Mental health issues are more common than you would think. And in fact, mental health problems are amongst the leading causes of disability worldwide. Astoundingly, 1 in 4 of people in the United Kingdom alone will experience mental health issues a year.
So when you look at the world overall, that is an awful lot of people.
Regardless of the universality of the problem, many people still labor under false beliefs. So we hope that by breaking some of these myths down that we can not only eliminate some undeserved stigma, but encourage a community driven empathy toward those who ask for it.
And with that in mind, I have invited some wonderful friends along with me to spread the message of what we have learned. I have also talked to psychiatrists and other medical professionals who have been kind enough to lend their time.
It is my belief that through knowledge we can really make a difference and, hopefully. together we can shine some light.
1. Mental health problems only affect ‘weak people.’
Being diagnosed with a mental health problem, be it depression or any other, can make one feel fearful and insecure about themselves and their future. This is a natural response, as any drastic change to our lives and sense of structure will influence our emotions.
‘Everyone can have a mental health disorder. If I were to lose someone, I would suffer and could get depression. I would not consider myself a weak person. We are all human, we are all built the same way.’ – Scott McGlynn, Present and LGBT+ Activist.
But let’s not confuse sadness with weakness, it is simply human. And since we know that the commonality of these issues is so great, it’s fair to say that just about anyone can suffer.
And from what we know about the causes of these problems, be they social, biological, psychological or a combination, we can say confidently that a ‘person’ is only part of the recipe for developing a problem. Some predisposing causes include childhood abuse, social issues and adult trauma, as well as genetic or biological antecedents.
And although there are many more factors prevalent in developing a disease, you would be hard pressed to conclude that a personal ‘weakness’ is solely to blame for somebody becoming unwell, or that a mental health issue is a sign of that weakness.
These issues can strike anyone, from military leaders to doctors, from artists to authors and beyond. Much like any disease, the human at the centre of it is who matters, not their job or what society demands. And many with mental health issues become world leaders. This is despite what society tmay wrongly consider a flaw.
Incredibly, they do this knowing that some members of society would reject them simply for their diagnosis. Former US President Abraham Lincoln and War-time UK Prime Minister Winston Churchill both presided over tumultuous times, but both were alleged to have suffered with mental health issues.
So instead of considering those with mental illness as ‘weak’, we would better reconsider what we define as making a person ‘strong.’ I think you would agree that Churchill’s tenure was one requiring a tremendous personal strength.
And on a personal note, living with depression requires more resilience and strength than you would realise. And to make a difference in the world, to enrich the lives of others, whilst battling every day, that is true strength by any definition.
2. People with ‘mental health problems’ are a ‘drain on society.’
A particularly uncomfortable idea, some believe that those with mental health issues are simply faking it. Or worse still, doing so with the intention of sponging ‘off the state.’ This is a particularly divisive attitude worsened by some social media commentators going as far to claim that depression isn’t a real condition.
Although it is true that in acute episodes of some mental health issues people may require time off work, it is important to note that the vast majority of patients work regularly. In fact this can be as high as 70% in those with anxiety or depression.
Furthermore, the idea ignores the very fact that: patients want to get better and businesses have a legal obligation to provide ‘reasonable adjustments’ to ensure an unwell employee can return to work. It is clear that many wish to return to a relative normality, and work with their employers to facilitate this. According to the Health and Safety Executive UK (HSE);
‘Most people who have ongoing mental health problems continue to work successfully. But when someone needs support, managers can work with them to ensure flexibility to suit their health needs.’
Being unwell is as simple as being unwell, and it seems that ‘mental health issues’ are viewed as a less legitimate to need time to recover than a more obvious physical illness. And where those with conditions like cancer are given worthy encouragement, those with depression may not be extended the same courtesy by the public.
By comparing the statistics we can see the bigger picture. Although the total number of work days lost to mental health was around 40% of the total during 2016/17, the vast majority of time off was due to other problems. So, we are forced to ask why the minority cause of time off receives such disproportionate stigma.
