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Mental Illness, Romanticized

In the petri dish of polarization that we currently live in, apparently nothing is safe. Allow me to explain.  The black-and-white all-or-nothing lens through which the world is viewed by an ever increasing amount of people breeds in the social media world, primarily when political or sensational social issues are the topic du jour.  Under the premise of ‘dialog’ a predetermined conclusion is then reinforced by argument after argument and attack after attack until the day job beckons (hopefully).


Unfortunately, this all-in or all-out approach has been extended to play out with virtuous causes as well.  What starts as a meaningful mission to address a need within a community, small or large, can sometimes become a blind mission, losing the ability to see any weakness or faults in how the mission is run or the platform it was built on.  Over time it can develop a leaning to extremism to one side of the sand line. For comparison sake, any business that is unable to self reflect on what is working and what is not, instead digging their heels in to stay with their initial conceptualization without hearing otherwise, will ultimately fail.  Businesses and social movements led like this can be observed avoiding acknowledgment of any weakness or faults by doubling down via heated exchange, mudslinging, more cash investment, etc. etc. In poker there is a phenomenon referred to as the sinking ship, or Titanic syndrome, where a player who has already bet X amount on a hand will continue to add to that bet even though their hand is weak.  Since money was already invested they are holding on to the ‘sinking ship’ instead of bailing and cutting their losses. Down they go with the ship. It is unfortunate that this happens to businesses, organizations, and social movements that would otherwise be the catalyst for much good.


A recent exchange with a client highlighted a recurring theme I have seen over the years.  It is related to the stigma often associated with mental health struggles. The issue of stigma is a topic that has been widely discussed and written about.  For demonstrative purposes just imagine the expectations and reactions people have to an amputee struggling as they inch their way through a half marathon vs the expectations and reactions to someone struggling to make it to work and through the day without a panic attack or depressive episode.  Historically, they have never been looked at the same. Medical and physical challenges and limitations elicit a response that is more understanding and compassionate.


For that very reason, countless individuals and organizations have taken the torch of reducing the stigma and normalizing the struggle one faces with mental illness.  Tremendous progress has been made. We are a long, long way from shackling those with mental illness to beds in out of sight institutions hoping they are forgotten. The discussion has been brought closer and closer to the dinner table.  Even slightly above hushed tones. This is amazing. Based on what clients have shared, I wonder if on some level our progress has brought with it a cost.


The following sequence is not that unusual.  A client comes in for treatment and engages in therapy.  The therapeutic relationship builds and they become more comfortable and vulnerable each session.  They are able to share their struggles and gain insight into the mental health disorder they are struggling with. The next step in treatment is to practice skills, moving them from where they were to where they want to be.  It is at this point they come in and express a sense of guilt. “For what?”, I ask. “I don’t think I am depressed enough to be allowed to say I have depression.” or “Is my anxiety really thaaat bad? I mean there are people I know who barely work or have no friends at all!  I have 1 friend, online at least. Who am I to make myself into a victim of mental illness when others have it much worse off.” I even had a client tell me a peer had asked in a huff, “Well, when was the last time you cut yourself? I was sooo suicidal last week. My mom wanted to take me to the ER!”


On the one hand we hope these individuals do not stigmatize themselves or identify themselves by their disorder.  On the other hand this ‘comparison of mental illness’ is a huge obstacle to further engagement in treatment and impedes their own progress.  So not only do they feel terrible about themselves from the outset, now they have to feel bad about feeling bad?! Seriously?! They already believe they are not good enough and now their mental illness is not good enough either? Rock. Meet hard place.  It is almost as if we transitioned from it being a stigma to being all the rage. “So have you picked up some of the latest Depression? What meds are you on? I take 3 different meds!” “ I have been in therapy for over 4 years! My therapist is awesome.  How good is your shrink?”


Obviously I am dramatizing this to bring out a point and this is more the exception than the rule.  We can likely analyze all day as to why certain individuals would behave this way. That is for another time.  Still, it is important to stay mindful of this. The objective of the professional is to create a space where the client can acknowledge and accept their challenges. Then work to move beyond that.  It is a stop on their journey, not a destination. Not to embrace mental illness as their new identity and feel stuck there. Not feeling the need to be more ill to merit engaging in this work.  They are not their mental illness. They are human beings who are facing challenges like everyone else who hope to move forward and see a better self tomorrow. Let us hope we can be the messenger that can facilitate such a journey.

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Shmuel Fischler

Shmuel Fischler is a Maryland based clinical social worker who is deeply involved in communal work as well as clinical practice. He is owner and director of CBT Baltimore, a specialized group practice founded on Cognitive Behavioral Therapy. They work with individuals struggling with Anxiety spectrum disorders such as Obsessive Compulsive Disorder, Panic, Trichotillomania, and Hoarding. Shmuel is also Director of Outreach for CHANA, a local agency working with survivors of trauma and abuse. He initiated the Magen Yeladim Safety Kid program in Baltimore and was fortunate to steward the Boy to Mentsch program, an initiative to build healthy relationship skills among the young men of our community.