Fighting the stigma of mental illness is a difficult and never-ending process, despite the great progress we have made in the last few decades. Unfortunately, the recent shooting in Aurora, Colorado, will likely add to the difficulty.

Misperceptions fuel stigma

Tragic events like these often fuel the misperception that anyone with a mental illness could be violent and dangerous. It is a natural assumption to make with the pain and shock of the murders fresh in our minds. However, such assumptions are inaccurate, and they unfairly stigmatize people with mental illness. The fact is, people with mental illness are not more likely to engage in violent behavior than the general public.

Defeating fiction with facts is one way One Mind for Research is tackling the stigma of mental illness. Led by former congressman Patrick J. Kennedy and businessman Garen Staglin, One Mind for Research is a bold initiative bringing together renowned neuroscientists, advocates, policy makers and others to cure diseases of the brain within the next 10 years. Kennedy compares their plan to the ambitious goal of his late uncle, President John F. Kennedy, to land a man on the moon, and the slogan for the current effort is “a moonshot to inner space.” It’s a huge goal, they admit, but they are committed.

Focus on stigma

I attended their first annual meeting in May — a dazzling event featuring sessions on the latest research and treatments for brain disorders and attended by mental health professionals from across the country. But what set the conference apart was its emphasis on stigma, most notably a panel on “The Science of Stigma,” moderated by actress Glenn Close, who has family members with mental illness. The panel featured Elyn Saks, PhD, a law professor at The University of Southern California, recipient of a 2009 MacArthur Foundation “genius” grant and author of The Center Will Not Hold, Saks’ bestselling, brave memoir of her struggles with schizophrenia.

I say brave, because schizophrenia is still one of the most misunderstood and “scary” types of mental illness, and the people who have it are often shunned. Saks, who is a leader in her field, is a great example of how a person with a brain disorder can lead a successful life with the right treatment and medication.

Financial burden

One Mind for Research is partnering with high profile people like Saks to underscore its message: Mental illnesses are brain disorders and should be treated like any other disorder or disease of the body, like diabetes or heart disease. They also cost our country a fortune.

At the conference, Michael Thompson, a principal at PricewaterhouseCoopers, presented new data showing that the annual cost of treatment and long-term care for brain disorders in 2010 was $476.1 billion and is estimated to be $515 billion in 2012 (19 percent of the United States’ total national health expenditure). If we include the indirect cost of treating brain disorders, such as missed work days and lost jobs, that cost estimate increases to $934 billion.

That’s a staggering amount of money, and it shows just how prevalent and widespread brain disorders are. We shouldn’t treat brain disorders as shameful secrets or as signs of “weakness.” Instead, we should help reduce the stigma of mental illness that prevents many people from getting treatment.

Helping veterans

In particular, One Mind for Research is focusing on members of military with brain disorders such as posttraumatic stress disorder (PTSD). Some members of the military and veterans view seeking help from a mental health professional as a “career killer,” and they don’t get the help they so desperately need. With General Peter Chiarelli (ret.) on board as chief executive officer, I have high hopes that they will break down some of the barriers to treatment for our deserving military.

Reducing stigma

Thanks to collaborations like One Mind for Research, we are getting people to take mental illness seriously — and we are making some good progress reducing stigma. Many people now think of alcoholism, anxiety, depression and PTSD as treatable conditions, rather than personal weaknesses.

Fighting stigma remains a difficult challenge, however, and each tragic news story linking a mentally ill person with a violent act increases that challenge. Eradicating stigma will take time and persistent effort, on the part of mental health professionals, advocates, patients and members of our community. We still have work to do.