Are people with cancer a drain on society? What possibly makes people think that an illness of the mind makes you lesser than anybody else? We need to realise that mental health is not a failing. The connotation is that these problems are some sort of societal betrayal. – Mike Stuchbery.
Instead of considering those with a mental health issue as a ‘drain on society,’ the truth is rather different. Like patients with all diseases there will always be a relative loss of work, and this is necessary to their recovery.
Even better, since most with mental health issues do choose to work, it is clear that the problems are taken in hand where possible. So you may ask why people would attack those with mental health issues when the evidence is so clear?
Personally, I think it’s because content creators recognise just how financially powerful encouraging that stigma can be for their channels, or perhaps that because stoking division is an effective political move. If this is true, then the problem does not lie with the patients themselves.
“Cinema, radio, television, magazines are a school of inattention: people look without seeing, listen in without hearing” – Robert Besson.
If society can be so easily hoodwinked, then combatting the stigma is that much more important.
3. ‘All people with mental health problems are dangerous’
Another dramatic misconception is that ‘all people with mental illness’ are dangerous, and when the public are repeatedly told that those committing mass shootings are ‘mentally ill,’ you can understand why there is a concern.
Mental illness plays no part in the majority of violent crimes committed in our society. The assumption that any and every mental illness carries with it an almost certain potential for violence has been proven wrong in many studies.
Although it is true that some people may commit a crime while unwell, only 1% of people in a recent survey believed that individuals with mental health issues pose a threat. There is something lost between the public and some of the papers here.
But thankfully, many in print media are very aware of the misconception.
In my time as a journalist I met a good number of people who could be described as violent. Some were guilty of some shocking deeds. Yet, I cannot recall a single one who had a recognisable, distinct mental health issue. But I think when it comes to misconceptions, it’s not just journalists making the leap but society as a whole – Andy West, Broadcaster and Writer.
Given that an estimated 7 million people in the UK have a mental health disorder, the average homicide rate is just between 50 -70. And over 2016-2017, this represented a tiny fraction of the 790 homicides in the UK (8.9%.)
This means that 91.1% of UK murders are committed by those without a mental health issue, and when it comes to acts of violence, those with mental health problems are responsible for only 3-5 % of crime compared to 96% (approximately,) within the general population in the United States.
In addition, within mental health overall, those with schizophrenia have a only slightly higher risk, mostly associated with substance abuse. But in the same vein, the vast majority will never commit a violent crime. But what of psychosis itself? During a psychotic episode, where in some psychiatric conditions a patient may lose contact with reality, only 6% may present any risk.
So, why the overinflated preoccupation with risk? Perhaps misconceptions about serial killers being insane, the vilification and over-dramatisation of mental health in movies and television, and most insidiously, the use of mental health patients as scapegoats.
Let us consider the US, where gun laws are under constant scrutiny. It is much easier to blame a mass shooting on a ‘mentally unwell lone wolf’ than admit that you may have a culture problem and access to firearms. For some gun advocates, perpetrating this horrible myth serves them well.
So all in all, those with ‘mental health’ problems commit less violent crimes than the rest of the UK (and US,) and are a greater risk to themselves than others.
Although there is some risk, the data bears out nothing significant beyond specific cases to a population level. The very idea that everyone with a mental health issue is dangerous is demonstrably false, stigmatising and worryingly, seemingly deliberately sold.
‘The only thing we have to fear is fear itself.’ – Franklin D Roosevelt
4. There is ‘no getting better’
‘People succumb to an idea that things don’t get better. You can’t see mental health, it’s not like a broken leg. There is an ‘end point.’ It’s clear, but with mental health its a lot more difficult for people to believe that there is a definitive fix.’ Ralf Little, Health Advocate and Actor.
For some, a mental health problem can last a long time, but for others, they may only brush with it briefly, once in their lives. Everybody’s experience of life is different and with that comes a different experience of mental health issues. It can be easy to feel trapped in disease, only to wonder why you felt so helpless months later.
