Before You Speculate About Amanda Bynes’ Mental State

[Content note: mental illness, ableism]

I wrote a piece for the Daily Dot about the gleeful speculations about Amanda Bynes’ supposed mental illness.

Former child star Amanda Bynes hasn’t been having a good month. After being arrested for DUI in California, Bynes left her family and made her way to New York City, where she’s attempted to shoplift clothing twice, which she claims was a “misunderstanding.”

Bynes also gave an interview to In Touch magazine in which she apparently said that she believes there’s a microchip implanted in her brain that allows people to read her thoughts. She later made a series of tweets claiming that the interview was fake and that she will sue the magazine for calling her “insane.” Celebrity gossip websites have, of course, taken this story and run with it, speculating about Bynes’ mental health and diagnoses and treating the situation like a spectator sport.

Even if Bynes really did tell In Touch that she believes she has a microchip implanted in her brain that allows people to read her thoughts, that doesn’t mean it’s okay to call her “insane” or “crazy,” and I’m not surprised she’s angry about it. Words like that don’t just mean “displaying symptoms of a mental illness.” They connote ridicule, ignorance, and sometimes even hate.

They also place people with mental illnesses in a category apart from the rest of us, the ones who aren’t “crazy.” In fact, mental illnesses exist on a spectrum. Some people have a a few hallucinations or delusions during a time of extreme stress (or perhaps sleep deprivation). For others, psychotic symptoms are a struggle they must manage for their entire lives.

Are all of these people “crazy?” Is everyone who has ever had a random and totally irrational thought “crazy?” Is everyone who takes medication for anxiety, depression, or bipolar disorder “crazy?” Words like “crazy” and “insane” do not refer to any specific set or level of symptoms. They refer to someone we wish to hurt, ostracize, or laugh at.

How do you report a story like Bynes’ without perpetuating the stigma that people with mental illnesses face?

For starters, recognize that some things are newsworthy whether the person who did them is a celebrity or not; others are newsworthy only when they’re done by someone we’re already paying attention to—or used to pay attention to. People get DUIs and shoplift all the time, but when a famous person does it, that suddenly becomes a reason to write an entire news story. Someone having delusions is also not in and of itself interesting to the public—although, in a way, I wish it were, because maybe then people would know more about it and stigmatize those who struggle with it less.

Obviously, journalists have to make money. Sometimes that means writing stuff that sells, whether or not you personally think that this information is important to collect and provide to the public. However, oftentimes journalists—especially those who cover celeb news—shrug off all responsibility for choosing their subject matter by claiming that it’s “just what sells” or “what the people want.”

Read the rest here.

Are Celebrities Responsible for Modeling Good Mental Health?

[Content note: depression, mental illness, suicide]

My newest piece at the Daily Dot is about Lana Del Rey, mental illness, and what we expect from artists and celebrities.

Singer Lana Del Rey has recently reignited an age-old discussion about the glamorization of depression and suicide among (and in) young musicians. In a Guardian interview she has since tried to distance herself from, Del Rey focused on death:

‘I wish I was dead already,’ Lana Del Rey says, catching me off guard. She has been talking about the heroes she and her boyfriend share—Amy Winehouse and Kurt Cobain among them—when I point out that what links them is death and ask if she sees an early death as glamorous. ‘I don’t know. Ummm, yeah.’

[…] It’s unlikely that statements like Del Rey’s actually make anyone go, “Huh, maybe I should try killing myself.” However, they can be harmful because they perpetuate norms that discourage seeking help and prioritizing mental health. Del Rey certainly isn’t single-handedly responsible for this, by the way—mental illness has long been associated with artistic brilliance, glamour, and even sometimes sexual desirability. Some believe that you can’t really be a great artist unless there’s something very wrong with your brain, but I think that’s largely confirmation bias. If you think that artists must be crazy, you’ll pay extra attention to the ones that are and little attention to the ones that aren’t.

We tend to expect that when artists go through difficult times, their way of coping is to make art about it. (Neil Gaiman gave a beautiful speech about this.) Making art can indeed help people deal with all sorts of adverse circumstances, including mental illness, but sometimes it’s not enough. Luckily, some artists, musicians included, have spoken out about seeing therapy and medication when they needed it—not an easy thing to do in a society where mental illness is still stigmatized and being a celebrity means having your private life constantly scrutinized and sold as entertainment.

On the other hand, I’m also leery when celebrities are expected to be “role models” and to demonstrate positive, healthy behavior to the children and teens who look up to them. It would certainly be nice if, when interviewed about her moods, Del Rey said something like, “I’ve been going through a hard time and dealing with lots of sadness, but I’m seeing a great therapist and taking good care of myself.”

But holding her responsible for the mental health of hundreds of thousands of young people is unfair and hypocritical. Del Rey’s young fans would benefit a lot more from seeing their own parents model good self-care, but we don’t encourage that in parents any more than we do in glamorous singers. Instead, we shame people who take poor care of themselves, and we shame people who are open about seeking therapy.

Read the rest here.

Correlation is Not Causation: STI Edition

I wrote a piece for the Daily Dot about a new study on STI rates among men who hook up with men using smartphone apps, and how easy it is to misinterpret the results.

new study by the L.A. Gay & Lesbian Center and UCLA suggests that men who have sex with men and use hookup apps like Grindr are significantly more likely to have gonorrhea and chlamydia than men who have sex with men but do not use such apps. But before you panic and delete Grindr from your phone lest it give you an STI, let’s look at what the study does and does not actually show.

[…]Careless headline writers frequently mix up correlation and causation, spreading misinformation and stigma. Despite Lowder’s balanced take on the study, the headline of his own piece reads, rather alarmingly, “Study Suggests Grindr-Like Apps Increase Likelihood of Sexually Transmitted Infections.” This wording implies that using such apps increases an individual’s likelihood of contracting an STI, not that, in general, people who use such apps are also more likely to have an STI. It’s a fine distinction, but an important one.