Editor’s note: Five years ago, Stacey Freedenthal, PhD, LCSW, a professor at the University of Denver, wrote a guest commentary in response to the mass shooting at Virginia Tech, where Seung-Hui Cho killed 32 people. Its message rings just as true today in response to the Aurora, Colorado, movie theater shooting in which 12 people were killed and 58 wounded by accused gunman James Holmes. With Dr. Freedenthal’s kind permission, we repost her commentary, which originally appeared on www.denverpost.com:

Treating mental illness

In 1999, when two teenagers shot 13 people to death at Columbine High School and then killed themselves, a memorial was proposed for all the victims – including the shooters.

Outrage ensued. Many parents of the teenagers killed by Eric Harris and Dylan Klebold argued that the boys were murderers, not victims. I can understand their outrage. A memorial for the murdered should inspire loving memories and cleansing grief.

That said, a sad fact remains: People who kill while in the throes of mental illness are victims themselves. Seung-Hui Cho, the shooter at Virginia Tech, stole 32 lives, but it is clear that his life, too, was stolen years ago. I cannot diagnose a stranger from news accounts, but definitely there are signs that he was deeply depressed and probably psychotic, too.

The overwhelming majority of people with mental illness, including those with exceptional disturbances such as paranoid schizophrenia or psychotic depression, do not ever become violent toward others. In fact, violence toward oneself is a larger problem, with more than 30,000 people in the United States dying by suicide every year. But when people with mental illness do kill others, the question becomes not so much who is at fault, but what?

When I have worked with suicidal clients, I have warned them that their minds can play tricks on them. Diseased and untreated (or inadequately treated), the mind can tell outrageous lies. I had a teenage client once who firmly believed that her parents would be happier if she killed herself, and that her suicide would be a gift to them. Imagine! Her parents were not abusive or neglectful monsters. Indeed, the teenager believed her parents would be better off with her dead precisely because they cared so much about her.

For whatever reasons, Seung-Hui Cho’s brain, with its toxic lies, led him to believe that he had to slaughter innocents.

Feeling compassion for a mass murderer does not mean excusing his actions, or necessarily sparing him punishment. It does not mean forgoing feelings of hatred, anger and incalculable grief. It does mean directing feelings of anger at their proper causes: mental illness and the barriers to treating it effectively. Gun proliferation and our culture of violence also undoubtedly contribute, but the underlying problem remains the brain’s uncontrolled impulses and false rationalizations to initiate violence in the first place.

By remembering that mental illness ultimately wrought this tragedy, we can be empowered to create at least one good consequence. As a society, we need to make it easier for people to ask for help with emotional problems, to provide that treatment, and to receive inpatient psychiatric hospitalization when necessary.

So far, we do none of those things. Young people do not seek help for emotional problems, possibly because of the stigma attached. We as a society can send the message that seeking help for emotional problems is no less acceptable or necessary than for the flu.

Other barriers to receiving effective help include a dearth of psychiatric hospitals; difficulties being admitted to a psychiatric hospital or staying beyond a few days; mental health professionals who rely on treatments with no documented effectiveness; insurance companies that provide few benefits for mental illnesses; insurance companies that require doctors to select medications based on costs rather than individual needs of patients; and lack of health insurance altogether.

We cannot change what Cho did at Virginia Tech. We can, however, do what we can to prevent it from happening again. Doing so requires that we keep several things in mind:

Mental illness, though not always curable, is treatable.

Stigma and lack of resources make it difficult for people to receive sufficient, effective treatment or any help at all.

The more we ignore the needs of people with mental illness, the more they will suffer – and, sadly, the more society will suffer, too.

Marsha Linehan, PhD

Last month, Marsha Linehan, PhD, spoke at Baylor College of Medicine, where she was honored for her significant contributions to the mental health field. Her lecture, “Dialectical Behavior Therapy: Where it started. Where it went. Where it may be now. Where we are going,” could have also been the title of her personal narrative. The lecture took place nearly a year after Linehan came out about her own mental illness.

Linehan is well-known for her development of dialectical behavior therapy (DBT) as a modality for chronically suicidal individuals. Treaters soon discovered that the therapy could be expanded to treat other severe and complex disorders, including borderline personality disorder.

