No Shame.

My mother suffered from major depressive disorder, generalized anxiety disorder, and bipolar. Growing up I never knew which way or when her mood would shift. She was deeply ashamed of her mental health problems and did not get proper treatment. Towards the end of her life as her physical health declined so too did her mental health. This was very difficult for me and my family. During this time my daughter was struggling with anxiety and panic attack. She was diagnosed with depression and anxiety. We started therapy and put her on medication. We waited more than a year before we finally let our family know that she was undergoing treatment. Why did we wait? Fear. Shame.
My daughter’s mental health issues have been an ongoing challenge. Unfortunately, she inherited her grandmother’s trifecta of MDD, GAD, and Bipolar II with depression. Unlike her grandmother, my daughter has been proactive about asking for and seeking treatment. Its been a roller coaster that has included two inpatient hospitalizations, two outpatient hospitalizations, weekly therapy sessions, and GeneSight testing. There have been numerous medication changes. We’ve tried changes to diet, exercise regimens, meditation, and a host of other alternative treatments and therapies. All of this closely managed by a wonderful psychiatrist. And the result is that today, as I type this, my daughter is on a medication regimen that has significantly reduced her symptoms. She has learned strategies to help her manage the triggers that worsen her symptoms, and for the first time in five years she is living a life not ruled by fear, overwhelmed by the weight of depression and the rollercoaster of bipolar. She is the happy, upbeat, silly girl I used to know.

Two years ago I found myself struggling to get out of bed in the morning. I slept my weekends away. The death of my mother combined with my daughter’s mental health issues left me depressed. The cost of my daughter’s treatment left me struggling financially. This combined with struggles at my job left me with anxiety. I didn’t recognize my anxiety at first. My daughter suffered panic attacks. I didn’t have panic attacks so I didn’t think I was struggling with anxiety. When it all became too much for me to manage I did what I lectured my daughter and everyone else to do. I asked for help. My doctor identified me with depression, anxiety, and grief. Yes, grief not processed becomes a mental health issue. I was prescribed an antidepressant and began therapy. Medication and therapy are a very important part of managing my mental health and I am not ashamed to tell you that because I am not ashamed to be taking care of myself. Just as people take vitamins and drink shakes for their physical health, psychtropics are a very important piece for some to manage their mental health. Just as exercise is an important part of managing our physical health, therapy and meditation are an important part of managing our mental health.

There has always been a stigma around mental health. The top reason people don’t seek out treatment for their mental health is shame and fear of rejection from their family, friends, and community. People desperately in need of inpatient treatment don’t seek it for fear of losing their job. We don’t think anything of taking a week or two off work to have surgery, but taking time off work to seek inpatient treatment for depression for many is out of the question for fear of their boss or coworkers finding out. If you fall on the ice and break your leg you are not embarrassed to spend a week in the hospital, but when my daughter had to spend a week in a psychiatric hospital most who knew preferred we keep it quiet. Don’t share it on social media. Don’t tell anyone. Why? What on earth did she have to be ashamed of?

There is no shame in the mental health treatment game!

Studies show that as many as 60% of people with mental health problems do not take their medications consistently. There are lots of reasons for this. First, there is the financial cost. Some antidepressants are very low in cost and available as generic, which is great. But, new medications and medications for issues like bipolar can be much more costly. At one point my daughter was on a bipolar medication that cost $110 a month after insurance! Thankfully, that medicine proved ineffective to manage her bipolar and she was switched out. Her new medication is not nearly as expensive. Another reason people are reluctant to take medication or go to therapy is denial. Taking medication and going to therapy is admitting that you need help. Its an admission that something is wrong. Society has shamed mental illness so badly that we are terrified to admit that we need help managing our mental health. But really, why should we? Diabetes is a disease of the pancreas. There is no shame in admitting you are a diabetic and no shame to take insulin. A person with diabetes doesn’t try to will themselves to be better. They know they need medical intervention to manage their disease so they can live their healthiest life.

Most people who pill shame or shame mental health in general do not do so intentionally. Their intent is not to make someone with depression or anxiety feel worse. In fact, most of the time their intention is to help. Most of the time pill shaming and mental health shaming don’t come from strangers on the internet or the street but from our own family and friends. Its done by the very people who love us the most and want desperately to help. The problem comes when they give advice and try with loving intentions to fix us. How do we get them to stop? Simply asking them to stop doesn’t work. “Please stop telling me what to do. Please stop sending me articles. Please stop…” all come across to the receiver of the message as “I don’t want your help.” And, the truth is we do want their help. We desperately want and need their support and help. But if those we love the most are going to help us, its up to us to teach them how.

How Do You Help Someone With Mental Illness?

First, let’s start with what mental illness isn’t. Mental illness is not a moral failing. Its not a lack of motivation or laziness. Its not something that can be cured by a change in diet or a strict exercise regimen. Mental illness is a chemical imbalance in the brain. Just as diabetes is an imbalance in the way the body produces insulin, mental illnesses are an imbalance in the way our body produces certain chemicals in our brain. Sometimes the severity of the imbalance is mild and so symptoms are mild. They can be treated without medication using different alternative strategies and therapies. But for most, the imbalance requires sufferers to seek and receive ongoing medical treatment in order to not experience symptoms or active illness.

