A take on the stigmatisation and understanding of mental illnesses

this blog includes a personal experience report on depression

Hello everyone,

this is the blogger writing to you. Considering it’s mental health awareness month, I recently gave the question some thought on how one could describe mental health or mental illness. Who decides when your mental status is fine? Is there a “normal” mental state?

Adding to that, a friend of mine kindly agreed to talk about her personal experience with depression and the prejudices she faced. I would like to thank her for being open and honest about her experience. To clear up stigmas surrounding the subject it needs to be talked about.

Small disclaimer ahead: This is a personal experience. Depression has many faces. The symptoms stated in the following text cannot be generalized.

Mental health. What does that mean?

The World Health Organisation published the following definition: “Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. […] Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time.”[1] . Mental health is more than the absence of a mental illness. There are multiple factors that determine mental health and there are “levels” of mental health (WHO).

For me this addresses the fluidity of mental health, as I have also learned in one of my internships. There seems to be no clear boarder where someone can be considered “sick” in a way there is with physical illnesses. Some people stray more towards one side but can also return to a more stable state.

“On some days it feels like the depression is “gone”. And just as easily it can “come back” any day. It is not a persistent state. Not being at work one day doesn’t mean you’re back to good health the next. “Get well soon” doesn’t work that well in this case. Mental health is much more of a fluid state. The diagnosis I have right now doesn’t stick with me for life. Symptoms or a diagnosis do not automatically mean you will have depression for the rest of your life. When you feel like you can’t get out of your current situation by yourself, get support, seek help. It will get better.”

Then, what is mental illness?

Mental illness per definition means: “Any mental illness (AMI) is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment […].” [2]

This means, the impact the mental health status has is of relevance. You could say that this is also an OT specific view, as we specialize in occupation and being able to perform activities of daily living. We ask ourselves: How is the person impacted in everyday life? This leads to thinking further than the diagnosis but rather in the direction of viewing the individual obstacles an affected person is facing.

In my internship I sometimes found it hard to grasp what the diagnosis meant for the affected person. For me it’s easier to imagine what it must feel like to break a leg. But how must it feel to i.e. not make it out of bed in morning, find it hard to structure your own life. What does it feel like to not be able to do that anymore because of one’s psyche? It seems to me that behaviours and feelings are considered worthy of a diagnosis as soon as a person is restricted in their daily life. Coming back to the paragraph above: The understanding comes from realising how the person is affected in their day-to-day life. 

“Getting up in the morning was hard. I sometimes cried for half an hour before being able to leave the bed. I knew getting up meant fulfilling expectations and treating patients when I didn’t feel like I could live up to my full potential. On the days that I made myself get out of bed, leave the house, work until the afternoon, I felt completely drained once I was back home. Doing the dishes, cooking, or washing clothes were not possible. I felt overwhelmed and helpless. A mixture of loneliness, emptiness – deep sorrow. On these days I felt like lying under a heavy blanket.”

Stigmatisation

Nowadays, you’ll find there are still a lot of stigmas surrounding mental illnesses. I suppose, among other things, it’s due to the fact that the psyche is not something you can see or touch. My assumption is that tackling the topic of mental health can lead to questioning your own feelings, behaviors and general mental state. It takes an open mind to gain a deeper understanding of a person’s health when there seems to be “nothing wrong with them from the outside”. Talking about these stigmas can help both the affected person and their important social contacts. My friend talks about her experience with this:

“For me personally it was hard to call in sick on days that I felt I wasn’t myself. I felt it wasn’t a good enough reason to stay at home, I couldn’t really explain my symptoms. What I knew was I would not be able to work today. I chose to tell two colleagues about my current mental state. With time I learned whom I could talk to, whom I could trust to be understanding. I don’t want anyone treating me differently; I want them to talk to me like before. My wish is for mindful considerate conversations that bear my struggles in my mind, but don’t make them the centre of everything.
In one of my internships I experienced stigmatisation first-hand. I felt the pressure of being there for the patients, supporting them emotionally, being empathetic when I couldn’t separate my own emotions from situations others were in. On some days I had to keep a distance from patients that reminded me of certain things I experienced at home. I told my colleagues about my current struggles. They acknowledged my circumstances, but thereafter never spoke about them again. I never received questions that signalize, I can talk about my current situation. It seemed they didn’t understand this is not something I can willingly influence. It seemed they started keeping their distance to me as soon as they knew. At the end of my internship, they suddenly brought up how I missed so many days. I still believe I did the right thing talking about it openly.”

Not too long ago I heard of a colleague who didn’t come to work for a few weeks. Rumours started that that the colleague must have “something mental”. Nothing more was mentioned about it. I understand if someone doesn’t want to share their diagnosis with a team. Nonetheless, this story got me thinking that if the colleague had had a broken leg, probably everyone would have known about it.

“I believe as soon as the mental state has an impact on the quality of work, the colleagues and employer should know about it. I hope it will have the effect of a non-judgmental acceptance of me and the days I call in sick.”

Stigmas cannot be cleared if they are not talked about!

“It should not be a tabu-topic. Every 5th person in Germany goes to therapy. In my experience talking about it leads to the realization that many other people are affected as well. Through this I have generally experienced more support, especially from colleagues. Of course, there will always be people who distance themselves and don’t want anything to do with it, which is totally fine. The most important thing for me is that they continue to treat me normally and respectfully.”

Conclusion

Mental health is a state which consists of many components. One cannot simply describe it as the absence of mental disorders. Viewing the mental health status as more of a fluid continuum can help to better grasp the concept of mental illness. It doesn’t have to be a stable state. With depression, it mostly isn’t. The personal experience described above gives an insight on how depression can change the way you feel and think. For my part I can say my friend’s story has helped me understand mental illnesses more and recognize no one is immune, there can come a phase in our life where we need to seek help from professionals. I hope in the future stigmas will disappear, but for this to happen, we need to address the topic openly. Mental health awareness month contributes to that.

With all of this said, I would like to use the chance to remind you to look after yourselves. Trust your gut and when you feel like you cannot manage alone any longer, seek help. Talk to close family or friends. As my friend has stated above, the more you talk about it, the more you will realise: You are not alone!

I would love to hear back from you – the readers. For any feedback, your point of view concerning mental health and/or stigmatisation, personal experiences you’ve had in your OT-studies and so on, feel free to contact me via blogger@spoteurope.eu (of course we guarantee anonymity), or interact through an upcoming padelt and polls on instagram.

[1] WHO
[2] National Institute of Mental Health

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