In 2011, Linehan spoke about her own struggle with mental illness at the very facility where she was first treated as a teenager. At the Institute of Living, a Hartford, CT-based clinic, Linehan entered treatment for her suicidality, self-harm and a diagnosis of schizophrenia. Linehan underwent electroshock treatment, a list of psychiatric medications and psychoanalysis, but nothing seemed to help. She spent a lot of time in one of the clinic’s seclusion rooms. By the time she was released three years later, her prognosis was grim.

None of this was known publicly until last year. Since then, a flurry of media attention has been bestowed on the famous founder of one of the mental health community’s most commonly used treatment modalities. In her April lecture, she spoke about her journey to founding DBT and where it might be headed. There were steps and missteps to manualizing the therapy, but through willing participants and government funding, Linehan found a way of reaching those who could not be reached, those whose prognoses were grim.

Wounded healer

Knowing more of her personal history gives the long process of fine-tuning DBT more of a basis. Yes, Linehan is persistent. She’s committed to helping others. But since coming out about her mental illness, she has also earned the badge of a wounded healer. The concept of a wounded healer hinges on the therapist’s use of self — many mental health clinicians have silently grappled with their own diagnoses and resolved to help others on their journeys.

It is said that the very concept of the wounded healer is derived from Carl Jung, who had a patient struggling with alcoholism. Jung reportedly told the patient that analysis could not help him with his primary concern of substance abuse, and said the patient’s best bet was a religious or spiritual conversion. That patient became one of the founding members of Alcoholics Anonymous, a program designed so that recovered individuals could help others. Years later, Jung acknowledged, “Only the wounded physician heals.”

Challenging the myth

In fact, Linehan said in her Hartford lecture,while she could not be reached in her seclusion room those many decades ago, she “made a vow: When I get out, I’m going to come back and get others out of here.” She joins the ranks of other popular therapists who have come out as wounded healers, including Kay Redfield Jamison, MD, who wrote An Unquiet Mind about her experience with severe bipolar disorder.

Linehan, Jamison and others have attempted to “say no to stigma” by breaking down the myth that mental health clinicians do not suffer from diagnoses, some just as daunting as the ones they deliver to their patients. Each of them had to consider the fact that their level of self-disclosure could affect how they are viewed by colleagues and patients, and yet they each determined it would be relevant and important to show their true selves.

As she finished her recent presentation, Linehan spoke of the significance of being honored for her achievements in the field. She said, “I’m a person who lived with stigma all my life.” From being the wounded to being the healer, Linehan serves as a model for resilience, perseverance and bravery. What would it look like if we all followed her lead?

‘Tis the season for giving and getting.

For many in the military, this “season” has been 10 years in the making. Now that the war in Iraq is officially over, the wishes of many loved ones across the country are coming true with the return of thousands of our brave warriors.

While their return will no doubt be joyful, our veterans face an uncertain future. Perhaps, if they remain in the military, they’ll be redeloyed to Afghanistan. If they return to civilian life, they face the prospect of searching for a good job in a bad economy. Either way, many will find themselves facing the challenge of mental health issues like depression, substance abuse or posttraumatic stress disorder (PTSD).

If that’s not enough, there’s also the challenge of combating the stigma of mental illness. According to the Department of Veterans Affairs, research indicates 10-18 percent of veterans are likely to have PTSD following their return home. While many will receive care at VA medical centers for physical care, many won’t seek treatment for mental health problems. The VA offers plenty of reasons why, including the fear of being seen as weak or of being treated differently. Stigma is the new enemy.

That’s why I was so happy to see this video clip of John Oldham, MD, MS, the president of the American Psychiatric Association and the chief of staff at The Menninger Clinic, talking about some opportunities for giving that the APA has in this battle.

(From American Psychiatric on Vimeo)

There’s lots more we can give to help these veterans–Santa, hint hint–and I hope that the coming years will prove that the mental health community has served these men and women as well as they’ve served us.

