20 things not to say to someone with a mental illness

Mental illness is hard enough to handle on its own. Having other people make insensitive comments just make it even worse. It is, however, important to acknowledge that these remarks are generally not meant to be hurtful. They often reflect a lack of understanding mixed with a desire to seem helpful or comforting. Still, words can hurt. Here are 20 things to avoid saying when speaking with someone about their mental illness (and what I’m thinking when you say it).

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“Just snap out of it.” If I could, I would.

“Stop feeling sorry for yourself.” Mental illness is a legitimate problem and it’s okay to have feelings about it.

“I promise it will be okay.” You have no way of knowing that.

“Why are you like that?” That’s for me and my therapist to figure out.

“Can’t you just try to be different?” I’m pretty sure I have.

“Yeah, my brother has depression, too.” Everyone experiences mental illness differently, so I don’t want to be compared to someone else.

“That’s weird.” I know. I don’t need to hear you saying it, though.

“You’ve been doing it long enough now. Stop.” There would be no need for therapy if we could go in and out of mental illness at will.

“There are others who have it worse.” I know, but suffering is not a contest.

“At least it’s only depression/anxiety.” Even the most common mental illnesses can be extremely difficult to handle.

“That’s just how you are.” Mental illness is not a character flaw.

“You brought this on yourself.” Even if I did contribute to the problem, I did not ask for this. 

“I know how you feel.” No, you don’t, and I’m offended that you think you do.

“Things will change soon.” Timing is always a big question mark with mental illness.

“It’s all in your head.” That’s why it’s called mental illness. But it affects physical health, too.

“Do something to distract yourself.” This is not nervous anticipation. It won’t just get better if I wait.

“Don’t be so negative.” I am entitled to my feelings. Besides, I’m pretty sure you would be “negative,” too, if you were in my shoes.

“It could be worse.” Yes, it could, but that doesn’t mean this isn’t difficult.

“But you have so many things to make you happy.” That doesn’t change that I’m also struggling.

“You don’t seem to have a mental illness.” Mental illness is not always apparent on the outside.

Sassy remarks aside, feel free to share this post with someone who might need a little perspective. For things you can do that are actually helpful, read this post.

What have people said to you about mental illness that you have found hurtful? How do you respond? Tell us in the comments.

Dating violence and your mental health

One of the saddest situations is hurting someone under the disguise of love. Unfortunately, abuse in the dating setting happens much too often. A third of adolescents are victims of abuse by a dating partner, while 43% of college women experience violent or abusive dating behaviors. Clearly, things can go sour long before moving in together or saying, “I do.”

Dating violence happens in many ways. Most commonly, there can be physical, sexual, verbal or emotional abuse. This doesn’t have to be extreme behavior in order for it to be legitimately abusive. You don’t have to break bones – a slap or a shove is physical violence, too. Rape is one form of sexual assault, but unwanted touching is as well. Verbal abuse may escalate to threats, but can start out with name calling or simply making you feel bad about yourself. Before controlling everything you do, an emotional abuser may start with something seemingly minor, like insisting you dress a certain way or constantly asking about where you are and what you’re doing. Abuse is abuse, no matter the degree, and abuse is wrong.

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There is a high emotional and psychological toll to dating violence. It sets up a pattern that allows for future abuse. It increases the risk of drug and alcohol abuse, as well as risky sexual behaviors. These things, if unchecked, can lead to a lifetime of pain. It gets so bad that half of all young people who experience both dating violence and rape attempt suicide. 

You can also experience mental illness as a result of dating violence. Depression, anxiety, phobias, posttraumatic stress disorder and sexual concerns are but a few of the potential results. Even if no specific disorder manifests, therapy may be necessary due to the stress and distortion resulting from being in a violent relationship. 

Unfortunately, leaving these types of relationships can be risky. If someone can hurt you while claiming to love you, you bet (s)he can retaliate if you try to end the relationship. Timing and safety are very important when leaving abusive relationships. This is one reason professional help is important. Creating a safety plan can honestly be a life-saver. If you are experiencing dating violence, talk to your therapist. If you feel you are in immediate danger, call 911. Otherwise, a list of some additional resources are below.

Loveisrespect

www.loveisrespect.com

1-866-331-9474

Text loveis to 22522

Chat available on website

National Domestic Violence Hotline 

www.thehotline.org

1-800-787-3224

Chat available on website

Rape, Abuse & Incest National Network (RAINN)

www.rainn.org

1-800-656-4673

Chat available on website

Have you experienced dating violence? Share your stories and advice in the comments.

7 reasons I speak up about mental health

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I grew up with a perception of mental health that was skewed in the way I assume it is for a lot of people. I thought you had to be really crazy to see a therapist. I believed that you either did or you didn’t have a mental illness and it didn’t occur to me that it’s really a spectrum that everyone is on. I reckoned that I probably knew a few people with some kind of “mild” mental illness, but didn’t know that one in four Americans struggles with a mental illness in any given year (NAMI). 

Boy, was I wrong about a lot of things. But I didn’t know that until I sought treatment myself and had years of experience in the therapeutic environment. As my progress with mental health increased, I also took classes on psychology in order to better understand what was going on both with myself and with others. And here I am, running a blog about the very topic that I so deeply misunderstood when I was younger.