It is often with the benefit of hindsight that the truth becomes clear. When it comes to mental health, this often shows us that recovery may require lifelong treatment to maintain. or nothing at all – it all depends on the person and their journey. In fact mild to moderate depression may need drug treatment for no longer than a year, if at all.
The misconception that these issues are ‘permanent’ or ‘inescapable’ is very much hyperbole, and does not take into account how different people define their quality of life. Or indeed, what people consider being ‘unwell.’
It is up to the patient to decide when they have escaped the disease, which for many is the cessation of its symptoms, and for others, never feeling them again.
Personally, I view my depression as companion who raises it’s head from time to time, and during those periods inbetween I consider myself ‘better.’
For me, its about assigning value to the moments and realising my choice in doing so. Perhaps many of you will understand this.
Yet somehow, society forces a double standard when comparing mental health issues with more physical ones. A cancer remission is treated as ‘getting better’ whilst many would say recovery in a depression is ‘only temporary.’ Both have a chance of returning, but we consider the time without illness as being ‘healthy again.’
While appreciating the complexity of the comparison, its fair to say that both have periods of being unwell and less unwell. Or not unwell at all, with a potential with recurrence or not. But in most cases, there is some level of improvement.
Have faith that on the other side of your pain is something good. – Dwayne Johnson
Whether this improvement is enough is up to you, but from personal experience and the stories of others, life can be just as good, if not better than before, when a condition is well managed. For me, my depression has added such value to my life that I appreciate living it all the more.
So, by using a medication, therapy, or lifestyle changes (or some combination of them), we can have great success in treating a wide variety of conditions. And, although many years ago these conditions could be something lifelong and debilitating, today’s patients can live rich and fulfilling lives.
What is important is realising that each patient is an individual, that treatments may need to change over time and that each step back can be regained. To suggest that there is ‘no escape’ poses only one limitation, on how well you understand human life.
5. ‘Mental health only matters when you are unwell.’
If you are reading this through twitter, you may have already seen the ‘I have mental health’ campaign. And for those who haven’t, the grassroots movement included people from all walks of life holding up a sign with the statement.
The idea was to make normal what many do not consider reasonable: that mental health is a constant and ongoing entity, one that we all share and one we can all lose. This idea is uncomfortable to some. But why?
Perhaps because of the idea of ‘weakness’, some societal expectation, or fear, many do not like to entertain the idea that their mind is like the rest of their body. Something that can become ill, and requires maintenance to work well. Just like our skin that can become itchy and red, things can change in an instant.
‘Mental health isn’t all of me, but it’s a massive part of my journey and a massive part of my whole being.’ – Adwoa Aboah
It seems that many only realise the fragility of our minds when something breaks. But unlike a precious vase, we rarely handle our minds with care. We expect them to be indestructible, when in fact all of us have our limits.
Since 75% of mental health problems begin before the age of eighteen, it is clear just how beneficial teaching people how to take care of their mental health can be.
When we consider the theories around mental health disorders, we can see that many explain problems as the result of misbalance. Either too much work, too little sleep, a significant life event, a loss of purpose or one of another million things. It can take just one extra thing to tip the scales.
In addition, when we consider treatment, the same can be said. Whether it be medication or therapy, a change is made to tip the scales back to equal. Mental health is an ongoing and organic process, the sum of our experiences and way of thinking.
It deserves as much kindness as our greatest treasure. And with that, it may be of huge societal benefit for all of us to embrace our own mental health, learn how to manage it and ensure that this is done from an early age.
6. You can ‘just snap out of it.’
I am sure many of you reading this will have heard a statement just like this, and for many, it will be very frustrating. There seems to be a belief that you can just ‘buck up’ and ‘snap out’ of mental health issue.
‘The idea that you can ‘positivity your way out of it’ is ludicrous. Its strange to believe that those unwell are just ‘being silly’, there is a real issue happening. Why do we collectively believe that such issues can dismissed so easily?’ – Ralf Little.
