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Published on Thursday, April 3, 2008 by The Capital Times (Madison, Wisconsin)

Health System Keeps Stigma on Mental Care

by Margaret Krome

"Our family needs therapy." "My child needs counseling." "My husband and I are in marriage counseling." "I'm in therapy for an anxiety disorder."

These are among the shortest and hardest sentences for most people to utter. Last week I had to tell someone I care about, "I think you need therapy." It was hard to say and hard for my friend to hear.

Parents of children who've been in counseling or spouses who have used marriage counseling off and on for years sometimes challenge me when I say there's still a stigma about seeking emotional or psychological therapy. They say there's no social stigma, or if there is, they resolved it long ago.

Perhaps that might be true among certain professions, certain highly urbanized communities, but it sure isn't the real world in most communities I know.

Twenty-five years ago, I was disqualified from entering into the Peace Corps because I was seeing a psychotherapist. Being an advocate, I successfully framed my therapy as resulting from being a victim of domestic abuse, but really, that wasn't the whole story.

My fiance who became physically abusive had been emotionally and psychologically abusive for years prior to that, and the extent to which I allowed it reflected my own emotional history and problems.

It took therapy to bring me to mental health. But it was hard to imagine myself in therapy until my fiance became physical, and that was partly because it was hard for anyone around me to suggest it. Even getting treated required contortions by my therapist, who had to call pretty normal psychological problems by names that my health insurance covered.

It's perfectly common to hear about a political or corporate leader's heart bypass operation, their pulmonary therapy program, diabetes or cancer treatment, or even the details of their colonoscopy. But treatment for depression? For anxiety disorders and phobias? Post-traumatic stress disorder? Obsessions?

For leaders and non-leaders alike such treatments are rarely discussed, other than between close friends, in confidence, and they certainly are shielded from the public.

Thus is a taboo fed, thus a stigma perpetuated. And its consequences are predictable. Nearly two-thirds of people with a diagnosable mental disorder do not seek treatment.

The military, for all of its failings, has become visible in recognizing the problem and seeking to address it. Many soldiers fear that their careers will be jeopardized by acknowledging the need for mental health care. Will their superiors trust their leadership and decision-making capabilities if they betray their weakness?

The high rates of post-traumatic stress disorder among Iraq and Afghanistan war veterans and tragedies that are surfacing among their families have prompted the military to develop new recommendations to overcome stigmas that impede soldiers' seeking treatment.

Similarly for the rest of us, job and school applications often ask whether an applicant has ever sought "professional help for emotional or psychological problems." Even I at one point counseled a family member to get a certain kind of treatment that fell outside of that screen, fearing institutional stigmas that could haunt that person.

The health care system is a principal driver behind mental health stigmas. Rosalynn Carter, the former first lady, worked as a mental health advocate for the Carter Center in Atlanta and earlier while her husband served as governor and president. She maintains that "if insurance covered mental illness, the stigma would go away almost immediately. It would legitimize mental illnesses."

In addition to the health care system's gross neglect of mental health, fear of job loss and other consequences, stigmas result simply from a sense of isolation in our culture.

Mental health is so personal and essential to one's identity that it's hard for many people to imagine that it's subject to change, including positive change. Which means that those of us who have needed and received good mental health care should share our stories.

Bit by bit, pushing the health care system, employers, and ourselves, we can make the normal challenges of living a little bit less scary and bring the remedies a little more in reach.

Margaret Krome is a Madison resident who writes this column every other week.

© 2008 Capital Newspapers

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