So what changed for me to go from a stigmatized and uninformed perception to being a voice for the mentally ill? There are a few major factors.

1. I was so confused and even hurt by the mental health system that I didn’t want anyone else to have to navigate it alone and uninformed. I am empathetic and I truly just want to make this process easier for even just one person. 

2. I heard the stories of others. Whether through reading, classes or conversations, I learned about other people with struggles similar to my own. I realized that I am not alone and that when I speak up for myself, I am also standing up for a whole invisible community.

3. I realized that the mentally ill are underrepresented in society at large. Because there is so much stigma, people don’t always speak up. But silence will not change things and I feel like it’s the right path for me to be vocal about this topic. 

4. I was sick of hiding who I am. Trying to keep up a front of everything being okay was exhausting and just made me feel even worse. While I had a lot of fear about being open, everyone who is close to me now knows that I struggle with mental illness and have (eventually) been great in their responses.

5. I want to do my duty as a citizen. They say that when letters and phone calls are being made to politicians, they estimate that each person speaking up represents over 1000 people who feel the same way. I want to bring another 1000 people’s struggles to attention.

6. I want to live in a world where I can say I have a mental illness the same way others can say they have diabetes or a broken leg. I don’t want a negative, judgmental, uninformed and awkward response. I want the same courtesy and sympathy that is given to those with physical illnesses.

7. I don’t want my mental health issues to be meaningless. These are the cards I have been dealt and I choose to play them in a way that can bring hope and healing to others. 

I acknowledge that it’s a difficult topic to speak about and that not everyone wants to do so. I didn’t either, for a long time. That changed and now this is a large part of who I am.

But you don’t have to create a whole blog to be a part of the conversation. Even a single post on your blog draws attention to the topic. Today is Mental Health Month Blog Day, sponsored by the American Psychological Association. If you submit your post about mental health here today, it will be added to a list along with other people’s posts. Even if you don’t submit anything, check it out to see other people’s contributions. The more informed you are, the better you will be able to address the topic of mental health both personally and publicly.

Why do you speak up about mental health? Or what stops you from doing so? Join the discussion in the comments.

25 safety tips

Being the victim of a crime or accident can be traumatizing and, as we know, trauma is bad for your mental health. This is why it’s very important to protect yourself at all times. Following are 25 ways you can be safer in your everyday life.

     

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1. Let someone you trust know where you are going and when you will be back.
2. When walking, be aware of your surroundings at all times. You can check your phone later.
3. Keep your car doors locked both while parked and driving.
4. Do not “check in” on social media when you are out of town. It will alert potential burglars that you are gone.
5. Have your keys out when walking to your car or home so you can enter more quickly.
6. Walk on the side of the street that is facing traffic.
7. Keep any entrances to your home well-lit.
8. Always secure your windows and lock your doors.
9. Never tell anyone that you are home alone.
10. If you receive a call from someone about a problem with your credit card, hang up and call the number on the back of your card to make sure it’s actually them. 
11. Never accept drinks that have already been opened or are given to you by strangers.
12. Do not leave valuable items visible in your car. Store them in the trunk.
13. If someone calls and has the wrong number, do not give them your name or repeat the number back to them.
14. Stay on well-lit streets. If it takes you longer to get somewhere, so be it.
15. Get a copy of your credit report once a year (it’s free) and check for inconsistencies. 
16. When out of town for an extended period, have someone check on your home regularly.
17. Shred all papers that contain personal information.
18. Stay away from bushes and other overgrown areas.
19. Use a headset while driving or, better yet, stay off the phone while on the road.
20. Don’t leave a spare key near your front door. Consider leaving it with a trusted neighbor or family member.
21. Hang up immediately if you receive an obscene or harassing call. If the problem persists, contact law enforcement.
22. Memorize important PINs and passwords; do not write them down.
23. Get sufficient sleep so you are alert, especially if you are driving long distances.
24. If you have a GPS, set “home” as somewhere near where you live, but not your exact location.
25. If you are being followed, don’t stop. Keep walking or driving to the nearest public place.

How do you keep yourself safe? Share your most helpful tips in the comments.

The isolation of mental illness

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Mental illness can be a very lonely experience. It can feel like what applies to the rest of the world gets turned on its head when it comes to you. When others ask questions like, “Why didn’t you come to the party?” or “Why haven’t you finished your assignment?” it can be hard to come up with answers that are both understandable and that protect your dignity. It’s hard to find words to describe what permeates your life and makes you feel separate from everyone else.

I wish I could say that people are generally understanding and that if you just say it how it is, you’ll get an empathetic response and an offer of help. The truth is, people are generally uncomfortable talking about mental illness. This societal silence perpetuates the feelings of isolation that mental illness can create.

Still, mental illness affects everyone, whether through experience or indirectly through others in their lives. With one in four Americans struggling with mental illness in any given year, everyone knows someone. It is, however, for the most part an “invisible illness” and people learn to hide their symptoms so no one knows anything is wrong. But it’s still there. 

