Euphemisms and stigma

I do not remember the topic of mental illness ever being directly discussed in my home while I was growing up. Certainly there were those among our friends and family who suffered from depression, anxiety, alcoholism, substance abuse and dementia to name a few, but a combination of ignorance and denial ensured that these individuals were discussed in hushed tones without ever directly naming the cause of their distress. “She’s not quite right in the head, dear” was the phrase used to describe an elderly neighbour with dementia. “Nervous breakdown” was as close as we ever got to describing a major depressive disorder, and the only explanation offered was often “they just couldn’t cope.”  Note that all these euphemisms carry the implication of blame, as if mental illness were somehow a lack of moral fibre. Even after I became a doctor, those within our profession who suffered from depression tended to hide it for a wide variety of reasons – not the least of which was knowing that the diagnosis could ruin your chances of ever getting disability insurance, and definitely had the potential to significantly limit your career options. Knowing now that mood disorders and psychoses are primarily issues of brain chemistry, our willful ignorance of the health of our fellow physicians is inexcusable.

Today we have better medications that allow those with mental health issues to function and live productive lives at home and at work. Earlier medication might have improved your mood, but meant the side effects would leave you so lacking in energy making work impossible. Yet still, the stigma persists.  

Stigma is defined as “a mark of disgrace associated with a particular circumstance, quality, or person”. The stigma that individuals suffering from a mental health illness feel is a huge barrier to effective treatment. The courage of many prominent and successful people in speaking publicly about their own struggles with mental health has helped remove some of the stigma, and also helped eliminate some of my patients’ reluctance to at least discuss the topic with me. Yet they still feel significant shame about having a mental illness and a significant amount of self-blame for a condition that is ultimately not their fault. And it is this shame, self-blame and fear of negative consequences that still lead people to hide their mental illness. These factors also contribute to patients I treat discontinuing treatment – be it counselling or medication – as soon as they feel marginally able to cope. I have these conversations every day at work and my message is always the same: this is not your fault, and experiencing depression and anxiety are not some sort of a moral failure.

January 31st is Bell Let’s Talk Day. It is time to address mental illness as an illness like any other deserving of appropriate medical care. More and more patients are hearing this message. I don’t use the euphemisms of my childhood any more, though I wonder how many of us truly believe that mental health is an illness like diabetes or hypothyroidism – especially when we suffer from it ourselves or see it in our colleagues. We need to remove the stigma, deal with the depression and burnout and addictions and suicides within our own profession. Let’s talk – not just with our patients but with each other as well. Only then will we truly bring an end to the stigma.