Occupy Wall Street protests grow.

It has been more than a month since the demonstrations in New York began, and protests have spread to cities across the country. Occupy Wall Street started as a movement about economic inequality in the country, with the demonstrators’ common refrain, “We are the 99 percent,” referring to the gap between the top one percent, who control about 40 percent of the United States’ wealth, and the rest of the population. The movement speaks of themes of unemployment, inadequate health insurance and the quest for a living wage.

The Occupy Wall Street group has seemed to tap into a common frustration and despair among Americans. According to Mental Health America, nearly half of Americans are stressed by finances, and 32 percent of Americans also report employment issues as a source of stress. And as anxiety levels increase, other mental health indicators are impacted, including depression and sleep disturbances.

Lessons to be learned

So what can the movement teach us?

First, it’s important to underscore what the National Alliance on Mental Illness makes clear:

“Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing.”

However, according to The Equality Trust (an independent, evidence-based campaign located in the United Kingdom), the bigger the gap between a nation’s rich and poor populations, the greater is the dysfunction in that nation’s society. Utilizing mental health studies culled from the World Health Organization, it appears that different societies have very different levels of mental illness. In some countries only five or 10 percent of the adult population have suffered from any mental illness in the past year, but in the U.S., more than 25 percent have. Mental illness is much more common in more unequal countries, not to mention in richer countries as well.

What the Occupy Wall Street movement serves to teach us, regardless of our stance on the intentions of the group, is that there is power in being part of a group process, and there is power in learning how to speak about our experiences.

Strength in numbers

In a sense, the therapeutic value in announcing something which has been stigmatized, such as your mental illness or lack of wealth, is akin to exposure therapy. As a society not accustomed to sharing privileged information such as our bank account or personal narratives, being a part of a movement which asks you to do just that can be a way to face and control fears that are not often addressed.

Being a part of a group with a shared goal can be a powerful experience. The commonality of the members of the Occupy Wall Street contingent can be seen through the sea of signs announcing their discontent or shared experiences of poverty and disenfranchisement. Similarly, being a part of a group in a mental health setting can bring up feelings of peer support and a greater sense of normalcy. Many people feel as though they are struggling with solitary experience, and it can be cathartic to realize that you are not the only one grappling with a particular issue. Group psychotherapy serves to create a container for people, as they begin to shed their feelings of isolation. The same could be said for political rallies and movements.

Perhaps one of the reasons why the Occupy Wall Street movement has continued is that people no longer feel so alone. Members of the movement have seen a unity that bonds them together. Might the same be said for people fighting the stigma of mental health?

More and more, people are clamoring to speak up about their struggles with poverty and the inextricable links to depression and anxiety. The shame of sharing continues to be alleviated, as evidenced by the growing movement. Even if you are not marching in the streets yourself, it’s hard to deny the importance of bearing witness to people finding freedom in speaking their truth.

October 11 is National Coming Out Day

October 11 is National Coming Out Day for people who identify as lesbian, gay, bisexual or transgender (LGBT).

This day is set aside to acknowledge the triumph and bravery of those who have come out as LGBT to themselves and their loved ones. Coming out is a never-ending process, not limited to a singular event or moment in a person’s life. Coming out can be an exhilarating and transformative process in the lives of LGBT individuals, but it can also be a source of frustration and loneliness as they attempt to explain their identity to the rest of the world.

The LGBT community frequently confronts prejudice and discrimination based on their sexual orientation or gender identity. This can lead to negative mental health outcomes, such as depression, anxiety and substance use. In some cases, it can lead to death, as evidenced by the startling number of youth who have suicided after facing anti-gay bullying from their peers. LGBT people are more vulnerable to feeling alone, unheard and ridiculed due to the societal stigma unfairly placed upon them.