The next time you sit in a meeting, classroom or other group situation, start counting off one in four people. Now take that group and expand. Remember, the one in four figure is for any given year. Some people have recovered from a past mental illness and others will experience it in the future. Seeing how common it is in this way can be an eye-opener. It’s a lot more prevalent than it seems when you’re lying in bed at 3:00 p.m. and wondering what’s wrong with you since “everyone else” can move on with their days. 

   

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But knowing you are not alone and feeling isolated are not mutually exclusive. While you might theoretically know that others are struggling, too, it’s not like people show up to work saying, “I didn’t come in yesterday because I had a really bad panic attack,” like they say, “I didn’t show up because I had the flu.” Mental illness is surrounded by so much stigma and perceived shame that it’s hard to talk about.

If you want to change the conversation and help others understand how mental illness impacts everyone, that’s great. Just take care of yourself while you do so. As a starting point, here is an article on how to tell others you have a mental illness. If you’d rather avoid the topic, that’s okay, too. It’s your right to decide how much you want to talk about your condition, if you want to talk about it at all.

One thing that can help you feel less alone is through entertainment. Finding stories of others we can relate to can be cathartic and empowering. There are lots of mental health memoirs that focus on specific conditions, so you can surely find one for yours. For instance, there’s Prozac Nation for depression and Girl, Interrupted about borderline personality disorder. There are so many more if you just search for them. There are also fictional stories of mental illness, as well as more technical books. (I’ve compiled a list of books that help you learn more about your condition.) Movies that address mental health topics abound, too, like these Oscar-winning best picture films.

There are also online communities that can offer support. For instance, HealthyPlace has a variety of forums addressing different conditions. Another cool site is PatientsLikeMe, where in addition to having access to forums, you can track your symptoms. Everyone’s data is used to come up with helpful information. It covers a lot of medical conditions, but there’s a section for mental health concerns. Be aware, though, that these groups are for support only. They are not a replacement for a doctor or a therapist. Simple symptom management tips and sympathetic stories are great, but you should not use forums to resolve more serious issues.

Remember that mental health issues are just as much a part of the human experience as anything else. It can feel isolating, but you are by no means alone. You can choose to seek out others who share your experience, or you can just comfort yourself with the knowledge that what you are experiencing is, in its own way, normal. How you approach your condition is entirely up to you, but always know that you aren’t broken, you aren’t weird, you aren’t crazy and you aren’t alone.

What do you do when your mental illness makes you feel alone? Share feedback in the comments.

7 signs of abuse in children

Child abuse is one of the greater evils in society. It can be incredibly damaging to children and affect them for the rest of their lives. This is why it’s so important to catch abuse as often or early as possible. Here are some signs to look out for. (This list is by no means comprehensive.) 

1. Problems regulating emotions

It’s hard for abused children to safely express emotions, so they might have outbursts of strong feelings. This can manifest in their behavior as well. When the child does something somewhat explosive, try to find out what feelings were behind it. This trouble regulating emotions can continue into adulthood.

 

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2. Excessive fear of doing something wrong

When a child has a strong fear of doing something wrong, it might be because she is used to being punished for her mistakes and shortcomings. Even trivial decisions might be difficult due to fear of making the wrong choice. This fear might also manifest as being withdrawn or anxious. It might be a fear related to a certain type of choices or a generalized fear.

3. Unexplained physical injuries

Look for bruises, cuts and other injuries. If the child has no explanation – or provides an unconvincing one – monitor it. If there is abuse in the home, it may be continuous, leading the child to have frequent injuries. Accident proneness is one thing, but that will have more credible explanations (though it might still indicate neglect). 

4. Extremes in behavior

Another sign of abuse in children is that they are very extreme in their behaviors. This can go either way. They might be very rigid or they might be disorganized. They can be excessively obedient or completely rebellious. If a child is “too much” of anything and completely lacks the ability to navigate a middle ground, it’s a bad sign.

5. Age-inappropriate sexual knowledge

If a child seems to know a lot more about sex than he should, it might be a sign of sexual abuse. This can manifest both verbally and in behaviors. They might have a lack of appropriate physical boundaries with others or even be overtly seductive. This can, however, also swing to the other extreme, where the child is wary of touch in general.

6. Avoiding someone specific

A child may be trying to escape abuse by avoiding the abuser as much as she can. If there is no obvious reason for the child to avoid this person, it’s worth looking into. This is more than just going to his room because he doesn’t feel like being around someone. The child might hide when the person is nearby or even run away from home.

7. Regressing to earlier behaviors

An abused child might use coping skills from a younger age. This might include wetting the bed, fear of the dark, thumb-sucking, needing a comfort object and clinginess. It can even extend to the child being less skilled in language usage, talking like someone who is younger. It is especially worrying if the child has quit the behavior before, but is returning to it.

If you suspect that a child is being abused, you need to contact someone. A good starting point is a child abuse hotline. In the U.S., the national number is 1-800-4-A-CHILD (1-800-422-4453). If you live elsewhere, search online for a number or contact local authorities. It is better to be safe than sorry when it comes to children who might continue to be hurt if you don't seek help.

Do you feel like you could notice if a child is being abused? Talk about what helps identify these children in the comments.

How do I tell someone I have a mental illness?

