MAY PAGE 8 | Today's Patient

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ELIZABETH LINDEN

Elizabeth Linden is a retired special education teacher with 25 years of experience. She has a bachelor’s degree in Special Education and a master’s degree in Health Psychology. Liz has been an advocate for the educational needs of special education students throughout her career as well as an advocate for her own medical needs as a person with a rare headache disorder. Liz is also a Senior Anchor with The Power of the Patient Project, and her interviews are featured throughout our digital library.

The Importance of Breaking Mental Health Stigma

There has been some increase in the awareness and understanding surrounding the stigma of mental health disorders in recent years. Many people have been inspired by stories shared by celebrities such as Dwayne the Rock Johnson who has discussed his battles with depression and Demi Lavato, who shared that she has bipolar disorder. However powerful their stories are, there still is much work to be done. Somehow the message of these very influential celebrities isn’t quite powerful enough to change the pervasive negative attitudes and discrimination towards people with mental health disorders. While many people have increased their general knowledge about mental illness over the last two decades, negative stereotypes have actually grown for people with more serious mental health conditions such as bipolar disorder and schizophrenia. Even though nearly one in five adults experience a mental illness in any given year, individual people afflicted still often feel alone and isolated in their illness. Too many people are still left untreated for their mental illnesses and whether you have a mental illness or not, we should all be concerned.

The Cost of Mental Health Stigma and Untreated Mental Illness

It is in everyone’s benefit to eradicate mental health stigma and end discrimination for those with mental health disorders. Stigma poses a very unfortunate obstacle for those who need treatment. Where mental health stigma and discrimination exists, you will find people less likely to seek needed help. If their symptoms are not addressed and worsen, an afflicted person’s health often declines. This can result in increased healthcare costs, decreased work productivity and missed work. Untreated mental illnesses can also lead to other health problems such as self-harm, substance abuse and even suicide. According to the National Alliance of Mental Illness, the cost of untreated mental illness in the United States is over $300 billion each year. One of the best ways to empower those with mental illness so they can be more productive in society is to reduce mental health discrimination and stigma.

What is Health Disorder Stigma?

According to the American Psychological Association (APA), stigma happens when people are viewed negatively for having a specific characteristic- whether that’s mental, physical or otherwise. Unfortunately, many illnesses face stigma. For example, people with Crohn's disease and psoriasis report a high degree of embarrassment or even shame due to their disease. However, while people with other health conditions also face social stigma, mental illness is reported to be the most stigmatized condition in the United States.

How Common is Mental Health Stigma?

According to the National Alliance of Mental Illness (NAMI) approximately 9 out of 10 people with mental health conditions have reported facing stigma and discrimination about their condition. This includes embarrassment and shame about their diagnosis. Unlike those afflicted with Chron’s or psoriasis, people with mental illness face added layers of stigma. Like those who are afflicted with addiction, obesity, or HIV, people with mental illnesses are sometimes held personally responsible for their illness through the perpetuation of inaccurate and negative stereotypes. For example, people with mental illness are often erroneously thought of as weak, dangerous or even violent. Some people even think that mental illnesses cannot be overcome and that the person afflicted has an inherent character flaw that cannot change. These false beliefs are often not only held by many in the public but also by the individuals afflicted.

The Connection Between Stigma and Discrimination

The National Alliance of Mental Illness (NAMI) has researched and found that there is still widespread discrimination for those with mental illnesses when seeking health care treatment, health care coverage and housing. For example, one law prohibits federal Medicaid funding for non-elderly adults from receiving psychiatric care in treatment facilities with more than 16 beds. No other physical health conditions have this limitation. In addition, a 2016 report also found that people who needed mental health care had more trouble finding in-network providers and facilities for mental health care compared to general or specialty medicine for other health issues. In regards to employment discrimination, a NAMI literature review found that people with mental illnesses remain unemployed or underemployed at a significantly higher rate than the general population. In their review, they found that people with mental illnesses receive lower wages and had less access to quality jobs. They are also sadly discriminated against within our criminal justice system where they are particularly vulnerable. In U.S. criminal justice system, people with severe mental illnesses stay booked and in jail awaiting pretrial hearings 2-3 times longer than people without a mental illness. People with mental illnesses face longer sentencing, are less likely to make parole, and are more likely to die through the system by suicide.