Almost as if its something flippant, volitional and subject to change at your whim.
From what we know about mental health conditions, this is not true, and often problems like depression can be pervasive, and take some time to sort out. This is also true for anxiety and a wealth of other issues.
The very complexity and individual nature of these conditions dictates that the right amount of time be taken.
The primary misconception lies in the general understanding of the problem, and that comes from familiarity. But if you have never had a disease, you simply don’t know as much about it as someone who does. That is forgivable, I wouldn’t personally understand how it is to live with heart disease.
However, there is information out there, it is just a process of making it available. I feel rather than ensuring everyone experiences a mental health issue first hand (although 1 in 4 do,) we can explain the problem instead. Most people are incredibly empathetic once talked to, it is the silence between conversations that breeds misunderstanding.
“I’m here to tell you that if you get broken, it’s possible to put yourself back together. I’m here to tell you that if you get lost, it’s possible that a light will come, dancing, on the horizon, to lead you home.” – Nick Lake
According to Health Communities, depression itself can take weeks to truly manifest and if untreated can last up to 18 months on average – and with treatment, can still take a number of weeks or more to even out.
When it comes to anxiety, those with generalised anxiety disorder (GAD,) the treatment process can take up a number of months before you see results. After that, continued treatment may be necessary. These are just two examples, but the same is true across the spectrum.
So, if we can help others to understand that mental health issues are not a quick fix, we can change their expectations. I feel that this would help both those with a mental health issue and without.
7. ‘Everyone will think I am crazy!’
‘People with mental health conditions are worried that others will judge and be afraid of them just because they are ‘different.’ Awareness needs to be brought forward that people with diagnosed conditions should never be ashamed of who they are. And just because someone is different doesn’t mean that they are dangerous in the form of being ‘crazy’. Never judge a book by its cover. – Paul Manners, Recording Artist and Influencer.
There is a lot of confusion around ‘psychosis’. But what is psychosis? According to the National Health Service (NHS);
Psychosis is a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions.
Put simply, and it isn’t quite as simple, psychosis is a loss of touch with reality manifest in either some hallucination (seeing, hearing or otherwise sensing something that others cannot,) and/or delusion (believing in something that is in conflict with reality.)
Psychosis can occur alongside numerous psychological issues when they become severe, including depression and schizophrenia. It can also be caused by medications, other organic illnesses such as dementia, and can relent when treated. Insanity is not necessarily permanent and resolves when the cause is dealt with. In each case it is important to not that a trigger can precipitate an episode, or that something can come on gradually.
So, now we know what ‘actual medical insanity’ is, we can remind ourselves that the symptoms of a depression or anxiety disorder (amongst others,) do not mean that you are ‘crazy’. The fear is very much in the mind, but that is understandable.
“Perfect sanity is a myth propagated by straitjacket salesmen. – Rebecca McKinsey
Given that society is so demanding, and that mental health issues are so emotionally depicted in media, people often associated mental health problems with psychotic symptoms. However, this is only relevant in the small fraction of people with psychosis. 0.7 % of those over 16 years old in 2016. And, unless you work in a psychiatric facility, your chances of meeting a psychotic person are vanishingly low. The issue lies with expectation, not reality.
So, when you compare this 0.7% percent with the number of those with active mental health problems (25% approximately,) you can see how rare actual ‘craziness’ is. It’s up to us to convince the public that the 25% are not the 0.7%.
If you perceive crazy as ‘abnormal’, i.e to exhibit the symptoms of a mental health issue, then it is worth reminding yourself that we all experience mental health symptoms. It is the duration and strength that differs, and how they affect our lives.
By realising that, the idea of others judging you can go away rather quickly, all it takes is a conversation to correct a misunderstanding.
8. It’s ‘all made up’
‘Nobody thinks that the pharmaceutical industry is completely above board. But problems with big pharma do not equal that everyone is lying. The idea that psychiatric diagnoses are made up is incredibly dangerous.’ Ralf Little.