Another important distinction is whether the participants contracted the STIs during the course of the study (while using GSN apps) or just happened to have them at the time that the data was collected. Here Lowder’s article is also unclear: “Specifically, geo-social app users were 25 percent more likely than their bar hopping comrades to contract gonorrhea, and 37 percent more likely to have picked up chlamydia.” And an article about the study at Advocate is headlined, “STUDY: Smartphone Hookup App Users More Likely To Contract Sexually Transmitted Infections.”

However, the actual study notes that the participants were tested for STIs at the same time as they were asked about their sexual behavior, including the use of GSN apps. This means that they did not necessarily contract the STIs while using the GSN apps, or after having used them. The infections could have preceded the participants’ use of the apps.

This is important because it can help untangle the question of why this correlation exists, besides the obvious hypothesis that using GSN apps can actually cause people to contract STIs at higher rates than other ways of meeting sexual partners. Perhaps people who already have STIs are more interested in using the apps because of the anonymity—it’s much less scary to tell a random person you’ll never meet again that you have an STI and need to use a condom than it is to tell someone who’s embedded in your social network. Or, on the more cynical side of things, people might feel less guilty about not disclosing an STI to a random app hookup than someone they’ve met in a more conventional way.

Or, maybe people who are attracted to “wild” and “risky” sexual situations are more likely to have STIs and more likely to use GSN apps. The common factor could be impulsivity or recklessness.

Read the rest here.

You Can’t Diagnose Mental Illness from a Tweet

Today at the Daily Dot, I discussed the strange Twitter behavior of a former Paypal executive and the predictable mass rush to claim that it’s evidence of “mental illness”:

Is Rakesh Agrawal mentally ill? I have no idea, and neither do you.

There’s a long history of using mental illness as a multipurpose scapegoat when people do bizarre, harmful, or dangerous things. Mass shootings are frequently blamed on mental illness despite little evidence, as is homosexuality, kinky sex, atheism, and, apparently, weird tweets.

This accomplishes a number of things. First of all, where the behavior is harmless to others but is nevertheless not tolerated by the public–homosexuality, kinky sex, gender nonconformity–categorizing the behavior as a mental illness gives us a convenient excuse to try to change it. Second, where the behavior is harmful but we don’t want to deal with its actual, structural causes–mass shootings, sexual assault, spending too much money–categorizing the behavior as a mental illness allows us to feel like we’re doing something to prevent it without having to ask any difficult questions about how our society may be contributing to it.

Finally, when the behavior has (justifiably or otherwise) made people upset at the person, categorizing the behavior as a mental illness packs an extra punch to the insults directed at that person. That’s because mental illness is stigmatized. It shouldn’t be, but it still is. Calling someone “crazy” or telling them to “get back on their meds” or “check into the psych ward” is insulting because being the type of person who needs medication or hospitalization is presumed to be shameful.

Read the rest here.

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Promoting Mental Health in the Workplace

[Content note: mental illness, including eating disorders]

This post was requested by Kate [not FtB!Kate], who donated to my conference fundraiser. She wanted to hear my opinion on mental health in the workplace and how employees and employers can foster a culture that values and promotes mental health. She had some of her own suggestions, which I’ve incorporated into this piece with her permission.

Work is often a concern for people who suffer from mental illnesses. They might worry, for instance, that their struggles will impact their work performance, that coworkers or employers will find out that they have a diagnosis and stigmatize (or even fire) them, or that offhand comments at work could trigger eating disorder symptoms.

I wrote about this topic much more generally in this piece, which was about how to prioritize and promote mental health in one’s community. Workplaces are particular types of communities, so a lot of this still applies. At the same time, workplaces present particular challenges to promoting mental health, as well as particular capabilities that might help.

Note that I’m writing this as a person with a mental illness, as a person who works, and as a person who observes human behavior. I’m not writing this as someone who’s ever been a manager or a supervisor, so while I can speak to what I would like to see from managers and supervisors, I don’t have firsthand knowledge of what it’s like to be one. If you have that experience and you’d like to weigh in in the comments, feel free to do so.

For employers/managers/supervisors

1. Ensure that the assignments you give your employees and the culture you foster in the office encourage and allow employees to take good care of themselves.

Every workplace that expects people to skip lunch or sleep less than 7 hours a night is a workplace that is detrimental not only to physical health, but mental health as well. Sleep deprivation can dangerously exacerbate many mental illnesses, and having to skip meals can cause people with eating disorders to relapse. Obviously this is unavoidable with certain jobs or when a big important project is nearing completion, but it’s avoidable with most jobs most of the time.

(At the same time, recognize that this is a problem with American culture at large, and companies feel pressure to pressure their employees in this way because if they don’t, a competitor will, and it’ll reap the profits.)

2. Make sure that new employees understand the health coverage they’re receiving under the company’s benefits plan, especially as it pertains to mental health.

Explain in as little legalese as possible what the coverage includes and doesn’t include, and where they can go to find more detailed information or look up specialists in their area. In my experience, many people are worried that if they see a mental health professional using their employer-provided insurance plan, their employer will somehow have access to their medical records. Emphasize that it’s none of your business as an employer what your employees do with their health insurance and that providers cannot disclose such information to you without a patient’s consent. For extra points, give a short overview of HIPAA.

Going over this information not only improves the odds that employees are able to get the mental healthcare they need, but it shows that you’re comfortable discussing mental health with employees and that your company thinks it’s important.

3. If you choose to have health-related contests at the office, focus them on fitness goals or healthy eating, not weight loss.

Personally, though, I’d avoid these altogether because many people consider health a personal matter and feel pretty uncomfortable about having to discuss it publicly and competitively. Even if the contest is optional, keep in mind that people will feel a strong social pressure to join in. Who wants to be the only person in the office who doesn’t seem to care about staying in shape?

In any case, framing weight loss as an intrinsically healthy and positive goal is harmful and counterproductive. You can weigh little and be very unhealthy, and if you lose weight in an unhealthy way, you’ll probably gain it back anyway. A better way to structure a health contest is by encouraging participants to achieve goals that are proven to be healthy and doable.

4. Make sure employees understand the policies and processes about taking time off for medical reasons (and remember that mental health is a medical issue).

