Destigmatizing Mental Health

We're talking about the stigmatization about mental health, because let's be real, everybody is a human being and everybody has mental health problems.  In this transcribed episode of The Shrink Think Podcast, Aaron and Nathan discuss how we can work together to de-stigmatize mental health.

Aaron Potratz:
We have been talking about mental health, all the different types of therapy that are out there, just kind of some of the most popular ones. We didn't cover all of the range of them, but we want to continue the conversation about mental health. And today we're going to be talking about the stigmatization about mental health and how we can work together to de-stigmatize mental health. Because let's be real, everybody is a human being and everybody has mental health problems. According to the DSM, you can look up any diagnosis and, like a hypochondriac, "Oh no, I have this, I have a tick. Or I've got trichotillomania." That's the one I always like to talk about. You can look that one up.

But we want to talk about how did we even get here in terms of mental health being stigmatized and then what can we do about it? So Nathan, get us started. How the heck did we get to this place where, in my opinion, normal, everyday human kinds of things are stigmatized. And of course, there's some wild disorder kinds of things that are out there as well and that we deal with. But how did that stuff get stigmatized in the first place?

Nathan Hawkins:
Picture it. Back in history, 19 something or other. I talked to you before about, we talked a little bit about psycho-analysis with Freud a long time ago. Well, back in the day, and this has been true, by the way, all throughout history. This is not like, "Oh wow, I guess now we have mental health. Before everybody was fine."

Aaron Potratz:
We discovered mental health, it now exists.

Nathan Hawkins:
Right. Before it was, we didn't know what stuff was and they would take people and just put them outside the village or outside whatever the city like, okay, see ya. And these people would be kind of your homeless folks that were just vagabonds, walked around...

Aaron Potratz:
Transients or whatever.

Nathan Hawkins:
Yeah, back in the way old days. And so it got to the place where, of course, society's come together, people are living closer together. Where are they going to go? Family members are trying... I mean everybody, these loved people that are having significant problems and you take them to the doctor. Well the doctor was like, "Yeah, I don't know what to do about that. We're going to put them in an institution and we will figure it out." So back in the day, there's a lot of experimenting and that's where all of the older words, like you're insane because it was an insane asylum. That's what they were called. And crazy and those different words, that word crazy actually doesn't do anything for me to be honest. That's kind of another thing. But my point is that it is not really a very good descriptor of any of the diagnoses that are out there.

But at any rate, a lot of what they were dealing with, imagine somebody just has a disease where their mind is not all the way there. And so they're running down the street naked yelling about being aliens or something that are coming and landing or they have superpowers or whatever. Some of you out there may have some of that going on. And I'm not saying that that's... I mean it is an actual disease is my point. What are you going to do with that? If you have no idea what that is, that sometimes is called schizophrenia. I mean there's other ways that you can get to that. If you have a drug overdoses and there's other pieces to the pie that you have to figure out what exactly is going on, but we're just going to move all the way to an actual mental health disease of, for example, schizophrenia. They didn't know what that was and the person won't stop. They don't go to bed and then wake up and are fine.

Aaron Potratz:
And it's like an all of a sudden thing as well, it's like this person, if it was somebody who had a psychotic break, for example, sometimes it's like this person was fine for a while and then boom, something happened and then now you're really different. Can't you just go back to how you were? They're just all kinds of unknown, unexplainable kinds of things that were happening.

Nathan Hawkins:
People are trying to figure out how to help somebody get back to quote unquote "normal." And then there's folks who are abnormal for having a psychotic break that seems consistent and will not stop for months. That's very much on the extreme. But they didn't have a clue what to do. So these people are having these weird behaviors from a society standpoint. And also to the people I've talked with. I work with schizophrenia, those folks don't like it either. Why would you like it?

Aaron Potratz:
I don't like being schizophrenic. Wow, what a shocker.

Nathan Hawkins:
Right?

