When Joel Gurin, gives speeches about depression, “at least half the time somebody will come up to me and say, ‘I need to talk to you later.’” Invariably the discussion will be about a loved one with serious mental illness.
Gurin, acting president of the National Alliance for Research on Schizophrenia and Depression (NARSAD), is pleased that people are willing to talk about mental-health concerns, but “having these conversations a little more openly will be better,” he says, adding, “That will happen over the next five years or so.”
Depression may be gradually losing its long-entrenched social stigma, but it's “still pervasive” enough to keep sufferers — especially older adults — from seeking treatment, says Jo Anne Sirey, an associate professor of clinical psychology at Cornell University's Weill Medical College in New York City. Elderly patients worry they will be put on an addictive medication or lose the community support they had, she says.
If she could find an older woman who would come out and say publicly that she suffers from the illness, “it would make my day,” says Sirey. “We have this old, kind of puritanical culture” that “shuns feelings, that values a stiff upper lip and we have a hard time realizing the influence of mind over body and body over mind” — that overcoming a mental disorder may not simply be a matter of will power. To many, she adds, depression “looks like laziness.”
Moreover, recent shootings on school and college campuses by mentally disturbed individuals have clouded public perceptions about depression. In several cases, students who voluntarily sought treatment for depression have been barred from campus and suspended, according to the Bazelon Center for Mental Health Law, a legal advocacy group in Washington.
Following incidents like the 2007 shootings at Virginia Tech University by a mentally ill student, “people often look for quick solutions to reestablish a sense of safety,” said Bazelon senior staff attorney Karen Bower.
“Virginia Tech has led to a backlash against students” with mental disorders, says Marc Salzer, an associate professor of psychology at the University of Pennsylvania School of Medicine. Colleges today “are more inclined to throw the students out.” That's especially troubling because in most major mental illnesses, including depression, the first breakdown may come at age 18 or 19, he points out.
“Often, when people step forward seeking help for their depression, they're asked to take a leave of absence,” Salzer says, because most colleges and universities have codes of conduct stating that a student must not be a danger to himself or others. “I've heard of students who are then discouraged from or actively prevented from getting back in,” perhaps due to liability fears.
While some students with mental illnesses take advantage of special accommodations available for them — such as extra time to take a test or permission to drink water in class to combat the “dry mouth” caused by psychotropic drugs, Salzer says, most are “less engaged” in their college environments so they don't use the accommodations.
As the U.S. military faces repeated deployments in Iraq and Afghanistan, the stigma connected to depression and post-traumatic stress disorder (PTSD) has become a huge issue for service members, says M. Audrey Burnam, a senior behavioral scientist at the RAND Corp., a think tank in Santa Monica, Calif. Military culture demands that people “shake off ailments and get on with the job,” so those wanting mental-health treatment are justifiably concerned about damaging their careers or being seen by colleagues as “unreliable”, she says.
At the Army's Fort Carson in Colorado, a rash of “preventable” suicides, prescription overdoses and murders has called attention to the “unaddressed madness and despair” — often in the form of severe depression — that veterans returning from multiple deployments are bringing home with them, write Mark Benjamin, a national correspondent for the online magazine Salon, and Michael de Yoanna, a Colorado-based freelance journalist. Even though soldiers' mental-health symptoms are “predictable,” in light of combat stress, the Army has responded “for the most part with disciplinary action rather than treatment.”
The military's own statistics indicate there may indeed be a great deal of untreated depression among veterans. In 2007, the U.S. Army reports, suicide attempts among active-duty soldiers occurred six times more often than in 2002, before combat began in Iraq. (See graph, p. 588.)
In November 2007 at Congress' urging the Department of Defense established a “centers of excellence” program for psychological and brain injuries, which includes suicide and mental-illness prevention efforts. In May, the program launched an anti-stigma campaign to educate service members about the availability of mental-health treatment.
After returning from duty in Iraq, Spec. Timothy Bowman, 23, of the Illinois National Guard endured eight months of nightmares, night sweats and sleeping in a closet with a 9-mm handgun. Then on Thanksgiving Day, 2005, the former Humvee turret gunner from Forreston, Ill., shot himself in the head. Since their son's suicide, Mike and Kim Bowman, have been urging the military to help eliminate the stigma felt by veterans seeking help for post-traumatic stress disorder and depression. (Wounded Times Blog)
A leader in the effort is Major General Mark Graham, commander of the Army's Fort Collins, Colo., installation, whose 21-year-old son Kevin, a ROTC cadet at the University of Kentucky, hung himself in 2003 after trying to battle depression largely on his own because he feared being stigmatized if he sought treatment. As part of Graham's anti-stigma efforts, Fort Carson soldiers who commit suicide receive full military funerals and memorial services, a mark of respect.
Stigma also helps to cloud access-to-care issues, said David Shern, president of the mental-health advocacy group Mental Health America. Mental-health clinics and assistance programs are often among the first targets of state budget cuts in recessionary times. While “we wouldn't tolerate people with infectious disease not getting access to… antibiotics” or being turned away from emergency rooms, “we routinely tolerate it when it's behavioral health conditions,” he said.
Society continues to stigmatize mental illness as “moral weakness,” with sometimes disastrous consequences, said Shern.