It’s especially important to find a way to emphasize that mental health is just as important as physical health, and little gestures make a big difference. For example, you could say something like, “If you know in advance you’re going to need time off, like for a physical or a therapy appointment, you can submit the form to me at at least a week’s notice.” That provides important information while also implicitly conveying the fact that you consider therapy to be a legitimate reason to leave work an hour early.

For employees

1. Consider your own mental health when choosing responsibilities to take on at work.

It’s understandable, especially in this economy, to try to impress your boss by offering to do as much as possible and overworking yourself. However, good mental health should be seen as an investment. If you take good care of it, you’ll ultimately be more productive than if you neglect it and burn out.

This applies to all those little volunteer opportunities that aren’t directly job-related, either. If you have social anxiety, it might be a bad idea to offer to organize a social outing for the office. If you have an eating disorder that makes it really stressful to choose food to buy, it might be a bad idea to offer to bring snacks for a meeting. You know yourself best.

2. If you feel safe and comfortable, let your boss know about mental health issues that may affect your performance and how you plan to deal with them.

The “if you feel safe and comfortable” is the key part. I’m absolutely not suggesting that everyone can and should come out about their mental illness to their boss, since I know that in many cases that’s a really bad idea. (It shouldn’t be, but it is.) But personally, I know people who did this and found it really helpful because they were able to work collaboratively with their boss to make sure that they can get the time off they need and that they can fulfill their responsibilities rather than having to keep it a secret and try to solve potential problems on their own. Disclosing also makes it possible to receive any accommodations you may need, which brings me to:

3. Educate yourself about laws related to mental illness and the workplace.

The Americans with Disabilities Act (ADA) is obviously a major one, but so is HIPAA, which I mentioned earlier. The definition of “disability” in the ADA is intentionally quite general, but mental illnesses are included: depression, anxiety, PTSD, ADHD, and so on. Title I of the ADA concerns employment. There’s a lot of useful information in there; for instance, an employer cannot ask you in a job interview whether or not you’ve been treated for mental health problems, or which medications you’re taking. Keep in mind that the ADA only applies to businesses with 15 or more employees, however. Here’s another useful article about it.

For everyone

1. When someone asks you how you’re doing, be honest (within reason).

In the piece I linked to earlier, I wrote:

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

At work, there are obviously different standards than in other communities, or with friends and family. But even at work, there’s room for honesty and mutual support.

2. Be mindful of using language that relates to mental illness.

Casual usage of diagnostic terms (“That’s so OCD,” “You’re being delusional,” etc.) hurts people with mental illnesses by trivializing their conditions and turning them into the butt of a joke. It also makes it more difficult for people to disclose mental illnesses because it keeps people from taking them seriously. If “ADHD” is what you call it when you can’t focus on a boring project and someone tells you they have “ADHD,” you’re not going to think, “Oh, this person has a serious condition that makes it neurologically impossible for them to focus on a task unless they get treatment.” You’re going to think, “Oh, come on, they just need to close Facebook and get focused.”

3. Remember that talking about dieting and weight loss can be very triggering for people with past or current eating disorders.

Fat talk (as it’s called) is so ingrained in our culture and communication patterns that it’s hard to imagine that it could be such a serious issue for someone. But anecdotally, it seems that eating disorders in particular are very easily triggered by offhand remarks like “Ugh I need to work off this cupcake” or “My thighs are huge.” Even when not actually triggering, these comments encourage unhealthy behavior and create a social norm of dieting and preoccupation with weight loss.

I sometimes dread being around groups of women who are not my friends because more likely than not, I’m going to hear these comments. And it’s not like you can avoid your coworkers. So if you must do it, try not to do it to a captive audience.

4. Respect others’ privacy when it comes to mental health issues.

Just as you should never out an LGBT person without their permission, you shouldn’t discuss someone’s mental health with others at the office. Although I generally encourage people to be open about mental illness if they feel they can be, that has to be on their terms, not someone else’s. If you’re concerned that someone’s mental health problems are causing them to be unable to do their work, do the same thing you’d (probably) do anytime a coworker isn’t pulling their weight: talk to them about it in a kind and considerate way rather than going straight to the boss.

(An exception to this is if you’re worried that someone may harm themselves or someone else. In that case, please call 911. )

When it comes to structural issues like ableism and stigma, no community can be an island, unfortunately. There will not be stigma-free workplaces until there is a stigma-free society. But the more power you have in a workplace, the more influence yo have over its culture.

Thank you to Kate for her donation and for this prompt. 

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Some Evidence Against Shame and Stigma as Weight Loss Motivators

[Content note: weight/size stigma and discrimination]

It is considered self-evident by plenty of people that shaming fat people for being fat gets them to stop being fat. That’s why a common reaction to body/fat positivity campaigns is that they’re going to make people think it’s “okay” to be fat. As opposed to…not okay.

However, even if we begin with the presumption that it’s a net good for fat people to stop being fat, research evidence is rapidly piling up that suggests that shaming and stigmatizing them won’t work. In fact, it may have exactly the opposite effect.

In a paper recently accepted for publication in the Journal of Experimental Social Psychology, the authors provide this overview of research on this topic:

Media attention to obesity has increased dramatically (Saguy & Almeling, 2008), as has discrimination against overweight and obese individuals (Andreyeva, Puhl, & Brownell, 2008). Overweight individuals are often portrayed in the media as lazy, weak willed, and self-indulgent (Puhl & Heuer, 2009), and as a drain on the nation’s resources (Begley, 2012). Because stigma can be a potent source of social control (Phelan, Link, & Dovidio, 2008), some authors have suggested that stigmatizing obesity may encourage people to lose weight (Bayer, 2008, Callahan, 2013 and Heinberg et al., 2001), and policies that utilize potentially stigmatizing elements (e.g., BMI report cards) are becoming more prevalent (Vogel, 2011). Little evidence exists, however, that stigmatizing obesity promotes weight loss. In fact, among overweight individuals, experiencing weight-stigmatization is associated with greater reports of maladaptive eating behaviors (e.g., Haines et al., 2006 and Puhl and Brownell, 2006), increased motivation to avoid exercise (Vartanian & Novak, 2008; Vartanian & Shaprow, 2010), and poorer weight loss outcomes among adults in a weight-loss program (Wott & Carels, 2010; but see Latner, Wilson, Jackson, & Stunkard, 2009). Furthermore, experimentally activating weight stereotypes decreased overweight women’s self-efficacy for exercise and dietary control (Seacat & Mickelson, 2009). Collectively, these findings suggest that stigmatizing obesity has negative behavioral consequences that may increase, rather than decrease the weight of overweight individuals.