Aaron Potratz:
I also don't only having one arm.

Nathan Hawkins:
Right? Yeah. Horrible. So, they basically didn't know what to do because they didn't know what that was back then. They put them in this place and then that was it. But if you were a person who watched that go down and watched that happen, the only people that go work on their mental health, at that point back in the '50s, were people that were extreme. Because you were dealing with your stuff, bro, this whole thing about anxiety wasn't a thing back then.

Everything only got dealt with in the extremes. As things moved forward, we have diagnoses like anxiety and these different things, depression. And so now people come in more often. So a large part of the stigma is age related. If you know folks that are older, grandma and grandpa for example, they were around during the time when the only people that went to get mental health were in the extreme. So they did not want to be associated whatsoever with that because they don't want to be like, oh my gosh, I don't want to go to that person. I am not like that other person that just ran down the street naked. I am not that guy. So I am not going to say I'm getting mental health help because people be like-

Aaron Potratz:
Are you crazy too?

Nathan Hawkins:
-I didn't know that you ran down the street naked.

Aaron Potratz:
Yeah, right. Oh, so you and Jimmy later, late at night, this is what you guys do. You're crazy town USA kind of activities, okay.

Nathan Hawkins:
Right? But if you're a millennial listening to this or younger or even a little bit older, you can understand what I'm saying. And you're also probably saying, this is not the way it is. I'm fine with this. They're literally listening to this podcast. So you're like, I'm okay, I'm your audience, just don't even talk about stigmatization because there is no stigma. Oh yes, there is. It's still there. And actually that's the other side of the coin. So the other side of the coin is now people go to therapy quite a bit like you go to your dentist and they kind of brag about going to therapy and that kind of thing. So at any rate, we've got just another side of that coin.

Aaron Potratz:
Let me add, as I was thinking about stigmatization, I think that's kind of some of your everyday, this is just happening out in public. There's another element to this that is really massive now and that was massive at the time, and I don't know if people realize the impact that it would have, but with the invention of the media, you have TV, movies, that kind of stuff. Those kinds of things coming out where now we can be in each other's homes essentially. You know what I mean? You might have somebody in your community with some mental health problem and they maybe they're living at home, they've got a doctor visiting or they're in the hospital, but it's pretty much sectioned off to that community. If you're not privy to that or if you're not connected to that community, then you might not really know about this stuff.

And so everyone is more disconnected from those kinds of things in general as a whole. Everyone lives in their own little community and that's what it is. But with the prevalence of the media, people could then watch movies and TV shows and they were trying to come up with entertaining and maybe even some everyday kinds of things for people to watch. And so you got things, people making movies and TV shows about mental health issues. Some of it was crazy, before they really understood things, it would be wild and wacky things, people doing wild and wacky things. I think probably that contributed to a lot of the stigma as well. Some of it, I don't know, I haven't studied it, but I don't think a lot of it was intentional. I think a lot of it was just, it's funny, it's entertaining, it's wacky, or this is the kind of thing that happens and we don't really understand it, so we're going to just portray it. But in doing so, I think it really was not very sensitive or mindful to hey, this is an actual issue that somebody has that might need some help and some treatment because that's not really the way people thought about it back then.

Nathan Hawkins:
Well, and that a large part of what I was trying to get at is that we just didn't understand it. We just didn't know. We didn't know anything. And so lot of even the words that we have these days are built from the negative words is what I'm saying. Stuff that's used as a mean thing to say. For example, moron, idiot, stupid. Those words literally were categories on the first Stanford Benet intelligent quotient tests like IQ tests and how people are, how kids are, they'll look at those words and then they use them to make fun of their friend. When their friend says something that's doesn't sound smart or doesn't sound whatever, they'll be like, oh, you're just stupid or whatever. And so now we get older, and this is a little bit of a bug for me and I'm not going to go on long about this whatsoever, but what we do as a community is we just essentially change our language and then therefore it's fine.