Likewise, people who have mental health issues often encounter similar feelings of isolation and hopelessness. So for members of the LGBT community who also grapple with mental illness, a double stigma occurs.

According to the National Alliance on Mental Illness (NAMI),

“Some people report having to hide their sexual orientation from those in the mental health system for fear of being ridiculed, rejected or in extreme cases, subjected to physical violence.”

The Family Acceptance Project reports that LGBT people are less likely to seek timely treatment in healthcare settings for fear of provider bias and discrimination.

Unfortunately, this chronic stress within the LGBT population is not uncommon.

A 2003 study on the prevalence of mental disorders among LGBT adults found that they are likely to be at higher risk for depression, anxiety and substance use disorders. The likelihood that LGBT individuals have a mental health disorder doubles when compared to heterosexual men and women.

Yet another study found that lesbian and bisexual women were more than three times likely to have experienced generalized anxiety disorder within the previous year. Gay and bisexual men were more likely to report major depression and panic disorder.

The mental health profession has come a long way, but we have a long way to go.

Up until 1973, the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the DSM, listed homosexuality as a pathological psychiatric condition. But then, in the 1973 manual, the American Psychiatric Association changed the definition of sexual deviance and further rejected the notion that homosexuality was a mental disorder. A fascinating insider’s look at how this took place can be heard on NPR’s This American Life.

Since then, the DSM has gradually shifted its thinking on homosexuality. When homosexuality was removed from the manual, a new diagnosis, sexual orientation disturbance, was added to describe persons attracted to members of the same sex “who are either disturbed by, in conflict with or wish to change their sexual orientation.” In the fourth and most recent edition of the DSM, there is no reference to homosexuality as a mental disorder.

In the transgender community, the diagnosis of gender identity disorder is often needed in order to get medical services to transition from one gender to another. There is a growing movement that contests the classification of transgendered individuals as “disordered,” and a proposed change to the DSM-V, which will be published in 2013, would create a new category of gender dysphoria instead. While it’s still a contentious issue, many people in the transgender movement acknowledge that retaining a diagnosis in the DSM will make it easier to have mental health services covered by insurance.

So what can mental health professionals do to decrease the double stigma?

In order to provide competent care, it is crucial for healthcare professionals to ensure that the LGBT population can feel comfortable disclosing their sexual orientation or gender identity. Mental health agencies can establish cultural competency models that underscore the acceptance of and respect for the LGBT population. Acknowledge where changes can be made and work within the system to address those issues.

Mental health professionals can educate themselves on proper terminology and common concerns of their LGBT patients; families and friends can do the same. Don’t assume that an individual is a particular gender or sexual orientation because of how they dress or what types of previous romantic relationships they’ve been in. Recognize that being part of the LGBT community comes with its own stressors and be sure to empathize and validate those experiences – use your mentalizing skills! Honor their triumphs and joys. Sit with their sadness, as you would with any other patient.

Just as we make it a priority to establish a therapeutic alliance with patients, we should strive to provide an open and affirming place from the moment a potential patient enters our care. LGBT patients should feel safe to disclose their feelings about their sexuality and gender identity. If they don’t feel supported, they may not be able to fully engage in the treatment process. If an LGBT individual feels comfortable disclosing with mental health professionals, they’re more likely to share their experiences with their peers.

Cultural competency is a learnable skill. Let’s take it upon ourselves to make sure that all patients are welcomed and affirmed!

Like many who came of age in the ’60s and ’70s, I was saddened to hear of Betty Ford’s death last Friday. For those of us from Michigan, we had reason to be especially proud of her role in our national life. Although I lived in a different Congressional district, Gerald Ford was the only Congressman I recognized growing up. His longevity in Congress made him feel almost like a family friend or neighbor – he was always around, affable and smiling. Gerald Ford and his wife Betty were dependable and likeable in that Midwestern way; in fact, they seemed a lot like my parents only with different politics.