The paper also reviews research suggesting that the reason this happens is because of something called identity threat. When an individual has an identity that they know is stigmatized and something happens that triggers their awareness of that (such as a joke about the identity or a person who invokes negative stereotypes about it), the individual may experience negative effects. Some of these are physical, such as increased physiological stress response. Some are psychological, such as feelings of shame or anxiety. The person may try to act in ways that “compensate” for the flaws others may perceive in them or avoid situations in which people might think poorly of them (for an overweight person, this may include eating with people or going to the gym).

In theory, all this stress, anxiety, and effort depletes cognitive resources available for other activities that require what is known as executive function–mental tasks such as regulating emotions, setting goals, using short-term memory, and so on. Research has shown that when people of various stigmatized categories are reminded of those stigmas and stereotypes, their cognitive performance on a variety of tasks worsens.

The researchers in this study hypothesized that feeling identity threat would decrease participants’ ability to subsequently regulate their food intake. Specifically, they tested whether or not exposure to news articles about weight stigma would actually increase the amount of calories participants consumed. They believed that the participants who would be most affected would be those who believe themselves to be overweight, regardless of their actual weight, because they would be the ones who would feel identity threat when reminded that weight stigma exists.

The participants were 93 female college students (45% White, 24% Latina, 18% Asian/Pacific Islander, 3% African American, 10% other races). Prior to the study, they had filled out a survey that included a few questions about weight (the rest were just there to hide the purpose of the survey). When they arrived at the study, they were told that the purpose was “to examine correspondence among verbal, nonverbal, and physiological signals.”

They were randomly assigned to one of two conditions. In the test condition, they read an article called “Lose Weight or Lose Your Job,” which was compiled from actual news stories and described the discrimination that overweight people may face in the workplace. In the control condition, the participants read a nearly-identical article that was about smoking rather than weight.

Afterward, they were led to another room and asked to wait for the experimenter to return. The rooms had bowls of snacks that had been weighed prior to the study, and the participants had the opportunity to eat some of the snacks while they waited for 10 minutes. They were then asked to return to the previous room to complete a final questionnaire.

One of the measures on the questionnaire was called “self-efficacy for dietary control.” Self-efficacy refers to one’s sense of having the ability to do something and control one’s outcomes in that domain. This particular measure assessed the extent to which participants felt they could control their eating, avoid unhealthy foods, and so on. Various studies suggest that having a sense of self-efficacy is more important in terms of actual behavior than other factors, such as believing that the behavior is healthy or important. (For instance, here’s an example involving elderly people and exercise.)

The results were pronounced. In the weight stigma condition, women who perceived themselves to be overweight ate significantly more calories than those who did not perceive themselves as overweight. In the control condition, there was no significant difference:

The interaction between perceived weight and article type.

The interaction between perceived weight and article type.

Furthermore, women who perceived themselves as overweight had significantly lower self-efficacy for dietary control in the weight stigma condition than in the control condition, while women who did not perceive themselves as overweight actually had higher self-efficacy in the weight stigma condition than in the control condition.

This means that, within the context of this experiment, women who perceive themselves as overweight increase their food intake in response to hearing about stigma against overweight people and feel less capable of controlling their food intake. The very people being targeted by this information in ways many people think are helpful are actually being harmed by it, not only in the obvious emotional sense but even in their ability to control what they eat.

One really notable finding in this study is that actual weight did not correlate with either calories consumed or self-efficacy in either condition. Perceived weight was the relevant variable. I’ve often heard people argue against the body positivity movement because but if fat people don’t think they’re fat then how will they ever stop being fat?! Ironically, the women who did not perceive themselves as overweight had higher self-efficacy in the weight stigma condition than in the control condition.

One weakness of this study is that it is unclear whether or not the participants who increased their food intake did so consciously–or deliberately. If it was unconscious and not deliberate, then this finding may fit with previous findings about identity threat. If not, it’s still an important finding, but it’s probably easier to get people to change mental processes that are conscious and deliberate as opposed to those that are subconscious and unintentional. It’s also possible (though probably unlikely) that the women in the weight stigma condition purposefully ate more as a sort of symbolic protest. Oh, you’re going to fire me because of what I do with my own body? Well, fuck you, I’ll eat as much as I want.

Another limitation is that the type of stigmatization invoked in this experiment isn’t quite what overweight people might actually experience in their day-to-day lives. While articles like the one used in the study are common, the idea behind stigmatizing people so that they lose weight is usually more direct: for instance, telling them they need to lose weight, penalizing them for being overweight, and so on. Telling a study participant that they’re fat and ugly and need to lose weight would probably never pass an IRB review, but it would be a more naturalistic scenario, unfortunately.

While the sample used in this study is more racially diverse than many other samples in psychology studies, that really isn’t saying much. The researchers did not discuss any racial disparities in the data, but that would be an interesting direction for future studies. Also, all of the participants were young women, so it’s unclear how well this generalizes to older women and men of all ages.

With research like this, it’s important to remember that the findings should be interpreted much in the way that the statement “consent is sexy” should be interpreted. Namely, you should get consent because it’s the right thing to do, not because it’s “sexy.” Likewise, you should refrain from shaming and stigmatizing fat people because it’s the right thing to do, not because shaming and stigmatizing them doesn’t work anyway. Activists rightly criticize research like this for suggesting the implication that we should stop shaming fat people because it doesn’t get them to lose weight, rather than because it’s a shitty thing to do. That said, I don’t think that’s an implication that the researchers mean to give. We should conduct, support, and read research about how human motivation works (and how everything else works) because it’s important to know. This is just one piece of that puzzle.