How Societal Stigma Leads to Self-Stigma

Societal views and difficulties in finding adequate and affordable mental health treatment are not the only obstacles for those with mental health disorders. There is yet another barrier in the way of recovery. That barrier is self-stigma. Self-stigma is the internalization of negative public attitudes. When this happens, the person suffers numerous negative consequences which can have devastating consequences. Self-stigma can lead to a delay in seeking treatment, self-sabotage of given treatments, lowered self-esteem, social withdrawal, negative self-talk and increased suicidal ideation.

According to David Susman, there are at least 8 reasons why people do not seek mental health treatment, many of which are related to the internalization of societal stigma. They are as follows:

Fear and shame
Lack of insight
Limited awareness
Feelings of inadequacy
Unavailability of professional care
Practical barriers (such as financial hardship)
Distrust in telling their story to mental health professionals
Hopelessness

Hope instead of Hopelessness

Given that there seems to be so many obstacles against the person who is mentally ill, one might think that the situation is pretty grim. It certainly isn’t great at the moment but there is still hope for change. There are laws already in place that do protect the mentally ill. Under the Americans with Disabilities Act (ADA) and other non-discrimination laws, those with mental health conditions can get the help they deserve and reclaim injustices. In many cases, they just need to know their rights or have an advocate if they are unable to understand the laws that are there to protect them. In addition, organizations like NAMI are continuing to work with the government in expanding access to health care coverage, advancing research, diverting people from criminal justice system involvement, and promoting early intervention for those with mental illnesses.

Another bright spot in the academic findings is that younger people have recognized the mental health crisis and have been more willing to publicly share their stories. That may be due to the fact that the Gen Z population is more likely to report mental health concerns than any other generation in the first place. As the first generation born with social media and mental health websites readily available their entire lives, the Gen Z population generally talk more openly about their mental health online. Online or in therapy groups, they are learning from each other about the need to prioritize mental health in their daily lives. Although the Gen Z population are still less likely to seek professional treatment due to financial barriers, they remain the most open to keeping transparent dialogue about the topic and are less likely to internalize mental health stigma.

What Can You Do to Help Yourself or Others to Fight Mental Health stigma?

If you are a person with a mental health disorder, keep in mind that you are not alone. Seek treatment and keep up with therapy appointments. Consider sharing your story in a therapeutic setting. Fight self-stigma by challenging any negative beliefs you have about your own mental illness and any needless shame you feel.

If you want to support the cause of ending mental health stigma, challenge negative stereotypes and educate others. Let the media know about television programs that display negative and harmful stereotypes.

Even if you are not a therapist, you can help a loved one who is struggling with self-stigma just by offering your time, empathy and understanding.

Deaf Awareness Week is celebrated annually from May 1 to 7 to highlight the accomplishments and issues affecting the deaf community. The purpose of this week is to raise awareness about the isolation that deaf individuals occasionally experience, the importance of inclusion, and the challenges they face in communication and accessibility. This week also serves to remind society that deaf individuals have had to create their own communities because of communication barriers, and that they often face discrimination in the workplace.

Communication and Accessibility Barriers

Deaf people face communication barriers in receptive and expressive language, which can be a very isolating experience for them, as they are often not fully integrated or represented in society. Deaf children are more likely to be born to hearing parents who need a great deal of support in caring for their children. In terms of listening comprehension, deaf people who can read lips often have a hard time keeping up when people are speaking quickly or do not face the listeners. Deaf people also face accessibility barriers in public places, which can exclude them from participation or needed services.

