As a medical professional, I can tell you it is important to know how to treat illnesses but it is even more important to know how to prevent them; and, for that we have to know and understand all of their aspects.
As a person and part of society, it is equally important to know what certain illnesses and conditions imply so society knows how to incorporate not only accommodation and assistance, but also ways to prevent spreading in case of contagious illnesses; a kind of “what to do, what not to do”. For example, accessible entrances for people who use devices for mobility, brailled materials and displays for individuals who are blind or have low vision, qualified interpreters or written materials for deaf or hard of hearing individuals, the use of condoms to prevent STDs, wearing surgical masks to prevent spreading the flu virus.
When talking about mental conditions, which are somehow still considered a taboo or a stigma, it is hard to acknowledge that someone you thought of as a “normal person”, a friend or a relative, suddenly is “not so normal”; and it makes it even harder when you can’t see what the problem seems to be, you only see a change in their attitude or their appearance. It is hard to believe in something you can’t see or understand but, beyond believing or understanding what’s happening, it is of greater importance to see that person reach a state of integral well-being.
Mental Illness Stigma
“Mental illness stigma refers to a given devalued social identity due to the negative attributes of mental illness. According to Thornicroft, stigma refers to problems of knowledge (ignorance), attitudes (prejudice) and behavior (discrimination).”
It is known that stigma is one of the main barriers to treatment, along with lack of time, lack of confidentiality, cost, fear of documentation on academic or professional record, fear of unwanted intervention. Stigma not only discourages affected individuals from seeking treatment, but also to adhere to it, by decreasing self-esteem, increasing feelings of shame, and limiting social opportunities. This may increase the risk of chronicity, comorbidity, lower long-term quality of life, and suicidal behaviors.
Stigma is also associated with an impaired ability of recognizing one’s own symptoms as potentially indicating a problem, thus it might hinder recognition of mental illness, even before perceiving a need for help.
Mental Health Advocacy and Awareness
The concept was developed to promote the human rights of neurodivergents and to reduce stigma and discrimination, by changing the major structural and attitudinal barriers to achieve positive mental health. Recently, the concept of advocacy was broadened to include the needs and rights of people with mild mental conditions (individuals with a small number of symptoms that have a limited effect on their daily life), and to enhance and protect mental health of the general population.
“The concept of advocacy contains the following principal elements: awareness-raising, information, education, training, mutual help, counselling, mediating, defending and denouncing. Along with these elements, other two strategies have been used to combat stigma: contact and protest.”
Stigma is reduced when individuals have contact with neurodivergents who are able to successfully and effectively function in society. Direct contact with a successful neurodivergent helps change negative stereotypes and erroneous beliefs about neurodiversity. It creates an opportunity to develop attitudes based on experience, rather than on prejudice.
An environment that allows stereotyping may diminish self-esteem and confidence, and increase feelings of imposter syndrome and other self-perceptions, which are obstacles to revealing one’s diagnosis and also create a barrier to well-being. For people to disclose their mental health status, seek treatment and adhere to it, an environment of trust and respect needs to be established. Edmondson called it Psychological safety, a sense of confidence that one will not be embarrassed, rejected, or punished for speaking up, a climate in which people are comfortable being themselves.
“Psychological safety, a sense of confidence that one will not be embarrassed, rejected, or punished for speaking up, a climate in which people are comfortable being themselves.”
Anti-stigma campaigns have been successfully created to change the culture and perception of how neurodiversity is viewed by society. Promoting stories about neurodivergents and their mental health continuum, and increasing awareness and knowledge about mental conditions, reinforces the normalization of explicit conversations about neurodiversity and openly provide the information and tools to address it. Addressing mental health stigma is key to creating a culture of equity, inclusion, and healthy well-being.
Positive Mental Health
“Positive mental health refers to feeling happy (emotional well-being), but also doing well in terms of socially contributing to society (social well-being) and pursuing personal growth through self-acceptance, positive relations, having a sense of purpose (psychological well-being).”
This concept can be used both in neurodivergents and neurotypicals.
The continuum of a mental condition comprises the two ends of the mental health continuum, which runs from none or a few clinical symptoms to a full-blown mental condition: flourishing and languishing mental health. People who are flourishing have a high level of emotional, social and psychological well-being.
That being said, it’s been demonstrated that high levels of positive mental health protect individuals from mental conditions, and that low levels of positive mental health are a risk factor.
Mental health protection and promotion should become a priority for the health care system. Raising awareness for building and maintaining high levels of positive mental health is fundamental not only for prevention, but also for recovery.
It is of great help that everyday more and more people want to learn about mental health and neurodiversity, and even better, with the creation of internet forums and websites, that people all around the world can unite for the same cause through media.
As a neurodivergent, I am never ashamed of sharing my diagnoses, nor the fact that I take medication and go to therapy. It was so hard for me to feel misunderstood and be discredited for having a mental condition, even inside the medical community; I hope that, by sharing my story and sharing information, I help prevent that from happening to anyone else.
Aline is a medical professional in her third year general surgery residency while living with ADHD, depression, and anxiety.
· Iasiello, M., van Agteren, J., Keyes, C., & Cochrane, E. (2019). Positive mental health as a predictor of recovery from mental illness. Journal Of Affective Disorders, 251, 227-230. doi: 10.1016/j.jad.2019.03.065
· Edmondson, A. (1999). Psychological Safety and Learning Behavior in Work Teams. Administrative Science Quarterly, 44(2), 350. doi: 10.2307/2666999
· McCleary-Gaddy, A., & Scales, R. (2019). Addressing Mental Illness Stigma, Implicit Bias, and Stereotypes in Medical School. Academic Psychiatry, 43(5), 512-515. doi: 10.1007/s40596-019-01081-3
· Schomerus, G., Stolzenburg, S., Freitag, S., Speerforck, S., Janowitz, D., & Evans-Lacko, S. et al. (2018). Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness. European Archives Of Psychiatry And Clinical Neuroscience, 269(4), 469-479. doi: 10.1007/s00406-018-0896-0
· Schotanus-Dijkstra, M., Keyes, C., de Graaf, R., & ten Have, M. (2019). Recovery from mood and anxiety disorders: The influence of positive mental health. Journal Of Affective Disorders, 252, 107-113. doi: 10.1016/j.jad.2019.04.051
· Thornicroft, G., Rose, D., Kassam, A., & Sartorius, N. (2007). Stigma: ignorance, prejudice or discrimination?. British Journal Of Psychiatry, 190(3), 192-193. doi: 10.1192/bjp.bp.106.025791
· von dem Knesebeck, O., Lehmann, M., Löwe, B., & Lüdecke, D. (2020). Causal attributions for somatic symptom disorder. Journal Of Psychosomatic Research, 129, 109910. doi: 10.1016/j.jpsychores.2019.109910
· World Health Organization. (2003). Advocacy for mental health. Mental Health Policy and Service Guidance Package. WHO Press.
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