It is my hope, though, that studies like this will work where “don’t be an asshole” won’t. The most important thing to me is for people to stop stigmatizing and discriminating against fat people, whatever the reason they stop doing it, because it’s harmful and needs to stop. Then maybe we can make these people understand why they were wrong to do it.

However, this research also opens up a lot of tricky questions. If shaming people who are overweight did actually help them lose weight, would more people think that this is an okay thing to do? If shaming people who do things that most of us would consider Definitely Bad, like rape or theft or even saying racist things, worked, would that be okay to do? Many would probably say yes to the latter but no to the former.

What is clear, though, is that human motivation (and reasoning in general) often works in ways that seem counterintuitive. You might think that people would respond to the stimulus of “being overweight can cost you your job” with “well I’d better stop being overweight, then!” But that’s not necessarily the case.

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Major, B., Hunger, J.M., Bunyan, D.P., Miller, C.T. (2014). The ironic effects of weight stigma. Journal of Experimental Social Psychology, 51: 74-80.

Small Things You Can Do To Improve Mental Health In Your Community

[Content note: suicide, mental illness]

A few weeks ago Northwestern lost yet another student to suicide. There’s been pressure building all year for improved mental health services on campus, and I think that pressure will soon culminate in real, helpful changes on campus.

At the same time, some have been saying that what we need is not better mental healthcare services, but changes in campus “culture,” such as a reduction in the stigma of accessing mental healthcare and an increase in our willingness to discuss mental health which each other.

I don’t think that these things are mutually exclusive; I think we need both. People whose troubles are relatively minor will benefit from increased openness about mental health on campus without needing any improvements in mental healthcare, but those who suffer from serious mental illnesses–the kind that can contribute to suicide–need more than just supportive friends and professors. They need treatment. Right now, it’s becoming clear that many of those people are not getting the help they need.

Echoing these debates, a blog run by Northwestern students called Sherman Ave posted a piece called “A Reflection on Death, Privilege, and The College Experience.” (Sherman Ave usually sticks to humor, but this time it poignantly diverged.) The author wrote:

In writing these words and thinking these thoughts, I do not believe that a “call to action” here ends in throwing more money toward psychological services. As much as I believe that funding of psychological services at this university should be increased, I would hesitate to claim that another few thousand dollars would have stopped Alyssa Weaver and potentially Dmitri Teplov from committing suicide. Rather, I encourage everyone reading this article to think carefully about the state of those without the privilege of stable mental health.  We should seek to sympathize with members of our community instead of ignoring them for the sake of convenience. If we have the tremendous power to come together in grievance of a lost classmate, then there’s absolutely no reason we shouldn’t be able to show the same love and solidarity for that classmate before they give up on our community.

And a commenter responded:

I agree with the need to come together to “show the same love and solidarity” to members of our community who need or want support and communication from others, but what does that practically mean? I find myself asking–how can I, as one person, contribute to a positive dialogue that moves our community towards supporting each other in the face of hardship? How do I even “identify” someone who needs my help? Or how do I make myself open to facilitating healing in my peers?

I don’t think there’s any easy answer to this. Practically speaking, changing a culture is like voting–it’s pretty rare that the actions of a single individual make an immediately noticeable difference. Westerners are used to thinking of themselves as individual agents, acting on their own and without any influence from or effect on their surrounding culture, and this is probably one of the many reasons it’s so difficult for people to even conceive of being able to make an actual impact when it comes to something like this.

You don’t have to be an activist, a therapist, or a researcher to make a difference when it comes to mental health. The following are small things almost anyone can do to help build a community where mental illness is taken seriously and where mental health is valued. Although I’m specifically thinking about college campuses here, this is applicable to anything you might call a “community”–an organization, a group of friends, a neighborhood.

1. When people ask you how you’re doing, tell them the truth.

This is something I’ve been really making an effort to do. This doesn’t mean that every time someone asks me “What’s up?” I give them The Unabridged Chronicles of Miri’s Current Woes and Suffering. But I try not to just say “Good!” unless I mean it. Instead I’ll say, “I’ve been going through a rough patch lately, but things are looking up. How about you?” or “Pretty worried about my grad school loans, but hopefully I’ll figure it out.” The point isn’t so much that I desperately need to share these things with people; rather, I’m signaling that 1) I trust them with this information, and 2) they are welcome to open up to me, too. Ending on a positive note and/or by asking them how they are makes it clear that I’m not trying to dump all my problems on them, but I leave it up to them to decide whether or not to ask more questions and try to comfort me, or to just go ahead and tell me how they’re doing.

2. If you see a therapist or have in the past and are comfortable telling people, tell them.

One awesome thing many of my friends do is just casually drop in references to the fact that they see a therapist into conversation. This doesn’t have to be awkward or off-topic, but it does have to be intentional. They’ll say stuff like, “Sorry, I can’t hang out then; I have therapy” or they’ll mention something they learned or talked about in a therapy session where it’s relevant. The point of this is to normalize therapy and to treat it like any other doctor’s appointment or anything else you might do for your health, like going to the gym or buying healthy food. It also suggests to people that you are someone they can go to if they’re considering therapy and have questions about it, because you won’t stigmatize them.

3. Drop casual misuse of mental illness from your language.

Don’t say the weather is “bipolar.” Don’t refer to someone as “totally schizo.” Don’t claim to be “depressed” if you’re actually just feeling sad (unless, of course, you actually are depressed). Don’t call someone’s preference for neatness “so OCD.” These are serious illnesses and it hurts people who have them to see them referenced flippantly and incorrectly. One fourth of adults will have a mental illness at some point in their life, and you might not know if one of them is standing right next to you. Furthermore, the constant misuse of these terms makes it easier for people to dismiss those who (accurately) claim to have a mental illness. If all you know about “being totally ADHD” is when you have a bit of trouble doing the dense reading for your philosophy class, it becomes easier to dismiss someone who tells you that they actually have ADHD.

