Mental health: still a stigma

When former Minnesota senator Mark Dayton recently disclosed his treatment for alcoholism and mild depression, I can’t say I was surprised by the reaction. Many people were understanding and felt Dayton’s issues make no difference in his qualifications as a potential future governor of Minnesota. Others, not so much.

“With all these problems, he’s not up for the job,” one person commented after reading the Minneapolis Star Tribune’s exclusive interview last month with Dayton. Someone else, referring to Dayton’s upbringing in one of Minnesota’s wealthiest families, wondered, “What does he have to be depressed about?”

You have to wonder: Would the reaction have been the same if Dayton had revealed a history of, say, asthma? Or cancer?

When it comes to mental health, there’s still a fair amount of stigma. Or, at the very least, a lot of misinformation about mental illness, the people who have it, the causes of mental illness and how to treat it. (For instance, the inaccurate notion that wealthy people should somehow be immune from clinical depression.)

More than a few experts believe it’s the stigma, not the mental health issues themselves, that’s most likely to derail Dayton’s latest political aspirations. The Star Tribune explains:

Mental illness is not the political kiss of death it once was, partly because it’s now more widely recognized as a treatable brain disease. Depression is now regarded as one of the most common medical conditions, affecting as many as one in five people at some point in their lives, by some estimates. But there is still enough stigma that many people commended Dayton for disclosing his history with both depression and alcoholism.

If this is the case, then I really don’t know what to think about the latest chapter in the story: that the Star Tribune is querying other candidates to find out whether any of them have ever received treatment for drug or alcohol use, depression or anxiety. (Politics in Minnesota broke this development late last week.)

Granted, we’re talking about a group of individuals from among whom Minnesota’s next governor likely will be elected. Perhaps some higher standards of disclosure ought to apply here – and candidates who are uncomfortable with this level of public exposure should rethink whether they truly want to be in public office.

Nevertheless, I’m uneasy with the underlying tone of “gotcha!”, the implication being that mental health issues are the damaging equivalent of a skeleton in the closet that should be dragged forth and revealed. And where, I wonder, do we draw the medical privacy line for candidates for public office?

I’ve been following the discussion at David Brauer’s media blog at MinnPost, where the issue has ripened into a contentious brew of politics, mental health, media ethics and privacy rights. Brauer asks: “Why should mental health questions be off limits if we wouldn’t bat an eye when candidates are asked for their traditional health histories?”

A sample of some of the comments:

- “Politicians are human beings with faults and frailties. It would help society in the long run to realize this, and not to demand some superhuman strength as a precondition of public service.”

- “As someone who feels most of the public can’t adequately understand the most primary of issues, it gives me pause to think we are going to let people make their own judgment about phenomena which aren’t even deeply understood by clinicians.”

- “The stigma doesn’t come from not talking about it. It doesn’t come from talking about it. It comes from treating that element of health as different from… you know… the health of ‘normal’ people.”

- “What do you think, every elected official currently serving is the picture of perfect physical and mental health? Medical records are confidential for a reason; keeping them that way doesn’t stigmatize anyone. The invasion of privacy will not promote human dignity. If we’re all gonna start voting based on our ‘medical’ evaluations of candidates, seriously, stick a fork in us… we’re done.”

- “If a candidate ingests potentially mood-altering drugs on a daily basis, does it really matter whether the candidate is self-medicating (alcohol or some illict drug), had been prescribed Vicodin or methadone for chronic pain, or takes a combination of antidepressants to correct a biochemical imbalance? I don’t think so. What does matter, it seems, is the moral judgment which still attaches to mental health conditions in the minds of many.”

While most of us would like to think we in the United States are understanding and caring when it comes to mental illness, the evidence all too often points to the contrary. Heiress Casey Johnson, for instance, who died last week at the age of 30, captured tabloid headlines for her outrageous lifestyle when in fact she may have been suffering from an undiagnosed – and untreated – psychiatric illness, Dr. Harold Koplewicz, a child and adolescent psychiatrist, writes in a commentary for the Huffington Post. “Regardless of the family’s income or celebrity, the stigma associated with mental illness encourages denial and inhibits the actions of those who care desperately and sincerely want to help,” he wrote.

In Britain, you can’t serve on a jury if you have a history of mental illness. Stigma also has been an issue in the U.S. military, where many service members are unwilling to seek help, even when they need it, because they fear being perceived as weak.

For what it’s worth, I think it was courageous of Mark Dayton to go public. It has put the issue squarely on the table for open discussion. Whether we’re ready to have a constructive discussion about it, especially in the highly charged political arena, is another question altogether. It’s true that we’ve made some progress; 25 or 30 years ago, an admission like Dayton’s could easily have spelled the end of his political career. But we clearly have a considerable way to go yet.

For more information on how to reduce the stigma surrounding mental illness and mental health, visit these online resources provided by the Minnesota affiliate of the National Alliance on Mental Illness.

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