So people get offended by this language and like, oh, we got to change it. Well, it just keeps changing. All that'll happen is whatever you change it to will become the stigmatized object again and then we'll have to change it again. It's kind of this rotating door. But that's what we do, I think as humans as we make fun of what we don't completely understand. And one of the things as therapists is these folks come in the room and now you need to help them. So back in the day, these folks were studied. Now, because long-term stuff still happens, treatments that still goes on in state hospitals. But the difference now is that the majority of the time we can understand, we actually already know what they're struggling with and we work from a perspective to treat them. But before it was, we don't know what's going on here.

And there's so many different ways that, for example, we've talked about schizophrenia. There's so many different ways for that to present itself that you start looking at different symptoms and trying to check boxes. And then another person comes in who is acting kind of the same way, but does things different. So is that the exact same thing or is it different? And you can imagine that they're just trying stuff. And then of course movies like you were saying, Aaron, pick up on this and are making insane asylums creepy and turning those into Halloween movies of some sort. And now people are like, whoa. And they're looking at that hardcore and still, it's even been more recent that things have been more normal, kind of what I was getting at the other side of the coin. Because the other side of the coin is if you go to therapy a lot, it's popular, it's stigmatized in that way. But you might be of the friend group that looks at the person and goes, yeah, you've been going to therapy for three years. I don't really know any difference in you whatsoever. You always say something, "I guess I'm going to have to talk to my therapist about that."

Aaron Potratz:
Right.

Nathan Hawkins:
I'm not going to therapy because it's not doing you any good.

Aaron Potratz:
And I think all of those things, when you put those together, you have this kind of rolling evolutionary, we don't really know what it is, but it is what it is and we're just kind of going with it. And then people pick that up and it's the kind of cultural thing that if you're not really paying attention, which most of us aren't, I think nowadays maybe people, we've got our finger on the pulse of society and culture, maybe even a little too much. But back then it was just like, there was no... You're just an American. You live in this country and you're American, you're self-sufficient, you're trying to work the American dream. And anything that's out of that ordinary is just weird, is strange. We don't know what it is and we want to understand it. We want to observe it, research it, poke the bear and then jot down some notes and research about it. And nowadays, I think it's a whole lot more humane. But the point we're getting at is that's where we came from. It's kind of like before technology, before brain scans and all this stuff that we could do to test the body and the brain and scan everything to understand what's going on, you just had your two eyes and your ears and you can be like, wow, that's abnormal. Let's call it this or that.

Nathan Hawkins:
Let me just say one thing. I want you to think of what your thought is when I say put electrodes to your brain and then we're going to turn on electricity, we're going to call that electroconvulsive therapy. Just notice what you think about that. Would you ever do that? Would that be something that you would think was a good idea? Or what would you think of somebody that had that done? Yeah, so back in the day they did that, they did get some results actually. Now, to be honest, if that was not so stigmatized, it would be more of a main treatment. Because what they have been able to do, they now know in a lot of different circumstances where to put those electrodes on your brain, how many millivolts to use and for how long in order to stimulate different parts of your brain. So it is actually still used to this day, shocker. But it is.

Aaron Potratz:
Unintended, shocker.

Nathan Hawkins:
Yes, that is way more awesome than I wanted it to be. But that's still because it's so stigmatized, it's really only allowed to be used in extreme cases when nothing else works. But it has effects on depression where people will get this treatment and then they will not be depressed. Literally it's over. They're not depressed for six months at a time and then they have to go maybe back and get another one or that kind of thing. But my point is we've gotten very good at these things, but stigma literally is holding this back.

