Try playing this little game with a friend, parent or co-worker.

Ask them to list three adjectives that describe a person with mental illness. Then ask them to list three adjectives that describe a person with breast cancer. Finally, ask them to list three adjectives that describe a friend.

More than likely the person will use words like “crazy”, “sad”, “depressed”, “lonely”, “patient”, “consumer or victim”, “scared”, “down”, “violent”, etc. to describe someone with a mental illness.

In describing someone with breast cancer they will likely use words such as “strong”, “confident”, “undeserving”, “survivor”, “thriving”, “family connection”, etc.

And in describing a friend the person will likely use words like “fun”, “caring”, “happy”, “smart”, “loyal”, “honest”, “responsible”, etc.

See the difference?

Whether you play this game with youth, parents, educators or even health professionals you get the same result - positive words to describe a friend or a  physical health problem like breast cancer and negative words to describe a mental illness like Depression.

And what if the your friend had Anxiety Disorder or Depression? Would that change your perception of them as a fun, smart, caring, loyal person? Would they suddenly be relegated to being a crazy, lonely, scared patient?

The stigma surrounding mental illness runs deep. It is embedded in our actions, our culture and our language.

Imagine a time when we describe and perceive people living with mental illnesses the same way we describe and perceive our friends or people living with physical health problems!

The case of Vince Li, the man who beheaded a victim aboard a Greyhound bus last year, made international headlines yesterday as judge ruled Mr. Li was not criminally responsible due to mental illness. The ruling means that Vince Li will be treated in a mental institution instead of going to prison.

While the ruling is probably the right one, the resulting media frenzy is doing little to dispel the myth that people with mental disorders are violent. It also begs the question: what is the role and responsibility of media in reporting on cases that involve mental illness?

A selection of headlines from major news networks clearly seek to sensationalize the case of Vince Li and in the process make a link between violence and mental illness :”Canada judge: Vince Li not responsible for bus beheading due to mental illness” (Associated Press), “Canada bus killer found mentally ill” (The West Australian), “Judge rules bus beheading suspect mentally ill” (CNN.com), “Crazy bus cannibal sent to mental institution” (Healthcare Industry Today). Even accompanying photographs (like the one above) attempt to “demonize” Li again reinforcing the idea that people with mental disorders look frightening.

While some people who suffer from mental illness do commit antisocial acts, mental illness does not equal criminality or violence - despite the media’s tendency to emphasize a suspected link (e.g. psychotic serial killers). In fact, people with mental illness are no more likely to commit violence than the general public, but they are 2.5 times more likely to be victimized and are more likely to inflict violent behaviours on themselves. Furthermore, the general public is more likely to be violently victimized by someone who does not have a mental illness rather than by someone who suffers from mental illness.

From Reuters:

According to Chris Summerville, the Chief Executive Officer of the Schizophrenia Society of Canada, the likelihood of violence by people with mental illness is exceptionally low. In fact, people living with mental illness are more often the victims of violence. “Fortunately, studies show that when people who were or would have been dangerous receive psychiatric treatment they are no more dangerous than people without a diagnosis. But they have to receive the treatment,” says Dr. John Gray, a board member of the British Columbia Schizophrenia Society.

Some evidence suggests that certain medications might rarely be associated with aggression, but this doesn’t mean there is a link between psychiatric medications and violent behaviour. In fact, the drug that is most often associated with aggressive behaviour is alcohol! Many medications used to treat mental disorders are also helpful in treating violent behaviour. It is important to remember that the best known predictor for future violent behaviour is past violent or criminal behaviour, not mental illness.

While a tragedy of this scale is awful, it can lead to constructive discussions about the need for improved care and a national mental health strategy.

This tragic event reinforces the urgent need for a national mental health strategy. Despite the significant health, economic and social costs of mental illness, Canada is the only G8 nation without a national strategy on mental illness. Summerville who is also a board member of the Mental Health Commission of Canada, says, “In many areas in Canada, there is a lack of psychiatric beds as well as lengthy wait times to access appropriate mental health care.” He adds, “If there were not a comprehensive hospital or community services for people with cancer, heart problems or other medical conditions, we as a society would be outraged. Stigma and the lack of social and political will have resulted in Canada’s failed mental health system.”