4. Know the warning signs of mental illness and suicidality, and know where to refer friends who need professional help.

You can find plenty of information about this online or in pamphlets at a local counseling center. If you’re a student, find out what mental health services your campus offers. If you’re not a student, find out about low-cost counseling in your area. If you have the time, see if you can attend a training on suicide prevention (and remember that asking someone if they’re okay or if they’ve been feeling suicidal will not make them not-okay or suicidal). Being aware and informed about mental health can make a huge difference in the life of a friend who needs help. This doesn’t mean you’re responsible for people who need help or that it’s your fault if you don’t succeed in helping them–not at all. It just gives you a toolbox that’ll help you respond if someone in your community is showing signs of mental illness.

Learning about mental illness is also extremely important because it helps you decolonize your mind from the stigma you’ve probably learned. Even those who really want to be supportive and helpful to people with mental illnesses have occasionally had fleeting thoughts of “Why can’t they just try harder” and “Maybe they’re just making this up for attention.” That’s stigma talking. Even if you didn’t learn this from your family, you learned it from the surrounding culture. Studying mental illness helps shut that voice up for good.

5. Understand how social structures–culture, laws, business, politics, the media, etc.–influence mental health.

If you learned what you know about mental  health through psychology classes, your understanding of it is probably very individualistic: poor mental health is caused by a malfunctioning brain, or at most by a difficult childhood or poor coping skills. However, the larger society we live in affects who has mental health problems, who gets treatment, what kind of treatment they get, and how they are treated by others. Learn about the barriers certain groups–the poor, people of color, etc.–face in getting treatment. Learn about how certain groups–women, queer people, etc.–have been mistreated by the mental healthcare system. Find out what laws are being passed concerning mental healthcare, both in your state and in the federal government. Learn how insurance companies influence what kind of treatment people are able to get (medication vs. talk therapy, for instance) and what sorts of problems you must typically have in order for insurance to cover your treatment (diagnosable DSM disorders, usually). Pay attention to how mental illness is portrayed in the media–which problems are considered legitimate, which are made fun of, which get no mention at all.

It’s tempting to view mental health as an individual trait, and mental illness as an individual problem. But in order to help build a community in which mental health matters, you have to learn to think about it structurally. That’s the only way to really understand why things are the way they are and how to make them change.

[blogathon] Does Anyone Deserve to be Stigmatized?

This is the third post in my SSA blogathon! Don’t forget to donate!

Last quarter I took a psychology class called Social Stigma. Social stigma, to quote the great Wikipedia, is:

the extreme disapproval of (or discontent with) a person on socially characteristic grounds that are perceived, and serve to distinguish them, from other members of a society. Stigma may then be affixed to such a person, by the greater society, who differs from their cultural norms.

Social stigma can result from the perception (rightly or wrongly) of mental illnessphysical disabilities, diseases such as leprosy (see leprosy stigma),[1] illegitimacy,sexual orientationgender identity[2] skin tone, nationalityethnicityreligion (or lack of religion[3][4]) or criminality.

In the first class, the professor ignited a debate by asking the question, “Does anyone deserve to be stigmatized?” As examples, she used neo-Nazis and pedophiles.

We were really divided. The understandable knee-jerk response is that, yes, some people do things that are so terrible that they deserve to be stigmatized. However, I came down on the “no” side for several reasons.

First of all, there’s a difference between condemning someone’s actions and stigmatizing them. Although we may talk about certain actions as being “stigmatized,” the way the phenomenon of stigma operates is that it puts a mark of shame on an entire person, not just on something they did. When someone does a thing that is stigmatized, we don’t just think, “Oh, they’re a good/cool person but I don’t like that they did that.” We think, “This person is bad.” They’re immoral or vulgar or even mentally ill (transvestic fetishism, anyone?).

When a group is stigmatized, they are considered less than human in some ways. Whichever aspect of them is stigmatized becomes the whole of their identity in our eyes, and often this means that even if they change the actions that caused them to fall into that category in the first place, the stigma remains. This is the case for ex-convicts, for instance, who are often denied housing, employment, and other opportunities simply because they used to be criminals, served their time, and are now trying to contribute productively to society.

So, stigma and social disapproval are not the same thing; there are some key distinctions between them that I think may have been lost on some people during that class discussion.

Second, there’s a bit of an idealist in me that wants to teach people why doing bad things is bad rather than just keep them from doing those things for fear of stigmatization. And I get that practically it doesn’t matter, and if the only way to prevent people from doing bad things was to make them afraid of stigma, I’d accept that.

But the thing is, if the only reason you don’t do a bad thing is because you’re afraid that people will judge you, what happens if/when you become reasonably sure that you can do it without getting found out?

Take sexual assault. Being a convicted rapist is actually a very stigmatized identity–it’s just that rapists rarely become convicted rapists. Rape is known to be a Very Bad Thing, but rapists know that they can get away with it if they commit it in certain ways. Despite the stigma, rape is pervasive and rape culture exists.

Third, what we stigmatize does not always correlate well with what is actually harmful to society. Rather, we stigmatize things for knee-jerk emotional reasons, and then we invent post-hoc explanations for why those things are harmful. That’s how you get the panic about gay teachers converting students to homosexuality (has there ever been any evidence for that?), abortion causing mental illness, same-sex couples being unfit to raise children, atheists being immoral, and so on.

We didn’t decide to stigmatize same-sex love, abortion, and atheism because they were harmful to society. We decided they were harmful to society because we were stigmatizing them. And now, even as modern science and research knocks these assumptions of harm down over and over again, bigots still cling to the fantasy that these things are harmful. That should tell you something.

Fourth, wielding psychological manipulation as punishment really, really rubs me the wrong way. The attitude that if someone does something bad they deserve to be cast out and hated and seen as inhuman scares me. I think it’s very normal and understandable to want to punish someone for doing a horrible thing, but, as I wrote after the Steubenville verdict, I’m not sure that that’s the most useful and skeptical response. I feel that our primary concern should be preventing people from doing bad things (both first-time and repeat offenses) and not satisfying our own need for revenge by punishing them.