One of the more insidious claims made is that ‘mental health’ conditions are not real, and worse still, they have been invented by ‘Big Pharma‘ or ‘government agencies’ to control people and make money.
Having already dealt with the logical fallacies inherent in conspiracy theories in my work on climate change, we can surmise that conspiracy relies on misconceptions and fiction to be believed. Where science relies on evidence, conspiracy relies on imagination.
Instead of accepting any evidence to the contrary, a conspiracy theorist will say that ‘it’s all part of the conspiracy.’ There are simply some people that are harder to convince. But when asked to provide evidence of their conspiracy, it often falls apart. As journalist and author Christopher Hitchens once said;
What can be asserted without evidence can be dismissed without evidence.
Others may point to the apparent difference between psychiatric diseases and more ‘common physical ones.’ They claim a paucity of verifiable evidence for these diseases, and when comparing them to the more easily believed metrics of physical disease, that the proof simply isn’t there.
This is what we call an argument from incredulity, the idea that the complexity of an explanation undermines its truth. And within psychiatry, there are physical changes in certain conditions we can demonstrate objectively, but diagnosis is a complex process looking at behaviours over time.
But those changes are real, and to suggest that things are being made up is quite a leap. Whilst we hazard to claim that Einstein’s equations are untrue, most of us won’t understand them. So why the double standard?
Personally, I suggest that when it comes to psychiatry there is a huge personal and societal stake involved. When emotions are riding high, people are more likely to make snap judgments, and when it comes to identifying with an idea, or joining a group, the idea becomes a sense of identity.
Being part of a movement fulfils basic psychological needs.
For many, their belief in a conspiracy becomes part of who they are – they may think they are ‘in the right’ and ‘helping’, so don’t judge them too harshly. But there are those who knowingly manipulate, and they are a different story.
So in the end it comes down to which is most plausible;
- Psychiatric conditions are complex and individual problems require expertise to diagnose and treat. There are replicable behavioural and physical changes that can be used to aid this process. There will always be some financial gain to those producing medications, but that is a separate issue to the truth of the disease.
- Psychiatric issues are made up, the evidence is ‘false’ and it’s all done to ‘make money’ or ‘control people.’
I think when you view the two side by side, one looks rather less believable.
9. Mental health issues are ‘simply biological problems’
‘There are reams of papers and journals dedicated to the idea that things like upbringing and trauma can have a remarkable effect on health. To say its just ‘chemicals whizzing around in your brain’ is just ludicrous. Demands on life are often unworkable, and this can lead to problems. It is important to realise that environment and behaviour factor heavily in mental health disease.’ – Mike Stuchbery, Writer and Broadcaster.
From what many understand about disease, this myth is an understandable one. We are brought up to only recognise diseases in terms of physical problems (a sneeze, runny nose, a painful stomach,) and it makes sense that we would attribute biology to their causes too.
These ideas are developed early on in our lives, and are hardwired.
With a move within psychiatry to reconcile behaviour with neurology, one could be forgiven to treat the two as one – but it is a little more complicated than that.
What we know from medicine places a larger influence on psychological and social factors than you would realise. For example, we know that patients with depression are more likely to suffer from heart disease, and that mental health problems find some cause in social factors.
Disease is the result of an interplay between biology, psychology and the environment. Some diseases are a tad more ‘biological’ in nature, and others seem to be purely ‘genetic’, but most fall between the categories, where one factor is just part of their makeup.
‘To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.’ – William Osler.
To dismiss mental health issues as ‘purely biological’ sells them short. Crucially, it means we are missing vital information in helping us treat them. If we can recognise the psychological and social determinants of disease, and understand their contribution, it gives us more avenues for treatment.
As such, psychiatrists and other doctors use a ‘Bio-psycho-social’ model of disease in their diagnoses.
With depression for example, although there are genetic factors and talk of biological antecedents, we know that stress, sleep deprivation and trauma are highly predictive. And for anxiety, childhood experiences of fear and hopelessness play a role.
