The mental health stigma

You don’t look depressed. Chances are if you struggle with depression you’ve heard that once or twice, or dozens of times on a seemingly never ending loop. If you have a broken bone you can be diagnosed via an x-ray or CT. If you have cancer, there are blood tests or MRI scans that can catch it. If you get sick, rapid tests or PCR will tell you if it’s COVID. But how do you diagnose depression?

Depression and other mental health issues don’t have the same quantitative diagnostic test that you get when you have a medical scan or any sort of bloodwork done. Instead we rely on qualitative tests to diagnose mental health issues. Since it’s a qualitative measurement there are a lot of problems with the way these tests are performed and more importantly, they aren’t seen in the same light as say an x-ray.

Thus finding mental health care can be challenging if not impossible in some cases. In the US for example, mental health care can be spotty, more so than regular health care and we live in a country where teeth are considered a luxury. The sad truth is there are a lot of people sitting in prison right now who are there simply because they are “crazy.” They have mental health issues that, left untreated, resulted in some sort of violent or illegal behavior.

I haven’t told this story in awhile, but I had a friend who lost an eye. He lost it because his brother tried to kill him. His brother was a paranoid schizophrenic who went undiagnosed until he snapped. Now people with mental health issues generally aren’t violent people, but there are exceptions to every rule. It’s not the brothers fault for having mental health issues, it’s the system that is the problem.

Even though my friend understood and forgave his brother the state pressed charges and he’s been in prison for the last two decades. Because my friend was the one hurt, he cannot legally see his brother so they only communicate through their parents and letters. Ironically almost immediately after he was arrested, he was diagnosed and was given proper medication. By all accounts he’s a brilliant young man who, if he had been properly treated, would’ve gone on to live a very normal life.

I hate this story because it demonstrates that need for mental health care and the use of the prison system to remove “less desirable” people from society. Drunk drivers, who mind you have full control of their actions, are treated more leniently. In fact, there are a lot of different crimes that are treated completely differently, rape for example is an incredibly violent crime and yet in most cases gets treated like nothing. Yet we as a society have little qualm with locking away someone who’s dealing with mental health issues. Partly because they are deemed to be less valuable to society and partially because that’s how the system has been designed to operate.

I think part of the problem is that a proper diagnosis can be so hard to get. Even with proper diagnosis treatment can be difficult. People are squishy, what works for one may do absolutely nothing for another. Or worse, starting a new treatment will cause serious side effects. For those with access, mental health professionals are doing the best they can to poke the brain just the right way to fix the problem, but for complex cases like depression for example, treatment can be lifelong with minimal or no result.

On one hand a way to test that would give a quantifiable measure of depression or whatever issue is going on mentally would be a boon in “proving” to the general public that it’s a real thing. To be clear, depression is a real thing, it isn’t just a mood issue, it has very real physically measurable impacts on the brain.

As I tend to point out, depression eats you alive, quite literally (more here). Depression, anxiety, PTSD, etc. these are all very real things that can have profound and, often times, measurable impacts on the brain. The problem is that these effects are, often times, only measurable after decades of suffering. Even then, you need to specifically know what to look for and it has no bearing on treatment or even a new diagnosis.

Then there’s the stigma of mental health to contend with. The “you don’t look depressed” as if there would be a label that pops up on my face to show I’ve hit the clinically depressed threshold. Or those who believe that mental health isn’t a real thing, that it’s “all in your head.” But I like to contend that all of your existence is in your head, pain is in your head, hunger, love, happiness, stress, all in your head. Your favorite color, it’s just in your head. That’s the point, we’re bound to the existence we have IN OUR HEAD. So of course mental health is all in your head, so is every damned thing else.

Most days I can barely hang on to the thought of living. Every day is a struggle just to not kill myself, but I manage. I’m not alone in living like this and I have a sad feeling I’m not even that rare. There are serious issues with how we deal with mental health in the world. From throwing people into prisons and ruining their lives, to gaslighting people into believing the problem is the way they think and not something physical. The point of this post isn’t that a test would fix all these issues, in fact I think being able to quantify mental health like that may (will) have its own very serious problems.

The point is simple. Being “crazy” is not a crime, or at least it shouldn’t be. Having mental health issues doesn’t make someone less than and it doesn’t mean they don’t deserve treatment for the issue like you would treat a diabetic or someone with cancer. I doubt I am going to change very many minds, but if others aren’t going to speak out for us, it’s important that, when we can, we speak out for ourselves.

Because there is a mental health stigma and that won’t change until we have the uncomfortable conversations so many times that they stop being uncomfortable. In short, mental health care is health care.