Businessman Hiding From The PublicThis morning while standing in the front office of the counseling practice where I see clients, a woman came to the window, to fill out paperwork for her intake assessment. She wasn’t scheduled to see me, but exclaimed with delight that she knew me from Facebook and through mutual friends. I assured her that if I happened to see her in a social setting I wouldn’t acknowledge that I had met her face to face in the office. She smiled and said that if she ran into a doctor who might be treating foot problems, it wouldn’t be a big deal, so why do we place such constraints on mental health treatment? She wondered why there is such a stigma attached to seeking treatment in the first place when most people wouldn’t feel embarrassed to see a medical professional if there was a physiological need.

Mental health conditions are common among the adult population in this country. Per NAMI (National Alliance On Mental Illness), “One in 5 adults experiences a mental health condition every year. One in 17 lives with a serious mental illness such as schizophrenia or bipolar disorder. In addition to a person’s directly experiencing a mental illness, family, friends and communities are also affected.”

Who You See Here, What Is Said Here, When You Leave Here, Let It Stay Here

I have a colleague who declines seeing clients who live in his town, since he wants to avoid running into them in a supermarket. I am aware that we live in such tight knit communities and are part of what I refer to as ‘overlapping soul circles,’ that there is a strong likelihood that I will see clients, former clients and potential clients in public. I have had that experience and when my son was young and I didn’t introduce him to those who approached me, since I would have otherwise, and said hello, he would respond with, “That person knows you from work, right, mom?” My response was always, “Can’t confirm or deny,” to which he would nod knowingly.

HIPAA laws were enacted to protect confidentiality within treatment protocol, as well as the fact that the person is in therapy. Licensed clinicians are not permitted to approach clients, have dual relationships (business interactions or friendships) with them or introduce them to other clients for personal or professional affiliation.

Dual Relationships fall into various categories such as social, professional, institutional and communal.  Each one carries with it the chance for boundary crossings or violations to occur. An ethical clinician will be mindful of ways to avoid such hazards.

One example:  A licensed therapist was working with a client in an outpatient substance abuse treatment program. Addressing the impact of multiple addictions were what brought him to therapy sessions. Shortly after beginning treatment, the therapist discovered that the client had begun to attend services at the faith community to which she belonged. When they spoke about it in session, she made it clear that she would not approach him, nor acknowledge where she knew him. He told her that this was acceptable to him and he was at ease with her acknowledging at least that they knew each other. He later chose to inform friends there that she was his therapist. The situation became uncomfortable for the clinician when they happened to encounter each other in a social setting that was not connected with the church. Before they had mutually agreed that he was ready to complete therapy, he had informed her that he had been maintaining sobriety and attending 12 step meetings, but arrived at the party with alcohol.  She spoke with him about that when he approached her and he admitted that he had been drinking and using again. She shared her concern that if he did indulge to the degree he had before, that he might leave the party intoxicated and drive home. That put her in a difficult position. He chose not to drink and left the alcohol there when he left the party a few hours later.

Another:  A therapist had attended a singles event in the home of a member of a meet-up. She had been speaking with three other attendees while standing in the kitchen. Two of the men walked back into the living room while one remained. He informed her that she had been on his treatment team in the psychiatric hospital where he had voluntarily sought care following a relationship breakup a year or so earlier. The therapist later expressed to friends that she felt a sense of discomfort and was not able to remain at the gathering much longer, where group games were going to take place, since she didn’t want to reveal much of a personal nature as she might otherwise.

Mental Illness in The Media: When Art Imitates Life

How does the media play into the stigma attached to mental health issues? Sensationalizing mental illness occurs in print, broadcast and theatrical media. Headlines that scream stories about the violent and unpredictable acts of those with distressing symptoms reinforce the myth that mental illness = destruction and danger. Movies that show the dark recesses of the minds of those whose lives are rendered unmanageable bring in the crowds. Some of them also misrepresent the treatment process with clinicians who run either of end of the professional spectrum; either they are over the top wonderful or horrendously manipulative and unsuited for their careers; using their own needs to supersede those of their clients/patients.

Shame is also a reason why people wish to remain anonymous in treatment. Somehow the idea that the brain needs care is an anathema, while reaching out for care of a cold or diabetes is acceptable in most cultures. A sense of weakness and ineptitude are part and parcel of a mental health diagnosis. A feeling of being broken or less valuable than those whose lives are on an even plane.

Ways to Push Back the Rising Tide of Shame

  • Realize that the line between mental health and mental illness can be paper thin and anyone could cross it at any time for a variety of reasons circumstantial, environmental, genetic or a combination of the three.
  • We don’t always know the struggles of another. Unless someone’s symptoms are obvious, it may seem that someone who is high functioning has no mental health diagnosis. Daniel Kaye has a responsible job to which he goes each day. He is happily married and has a precocious teenage son. He has many friends and is a published author. Unless you could see the man behind the curtain, you would never know that anxiety and depression were regular companions. He writes and speaks regularly and unabashedly about his experiences.
  • Accept that we are body-mind-spirit beings and sometimes find ourselves in crisis in any or all those realms and need support to heal and recover.
  • Know that recovery is possible. A client recently asked his therapist if she had ever seen someone who struggled as much as he did who rebounded. She assured them that she had.
  • Seek support, both personal and professional. You need not go it alone.
  • If you are a survivor of trauma, whether it is because of abuse or another life event, you may recognize that it wasn’t your fault and that you never need carry the acts of another perpetrated upon you.

Remember that you are no more your mental health diagnoses than you are that bunion on your toe to which you are hightailing it over to your foot doctor who now knows your shoe size.