When Gerald Ford was plucked from Congress to replace the disgraced Vice President Spiro Agnew, there was a new spotlight on Betty Ford. By then I was living in NYC, and I came to see Betty Ford as poised, personable and reflecting a brave honesty I hadn’t seen in our home state. I applauded her tenacity when speaking up on important issues, including the feminist issues that often put her at odds with her husband’s  political party.

As the media focused on Betty, I learned some things about her that I hadn’t known before. After high school she went to New York City and trained in modern dance with the iconic Martha Graham, who was known for her searing criticism and relentless perfectionism. I assumed Betty Ford possessed a daunting degree of self-confidence to subject herself to the demands of Martha Graham.

Televised breakdown

Once, Betty was set to narrate a live televised performance of the Bolshoi Ballet from the former Soviet Union. As a young girl, I had seen the Bolshoi and was mesmerized by the power and precision of their movements. Of course, the Bolshoi was the epitome of the traditional ballet that Graham had rebelled against, so I was excited to hear what the First Lady had to say.

Soon she appeared on the screen, resplendent in a glistening, floor-length gown. At first I thought the reception was bad: Ford’s words were not coming out in any discernable manner. I pounded on the top of the TV trying to correct the problem, to no avail. I positioned myself squarely in front of the screen and prepared to concentrate and not get sidetracked by the poor sound quality. The camera swooped in for a close-up, showing off Ford’s chiseled features.

But the usual spark in her eyes was not there. She didn’t look well.

“She’s nervous,” I thought. “Who wouldn’t be? This is new to her.”

Paying closer attention, I noticed she was speaking slowly and her “s’s” slurred. She struggled from phrase to phrase. It seemed she could hardly read the teleprompter.

I remember becoming nervous for her, and embarrassed. I shouted to no one in particular, “Oh no! I think Betty Ford is having a stroke! They need to do something! She needs help!” But as I listened more closely, the realization hit me – she wasn’t having a stroke; the culprit must be that other famous Russian product – vodka!

The next day I scoured the newspapers and news magazines for a review or anything that would explain what had happened. Nothing – there seemed to be a code of silence in the press. Was I the only one to think she was inebriated? I resigned myself to the fact that I would never know what had happened during the broadcast.

Soon, Jimmy Carter was elected, and I lost track of Betty Ford. That was until the early ’80s when she established The Betty Ford Center, a state-of-the-art rehab center to treat addictions – addictions like her own. Now a mental health professional, I felt a sense of amazement and profound respect for this person who did not bury this issue, but instead continued to work on her own health and fight for the health of others.

No ordinary woman

It is well known now that Betty Ford considered herself an “ordinary woman.” Her addictions to alcohol and medications, she said, ultimately came from her “lack of self worth” and feeling “useless and empty,” feelings she and so many others have tried to manage in the same way – externally, by self medicating with drugs and/or alcohol.

Debt owed

Ford’s feelings about herself were so different from what I had imagined, yet her willingness to use her notoriety to openly talk about her vulnerabilities and equally, to stand up for her beliefs, was a gift for all of us. In speaking out, she made a huge contribution to changing how addictions are perceived and, I believe, helped advance parity for addictions so treatment would and could be covered by medical insurance. There really is no way to measure her influence, and I feel those of us in the mental health field owe her an enormous debt of gratitude.

Former First Lady Betty Ford

When her husband became president, Betty Ford said that she was “called on stage,” but not in a manner she could have imagined when she was young. She was someone who weaved a special thread throughout my own life by proximity of birth and common interests. Now and again I had the opportunity to see how her talent, courage and grit came together in a dance much like those of Martha Graham’s – authentic, thought provoking and imbued with meaning, beauty and astounding grace.

Editor’s note: For more on Betty Ford, check out “Honor, grace and courage: a tribute to Betty Ford.”