It is hard to come to terms with having a mental illness. It can be even harder, at times, to help others understand where you’re at because they are not living it. But the path to recovery is best walked with support, so at some point, you might want to tell someone about your mental health condition. Since May is Mental Health Awareness Month, let’s look at talking about mental illness.

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Remember that you get to decide who does and doesn’t know about what you’re struggling with and how much you want to share. Telling someone one thing does not entitle her to know everything. It’s also important to feel safe with the person you are confiding in. When you have carefully considered telling someone and feel comfortable with it, here are some tips on how to have that initial conversation.

Be aware of your own feelings in advance

Don’t go into the conversation unprepared. You are opening up a whole new box of information and feelings, so know what’s in it. Plan for how you are going to deal with any emotions that come up while you’re explaining yourself. Remember that it’s okay to take breaks or to finish the conversation another time. 

Also attend to how you are feeling before you have “the talk.” Are you anxious? Scared? Relieved? Practice some self-care that is appropriate to how you are feeling. Plan for what could help you during the conversation when you are having strong emotions. Maybe playing with a stress ball would help. Perhaps your anxiety is reduced if you have a bottle of water so you can take a drink to buy time when you’re uncertain about an answer. Find whatever works for you.

Understand your condition

If you want him to be understanding of you, some education might be needed. In order to provide that, you need to learn about your diagnosis and/or symptoms. There will probably be questions and it’s best to have the answers. You can read the post on learning about your diagnosis. The chance of misunderstandings and confusion are decreased if you can use factual information instead of conjecture. 

But it’s okay not to know everything. If you are unsure of the answer to a question asked, say something like, “I don’t actually know the answer to that. I’m still learning, too. Let me see what I can find out and we can talk more about it later.” You don’t have to be an expert on your condition; you just need to be appropriately informed about your mental health concerns.

Set appropriate boundaries

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I once told someone about some of my problems who went on to share them with other people. That was difficult, but I realized that I never set the boundary of who I was comfortable with knowing. I now spell out who I want to know if I am going to say something to an individual who is a part of a group I'm in (family, a circle of friends, support group, etc.). 

If the person you are confiding in can’t promise to respect your privacy, reconsider telling her unless you are ready for everyone to know what you are about to share. If you need to set boundaries about what you are willing to discuss, make sure to do that, too. Think ahead so you can express any limitations and boundaries that you need him to respect in the future as well.

Explain the support you need

People will leave the conversation feeling much more positively about it if they have some answers about how this applies to them. If these people are trusted enough for you to talk with, they are likely the kinds people who will want to help. Think about this in advance and be specific. Ask if it’s okay to call her if you have the urge to self-injure. Request to have lunch with him after your therapy appointments to de-stress. Tell her that you need someone to just ask how you’re doing from time to time.

Also let him know what you want him not to do. Again, be specific. If you have triggers, it might help to give her a list of them. If you feel it would be helpful, you can also refer him to the post about helping loved ones with mental illnesses. 

Be prepared for a variety of responses

As much as I wish there wasn’t, there is a lot of stigma surrounding mental illness. This means that people already have ideas of what mental illness is and those beliefs are going to influence their response to you. Not everyone is going to be completely supportive from the get-go. Instead of blurting out everything at once, pace the conversation. See how she reacts to minor information before revealing major points. If there seems to be a negative response, find a way to end the conversation. 

On the other hand, some people can become overly invested in your situation. If he tries to take control over your treatment or starts coddling you excessively, have a conversation about how this affects you. Tell her that your treatment team is plenty competent to help you make decisions about the hows of recovery. No matter the response, plan on engaging in some self-care after the conversation. It’s stressful and you need to take care of yourself.

Have you told someone about your mental illness? How did it go? Post your own tips and observations in the comments. 

Mental health myths: Is mental illness a choice?

I am taking on another mental health myth. Today I want to debunk that mental illness is a choice and that there are easy ways out of it. I am going to label this as an opinionated piece, so if you’d rather not read it, go ahead and stop now. I’ll see you next time.

Myth: You can just snap out of mental illnesses.

Fact: Mental illness is not a choice.

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I have a way of knowing that my mental illnesses are real. If they weren’t, I would change them. I have been trying for years, but I still have disorders that I am gradually recovering from. I have some physical health conditions as well. If I could stop those symptoms, they would be gone, too. But no one expects me to do that. And I have put way more effort into stopping my mental health issues than my physical ones. If I could make them go away, they would have been gone years ago.

Trust me, if you could just make it stop, mental illness would not exist. It’s miserable. It damages your relationships and your ability to function. It can make you your own greatest enemy. Sometimes it causes you to do damage to yourself physically, socially or emotionally. It can be insidious, or symptoms might get unmanageable in an instant. You never know.

If mental illness were not real, the United States would have been $57.5 billion richer in 2006 (The Agency for Healthcare Research and Quality). This was equivalent to the cost of cancer. Thousands of health care professionals would be out of work. The American Psychological Association estimates that there are close to 100,000 licensed psychologists in the U.S. alone. And that number is not considering other types of therapists, psychiatrists, social workers, psychiatric nurses, substance abuse counselors and others who work in the mental health field. There would be no need for such a large industry if people were simply being grumpy or nervous and blowing it out of proportion. 