The problem starts when we tell someone we love that we are undergoing treatment. We share that we are taking medication because medication has side effects and sometimes, with mental health, we don’t realize we are experiencing those side effects. We need our family and friends to be honest with us and look out for us. But, when we tell our loved ones that we are taking medication we are met with silence, stares, and then advice. “Have you tried this herbal?” “You should read this book!” “You should start going to the gym.” “Have you tried this new diet?” “You should come to my church and do this bible study with me”. All of these suggestions while meant well imply that there is something unacceptably wrong with us. A heart attack is a life-threatening illness. When someone you love is prescribed medication to prevent them from having another heart attack you don’t make that person feel badly for taking their pills. Rather, you insist and fret over whether or nor they’ve taken their pills. Mental illness is a life-threatening illness. People with untreated depression and anxiety often end up attempting suicide. Tragically, many are successful. Psychtropic medications and therapy saves lives.

Mistrust of the pharmaceutical industry drives a lot of pill shaming. Antidepressants have a particularly bad reputation. When antidepressants like SSRIs and Prozac were brought to market the media was flooded with stories of people who committed suicide while on these medications. What was not understood then was that patients with severe depression lack motivation. Their depression may be so bad that they are suicidal but lack the motivation or energy to develop and implement a plan. Once a medication regimen is started improvement is slow and gradual. People with depression don’t take a pill before bed and wake up with the sunny disposition of Mary Poppins the next day. Medication takes time to build up in the system to a therapeutic level and as that therapeutic level is increased depression is slowly lifted. This can be a dangerous time for someone struggling with depression. A person who didn’t have the motivation to commit suicide last week may be improved enough this week to find that motivation. But, with close monitoring and careful management and lots of support, we can prevent our loved ones from hurting themselves and in time, the medication will lift their depression so they no longer feel suicidal. Medications also have side effects. Watch a commercial for any prescription drug and it always ends with a voice over detailing all the possible side effects of the medication. Its terrifying! Why would anyone want to take something that could cause severe dry mouth, leg cramping, diarrhea, skin rash, partial facial paralysis, risk of blood clot or stroke, racing heart, or any of the other frightening reactions? In truth, we choose to take medication because we all deserve to live a life that is not ruled by fear or crushed under the weight of depression. The risk of any of those side effects is small. The potential benefits of the medication are great. Pill shaming is toxic. Living with a mental illness is hard enough. Having to defend the decision to take medication and go to therapy to your family and friends makes it harder. People suffer more and much longer because they are afraid of what their family and friends will say and do when they know their loved one has decieded to seek and receive help.

  • Pill shaming isn’t the only driver of fear. Shame and embarrassment associated with going to therapy or inpatient or outpatient hospitals stays is one of the biggest deterrents to patients receiving treatment. We’re not afraid or embarrassed to let our coworkers, boss, or family know we are going to a dentist or doctor’s appoint. We’re not afraid or ashamed to say we’re going to a physical therapy appointment. But we are terrified and ashamed to admit we are seeking treatment for mental illness. And, the fear is justified! The repercussions can include loss of employment, loss of friends, loss of family, and being ostracized from your community. There are a lot of assumptions made about people who seek treatment for their mental illness.
  • They’re weak. Oh Lord! This is the biggest misconception of all of them. People with mental illness are a lot of things but weak is not one of them. They are the strongest, baddest, MF’ers out there. They are battling the demons in their head in silence. They are literally fighting for their lives every minute of every day. They are in a constant state of crisis yet walking around behaving as if all is fine.
  • They’re “crazy”. Yeah, so what? Everyone is a little crazy. What the hell is “normal” anyway?
  • They are talking about YOU to their therapist. No. They’re not. They are talking about their feelings, trying to make sense out of their extreme emotions, and figuring out how to quiet the cacophony inside their heads.
  • Their therapist and psychiatrist are telling them what to do! Oh I wish. I really do. This would all be so much easier if the therapist could just say “Next time do this..” and everything will be better. Its just not that easy. Therapy is really hard work. Its painful. It requires you to go to the places in your head and heart you are desperately trying to run away from. It forces you to confront the monsters in your head. But, it allows you to do those things in a safe space.
  • There is a time table. “When will you be done with your therapy?” Well, maybe never. Depression and anxiety are lifelong diseases just like diabetes, hypertension, and heart disease. Therapy may be required as part of the regular treatment plan for life. And really, there isn’t anything wrong with that. Some people consider it a waste of money. Therapy is not cheap. But everyone prioritizes their money in a different way and there is nothing wrong with prioritizing your mental health. Especially if therapy keeps your depression and anxiety managed well enough to prevent suicide.
  • So what do you do for someone you love who is living with mental illness? Just support them. When they tell you they are taking medication keep your ideas and opinions to yourself. Keep your fears and worries to yourself. I promise you the person who prescribed the medication went over the risks in detail with your loved one prior to handing over that prescription slip. What your loved one needs from you is your unconditional love and support. Let them know if you see their mood or behavior getting better or getting worse. Let them know if you notice any tremors or other strange ticks. But otherwise, keep your advice to yourself. And, most importantly do not ask them to explain it all to you. Its difficult to wrap our minds around mental illness. Its hard for patients to understand their disease and until they find the right medication and therapy they can’t answer your questions anyway. The answers change from week to week and month to month. Again, just provide your unconditional love and support.

    Lastly, if you reader are struggling with anxiety, depression, racing thoughts, or any other mental illness, please seek help. There is no shame in the mental health game. There is nothing wrong or bad about seeing a therapist and taking medication. Your mental health is as important as your physical health. Make it a priority.

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