In honor of Mental Illness Awareness Week earlier this month, Behavioral Tech trainer and consultant Randy Wolbert, LMSW, CAADC, shared his perspectives on the stigma surrounding mental illness and what he has observed throughout his career.
I have been fortunate to be involved in the delivery of mental health services since 1978, and much has changed over the years. Back in the day parents were often seen as the cause of mental illness, and mental health care was seen as palliative in nature. The pharmacological options were few and most psychotherapy was utilized on the “worried well”.
Now a days, there is better recognition of the neurobiological component of mental illness. The number of pharmacotherapy options has exponentially increased, and there is an emphasis on empirically-supported psychotherapies. Also, there is a growing recognition that recovery is not only possible, but is more the expectation than the exception. The influential rise of consumers (individuals) and families has pushed the system both professionally and legislatively towards recognition of the problem and resources towards solutions. The consumer movement has led former service recipients into the role of service providers working as peer support specialists.
I have been privileged over the years to have been personally involved with empirically-supported psychotherapies, including Assertive Community Treatment (ACT) and Dialectical Behavior Therapy (DBT). Both of these programs have a particular emphasis on building lives in the community, seeing the person beyond the illness, and acknowledging the wisdom of their goals and working towards them.
While it would be tempting to congratulate ourselves for progress made, we still have a long ways to go. Mental health parity is not yet fully realized; twenty-one states have failed to expand Medicaid leaving the poor and most vulnerable individuals with mental illness with no coverage for physical or behavioral health. The number of mentally ill in jails and prisons remains a national disgrace and the suicide rate is increasing.
Finally, there is the problem of stigma. Mental illness is still seen as a sign of weakness and that behaviors associated with the illness are intentional and could be stopped if only the individual desired to do so. As a trainer of DBT, I am still struck during workshops by participants using descriptors such as: “feeding into the drama; playing games; self-sabotage; attention seeking; upping the ante; and being manipulative.” Recipients of service are often referred to by the diagnosis (e.g., the schizophrenic, the borderline; the bi-pole; the addict) rather than as a person first who has the same desires and goals in life as everyone else. These descriptors have the effect of blaming the victim for their illness.
We all have an obligation to work on eliminating stigma. An excellent starting point would be embracing DBT assumptions and consultation agreements (Linehan, M.M. 1993, Cognitive Behavioral Treatment for Borderline Personality Disorder, New York: Guilford Press), which include the assumption that individuals are doing the best they can and want to improve, that the therapeutic relationship is a real relationship among equals, and also that the most caring thing a treatment provider can do is help people change in ways that bring them closer to their own ultimate goals. Finally, let’s all embrace the DBT consultation agreement that all other things being equal, we should all search for non-pejorative or phenomenologically empathic interpretations of the individual’s behavior; in other words, we agree to view one another’s behaviors through an empathic lens and not assume negative or ulterior motives.
Let us all strive to eliminate stigma-enhancing stereotypes regarding mental illness and continue to push for dissemination and implementation of evidence-based treatments. So, congratulations on our progress made, and know that there is still a lot of mountain to climb.
Randy’s next Behavioral Tech training will be at the Dialectical Behavior Therapy Foundational Training™ in Apple Valley, MN (http://behavioraltech.org/training/details.cfm?eid=4743.)