One in four Americans suffers from a mental illness in any give year (National Institute of Mental Health). If mental illness had quick fixes, the only logical conclusion is that this number would be a lot lower. 

It can be very harmful to treat people with mental illnesses as if it is a choice. Gender is not a choice. Race is not a choice. Sexuality is not a choice. Physical illness is not a choice. And mental illness is certainly not a choice either. Biological bases for certain mental illnesses are considered scientific facts. There are high correlations between environmental and developmental difficulties and mental illness. 

By treating someone as if she is being weak or lazy, you are invalidating a very real struggle that you should be so thankful that you aren’t the one dealing with. Having others reject, mock or belittle mental health issues can make symptoms worse. You will never help someone with a mental illness by encouraging him to snap out of it. Instead, focus on how you can help. Be someone family, friends and colleagues can turn to for understanding and kindness. For ideas about how to do this, read the post about helping loved ones with mental illnesses.

Mental health myths: children and mental illness

I am taking some time to discuss issues related to childhood and adolescent mental health. Let’s start with a very basic mental health myth.

Myth: Children cannot develop mental illnesses.

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Fact: A significant number of children and teens struggle with mental health issues. 

Sadly, being a minor does not eliminate the possibility of having mental health issues. According to the National Institute of Mental Health, 13 percent of kids and teens between the ages of 8 and 15 struggle with a severe mental health condition. For teens between 13 and 18, that number increases to 20 percent. And those are just severe conditions – there are even more that are struggling with mild and moderate mental health issues.

There are dozens of diagnoses that are considered childhood disorders. These include learning disorders, but also conditions related to development, attachment, behavior, and more. In addition, mental illnesses that adults get can have separate diagnostic criteria for childhood versions of the same condition.

By some estimates, there are more children suffering from mental illnesses than physical ones in North America. These conditions can be devastating not only to children, but to entire families. When one family member struggles with mental illness, it affects the whole family. The family dynamic is disrupted and other family members can experience stress, anger, guilt, shame or denial. It is therefore important for everyone’s needs to be considered, not just those of the one struggling with mental health issues.

By being young, kids and teens won't always have the perspective of knowing what is and isn't normal in terms of their psychological health. We assume that others are like us, so until someone points out that, no, most people don't have to wash their hands repetitively, they might think it's the standard. Some children have never really had a chance to not struggle with mental health, so they don’t know that there is something wrong. That’s why it’s so important for adults to look for signs of mental illness in children.

Some symptoms to watch out for in children and teens include:

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• Being unable to cope with everyday problems.

• Not doing well at school (especially if the child is really trying).

• Difficulty concentrating.

• Loss of interest in activities and friends.

• Persistent negative moods.

• Sleep problems, including disrupted sleep, nightmares and sleepwalking.

• Frequent physical symptoms, such as headaches and stomachaches.

• Changes in eating habits.

• Unwarranted amounts of worry and anxiety.

• Regressing to behaviors of a younger age, such as becoming clingy or bedwetting.

• Risk-taking behavior.

• Repeated anger outbursts.

• Frequent disobedience and aggressive behavior.

• Self-injury.
• Substance abuse.

• Unusual amounts of time spent alone.

• Disproportionately intense feelings.

• Seeing or hearing things that aren’t there.

Take these symptoms seriously. On Saturday, there will be a post detailing how to get help when children and teens experience mental health concerns.

Do you have an experience with childhood or adolescent mental illness that you’d like to share? Please post in the comments.

Women's mental health concerns

Happy International Women’s Day! In honor of this worldwide celebration of women, let’s take a look at mental health issues that are of special concern to females.

Mood disorders

According to Columbia University Medical Center, women are twice as likely as men to have a mood disorder. In addition, the WHO reports that depressive disorders account for 42% of neuropsychiatric disability among women, compared to 29% of men. Mood disorders can cause serious impairment in all areas of functioning. Report any serious or unusual changes in mood to your doctor so you can be screened for mood disorders.

Female biology

Women have a host of medical concerns that don’t affect men. The menstrual cycle – both monthly and across the lifetime – can cause significant symptoms. Premenstrual dysphoric disorder became an official diagnosis is the latest psychiatric manual and menopause can trigger new mental health issues in previously healthy women. Fertility (or lack thereof) also has huge implications for mental health and there are mental health services that exist specifically to deal with these concerns.

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Postpartum conditions

The physical changes associated with pregnancy and childbirth have psychological implications as well. The most common way this is seen is with postpartum depression. For up to a year following child birth, the mother can enter a depressive state much like what is seen in major depressive disorder. This might include a focus on the child, such as obsessing over her newborn’s health or even thoughts of hurting the baby. Less common is postpartum psychosis, wherein women experience delusions and hallucinations that affect their behavior. This may require hospitalization. A final condition associated with child birth is birth-related post traumatic stress disorder. This comes from a dangerous birth experience that threatened death or serious harm for mother and/or child. For more about PTSD symptoms, read this.