Stigma is a blunt weapon. By its very definition it transcends the boundaries we try to set for it (i.e. condemn an action) and strongly biases our views of people (i.e. condemn a whole person). That’s why “hate the sin, love the sinner” just doesn’t work. If we are to promote rationality in our society, we should find ways to prevent crime and other anti-social acts without using stigma and cognitive bias as punishment.

~~~

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Blaming Everything On Mental Illness

The Associated Press has revised their AP Stylebook, the guide that most journalists use to standardize their writing, to include an entry on mental illness. Among many other important things that the entry includes, which you should read here, it says:

Do not describe an individual as mentally ill unless it is clearly pertinent to a story and the diagnosis is properly sourced.

And:

Do not assume that mental illness is a factor in a violent crime, and verify statements to that effect. A past history of mental illness is not necessarily a reliable indicator. Studies have shown that the vast majority of people with mental illness are not violent, and experts say most people who are violent do not suffer from mental illness.

That first one is important because there is a tendency, whenever a person who has done something wrong also happens to have a mental illness, to attempt to tie those two things together.

Some things I have seen people (and, in some cases, medical authorities) try to blame on mental illness:

  • being violent
  • being religious
  • being an atheist
  • abusing children
  • spending money unwisely
  • raping people
  • stealing
  • bullying or harassing people
  • being upset by bullying and harassment
  • enjoying violent video games
  • being shy
  • being overly social
  • being too reliant on social approval
  • having casual sex
  • being into BDSM
  • not being interested in sex
  • dating multiple people
  • not wanting to date anyone
  • not wanting to have children
  • being attracted to someone of the same sex
  • being trans*
  • wanting to wear clothing that doesn’t “belong” to your gender

You’ll notice that these things run the gamut from completely okay to absolutely cruel. Some of them involve personal decisions that affect no one but the individual, while others affect others immeasurably. All of them are things that we’ve determined in our culture to be inappropriate on varying levels.

That last one, I believe, explains why these things (and many others) are so often attributed to mental illness. It is comforting to believe that people who flout social norms, whether they’re as minor as wearing the wrong clothing or as severe as abusing and killing others, do so for individual reasons or personal failings of some sort. It’s comforting because it means that such transgressions are the acts of “abnormal” people, people we could never be. It means that there are no structural factors we might want to examine and try to change because they contribute to things like this, and it means that we don’t have to reconsider our condemnation of those behaviors.

It’s easier to say that people who won’t obediently fit into one gender or the other are “sick” than to wonder if we’re wrong to prescribe such strict gender roles.

It’s easier to say that a mass shooter is “sick” than to wonder if we’ve made it too easy to access the sort of weapons that nobody would ever need for “self-defense.”

It’s easier to say that a rapist is “sick” than to wonder if something in our culture suggests to people over and over that rape isn’t really rape, and that doing it is okay.

It’s easier to say that a bully is “sick” than to wonder why we seem to be failing to teach children not to torment each other.

It’s easier to say that a compulsive shopper is “sick” than to wonder why consuming stuff is deemed so important to begin with.

Individual factors do exist, obviously, and they are important too. Ultimately people have choices to make, and sometimes they make choices that we can universally condemn (although usually things aren’t so black and white). Some things are mental illnesses, but even mental illnesses do not exist in some special biological/individual vacuum outside of the influence of society. In fact, in one of the most well-known books on sociology ever published, Émile Durkheim presents evidence that even suicide rates are influenced by cultural context.

In any case, it’s an understandable, completely human impulse to dismiss all deviant behaviors as the province of “mentally ill” people, but that doesn’t make it right.

It’s wrong for many reasons. It dilutes the concept of “mental illness” until it is almost meaningless, leading people to proclaim things like “Well everyone seems to have a mental illness these days” and dismiss the need for more funding, research, and treatment. It leads to increased stigma for mental illness when people inaccurately attribute behaviors that are universally accepted as awful, like mass shootings, to it. It causes those who have nothing “wrong” with them, such as asexual, kinky, and LGBTQ people, to keep trying to “fix” themselves rather than realizing that it’s our culture that’s the problem. It prevents us from working to change the factors that are actually contributing to these problems, such as rape culture, lack of gun control, and consumerism, because it keeps these factors invisible from us.

People disagree a lot regarding the role of the media in society. Should it merely report the facts as accurately as possible, or does it have a responsibility to educate people and promote change? Regardless of your stance on that, though, I think most people would agree that the media should at the very least do no harm. Blaming everything from murder to shyness on mental illness absolutely does harm, which is why I’m happy to see the Associated Press take a stand against it.

That said, it’s not enough for journalists to stop attributing everything to mental illness. The rest of us have to stop doing it too.

A Handy List of Everything Wrong with Creating a Database of People with Mental Illnesses

It’s not like anyone expected the NRA to say anything intelligent during its long-awaited press conference on Friday, so I’m not exactly disappointed by what they said. I am, however, completely appalled at the NRA’s ignorance of mental illness and insensitivity to those affected by it.

Along with a few other laughable suggestions, like putting armed security guards in elementary schools, Wayne LaPierre, the NRA’s Executive Vice President, said this:

“How many more copycats are waiting in the wings for their moment of fame from a national media machine that rewards them with wall-to-wall attention and a sense of identity that they crave, while provoking others to try to make their mark.

A dozen more killers, a hundred more? How can we possibly even guess how many, given our nation’s refusal to create an active national database of the mentally ill?”

Now, I’m not sure to what extent LaPierre actually believes that this is a realistic and ethical goal as opposed to a throwaway remark intended to deflect responsibility from his organization and the products it defends. It’s also unclear how much the NRA’s leadership has discussed and promoted this idea.

However, I think it’s still worth using this example to show how ignorant these people are about mental illness, because I’m quite certain that they are not alone.

So, here’s everything I can think of that’s wrong with the idea of creating a national database of people with mental illnesses.

1. It’s redundant.

As Kate explains on Ashley Miller’s blog, mental health professionals are already required to break confidentiality and report when patients pose a clear threat to themselves or others. Rather than putting this in some sort of “database,” they report it to the people who know best how to use this information–the police. I’m not sure if LaPierre is suggesting that we create a public database of people with mental illnesses so that armed vigilantes can take matters into their own hands or what, but I think most reasonable people agree that dealing with people who have expressed the intent to harm others is best left to the police.