Canada has recently made some important strides in addressing mental health and mental illness. The establishment of the Mental Health Commission of Canada is indeed a vital step. But unfortunately it may be some time before the national discourse and media coverage of people with mental illness catches up, and we stop stigmatizing and sensationalizing people living with mental illness.

~ D. Venn & Dr. Stan Kutcher

In the past decade we’ve come a long way in understanding mental illness, but we still have far to go. Dispelling myths about mental illness is one important step. Stigma about mental illness is still largely present in our social structures and institutions – including our health, social services, education and justice sectors.

An October article in Canadian Living explored ten common myths about mental illness. One of the myths focused on children and adolescents:

Myth: Children don’t get depression or other mental illnesses; their emotional problems are just part of growing up.

Parents naturally want their children to do well, so some may brush off or explain away behavioural problems or other childhood difficulties as being mere growing pains. However, numerous psychiatric conditions, including depression, eating disorders, obsessive compulsive disorder and anxiety disorders, can and do occur in childhood, according to Kutcher. The U.S. Center for Mental Health Service reports that one in every 33 kids and one in every eight teens suffers from depression – and that’s just one disorder.

Enhancing our knowledge and understanding about mental illness is one of the best ways to dispel these myths.

~ D. Venn

This week the Globe and Mail is revisiting the issue of Canada’s mental health crisis in a week long expose. Saturday’s article addressed child and youth mental health. Kudos to Anderssen and Picard for bringing attention to an issue that is often underreported and often misunderstood by mainstream media outlets.

The piece has some important points to make - most notably about the absurd double-standard we have about mental health care in this country:

“If only one in six adults who needed a hip got one, there would be a revolt,” says Simon Davidson, a psychiatrist at the Children’s Hospital of Eastern Ontario. “So how can we tolerate a situation where one in six sick children get care?”

The article also successfully highlights the many ways that mental illness affects all aspects of a child’s life, especially relationships with parents and teachers. The complexity of understanding mental disorders in children and youth, as well as the complex health systems in place for youth to get help are indeed barriers that need to be addressed.

“Most young people with mental illness suffer in silence … Sometimes their parents are oblivious, or put it all down to a phase. But often their families suffer with them, unsure of where to turn in a system bogged down by turf wars, waiting lists and funding shortages.”

The need to address mental health problems early in is also clear. Dr. Waddell’s metaphor is apt: “If we wait until adulthood to treat these problems, it’s like using a teacup to bail out the boat”.

However, for all the positive points addressed in the article, the authors somewhat undermine their own message by using language that only seeks to enhance the stigma associated with mental illness. By telling the stories of youth who have “violent rages”, and by using phrases like “locked in their rooms, cutting themselves, crying and plotting suicide”, and suffering from some kind of “Dr. Jekyll and Mr. Hyde” syndrome, the authors are not providing a very balanced viewpoint about youth with mental disorders.

The challenge is to give mental illness a “face”, without giving it a face that paints a very extreme picture of what people with mental disorders experience. So much of the public understanding of mental illness is informed by these extreme pictures - people who are violent, out of control, hallucinating, etc. - when in reality people who experience those episodes comprise a very small percentage of the population.

if we are truly going to normalize and destigmatize the issue of mental illness we need to start telling stories from different perspectives that reflect the wide spectrum of experiences that youth and families dealing with mental illness have.

~ D. Venn

Depression is not just being blue.

Everyone feels low or sad sometimes. Often those feelings are in response to a negative event or life problem. Those feelings are perfectly normal. Indeed the ability to experience these emotions may be an essential part of what it means to be human.

These feelings will frequently lead to changes in our behaviour. That is, they help us adapt to our environment – often by enhancing our use of social supports. That is why we feel better when a friend, parent or family member gives us a hug or spends quality time with us. These feelings can also be helped by us seeking out and participating in activities that we usually enjoy.