So when we treat psychiatric issues we combat each domain, where therapy and medication can be just as important as each other. To separate psychiatric diseases from biology is incorrect, just as saying that they are ‘only’ biological.
‘Doctors and patients need as much data as possible to make an informed decision about what treatment is best’ – Ben Goldacre.
The truth is somewhere inbetween, and with it, our best chance of making people’s lives better.
10. ‘Mental health issues are rare.’
The final myth is particularly pervasive, and you may have already been convinced otherwise of its assertions. Mental health problems are extremely common, it is the severity that differs.
All in all, 1 in 4 people in the UK will suffer from a mental health issue at some point in their lives.
The very idea that these issues are rare can be traced to a misconception about what they are. Many consider mental health issues to be exemplified in rare cases of psychosis, or those dramatised in media. But mental health problems are not always as dramatic.
I don’t think it’s a healthy way of living to assume mental issues are a rarity, everyone will probably stumble across a mental issue at some point in there life, it’s how we deal with it that determines our outcome and if we’re prepared to accept it. ‘ – Charlie Parsons.
But they are worth knowing about. Considering just how common they are, and that they are becoming more common, we can build a community that wants to recognise why and do something about it.
By correcting the idea that ‘mental health’ issues convey only the extremes of behaviour, we miss the vast majority of people who suffer. We owe them the time to recognise not just how common mental health issues are, but how they affect each and every one of us.
There is no standard normal. Normal is subjective. There are seven billion versions of normal on this planet.” – Matt Haig.
One in four is a big number, so next time you are out shopping consider just how many around you are suffering in silence.
Let’s end the stigma.
For small creatures such as we the vastness is bearable only through love.” – Carl Sagan
I hope that this work has explained why some of these myths exist, and what the real truths actually are. And I hope that by taking the time to explain them that we can correct some of the harsh inequalities experienced by those with mental health problems.
Crucially, we can see that whilst each myth can be debunked, there is always some believable idea behind it. It is what happens next that builds a misconception into a commonly held belief.
Stigma against mental health problems, like any stigma, is founded on misconception and fear. And like any stigma, it disappears as the truth of the matter becomes well known. We have seen it time and time again, but it takes work from the ground up.
When it becomes clear that the public will no longer tolerate the abuse of the mentally unwell, (and why should they?) the financial and political motivations will die along with the stigma itself. People are generally good, so if we can respect each other and work together the sky is the limit.
‘Mental health stigma is killing a lot of people, especially men. This is not addressed in dialogue, men try to ‘power their way through.’ Mental illness is ‘not a challenge to be overcome’, it’s a whole load of added pressure. It’s an illness.’ – Mike Stuchbery.
I hope that in some way I have given you something that you can discuss and share. Together we can end the stigma, so here is as good a place as any, So please help by sharing, and let me know your thoughts in the comments below.
In memory of R.O
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The opinions above represent those of Dr Janaway alone and do not necessarily represent his affiliates. Any quotation or contribution made by a third party (signposted in text,) has been done under volition and without financial compensation. There is no direct financial gain to either the author or contributors from the publication of this work, it is all done for free in our own time to help others. All text has been discussed and reviewed with senior mental health professionals to ensure accuracy. There are no concerns of breaking patient anonymity or confidentiality.
Several twitter posts were originally going to be used, but due to the confusion noted of others in questioning the users intent these have been omitted out of courtesy. Apologies to those wishing to be featured, but your responses were incredibly valuable. And to those I was not able to get back in touch with, I appreciate your willingness to help and look forward to new opportunities to work together in the future. If you are concerned about your health please see your local healthcare provider. Featured image referenced above.
A special thanks to; Scott McGlyness, Paul Manners, Andy West, Ralf Little, Charlie Parsons, Mike Stuchbery, Ayden Callaghan , Stephen Ritchie and Chloe Whichello and my twitter community for providing such great feedback. And not forgetting Ashleigh Howells for her patience in reading and editing, as well as much needed encouragement, as well as Dr David Denton for his keen insights.