Challenges in the Workplace

Unfortunately, deaf people still face employment discrimination not only in the interview process but on the job as well. For example, some employers are reluctant to include American Sign Language (ASL) interpreters in the interview process. In addition, if a deaf employee makes a mistake on the job, the communication barrier often leads the employer to blame the blunder on the employee’s inability to hear first before considering other reasons.

The Loneliness Epidemic:
How Isolation Affects Mental Health

While some alone time is healthy and often a choice to for those who want to rest, relax and recharge, being alone or isolated for extended periods of time is not healthy physically or psychologically for humans given that our brains need the stimulation that social interaction provides. Humans are social creatures. According to studies reviewed by Harvard medical school, isolation is associated with increased risk for dementia and even death. In lab animals, isolation causes brain shrinkage and the kind of changes to the brain that you would typically see in Alzheimer’s patients. Loneliness is a significant and a growing problem across all age groups worldwide. Given the mental and physical health ramifications, it is imperative that we address the causes of and potential ways to help isolated individuals in order to prevent the needless pain for those affected.

Preventing Isolation- Who is at Risk?

In 2018, health insurer Cigna found that 46% of Americans reported feeling lonely sometimes or always and 47% reported feeling left out sometimes or always. Sadly, 43% reported feeling isolated from others with a lack of companionship or meaningful relationships.

There are some commonalities that can predict loneliness across age groups. In the last several years, feelings of loneliness have been markedly worse for people ages 11-25. In the survey, about 60% of people in this age group reported feeling left out or isolated from others. In contrast, people over 60 years old are more likely to feel connected to people unless they have physical or mental health problems that create barriers to connection. Studies have also shown a pattern of a mid-life loneliness in people around age 45, as this is a typical time when people start to lose love ones and children in the home start to become independent.

The pandemic also increased loneliness for all age groups. According to a review of 34 studies of 200,000 participants from four continents, researchers found a small but significant increase in loneliness.

Risk Factors for Isolation and Loneliness

While the risk of isolation and loneliness can be somewhat predictable in age-cohorts due to common experiences, it is more important to look at varied individual experiences in order to help people overcome any obstacles for human connection. For example, helping others cope with loneliness caused by the loss of a loved one versus self-imposed isolation due to social phobia requires a much different approach for family members and therapists. Below are some of the common risk factors associated with loneliness and isolation.

Excessive Use of Social Media: According to a 2014 study of college students, use of the internet and social media has shown to increase isolation and loneliness. Those who rely too much on social media for connection tend to have increased loneliness. Social media can be particularly harmful to a person if they compare themselves to others and base their self-esteem on the number of likes and followers they have.
Life Transitions: Dramatic changes that take us away from our social circles can have a profound effect on our feelings of connectedness. Death of a loved one, moving, divorce or facing an empty nest can increase the chance of facing isolation or loneliness dramatically. Even young adults are prone to loneliness as they face challenges and new responsibilities such as getting a well-paying job, living on their own and finding a life partner.
Physical Health Problems: People with chronic illnesses and mobility challenges may be more susceptible to isolation due to their inability to engage in the same range of activities as their peers. Elderly people in extended hospital stays are particularly vulnerable to feelings of isolation and loneliness as well. Patients in individual hospital rooms who have few visitors are very vulnerable to feelings loneliness and often suffer from depression as a result.
Societal and Cultural Barriers: Race, language and socioeconomic status can also cause barriers to socialization which can, in turn, lead to feelings of isolation and loneliness. If you do not share the same language with those around you or are unable to relate or communicate for any reason, it is difficult to form friendships.
Mental Health Issues: Anxiety, social anxiety and depression can lead to isolation. This type of self-imposed isolation is a very difficult cycle to break because as the person cuts contact with others, it exacerbates their depressive symptoms, causing them to continue the pattern. As a person with social anxiety and depression, I recognize these patterns within myself. When my son moved out of the house and my best friend moved away, I joined a lot of meetup groups and RSVPed to many events, only to cancel at the last minute because my nerves got the best of me. Every time I canceled, it reinforced the idea that I was not up for the task, and I would feel even more depressed and lonely. By not taking the risk and just showing up, I did not practice my conversational skills. I started to believe I did not know how, which reinforced the idea that I should just stop trying. I was fortunate in that I was able to seek help and eventually find my way out of that cycle (although I still struggle). I can recognize the pattern of behaviors that lead me down this path because I have had a lot of help doing so, but some are not so lucky. The negative effects of loneliness combined with social anxiety, depression and social phobia can be particularly devastating for those who have not or are unable to get treatment. Unlike some adults who have had years of access to therapy, adolescents are particularly vulnerable to substance abuse and suicide during periods of isolation.