In the evening on July 8 we learned that former First Lady Betty Ford had died at the age of 93. Those of us who were around in the ’70s remember well the impact Mrs. Ford had on the country. She was known for being gracious, elegant, poised and outspoken, characteristics that don’t easily go hand-in-hand. Betty Ford was able to help create a shift in the country’s thinking about a number of issues that were socially taboo at the time by using the power of her position and her unique personal characteristics to compel us to think differently about many social concerns.

Former First Lady Betty Ford

Initially, she showed us how to blend wifely and motherly roles with the feminist movement. At every possible opportunity, she encouraged women to use their voices, communicate their opinions and take a stand. This was a very courageous stance for a First Lady to take in the 1970s. But much bigger challenges lay ahead for Mrs. Ford.

Sharing her story of survival

In 1974, Betty Ford was diagnosed with breast cancer. This was a time when it was still somewhat socially taboo for women to disclose a breast cancer diagnosis, sometimes even to their own family members. For many women, it was a shameful diagnosis. Because of the social stigma around breast cancer, it was considered unbecoming to discuss “female health problems.”

So how did we know that Betty Ford, First Lady of the United States, had a radical mastectomy to treat breast cancer? Because Mrs. Ford herself made this public. Why? She said she was concerned for the health of women, and that by disclosing her own diagnosis and treatment, perhaps more women would participate in breast cancer screening – and that is exactly what happened. The walls of shame and stigma around breast cancer cracked and soon came tumbling down.

Battling addiction

Mrs. Ford also suffered with painful arthritis. She became addicted to painkillers and alcohol, and in 1978, with her family steadfastly at her side, she admitted herself to a treatment facility. In keeping with her honorable approach to life’s difficulties, Betty Ford publicly announced her addiction. This stunned the nation. Mrs. Ford had broken the silence expected of women about such things.

She put the issue of women, drugs and alcohol on the table – actually the kitchen table. Her openness was discussed in homes all over the country at dinner time and when families watched the news together. Yes, there really was a time when people did such things. The walls of shame and stigma about drug and alcohol addiction cracked – but have not come tumbling down – not yet. This wall is strong.

Paying tribute

In tribute to Betty Ford, I believe it is our duty to bring those walls down! We need to do this by developing interventions and programs that are more effective than exist today. We can start by committing to using evidence-based approaches to treatment and applying improvement science and practice-based evidence to continuous advancement and by funding a robust plan of research to break through this debilitating condition. This would be our most enduring tribute to a real American hero, Betty Ford.

Editor’s note: For a related post by another blogger, take a look at “Remembering Betty Ford.” For other blog posts by Dr. Mahoney, check out:

• Do you want to be a jailer or a healer?
• Can we afford to tolerate the idea that jails and mental illness go hand-in-hand?
• Nature and nurture: Promoting an optimal healing environment in mental healthcare
• Blending grace, honor and resilience through healing relationships

We’ve all heard the truism about mental health professionals: They go into training in mental health looking for solutions to their own problems. As a psychologist, I’ve always felt a little offended by this stereotype, even while acknowledging its unsettling kernel of truth.

Psychologist and patient

Marsha Linehan, PhD

Now Dr. Marsha Linehan shows us that, far from being cause for shame, this is something one might actually feel good about. Linehan is the iconic creator of dialectical behavior therapy (DBT), a form of cognitive-behavior therapy that has revolutionized the treatment of borderline personality disorder and suicidal behavior.

DBT challenges patients to approach therapy as a balancing act between learning better ways of coping with stress and trauma while working equally hard at accepting oneself and one’s situation exactly as they are. Not only did she introduce this innovation to the clinical community, she proved through rigorous research that it really works.

When, through the years, I have heard fellow professionals smugly whisper, “You know, there’s a reason why Linehan understands borderlines so well,” I’ve never known quite what to say. Now, as a result of a remarkable act of self-disclosure, the answer emerges: The rumors are true – get over it.

