Tuesday, September 4, 2018

Day Four - Stigma Can Be Fatal



It is not possible to overstate the devastating impact that stigma has on every aspect of mental illness and suicide.

The concept of mental illness as a character flaw is antiquated. Expecting people to shake off their suicidal depression is neither fair nor effective. Shaming people for dying by suicide also shames those who are still living with thoughts of suicide. This shame can push a person from contemplation into action and can have tragic consequences.

Almost all new research into suicide indicates that there are physiological responses in the brain that impact a suicidal person't ability to process information and maintain a balanced emotional state. There are numerous evidence based scientific studies that indicate that everything from erratic dips in serotonin levels, to neuro-transmitter impairment, have an effect on the brain that significantly increases suicidal ideation.

While behavior modification based therapies (counseling, making phone calls, socializing) can have a very positive impact on treatment outcomes, alone these efforts are sometimes not enough. One symptom of mental illness is that the sufferer's motivation levels are so impaired, they isolate and are unable to make it to therapy appointments or reach out for social support. Many will tell you that their bodies felt heavy, achy or exhausted - in addition to the emotional symptoms of depression and despair. Research has shown that the areas of the brain that are impacted by mental illness also have physiological symptoms.

The more we learn about the physiological causes for mental illnesses, the better we'll be at identifying effective treatment.

However, stigma means that the vast majority of the general public believes that suicidal desperation is a choice that a person is making. It would be more accurate to say that suicidality is a life-threatening symptom of physiological brain malfunctions.

Some might say: "I was very depressed once, and I just pulled myself together for the sake of my friends/family/commitments. Therefore, everyone should be able to do the same thing, and those that can't are lazy/selfish/uncaring."

This is a completely illogical train of thought.

Some people have minor heart attacks. Their life is in danger, but they are able to get themselves to a hospital without losing consciousness. The treatment they need may be less intensive than other treatments for heart attacks.

On the other end of the spectrum, some people have a massive heart attack. Often, unless immediate intervention is available, these heart attacks are fatal within minutes. If the person does live after having this type of heart attack, it is usually because of a confluence of factors. The presence of trained persons who know CPR and/or how to use a portable defibrillator. How expeditiously an ambulance arrives. The proximity of a hospital. All of these factors will make a difference in whether or not a person with a massive heart attack lives, And often, we lose people to heart attacks even when every intervention was available, anyway.

Mental illness is exactly the same. That deserves to be said again. Mental illness is exactly the same.

The severity of the illness differs and varies from person to person. The availability of treatment varies, the effectiveness of treatment varies, the brain's ability to rebound varies depending on the severity of the illness. We have numerous interventions that will help to save the lives of those who are just well enough to make use of them. The rest of those who are suffering are falling through the cracks.

So, we are in desperate need of more research and more effective treatment modalities. But, because of the pervasive and stigmatizing belief that suicide is a 'choice', research into the physiological causes of mental illness and suicide (and identification of effective treatment) is not funded well enough.

Because of stigma, insurance companies have gotten away with providing appallingly limited services to their members who are dealing with mental illness.

Because of stigma, those suffering with suicidal despair are far less likely to reach out for help.

Because of stigma, the families and loved ones who are grieving a suicide receive far less support than those who have lost someone to a cause other than suicide.

Because of stigma, social service agencies and other organizations who are serving at risk populations do not have the financial ability to make the treatment and resources needed available to all who need them.

Because of stigma, the ugliness of guilt and blame are perpetuated and contribute to shame.

Shame can have a devastating and lethal impact on a person't mental health.

Stigma can be fatal.

We must remove the barrier of stigma from effective suicide prevention and treatment.

You can make a difference in fighting stigma. Educate yourself about the statistics, causes, and treatment available for mental illness and suicide. Reach out and support those who are suffering. Talk to others about the issues. Speak up anytime you hear fallacies being spread.

We need you. Begin now.

"Many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness. As a result of both, people with mental illness are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people."


Patrick W. Corrigan and Amy C. Watson

National Institutes of Health

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