"Most humans already have some existential wrestling that they have to do with feeling “good enough”. Do we really need to stigmatize people as “bad” or “defective” for suffering as well?" - Traci Ruble
The Stigma Associated With Human Suffering and Mental Illness
by Traci Ruble, Licensed Marriage and Family Therapist
Ever heard of a little something called the DSM? It stands for the Diagnostics and Statistics Manual cataloguing all the mental disorders for diagnosing mental health patients and for insurance billing use. The newest version came out in the last six months and as every new edition creates, controversy ensued, largely because some behaviors that might be considered “everyday suffering” are now listed in the DSM as a problem. Tantrums by little kids are “disordered”? What is more, this manual is created essentially by a vote of psychiatrists after reading literature as to what should go in the darn thing. No other scientific medical field “votes” on diagnoses. Aside from the DSM controversy which you can learn more about in Gary Greenberg’s "The Book of Woe" or at this NPR discussion with all the powers that be called Bad Diagnosis I am curious how this turning regular old everyday human suffering into something that is labeled a disordered illness impacts: seeking treatment from a mental health professional, seeking support from family and friends and supporting ourselves when we are suffering?
Some interesting statistics and I am quoting Greenberg - 60% of people suffer some sort of mental illness in their lifetime and 30% suffer a mental illness in a year’s time! I prefer to call mental illness these days a “psychological flu” or “mental flu” because mental illness conjures up some state of “permanent defect”. Most humans already have some existential wrestling that they have to do with feeling “good enough”. Do we really need to stigmatize people as “bad” or “defective” for suffering as well? Moreover, calling someone “mentally ill” or “mental” has entered our vernacular as an insult so taking everyday suffering and labeling it as a “mental illness” can feel like a real insult. I don’t think my suffering makes me ill. Yes some people suffer more and more chronically. I have some of these patients and am saddened when they are labeled by anyone as defective. Chronic illness or a flu - in my mind suffering is suffering. But most of my patients are people with a “psychological flu” and I am so glad they gifted themselves the support to alleviate their suffering.
On the flip-side though, more diagnoses in the DSM means that more people can seek help for more “common cold” psychological pain like dealing with your child’s tantrums or “work anxiety” or “work life balance” and have it paid for by insurance. But I still can’t shake the stigmatization of putting that darn psychological “cold” as a disorder in the DSM and how it may turn others off too, not just me. We may be willing to raise our hand and say “ouch I need some help” but not many are willing to raise their hand and say “hey I am fucked up”.
But for others, the diagnosing part is irrelevant. Diagnosis - shmiagnosis. I was talking with an old middle school friend and she said down in her area, entering therapy already feels like an admission of being “broken” “mental” “screwed up” “fucked up” “disposable” or whatever label you want to give a person who suffers with a “mental flu” who goes to get help. Isn’t that sad? She said some friends and colleagues have severe suffering that would be served well by some treatment but they won’t go see a therapist because the social stigma (and internal fear I suspect) is too great.
How do we respond personally to our suffering when the cultural at large wants to disavow its existence because of what others might think or because of our own shame of being ill? My hope is this article expands hearts and minds everywhere. Being human, in this day and age, is so complicated. We have so much in first world countries and yet we have so little time to live and be. Our connection with all that makes us well as human animals - connection, creativity, movement, nature, mindful reflection - all get lowest rung on priorities. Instead success, achievement and lots of of other “doing” related activities take center stage. As a result, we catch “the psychological flu” and psychotherapy becomes a vehicle to be human again rather than superhuman. But we scoff at our own suffering because the culture tells us to “buck up” “get over it” “overcome” “ignore”. Many patients I see come in way too late - especially couples because they relate to their own suffering in this cold and really even a "mean" way.
If you want an insiders view, I honestly have felt more inspired and in awe of the people who come in to see me than people I have known who would never step foot inside a therapists’ office.. Parents, couples, individuals - suffering great loss, traumatized, lonely, aggressive, anxious … and for the clients who choose to stay and work with me the thing they all have in common is courage. I don’t see anything “fucked up” about looking really honestly at oneself, noticing what isn’t working, courageously taking responsibility for your part, learning something you never knew about how you operate, changing what can be changed and accepting what cannot be changed with a massive amount of self compassion.
We all tend to scoff at and judge people or experiences that scare us in order to get some distance from them. I think psychotherapy and human suffering are scary so we stigmatize them both. If you judge therapy, maybe ask yourself, “What scares me the most about sitting across from another human and deeply looking at myself and receiving support?” People doing any kind of growth work in therapy or with a coach or with a spiritual teacher....I think they are some of the most sane healthy and frankly interesting people I know! And for those that don’t come to therapy but probably could use the support, my message to you is this “What is the kindest most loving way you can respond to your own pain right now?” If you don’t know how to, “What would it be like to get help being kind and loving to your pain?”
Traci Ruble is a Licensed Marriage and Family Therapist. She has been working with couples, adults struggling in relationships, with depression, PTSD and anxiety and leads online mothers groups. She is also the founder of this here blog, Psyched in San Francisco. You can find out more about her a twww.traciruble.com, call at 415-520-5567 or follow her on twitter @TraciRubleMFT.
Labels: DSM, Gary Greenberg, Judgement, Mental Illness, Psychotherapy, Traci Ruble, wellness