In a recent interview in the New York Times, Linehan for the first time publicly discusses her own mental health history. More than two years in a psychiatric hospital in the early 1960s. Multiple suicide attempts and acts of self-harm that left her arms a “macramé of faded burns, cuts and welts.” Medical treatments that included high doses of antipsychotic medications and two courses of electroconvulsive therapy. All before the age of 21.

Her explanation for making this disclosure at age 69, after achieving success in the mental health arena equaled by only a handful of other professionals?

“I owe it to them. I cannot die a coward.”

Coward? As if it weren’t enough to emerge from her hellish past, not only to survive, not only to thrive, but to show the way to recovery to countless other sufferers, she now presents herself as proof that there is hope, even from one in such dire straits that her own care providers saw little hope for her.

In good company

Dr. Jamison's classic memoir.

Linehan is not alone as a mental health professional in revealing her own demons as a means of giving hope to others. World-class bipolar disorder researcher Dr. Kay Jamison did so in poetic fashion in An Unquiet Mind, as did York University psychologist Norman Endler in Holiday of Darkness.

Such acts of courage go far, not only toward destigmatizing mental illness for the public, but also toward showing all of us that mental health professionals are not perfect and need not present themselves as paragons of mental health. Indeed, it is in dealing with our own demons that we become most human and perhaps better able to connect with those we seek to serve.

Editor’s note: For another post about Dr. Linehan, check out “Renowned psychologist acknowledges personal struggle with mental illness.”

University of Washington faculty member Marsha Linehan, PhD

The New York Times really knows how to get folks excited. Ever since it published an article yesterday about Marsha Linehan, PhD, a renowned psychologist and researcher, in which she acknowledged her own mental illness, it seems like no one’s talking about much else around here.

And with good reason. While I’m not clinician, I’ve worked at Menninger long enough to know that Dr. Linehan is an influential figure in the mental health field. She’s been lauded far and wide for her work developing dialectical behavior therapy and for her work with some of the most severely ill patients, including those who have attempted suicide. Now that she’s publicly sharing her own history of mental illness, I think it’s likely her influence will expand still further.

No one is immune

Yes, there have been other clinicians who have discussed or written about their own struggles – Kay Redfield Jamison is the first to come to mind – but it still seems like there should be more, especially since the statistics – 1 in 4 adults suffer from a mental illness in any given year, according to the National Institute of Mental Health – surely apply to that group as well as to the rest of us.

I  hope more clinicians will follow her example and cop to being, as the Times quotes one of her patients, “one of us” because that simple, yet courageous decision could well have a significant impact on the stigma that has long haunted those with mental illness. Yes, I know that things are better with regard to stigma than they were 20 years or so ago, but you have to admit that we still have quite a ways to go before stigma is a relic of the past, like rotary phones, VCRs and dinosaurs.

Breaking boundaries

I also wonder what such an admission might mean for the dynamic between patient and therapist. Maintaining boundaries is a big deal when it comes to treatment, as it should be. A therapy session is probably one of the few places where someone can and should say, “It’s all about me.” That’s a sacred time and place in which someone who’s stuggling can focus on their own story, from how it got written to how to change it for the better.

Does a therapist’s revelation of a personal struggle with mental illness change that dynamic? It seems to me that it would have to because the patient is now getting to see beyond the professional aspect of the therapist and into the personal.

I can imagine some clinicians might say that’s a taboo that shouldn’t be broken, but I can also see that it might actually help the healing process. I mean, wouldn’t hearing about a therapist’s personal experiences inspire hope in a patient? Wouldn’t a patient feel a stronger connection with his clinician and might that make for a safer therapeutic environment? Might it not even lead a patient to make greater use of his time in therapy?

Given the play the article has gotten across the Internet, it’s clear Dr. Linehan’s revelation has struck a powerful chord. I, for one, was thrilled to see someone of her stature be so honest and revealing, and I hope she will  be lauded as much for her courage in going public as she has been for her considerable therapeutic and research accomplishments.