Violence against women

Women are more susceptible to physical and sexual violence than men. The WHO estimates that violence against women has a lifetime prevalence rate ranging from 16-50%. They have also found that at least one in five women experience rape or attempted rape in her lifetime. Other estimates are higher. Women generally have a physical disadvantage compared to men and can also be bound by the gender roles of their societies. This leads women to be more vulnerable to dating violence, sexual assault and domestic violence. 

The unique mental health concerns facing women mean that we should pay careful attention to these areas of life. All of these issues can be addressed with appropriate intervention, but it requires getting help. Talk to your doctor or mental health professional if you believe you are struggling with any of these concerns. In the U.S., you can also call any of the following hotlines:

Depression and Bipolar Support Alliance: 1-800-826-3632

Postpartum Support International: 1-800-994-4773

National Center for Posttraumatic Stress Disorder: 1-802-296-6300

National Domestic Violence Hotline: 1-800-799-7233

National Sexual Assault Hotline: 1-800-656-4673

National Suicide Prevention Hotline: 1-800-273-8255

Mental health myths: violence

When it comes to mental illness, most people are not as well-informed as we'd like to think they are. This is true of both those who have and have not struggled with it. What is thought of as matter-of-fact might not actually be supported by research and common sense doesn't always apply. This is why it's important to reconsider our assumptions.

From time to time, I'll cover different mental health myths and show the facts behind the truth. Today's topic is violence.

Myth: Mentally ill individuals are violent.

Fact: The mentally ill are generally no more violent than anyone else.

  

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Despite what Hollywood movies and the news would have you believe, mental illness does not account for a much violence at all. Only 3-5% of all violent acts are caused by individuals with serious mental illnesses. This isn't much, especially since 6% of the population qualifies as seriously mentally ill. This means that they are actually doing less than their expected share of violent acts.

In addition, mentally ill individuals are at a higher risk for being on the receiving end of violence. This same group of seriously mentally ill individuals are ten times as likely to be the victim of a violent crime than the general population. That is a very significant increase.

When mentally ill individuals do become violent, it is most likely towards themselves. Over 90% of those who lose their lives to suicide can be diagnosed with a mental illness. It's hard to find exact numbers, but it is generally accepted that suicide is far more common than homicide. Self-injury is also a serious mental health concern and another way that the mentally ill turn on themselves.

While the messages we get from the media suggest mental illness as a predecessor to violence, the concern should be more along the lines of protecting the mentally ill from the violence of others. If you are experiencing violence in your interpersonal life – whether related to mental illness or not – visit the National Domestic Violence Hotline at www.thehotline.org or call 1-800-799-7233.


Sources:
http://www.mentalhealth.gov/
http://www.nimh.nih.gov/
http://www.nami.org/

15 Best Picture winners about mental illness

The entertainment industry has a tremendous power in shaping the public view of mental health topics. With Silver Linings Playbook, a romantic comedy featuring a protagonist with bipolar disorder, up for eight awards at tonight's Academy Awards, attention is currently being focused on the challenges faced by those affected by mental health conditions. 

It is the first movie nominated for all of the "Big Five" awards (Best Picture, Best Director, Best Screenplay, Best Actor and Best Actress) and all four acting awards (add Supporting Actor and Actress). While it is highly unlikely that it will receive all of the awards, Jennifer Lawrence is considered a frontrunner for Best Actress for her portrayal of a young widow facing a her own set of complications following the traumatic death of her husband. After seeing how the film fares tonight, I intend to write a commentary on it in the coming days. It has a lot of interesting implications.

Looking back, however, mental health conditions have definitely had their place in creating award-winning movies. Starting with the early days of the Oscars, here are fifteen films that emphasize a variety of aspects mental health and illness.

All Quiet on the Western Front (1929/30)

Showing World War I from the perspective of the Germans, this film deals with the expectations and realities of war, including the psychological aspects. Well before PTSD was officially defined, elements of it can be gleaned from previous wars, as demonstrated in this production.

Gone with the Wind (1939)

In this epic, the effects of personality disorders on oneself and others can clearly be seen. Critics have noted that heroine Scarlett O'Hara displays characteristics of narcissistic, histrionic, anti-social and borderline personality disorders. In other words, she's the epitome of the cluster B subsection. In addition, leading lady Vivien Leigh, who played O'Hara, struggled with bipolar disorder.

Rebecca (1940)

Hichcock's psychological dramatic noir thriller (thank you, Wikipedia) features characters who certainly have some significant problems. Based on the novel by Daphne du Maurier by the same name, it also handles themes such as grief, manipulation and suicide.

The Lost Weekend (1945)

With its plot centering on a writer's struggle with alcoholism, The Lost Weekend is, according to the Library of Congress, "a landmark social-problem film" with "an uncompromising look at the devastating effects of alcoholism." While the premise might seem like a cliché nowadays, it received significant opposition when it was being produced.

The Best Years of Our Lives (1946)

In the wake of World War II, a new group of veterans had to learn to adjust to civilian life. This movie follows three of them as they struggle to find normalcy. One of them, Homer, lost both hands in the war (which actually hard happened to the actor, Harold Russell). His struggle to deal with a physical handicap that he believes makes him unfit for his fiancée is metaphoric for a lot of the psychological aspects of living through a prolonged trauma like combat. Part of this film's strength is in how it shows the role of social support, both between fellow veterans and those around them.

