The Sad Little Secret

By Muffy Walker MSN, MBA

I was 11 when my grandfather died. I remember my mother showing up at school and me getting excused from classes early. In my young, innocent mind I thought she was quite possibly going to surprise me with an Easter break trip to Florida.

Her eyes were ringed in red and her mood not suggestive of a vacation on the beach. She explained little as we drove home, except to tell me my grandfather, her daddy, had died of a heart attack earlier that day. She and my father were going to Boston for the funeral and my brother, sister and I would have to stay home with a sitter.

It wasn’t until I was in my 20’s that I learned the truth. My grandfather, Ampa we called him, had gone down to his basement and shot himself.

I am now married and have three wonderful children. All of my children know about my grandfather’s suicide, my grandmother’s shock treatments, my father, brother, brother-in-law and mother-in-law’s alcoholism. They know that when my parents divorced I kept vigil over my mother for fear she would follow in her father’s footsteps. They know that I take an anti-depressant to help with menopause.  My youngest son has bipolar disorder, and they know that it is a genetic biochemical brain illness that carries with it a 20% risk of suicide.

In the last two months, I have personally known of FIVE suicides, only one of which was fortunately not successful.  In all but one, the attempt and completed deaths were kept a secret. Funerals were private, visits halted, phone calls not returned, obituaries never written.

This is not a judgment on how others deal with illness or death, but rather a plea to help break the stigma associated with mental illness. Mental illnesses are no different from “body” illnesses, they simply affect the brain, another organ in the human body.

“I had no idea” I heard, “he was always such a nice boy”. The secrecy of mental illness not only perpetuates the devastating and destructive effects from stigma, but become a barrier to care, an obstacle to reaching out for help, telling someone how you are feeling.

While there are many reasons for the discrepancies in help-seeking behavior, stigma can prevent people from receiving the help that they need. Individuals with a mental health disorder may feel similarly ostracized and feel embarrassed about having a psychological or emotional problem. (1)

This barrier to seeking help can have a ripple effect. Some individuals may attempt to handle their “mental health issue” through drugs or alcohol, both of which only exacerbate the illness by increasing the feelings of sadness and despondency. Left untreated, the illness only gets worse causing more isolation, emotional pain, and distress. In some cases, suicide may seem to be the only option.

The stigma impedes recovery by eroding individuals’ social status, social network, and self- esteem, all of which contribute to poor outcomes, including unemployment, isolation, delayed treatment-seeking, treatment-refractory symptoms, prolonged course, and avoidable hospitalizations. (2)

The downward spiraling behavior impacts everyone. The family member, friend or boss who is not privy to the person’s illness, may misinterpret behaviors, once again wrongly judging them.

If there is no shame or fear of rejection, then we not only can ask for help, but we can offer help and open up the dialogue without fear of embarrassing someone. “ I saw her crying at the market, but I didn’t think it was my place to ask”. Why not? If a child was bleeding or an old man fainted, would you rush to their aid? When your neighbor’s child is diagnosed with cancer or your co-worker with Multiple Sclerosis, do you send cards, flowers, arrange dinner delivery and offer prayers? Of course you do.

Why then do we remain silent, perpetuating the sad little secret of mental illness?

Stigmatizing others has been around for centuries. Criminals, slaves, or traitors had a tattoo mark that was cut or burned into their skin in order to visibly identify them as blemished or morally polluted persons. These individuals were to be avoided or shunned, particularly in public places (1). Separating and judging groups by color, religion, sexual orientation, medical conditions (i.e. leprosy), and mental ability functions to establish a “us’ versus “them”. Discrimination, rejection, intolerance, inequity and exclusion all result from being stigmatized.

It is sometimes easy to forget that our brain, like all of our other organs, is vulnerable to disease. People with mental disorders often exhibit many types of behaviors such as extreme sadness and irritability, and in more severe cases, they may also suffer from hallucinations and total withdrawal. Instead of receiving compassion and acceptance, people with mental disorders may experience hostility, discrimination, and stigma. (3)

Stigma, although powerful, does not have to be inevitable.

Speak Up, Speak Out, Help Someone in Need.

(1): Lacondria Simmons: http://www.med.upenn.edu/psychotherapy/Stigma.html

(2): Link, Mirotznik, & Cullen, 1991; Link, Struening, Neese-Todd, Asmussen, & Phelan, 2001; Perlick et al., 2001; Sirey et al., 2001; Struening et al., 2001

(3): Mental Health America; Colorado