Sometimes we feel low or sad for no reason. This is also normal. Our moods fluctuate over the course of a day, monthly and yearly. Spontaneous mood changes may be more pronounced over the teen years but everyone has them. These changes are short-lived, do not lead to pronounced social, interpersonal or job problems and usually go away as mysteriously as they came. When these feelings are there you can help them leave by hanging around with people you care about, exercising, listening to music or doing things you like to do.

Unfortunately, we often refer to these normal feelings as depression. This is a shorthand for a whole host of different emotions, including the following: despondent, distressed, despairing, demoralized, disturbed, frustrated, blue, sad, low, etc. Not only does the use of the shorthand “depression” to mean all of the above detract from our ability to communicate the rich nuances of our feelings, but the word depression used as a substitute for these normal feelings can be confused with the concept of clinical depression – which the word depression could be reserved for.

A clinical depression represents a failure of brain adaptation. Unlike feelings of sadness, distress, despondency, etc. which signal brain adaptation, a clinical depression describes a state of being in which a person’s functioning is impaired – that is, they cannot do what they usually do because of how they are feeling. Fundamental to understanding a clinical depression is the decline in functioning that it causes; such as, poor performance at school or at work, problems in interpersonal interactions, social withdrawal, etc.

Unlike the usual and common feelings of sadness, despondency, distress, etc. which are often alleviated by increased positive social interaction or usual enjoyable activities, a clinical depression will usually require a more specific and sustained intervention – usually a psychological or biological treatment. That does not mean that doing things that usually make you feel better (for example: talking with friends, exercising, etc) are not helpful – on the contrary, they may well be. What this means is that for clinical depression these interventions are unlikely to be helpful by themselves. If someone is living with a clinical depression they usually require professional help – from a therapist or physician. These professional helpers will provide additional specific treatments that have undergone rigorous empirical scientific evaluation and have been generally shown to be effective in promoting recovery from the clinical depression.

In addition to the functional impairment, a clinical depression differs from usual low moods in many ways. The low feelings must be persistent and sustained; there is a marked loss of interest or pleasure; there are substantive and persistent feelings of worthlessness or hopelessness; there is often fatigue, lack of appetite and sleep difficulty and there frequently are persistent ideas about suicide or even suicide attempts. Clearly, this state is not a brief response to environmental adversity or a temporary blip in mood.

So, depression is not the blues. Personally, I would really like to see us get away from using the word depression as a shorthand term. So instead of saying “I feel depressed because my boyfriend broke up with me” say instead “I feel distressed (or unhappy, or pissed off, or hurt, or despondent, or whatever) that my boyfriend broke up with me”.

Let’s start using the rich lexicon of our language to identify the varied and nuanced expressions of our moods.

~ Dr. Stan Kutcher

If I Had - A Teen With Extensive Mood Disorders - Dr. Stan Kutcher, MD, FRCPC, Professor of Psychiatry at Dalhousie University

What does the face of a person with mental illness look like?

That question is at the heart of this year’s national anti-stigma campaign “Face Mental Illness,” which is the theme of Mental Illness Awareness Week (Oct. 5-11). In Canada, one in five people is living with a mental illness. Mental disorders are some of the most disabling medical conditions, with about 70 per cent of them onsetting prior to age 25. They exact a huge negative impact on health, society and our economy. Yet a strong and persistent stigma prevents thousands of adults and youth from accessing and receiving the help they need to get well and say well.

While the scientific understanding and treatment of mental disorders and the awareness of the importance of mental health in all aspects of life have advanced considerably in the past decade, the public perception of people with mental illness has been much slower to change. A recent national survey conducted by the Canadian Medical Association found extremely high rates of stigma against those who suffer from mental disorders, permeating all aspects of Canadian society. This stigma is largely present in our social structures and institutions – including our health, social services, education and justice sectors.

Stigma is essentially the polite word for discrimination. There is no room in our caring society for discrimination against those living with mental illness. There is no reason for those living with mental illnesses to be denied adequate housing or equitable health care or to spend their lives in the shadows.

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