Aaron Potratz:
Yeah, there's another one I think of that we hear all the time, Nathan, as soon as I say this, I know you're going to be kind of rolling your eyes at it, but you have your typical relationship scenario and maybe it's a married couple and they're talking about their relationship, they're talking about each other. They're arguing, blaming one another, and inevitably he says, "Yeah, she just is doing this and is one way this day. And then the next day she's all over the place and then the next day she's fine. I think she's bipolar." Right? Bipolar is this wacky, insane, you're completely unstable, erratic sort of a thing. And then she'll say something like, "Oh yeah, well everything that he does is all about him and he can only think about himself. I think he's a narcissist." Those are a couple of the common things that we hear.

And statistically I can't recall about bipolar disorder, but something like narcissism is a very small percentage of the population, one to 3% or something. It's very, very small. So if you happen to be with somebody who is an actual narcissist, then congratulations, you've hit the lottery in terms of the percentage of the population. But that's a great example of how we describe things that might be very normal. But we put these stigmas on them because they just seem abnormal to us and we don't know how to understand them except with a label. So with bipolar disorder, it's the situation where somebody is having emotions, they're upset, they're responding to something. They might be having normal human emotions, but because we don't understand them, we call that crazy and bipolar, up and down, erratic. Or somebody who is trying to defend his own perspective, or maybe he is more self-centered than you are because that's not understood or because you don't value it.

We slap the label of that's a narcissist rather than somebody might have selfish tendencies or be self-absorbed or self-focused. Those kinds of things, we all have those to some degree. And so we want to destigmatize those and accurately call people who actually have bipolar disorder or schizophrenia or narcissism, call those people in those situations, what those are, and then call every average everyday folks' experiences what they actually are as normal and average and typical. And I think that will help take the stigma out of it. So let's transition from how things got stigmatized to how can we actually destigmatize the whole idea of mental health, first thing that people should do.

Nathan Hawkins:
Well, I mean it's obvious. I think you just listen to this podcast, the Shrink Think podcast indefinitely. Start at the beginning.

Aaron Potratz:
And where can people find out about this said Shrink Think Podcast, Nathan?

Nathan Hawkins:
I think it's shrinkthinkpodcast.com, Aaron.

Aaron Potratz:
And is it available on all the current smartphone devices?

Nathan Hawkins:
Yes. All of the different smartphones, anywhere where media can be listened to, you can listen to my sweet voice.

Aaron Potratz:
And that will help destigmatize mental health.

Nathan Hawkins:
Yeah, I mean the biggest thing with destigmatizing I think is largely education, but that doesn't mean you need to go to some class on it. Because that's really weird.

Aaron Potratz:
Everybody should get a master's degree in mental health.

Nathan Hawkins:
I think one thing you need to do is check yourself a bit. One of the things that's true is that we have developed accurate details for diagnoses and symptomology. So the mental health world out there has got actual criteria. So just because a diagnosis is popular and you kind of think you've heard it before and you've kind of thought, oh, that makes sense, bipolar is a great one. It seems like, oh, that person changes emotions. They're probably bipolar. But you're smarter than that, you're like, no, that's not totally what it is. But if I notice they do that a lot, then I'm going to call it bipolar.

Aaron Potratz:
Right. Or if I don't understand why that must be bipolar.

Nathan Hawkins:
So I would just challenge you to say, no, it's not. You're not a clinician, you don't know. And that's fine. Oh, I know WebMD, that's it. I'm going to WebMD. I'm going to figure this out. I freaking knew they had bipolar. They've had this for six months. Yes, check the box. They've had it for six months.

Aaron Potratz:
And they have hyperthyroidism now too as well.

Nathan Hawkins:
Right. The thing of it is that, just think of it this way. We explained how this stuff happened, the stigmatization. Well, as we started figuring stuff out, we've looked at all this crap quite frankly and had to figure out criteria in order to call it whatever it is, spent at this point, the mental health field, it's been decades. Actually, you could argue over a century of trying to figure this stuff out. When you casually have a relationship with your friend and then look at a name or whatever, what it is, a bipolar, whatever it is, and then you're like, "Oh, freaking A, I know five people with that." No, you don't. And if you do, your friend group is interesting.

