Blasting through mental health misperceptions

illustration showing silhouettes of two heads facing in opposite directions, filled with words associated with mental health

For all its downsides, the pandemic helped us to do a better job of openly discussing mental health. But that doesn't mean everyone is up to speed on how strikingly common mental illness is — or immune to stubborn stereotypes that label people struggling with mental health challenges as somehow defective.

An estimated 58 million American adults — more than one in five — live with a mental illness such as anxiety, depression, bipolar disorder, post-traumatic stress disorder, or obsessive-compulsive disorder, among others. And more women than men receive treatment such as medication or counseling for such an issue, according to the National Institute of Mental Health.

But despite its pervasiveness, mental illness remains largely stigmatized, says Dr. Arthur Barsky, a psychiatrist at Harvard-affiliated Brigham and Women's Hospital.

"It still has that implication, I think, that it's somehow a failure of one's inner resources — a weakness," Dr. Barsky says. "Those with mental illness aren't viewed as winners on top of their game."

Damaging effects

Perhaps predictably, such stigma can prove quite damaging to people who cope with mental health problems, affecting their morale and even their recovery. Feeling labeled and marginalized by their condition can worsen people's depression or anxiety — for instance, by pushing them toward substance abuse or promoting secrecy or social withdrawal.

"It's got to worsen the underlying disorder, because you're feeling blamed for it," Dr. Barsky says. "Unfortunately, you may buy in to this thinking to some degree, thinking if you were stronger, you could beat this. I think the stigma changes your view of yourself and also creates more isolation."

Changing minds

Fortunately, scientific advances are helping to dismantle long-held attitudes about mental illness. "One thing turning the tide is brain imaging that clearly shows structural changes to the brain in people with certain mental disorders," Dr. Barsky says. "That's probably eroded some of the stigma."

For example, more people now understand that someone with depression can't "snap out of it" any more than someone with liver disease, heart failure, or another physical ailment can simply decide not to have that condition.

"More recently, there's also some acknowledgment of anxiety disorders as being valid illnesses rather than part of the imagination," he says. "The pandemic accelerated that, but the trend has been to legitimize the fact that psychiatric illnesses are not a personal failing."

Turning the tide

If you deal with mental health challenges, Dr. Barsky suggests these strategies to help blast through any lingering stigma.

Embrace treatment. Don't let labels stop you from getting the treatment you need, whether it's therapy, medication, or both. (See "Tips to get the most out of therapy.") "While they're not miracle cures, we've got a repertoire of effective treatments," Dr. Barsky says. "Don't suffer needlessly."

Don't believe you are your illness. Remember that your condition is a separate entity. For example, say "I have bipolar disorder," instead of "I'm bipolar."

Don't take offhand comments personally.Even well-meaning people say the wrong things occasionally, while others are careless or cutting with words. "Think about why someone would say that and what it says about them rather than about you," Dr. Barsky says.

Share your story, if inclined.When you hear false or misleading information, you can help set the record straight by choosing to reveal details about your situation. "It can be terribly hard to do, but it's very beneficial," Dr. Barsky says. "It can take a tremendous load off your mind."

Tips to get the most out of therapy

Embarking on therapy to tackle mental health troubles can feel like a leap of faith. But if you do it reluctantly, you're probably not poised to get the most out of the process, says Dr. Arthur Barsky, a psychiatrist at Brigham and Women's Hospital.

"People often resist getting help initially," Dr. Barsky says. "Some also have an inherent impulse to try to solve their problems themselves— to not ask for help or concede they're up against a problem they can't solve on their own."

Once you commit to therapy, however, you can maximize the results—and promote your own healing—by taking several key steps.

Choose your therapist carefully. Don't settle for someone who's merely convenient to your home or office; rather, look for a counselor who specializes in your particular problem. Once you meet her, get a sense of your mutual comfort and rapport. "Think about whether this person is someone you can spend time with and trust," Dr. Barsky says.

Treat therapy as teamwork. "Initially, you'll have to lead the show," he says. "But over time, as the therapist understands you and your situation, she's going to provide more insight and guidance and offer suggestions about how to tackle the problem. It's a collaboration, and it's not a cookie-cutter approach."

Be vulnerable. You can't benefit from therapy unless you're willing to fully open up about your experiences and feelings. And while it may be uncomfortable, you have to be willing to talk about things you'd often rather not discuss. "You need to share stuff that may be embarrassing, painful, or depressing," Dr. Barsky says. "Your therapist can't help you until she knows exactly what you're struggling with."

Take any prescribed medications. "It's pretty obvious, but if your therapist thinks you need medicine and you agree, then you need to take your pills," he says. "But don't agree and then go home and not take them." Many times, there are choices among medications. Ask about side effects, risks, and benefits, and work with your clinician to make the best choice.

Define success. Setting goals with your therapist will suggest a framework to move forward. But keep in mind that therapy often isn't a linear process, where you explain a problem and promptly discover a solution. Instead, you'll construct thought patterns and behaviors that lead to healthier ways of living. "It's important to be able to think through where you'd like to be at the end of the therapeutic process and ask if the therapist thinks that's feasible or likely," Dr. Barsky says.

Be patient. Depending on your issue, effective therapy can take months or even years. "You can't expect you're going to walk out after a few sessions and the problem will disappear," Dr. Barsky says. "It may be a long process, but that doesn't mean it's not helpful."