The Impact of Isolation on Your Mental Health

As stated earlier, isolation not only negatively affects your mind, but it is also dangerous for the rest of your body. Some of the mores specific negative effects are as follows:

Depression: Isolation can lead to depression and feelings of sadness, worthlessness, and hopelessness. If left untreated, it can develop into clinical depression which can affect a person’s mood, energy, and ability to function.
Substance Abuse: A person may develop a substance use problem as means to cope with loneliness and isolation.
Cognitive Decline: Isolation can lead to cognitive decline due to lack of stimulation to the brain which is necessary to maintain brain health.
Anxiety: Isolation can increase anxiety levels which can turn into panic attacks, social anxiety and even phobias.
Suicidal Ideation: Isolation can increase thoughts of self-harm and suicide in vulnerable individuals.

Given that isolation can be so harmful to mental and physical health it is very important to support yourself when feeling less connected. It is also imperative that we find ways to reach out to others who feel isolated as well. Connecting with others who feel isolated and lonely can be a very challenging task given that they are not often vocal about their needs in the first place or are hidden from view.

Helping Yourself

Get Out of the House: Even if you do not want to, the most effective way to combat isolation is just by making contact with others. Join a club, meetup group or volunteer.
Therapy: If you have mental health issues that are causing you to self-isolate, the cycle can be difficult to break on your own. A trained therapist can offer support, guidance, and coping strategies.
Online Communities: If you keep it in moderation, social media can provide a sense of connection, especially for people who have mobility issues or who live in remote areas.
Exercise: Exercise can boost your mood, self-esteem and reduce stress. Plus, joining a gym can provide you some social interaction as well.
Practice Self-Care: Take time to meditate, journal or practice whatever hobbies help you relax to reduce stress and anxiety.
Create: Engage in hobbies that you really enjoy. Connect with others that have similar interests in your community.
Volunteer: Volunteering not only brings you in connection with others, but it can also boost your self-esteem and give you a sense of purpose.

Helping Others that are Lonely.

Become a Pen Pal to the Elderly: Organizations like Love for Our Elders have volunteer opportunities for people to write kind letters to elderly around the world.
Listen Actively: If someone shares their feelings of loneliness with you, give them your full attention. Let them know that they are not alone.
Offer Practical Help: If you know someone who is struggling with loneliness, encourage them to join a social group and offer to introduce them to new people.
Encourage Self-Care: Encourage your friend or loved one to engage in self-care, hobbies and exercise which will boost their mood. You can offer to join them in these activities.
Encourage Professional Help: If someone you know is experiencing extreme loneliness and depression, professional help may be necessary. Encourage them to see a mental health professional. You can offer to find necessary resources or drive them to appointments.

Presence in Pop Culture

While the deaf community has experienced many hardships and is sadly underrepresented in pop culture, raising awareness will hopefully lead to increased inclusion. While there have been disproportionally few films that have included deaf characters and employed deaf actors/actresses, there have been recent positive developments. For example, the 2019 movie "Sound of Metal" portrays the difficulties and challenges faced by the deaf community. The movie tells the story of a heavy metal drummer who begins to lose his hearing. The movie depicts the character's struggle to come to terms with his deafness and learn how to communicate with others. It also shows the barriers he faces in accessing services and the discrimination he experiences. Another fantastic movie,” Coda” was released in 2021, and it tells the story of a teenage girl who is the only hearing member of her deaf family. The movie explores the challenges of growing up as a hearing child in a deaf family and the struggle to balance her passion for music with her responsibilities to her family.