Aaron Potratz:
Yeah, or you're a therapist like we are. But you actually do know five people that five of your clients.

Nathan Hawkins:
Yeah. Which could be a thing. So some of it is just check yourself, just be realistic. You don't know any more about that than I knew than I do about engineering. I can build stuff in the back of my house, but I'm not going to sit there and do the calculations for a weight limit type of a thing. I just got to be honest with it. So a lot of this is accurately depicting what you have to deal with, or not what you have to deal with, but what you see in media. And they're actually doing a pretty good job in media these days.

Aaron Potratz:
Yeah, there are a lot of, as I was preparing for this, I was looking up some different movies that have come out recently on the subject. Because I think people are really trying to destigmatize mental health and portray it maybe in a more accurate sense or in a sense that can give you more compassion. There are a lot of them out there. I wanted to stick with more recent ones that I have seen and that I know about. For example, Silver Linings Playbook was one of those, A Beautiful Mind was a great one with Russell Crow. That one was schizophrenia, if I remember right. Lars and The Real Girl, great movie. The guy from The Notebook is in it, I can't remember his name. In fact, I don't want to remember his name because frankly I'm a little jealous. He's got a beautiful head of hair. And then As Good As It Gets is another one, it's a little bit older movie, but that's the one with Jack Nicholson and OCD.

Those kinds of movies do a great job of depicting kind of the human side of these disorders. Oh, there was another one too, The King's Speech that I was thinking of. That's where this guy had a stutter and they show how he goes to therapy. I think he privately goes somewhere to get some therapy around his speech therapy, but the idea is great because he got some sort of issue, some hangup that is keeping him from being able to talk smoothly that he works through. And I love that kind of stuff because that's ultimately the real human experience with these disorders. Some of them, like a bipolar disorder or a schizophrenia, are actual chemical issues in your brain, in your body where it's like there's nothing you can do about it. You can't just act normal. Or the Tourette syndrome, it's literally a neurological disorder, meaning there are messages that are firing inside your body that you cannot control, you cannot stop, that are sending you messages to twitch your body or to say things out loud, make sounds or whatever.

These kinds of things, we just need to have some compassion on people with these issues that it's not something that they can control. They want to control it, they wish they didn't have those things as well. And so if we can have some compassion for them, part of that will destigmatize mental health. But then also some of these movies that depict people with normal human emotional experiences like grief, I think that was the thing with Lars and the Real Girl, this guy had dated a woman and she broke up with him and he was grieving basically and he was grieving through some blow up doll person that he was attached to. That kind of stuff is like, okay, it might seem a little bit weird, but when you actually watch the movie, you can understand how somebody can go to that length or do that kind of a thing in order to cope with some real normal human experience of things that we all go through.

Nathan Hawkins:
The one thing that will destigmatize you is having a family member go through something that's actually real, meaning they do have a diagnosable disorder. It becomes this kind of a deal where you're like, but they're normal. I mean they do have this thing. And that's kind of what destigmatization is. It's realizing we all have something. With that I would encourage you, some of the stuff that's out there, you might have a friend or whatever that their child has autism or you have a friend that has something else going on and then you start listening and you're like, okay, I actually have similar stuff with that. Why are you getting treatment and I'm not? Meaning, why do you need it? I think I do fine or whatever. I would say what you need to do is be curious. A lot of this is realize that you've probably made quite a bit of assumption because we do that as humans by the way, and I'm not coming at you for that because everybody does that, has some assumptions. And all I'm saying is check it out and be curious and compassionate for what the other person's going through.