One Flew over the Cuckoo's Nest (1975)

Because the film takes place in a mental institution, there is a lot of psychological material to draw from. The characters struggle with different conditions, but they also develop a community. The tyrannical Nurse Ratched is a legendary villain and under her reign, the viewer is exposed to a lot of the treatments that have historically (and presently) been used to treat mental illnesses. It's also one of only three movies to win all of the "Big Five" Academy Awards.

Annie Hall (1977) 

Considered one of Woody Allen's greatest and most influential films, Annie Hall follows the anxious and neurotic Alvy Singer as he tries to find out why his relationship with the title character failed. This film is worth noting because while Alvy has what appears to be a clear case of generalized anxiety disorder, he has actually lived a relatively normal life. This helps show that mental illness is not just reserved for those with traumatic histories or psychotic symptoms.

Ordinary People (1980)

An upper-middle class family struggles with the accidental loss of one son and attempted suicide of another. It tackles family dynamics in a stressful environment where each individual handles grief in his own way. Since one person with mental health issues will impact the entire family, this film is important in its portrayal of the struggle for normalcy without clear direction.

Amadeus (1984)

While Amadeus is not very historically accurate, it does tackle the interesting issue of delusional obsession. As contemporary composers, Antonio Salieri cannot overcome his jealousy of Mozart's talent. The film shows how Salieri creates a worldview in which he feels justified in using a vengeful plot to gain some sort of "victory" over both Mozart and God Himself. Obsession is usually portrayed in a romantic context, making this film all the more fascinating.

Rain Man (1988)

After his father's death, the narcissistic Charlie finds out that he has a brother, Raymond, who is more or less inheriting everything from their father. An autistic savant, Raymond lives in a mental institution. The question of why Charlie was not told about his brother points directly at the issue of stigma against mental illness, even within families. 

The Silence of the Lambs (1991)

The only horror film to ever win an Oscar for Best Picture, The Silence of the Lambs is the most recent winner of the "Big Five" awards. It features Hannibal Lecter, who is both a psychiatrist and a cannibalistic serial killer. The epitome of genius and (criminal) insanity combined, this character has been deemed the greatest villain in movie history by the American Film Institute.

Forrest Gump (1994)

In this beloved movie, Tom Hanks plays Forrest Gump, a man with an intellectual developmental disability. The film displays a very positive attitude towards Forrest, giving him his own talents and showing how he contributed to a variety of historically significant events. It tackles both the challenges and joys experienced by the title character, offering a glimpse into how society treats those who are intellectually challenged.

A Beautiful Mind (2001)

Based on the Nobel-prize winning mathematician John Nash, this film tackles the role of schizophrenia in the protagonist's life. It follows the onset of the illness, which commonly manifests in early adulthood, its identification and how it affects Nash personally and professionally. It acknowledges the permanent nature of the condition, showing that he could achieve success while still experiencing symptoms.

The Hurt Locker (2009)

The effects of war are tackled again, this time with the Iraq War. The film, which made Kathryn Bigelow the first female to win Best Director, covers the acute stress experienced in a war zone and how it affects decision making. Instead of having the focus on the posttraumatic symptoms likely experience by the characters after the story's end, the movie gives insight into its development. This is a valuable perspective, considering the current public discussion surrounding PTSD.

The King's Speech (2010)

Not all mental illnesses are defined by mood or disconnect with reality. Stuttering is categorized as a mental health condition and can be comorbid with other disorders. In telling the story of King George VI, The King's Speech shows that not even royalty is immune to these challenges. With the help of a speech therapist, George admirably demonstrates the effort that goes into recovery.

Who do you think will win best picture this year? What awards do you think the cast and crew of Silver Linings Playbook might take home tonight?

Can you keep a secret?

One of the reasons that people seek out professional counseling instead of just talking to people already in their lives is that the conversations are confidential. While some people find talking to strangers uncomfortable, others find it liberating to be able to disclose details of their lives without the knowledge and involvement of other parties.

While an ethical mental health professional can be trusted with sensitive information, it's important to know the limits. The nature of their work means that they will encounter sensitive information that occasionally must be acted upon. Each therapist should provide information on when confidentiality must be broken before treatment begins. If this is not done (or if it's been a while and you've forgotten), ask your therapist to give you a copy of her policies. 

In general, the exceptions apply in these four situations:

1. Danger to self or others

If you threaten to hurt yourself or another person, your therapist will have to evaluate what actions are appropriate to keep all parties safe. Factors such as the the presence of an exact plan, directness of the threat, severity and the ability to follow through with it are all taken into consideration.

Don't hold me to these, as this is not an exact science, but here are some examples:

Should not report: 

"I'm so mad at my husband that I wish he'd get hit by a bus." 

"I wish I had a gun so I could shoot myself."

"If I catch my wife cheating again, I'll kill them both." (Contingent on followup questions suggesting it's a sentiment, not a plan.)

Should report:

"I bought a bunch of pills and alcohol so that when I go to bed tonight, I'll never wake up."

"I carry a knife so that when I see him, I can stab him repeatedly."

"After this, I'm gonna head over to my uncle's house and take care of him for good."

