Mental health has been receiving a lot of attention lately, thanks to campaigns such as Bell Let’s Talk, as well as Changing Minds of the Canadian Mental Health Association. But changing the stigma associated with mental health is a process that each of us can play a role in, right in our everyday lives. This process begins with the language that we use, and how we talk to each other. We know that mental health stigma exists, but how do people learn and unlearn it? Consider for a moment the very worst insults that people are used to hearing: “You’re insane”, “She’s completely lost her mind”’, “What an idiot”, “He’s such a retard!”, “You’re crazy” and of course the most damning: “You need serious professional help!” These comments are heard everyday.
“Idiot”, “moron”, “imbecile”, “retard” and others, were originally terms used by physicians and psychologists to describe specific categories of low intellectual functioning. These terms have a dark history, and were used to justify forced sterilization among the intellectually disabled, as well as anti-immigration policies to keep Jewish people and other groups out of North America when they were fleeing persecution. Being labelled “crazy” or “hysterical” was also amongst a woman’s worst fears, as a husband’s claims that his wife was emotionally unstable was enough to have her institutionalized against her will. As we know through classic studies such as the Rosenhan experiment, once people believe you are “insane”, it is really hard to convince them otherwise.
While not everyone is familiar with the history behind these terms, we all know that they have a negative connotation and are related to deficiencies or disorders of the mind/brain and personality.
In most Canadian hospitals and clinics, the third most common reason for a patient visit is mood problems, such as depression or anxiety. Although we often still refer to annual check-ups as “physicals”, more and more patients are reporting mental health concerns to their family doctor. Many others with mental health difficulties— including mood disorders but also learning and behaviour difficulties in children, trauma, and relationship problems going on in their families— are suffering in secret. These problems impact not only their own well-being but also serve as risk factors for smoking, alcoholism, and heart disease. One of the most potent risk factors for hypertension as well as early onset of myocardial infarction is an emotional factor: “free-floating hostility.” This refers to people who are ready to fight, impatient, and quickly become aggressive. Often, these traits are highly associated with social isolation, a lack of appropriate ways to take care of your mind and your body, and unhealthy lifestyle choices, which are further risk factors for chronic disease. Mind and body factors are much more intertwined, interrelated, and reciprocal than many of us realize.
So how can we encourage people to share all of their health concerns, without so much shame? It starts with how we talk about mental health Here’s what we can do: 1) Remove some of the highly-stigmatized terms and phrases from our language; 2) Ask about depression, anxiety, and learning difficulties as easily as you would ask about how well someone is sleeping or eating; 3) Respond to what we see in the person’s body language and mood (Are they keyed up and tense? Are they seeming nervous or sad?), and ask direct questions about anything from parenting stress to emotional eating.
If we ask “How have you been feeling” and the person responds only with physical concerns.(e.g. I’ve been tired, haven’t been sleeping well, or I have a cold), we can add “And how have you been feeling emotionally?”, then listen and watch as they respond. The first ten times you try and speak this way to someone, they may become very uncomfortable or seem surprised. This is just because they are not used to talking about emotions as part of daily conversation. Let’s keep at it, showing our children, friends, and family over time that their mental health matters to us. It is likely that the people most “tight-lipped” about mental health are the ones who could benefit the most from having permission to talk about it.
It may help to remind ourselves that, as parents, family members, and friends, we are part of the “societal stigma” around mental health. This also means that we have the power to help free our loved ones from this stigma, just by the way that we talk about it.