Because if you actually come to them from the place that you don't know, you are not pretending to know and you're just asking a question, a lot of times these folks going through this are alone. They don't want to talk about it because they know you're going to have a list of assumptions as soon as they start talking and you're going to probably be wrong because these disorders are experienced differently by different people even though the symptoms are similar. And one of the reasons, actually, the reason Aaron and I are even talking about this in the first place, at this point, is we were at a restaurant talking about podcasts and the server came up and asked us, servers do their job, and Aaron brought it up, said, "Hey, what would you ever want to know about the podcast, mental health type of stuff and relationships and that?
She said, "I actually suffer from this disease. And to be honest with you, I feel like the whole thing still needs to get destigmatized." And she was a young woman probably, I think she was in her twenties, I'd imagine.

Aaron Potratz:
Yeah.

Nathan Hawkins:
And what sticks out about that is for a younger person that would qualify as a millennial, still trying to work through destigmatizing something is kind of a wake-up call. It's like, well man, I mean we already kind of... Then again, I'm like, well, I guess I've been a therapist a long time, all of this is destigmatized to me.

Aaron Potratz:
Right. In my office, this is perfectly normal.

Nathan Hawkins:
So I started thinking, wow. And Aaron's like, we need to do this baby. And so now here we are.

Aaron Potratz:
Yeah, and really, I think you talked about people feeling alone. I would say if you need help, seek help. That's one thing. If you're struggling with something, if you are not sure about something, if you would love to just talk things out, if you want to get somebody else's perspective or get some feedback on yourself. If you've ever thought about any of those things, consider talking to a therapist. And that's not just a sales pitch, but it really is. We're trying to destigmatize mental health. So if you're curious about something like that, talk to somebody. What you will find and what you will experience in those sessions is you're just basically talking about what it's like to be a person. And then secondly, I would say, take some of those interactions and share them with your friends and family members.

If they're asking, oh, you're seeing a counselor, tell me about that. And you can just share, yeah, I mean, I talk about this and what's going on and they listen and reflect things back and then they see things that I didn't see or they tell me like, oh, I didn't realize I was not in touch with my emotions. And other people were like, oh yeah, I've kind of noticed that about you. Welcome to the party. But when you can start having some of those conversations with people, like you said, Nathan, it's so interesting that when people are talking about some of this stuff, I'm like, yeah, totally, me too. I've had that same issue. Or yeah, I've wrestled with that for a long time and here's what I've been doing about it.

I'm not all the way there yet, but I've made some progress on it. You realize that there are all these different spectrums of issues that people have, and we're all on a whole bunch of them to varying levels and degrees, and so when we talk about them, it's like, oh, you're on that spectrum too. Yeah. Where are you at? Cool. You're there. I'm back here. Hey, could you help me with it? Or what's been helpful to you? All of a sudden, these things that make up being a human being are very normal, are very typical. They make a lot of sense and we can connect over them together.

Nathan Hawkins:
As we close this down, I want to tell you that, this is going to be a little bit of a chunk. We've talked about diagnosis and that kind of thing and all the different studies and research and that and that, but what mental health has turned to, I think largely because the culture, as people, we don't spend a lot of time one on one and in depth with ourself. And so what ends up happening is we might have something, we realize that we just need to talk to somebody, but we don't really want to talk to a friend about this. We kind of think our own experience is a little weird. Maybe we're a little self-critical and think we're a little off, and maybe I'll talk to a therapist, and you know what? That's totally fine.

The reason at this point, a lot of the reason or how we use diagnosis is actually to just receive insurance payment, to be honest. The mental health field has moved more to wanting to not worry about diagnosis, just come in the room. We're going to help you out, and we're just going to be another human that you're going to talk to that knows how to be a human that can be helpful to you. So that's why actually a lot of people go to therapy for a long period of time because it's the place where you can just go and you can vent and it can be all about you. So I just want to say that that's what it's for. That's what it's out there. You know what, guys? Have a great day.

Aaron Potratz:
Thanks for listening to our show. Don't forget to head over to Apple Podcasts, Spotify, Stitcher, or wherever you get your podcast to leave us a review and subscribe to our podcast so you never miss an episode.