A threat of harm to self can be responded to as needed in the situation, ranging from calling a friend to come over for the night to forced hospitalization. As far as threats to others, law enforcement will usually be contacted, although the potential victim(s) may as well. Past crimes aren't held to the same standard as imminent threats, with a couple of exceptions.

2. Child or elder abuse

Because children and elders are considered vulnerable populations, reporting abuse and neglect of these groups is an obligation by law. Some states require everyone to be mandated reporters while others limit the duty to both therapists and some other groups, which may include teachers, health care professionals and law enforcement. 

The appropriate course of action is that when there is a reasonable suspicion of abuse, a report is made. The reporter gives relevant information to another agency, which then decides what the appropriate course of action is. Information leading to a report does not necessarily have to come from the victim or even be a verbal confession. A child with cuts and bruises of different ages with no compelling explanation, a mother who mentions her boyfriend's mistreatment of her son and a teenager mentioning that her underaged friend is a victim of incest are all cases that will most likely be reported. An adult discussing abuse from his childhood, however, will probably not require further action unless, for instance, he has a younger brother who is in the same environment and is likely to be abused as well. A therapist is also not forced to report situations between adults, such as domestic violence in the home of a childless couple. 

The same standards will often transfer to elders and possibly disabled individuals. 

If you have questions about reporting abuse, receiving support or available services, call 1-800-4-A-CHILD (1-800-422-4453). This will not create an official report, but the people on the line can help you find out the next steps. If you are unsure about a situation, please call. It's not a commitment and it's okay to just ask a question.

3. Court order

Occasionally, mental health professionals are asked by the courts to provide information about their clients. This does not mean that any time someone is arrested, the therapist is called to confirm the offense. The principle of confidentiality is so important to therapy that mental health professionals will only reveal the least amount of information required of them and only when presented with official orders. There are also limitations on what can be asked of them, as it has to be relevant. In a murder trial, your therapist can be asked to confirm that you confessed to being at the crime scene, but probably won't answer about whether or not you're having an affair (unless it's directly related to the case). 

This exception rarely comes into play, but it has to be mentioned. The point of therapy is to help you get better, so that should take precedence over the possibility that some day five years from now your therapist will be called upon to answer if you smoked some weed. (She won't.)

4. Medical records

A limited amount of information is given to your insurance company in order to qualify you for treatment. This usually is a diagnostic code showing what you are receiving treatment for. It's not comprehensive and it doesn't involve details; it's just a way of indicating what you are receiving treatment for so that they can cover you. This is a current issue, though, and if this is a concern, learn more about what is required in your area and by your insurance company.

Outside of this, your information may be disclosed to other health care providers with your permission. This will require you signing forms and you get to specify what, exactly can and can't be released and for how long. This applies to the medical field in general, so if you want your wife to be able to get your test results for you when you aren't at home next week, ask for the paperwork!

The topic of mandatory reporting is not without controversy, but these are general descriptions of the current standards. Please don't be afraid of opening up because the information may get out. Breaking confidentiality unless it's absolutely necessary would ruin the whole point of the entire field, so it's an ethical (and legal) obligation that is taken very seriously. 

If confidentiality is a concern, talk to your mental health professional. He'll be able to give you more information on local laws and his own stance on these issues. 

An incomplete education

There are certain challenges every adult is expected to know how to respond to:

Photo courtesy of @norwigger on Instagram.

How do I do laundry?
Where do I take my car for an oil change?
How do I fill out taxes?
Which stores have pants that fit me?
What do I do if my kid breaks her arm?

But then there are the ones that the average person is ill-prepared for:

What do I say to a friend who has suddenly lost interest in all his friends and hobbies?
Where do I go if I can't remember significant stretches of time?
Who can help me when I'm afraid to even leave the house?
Is there a supplement or medication that can make me focus better?
When do I seek treatment for my father's increasing disconnect with reality?

Mental health topics are given a cursory nod in high school health class and suicide hotlines are a small news item – sometimes – because of underfunding.  There's always the crazy aunt, but no one really cares to get involved because what can you do? A broken bone is met with sympathy while a diagnosis of
schizophrenia is unmentionable.

And yet the general population has a fascination with the functions (and dysfunctions) of the mind. There are movies about escaping mental institutions, TV characters with personality disorders and songs on the radio about bipolar lovers. Although cases of mental illness usually do not involve violence (at least not towards others), it suddenly becomes a temporarily real issue when a school shooting or suicide from bullying occurs. College students live on Ritalin and at any given workplace, you can be sure that there is someone on anti-depressants.

People manage their weight, check their blood pressure, get mammograms and visit doctors with complaints of the common cold. Is something hurting? Get it checked out. While you're at it, it's a good idea to get preventative care. Yearly physicals are a standard recommendation.

But when it comes to matters of the mind, hurting actually impedes getting help. How is someone bedridden with depression supposed to seek treatment when he doesn't even have the motivation to shower and get dressed? How is a student supposed to confront her roommate when she is becoming dangerously thin?

There are so many questions. There are also so many answers. So consider this blog the orientation you never got. The mental health system is complex, but a little street savvy advice and dissection of jargon can go a long way.

Health care – including that of the mind – is a business. Become an informed consumer.