Furthermore, as Sarah Kliff writes in the Washington Post, 38 states already require or allow the use of mental health records in background checks for people trying to purchase guns, and the Gun Control Act of 1969 bans the sale of guns to people who have been committed to a mental institution in the past. However, that act is difficult to enforce because state reporting laws vary so much, and unfortunately for LaPierre, it is unconstitutional for the federal government to require states to report mental health records for a national database.

2. It violates existing laws.

As Kate also mentions, HIPAA (the Health Insurance Portability and Accountability Act) requires that people’s medical records be kept private. (So strict are medical confidentiality rules that when I saw a psychiatrist as a 19-year-old dependent on my parents’ medical insurance, the psychiatrist had to ask for my consent before she explained to my mom why she thought I needed antidepressants.) Creating a national database of people with mental illnesses would mean repealing or amending this law. Can the NRA summon up enough support in Congress for that?

If LaPierre intends to use this database to restrict the ability of people with mental illnesses to access to resources they need, such as jobs and schools, that would also violate the ADA (Americans with Disabilities Act), which bans discrimination on the bases of mental and physical disability. And, regardless, as mentioned in #1, creating a national database would probably not be constitutional because the federal government would have to force states to report mental health data.

3. It’s probably impossible to determine which diagnoses should be included.

Repealing or amending HIPAA would also mean deciding which diagnoses would suddenly not be subject to confidentiality. People like LaPierre seem to think that schizophrenia and bipolar disorder are the most “dangerous,” but what about substance addiction, which is highly correlated with violence? Would every alcoholic have to be registered? What about autism, which many people falsely associate with violence? And, if yes, then what about Asperger’s Syndrome, now considered a “mild” version of autism that’s on the low end of the spectrum? What about depression, which can sometimes involve psychosis?

Or, since LaPierre simply called it a “national database of the mentally ill,” should we include everybody with mild depression, social anxiety, a phobia of elevators, an eating disorder? Should we include people whose mental symptoms are caused entirely by another, purely medical illness? Should we include people who develop depression as a result of, say, cancer?

4. The list of ethical ways to use this database is very short.

Seriously, what would you do with it? Deny these people access to employment, education, and housing? Then you’d have to repeal the ADA. Surveil them? That’s a violation of civil liberties (not that our government’s great about that). Bar them from purchasing guns? As mentioned above, that’s already going on in the majority of states, and it’s one of the reasons “liberals” are trying to pass stricter gun regulations. But this is where the common argument against such regulations–that criminals will find a way to get guns anyway–can be turned right back on those who tend to spew it. It’s worth noting that Adam Lanza did not purchase his guns; he got them from his mother, who bought them legally and is not reported to have had any mental illness.

5. Most people with mental illnesses do not get treatment.

And you can’t register them in a database unless they do, obviously. One study suggests that over 60 percent of people with serious mental illnesses, such as schizophrenia or bipolar disorder, do not receive consistent treatment. This means that a majority of the people who should be in the database wouldn’t be in it, anyway.

Although the association between mental illness and violence is tiny, people with untreated mental illnesses are more likely to be violent than those whose illnesses are being treated properly (although the link between mental illness and violence is still very small). This means that the people who would be on this database are the ones who are least likely to cause anyone any harm.

In any case, the percentage of people who don’t get the treatment they need would probably go up, because:

6. It would discourage people from seeking treatment.

The stigma of mental illness and treatment already keeps many people from reaching out for help. If you know that going to see a therapist or psychiatrist could put your name on a national registry of people to be feared, stigmatized, and discriminated against, why would you do it?

Even if most of what I’ve said above about misuses of this database turns out to be a huge strawman–which I don’t know, because LaPierre hasn’t specified how he wants this database to be used and it’s important to consider the potentially dangerous ramifications–people will still worry. Even if the only purpose of the database is to prevent people with mental illnesses from purchasing guns, people will still be worried about that information falling into the wrong hands.

This, of course, is the final nail in the coffin of LaPierre’s idea. Even if nothing else that I’ve said about it were true, this point would be reason enough not to do it. Anything that prevents people from getting treatment is, by default, the wrong solution.

I already know many people who refuse to seek treatment for a mental illness because they are worried about being discriminated against if the wrong person finds out. Although the ADA supposedly protects them, it is difficult if not impossible to prove that discrimination has occurred. Those fears could grow much more urgent if simply going to a doctor and receiving a diagnosis puts your name and medical information into a national database accessible to god-knows-who.

This is what tells me that not only is LaPierre scapegoating people with mental illnesses to divert opprobrium from his own organization, but he also completely misses the point and fails to understand the first thing about mental health and treatment.

He gives away his views on people with mental illnesses when he says this: “The truth is, that our society is populated by an unknown number of genuine monsters. People that are so deranged, so evil, so possessed by voices and driven by demons, that no sane person can every possibly comprehend them.”

We are “genuine monsters” to him.

He’s wrong, of course. There are plenty of “sane” people who comprehend those with mental illnesses–researchers, therapists, psychiatrists, social workers, friends and family of those affected, and people who have recovered from those illnesses. That LaPierre personally fails to understand them says more about his own lack of both empathy and research in the field than about the supposed need to stick them all in a national database for the perusal of bigots.

It is also worth noting that in this emotionally charged statement, LaPierre fails to distinguish between people who commit acts of violence because of an illness they cannot control without proper treatment–which LaPierre wants to make it even harder for them to get–and people who commit acts of violence because they have no respect for human life and are seeking to make a political point, get personal revenge, and so on. Although violence and death, especially of children, is tragic regardless of the cause, that doesn’t mean that all violence is caused by the same type of person.

If I could make a suggestion to LaPierre, I would tell him to talk less, read and listen more. There’s reasonable disagreement to be had about how to prevent further mass shootings, but his suggestion was not reasonable. It was ignorant, offensive, and probably dishonest.