical.”

WHAT ARE WE SO AFRAID OF? Of course this is a rhetorical question. I am curious to learn how other readers of this blog respond to resistance geared towards status quo.

I have already read some great posts on this blog- and will forward it on to the folks practicing in my clinic.

Jan Neighbors March 15, 2010 at 7:15 am

I found this article encouraging and so true. I am a family member of someone who experienced serious mental illness and also a counselor. I think it would be great if everyone had mental health check ups because I think everyone has times in their lives where they experience depression, anxiety, relationship issues, grief or just personal situations where they need an objective professional to help them find healthy ways to deal with life. This can change their life significantly. The stigma is ever present, a friend just had to get a counselor to evaluate them for disability and she was so nervous, I explained she would be the same person before and after the appointment and since she had worked for many years her mental status was not going to be the reason she would be considered disabled to work but her serious physical health issues would be where that decision rested. We recently had a college professor get angry after being denied tenture and she shot six professors, killing three and seriously injured two others who according to reports was very seriously ill but working as a Harvard graduate at a respected University. People need to address the importance of getting help for themselves or others the stigma still stops many from addressing their issues until a diaster happens, very often suicide. I am grateful to see that the care has improved and the stigma has been on the decline the last thirty years especially, a very positive trend. It is not shameful to need care just a shame not to accept care.
Jan Neighbors, M.A.

Audrey Auernheimer March 12, 2010 at 11:27 am

How true it is. My name is Audrey Auernheimer. I’ve lost two children to suicide in the state of Arkansas due to inappropriate treatment services. There are caring proffessionals within the mental health system. However, laws regulating treatment (due to stigma) limits their ability to treat appropriately. My 28 year old son actually took his life in ’02 in the Arkansas State Hospital. He was supposed to be on suicide watch. I wonder if anything has changed at that hospital?

Cindy Nelson March 9, 2010 at 6:49 pm

Thank you Tom Ellis for addressing this issue. I, like many others feel stigma, (prejudice, discrimination, it has many nuances) creates barriers to treatment, employment, housing, and ultimately acceptance. You make many valid points and they’re well taken. It’s true that the individual effected by a mental illness has to come to terms first. Secondly, their family and friends have to come to terms and then the extended family and friends and so on. Mental illness is treatable; people can recover and live productive lives. I look forward to your future posts. Perhaps if enough of us are talking about how stigma effects individuals with mental illness and their families and friends, more of society will realize mental illnesses are treatable like any other medical illness of the body and the stigma will become a thing of the past.

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