Contributions to Society

Deaf Awareness Week is also a time to celebrate the many accomplishments made by deaf individuals. Many important contributions to society, from sports and medicine to science and technology have been made by deaf individuals. For example, Laurent Clerc, a deaf Frenchman, co-founded the first school for the deaf in the United States with Thomas Hopkins Gallaudet. Today, many famous deaf athletes, such as Matt Hamill, a UFC fighter, and Tamika Catchings, a WNBA player, have shattered stereotypes and paved the way for future generations of deaf athletes.

In the medical field, Dr. Philip Zazove, a deaf physician, has made significant contributions to the field of family medicine. He has worked tirelessly to improve healthcare accessibility for deaf and hard-of-hearing patients, and his contributions have helped break down communication barriers between medical professionals and the deaf community.

Ways to Support the Deaf Community

It is also important to understand the struggles that the deaf and hearing-impaired face in order to take actionable steps towards making our society more inclusive. Some steps we can take include learning about deaf culture and language, supporting deaf-owned businesses, attending deaf-friendly events and advocating for deaf rights. These small actions can make a big difference in creating a more inclusive society.

Here are some tips and strategies that can help you communicate better with people who are deaf:

Ask the Person How They Want to Communicate

One of the most important things you can do when communicating with a deaf person is to ask them how they want to communicate with you. Some may prefer to read your lips, while others might prefer to exchange dialogue in written form. By asking and respecting their preferences, you can ensure that communication is clear and effective.

Look Directly at the Person

When speaking with a deaf person, make sure to look directly at them. This not only helps them read your lips if they rely on lip reading, but it also shows them that you are engaged and interested in what they are saying.

Avoid Shouting

While it may be tempting to shout in an attempt to help a deaf person hear you better, this can actually make communication more difficult. Shouting distorts your face, making it harder for those who rely on lip reading to understand you. Speak clearly and at a normal volume instead.

Keep in Mind That Hearing Aids and Cochlear Implants Are Not Perfect

Even if someone has a cochlear implant or hearing aid, they may still have difficulty hearing. These devices are not perfect and may not work well in all situations. Be patient and understanding if someone is having trouble understanding you, and be willing to adjust your communication style as needed.

Learn Basic American Sign Language (ASL)

Learning some basic ASL can go a long way in improving communication with deaf individuals. You don't need to become fluent, but knowing some common signs can help you communicate more effectively.

Learn About Deaf Culture and Language

You can take time to learn about deaf culture and language. This can include learning sign language, reading books or articles about deaf history, or watching documentaries about deaf people and their experiences. By learning about deaf culture, you can gain a deeper understanding of the challenges and experiences of deaf individuals.

Support Deaf-Owned Businesses

Seek out and support businesses that are owned and operated by deaf individuals. This can include deaf-owned cafes, restaurants, or shops. By supporting these businesses, you can help promote economic opportunities for deaf individuals.

Attend Deaf-Friendly Events

Look for events that are accessible and inclusive to the deaf community. This can include performances or workshops that feature sign language interpretation or events that are specifically designed for deaf individuals. By attending these events, you can show your support for the deaf community and gain a better understanding of their experiences.

Advocate for Deaf Rights

You can contact your elected representatives and advocate for policies that support the rights and needs of the deaf community. This can include advocating for greater accessibility in public spaces, promoting the use of sign language, or advocating for greater access to education and employment opportunities. The National Association for the Deaf (NAD) is a great resource for those who want help with advocacy and has even constructed template letters for those interested in contacting senators and representatives to take action.