How should we talk about mental health? |

Mental health suffers from a major image problem. One in every four people experiences mental health issues — yet more than 40 percent of countries worldwide have no mental health policy. Across the board it seems like we have no idea how to talk about it respectfully and responsibly.

Stigma and discrimination are the two biggest obstacles to a productive public dialogue about mental health; indeed, the problem seems to be largely one of communication. So we asked seven mental health experts: How should we talk about mental health? How can informed and sensitive people do it right – and how can the media do it responsibly?

End the stigma

Easier said than done, of course. Says journalist Andrew Solomon: “People still think that it’s shameful if they have a mental illness. They think it shows personal weakness. They think it shows a failing. If it’s their children who have mental illness, they think it reflects their failure as parents.” This self-inflicted stigma can make it difficult for people to speak about even their own mental health problems. According to neuroscientist Sarah Caddick, this is because when someone points to his wrist to tell you it’s broken, you can easily understand the problem, but that’s not the case when the issue is with the three-pound mass hidden inside someone’s skull. “The minute you start talking about your mind, people get very anxious, because we associate that with being who we are, fundamentally with ‘us’ — us as a person, us as an individual, our thoughts, our fears, our hopes, our aspirations, our everything.” Says mental health care advocate Vikram Patel, “Feeling miserable could in fact be seen as part of you or an extension of your social world, and applying a biomedical label is not always something that everyone with depression, for example, is comfortable with.” Banishing the stigma attached to mental health issues can go a long way to facilitating genuinely useful conversations.

Avoid correlations between criminality and mental illness

People are too quick to dole out judgments on people who experience mental health problems, grouping them together when isolated incidents of violence or crime occur. Says Caddick, “You get a major incident like Columbine or Virginia Tech and then the media asks, ‘Why didn’t people know that he was bipolar?’ ‘Was he schizophrenic?’ From there, some people think, ‘Well, everybody with bipolar disease is likely to go out and shoot down a whole bunch of people in a school,’ or, ‘People who are schizophrenics shouldn’t be out on the street.’” Solomon agrees that this correlation works against a productive conversation about mental health: “The tendency to connect people’s crimes to mental illness diagnoses that are not in fact associated with criminality needs to go away. ‘This person murdered everyone because he was depressed.’ You think, yes, you could sort of indicate here this person was depressed and he murdered everyone, but most people who are depressed do not murder everyone.”

But do correlate more between mental illness and suicide

According to the National Institute for Mental Health (NIMH), 90 percent of people who die by suicide have depression or other mental disorders, or substance-abuse disorders in conjunction with other mental disorders. Yet we don’t give this link its due. Says Solomon, “Just as the association between mental illness and crime is too strong, the connection between mental illness and suicide is too weak. So I feel like what I constantly read in the articles is that ‘so-and-so killed himself because his business had gone bankrupt and his wife had left him.’ And I think, okay, those were the triggering circumstances, but he killed himself because he suffered from a mental illness that drove him to kill himself. He was terribly depressed.”

Avoid words like “crazy” or “psycho”

Not surprisingly, nearly all the mental health experts we consulted were quick to decry playground slang like “mental,” “schizo,” “crazy,” “loonie,” or “nutter,” stigmatizing words that become embedded in people’s minds from a young age. NIMH Director Thomas Insel takes that one step further — he doesn’t like the category of “mental health problems” in general. He says, “Should we call cancer a ‘cell cycle problem’? Calling serious mental illness a ‘behavioral health problem’ is like calling cancer a ‘pain problem.’” Comedian Ruby Wax, however, has a different point of view: “I call people that are mentally disturbed, you know, I say they’re crazy. I think in the right tone, that’s not the problem. Let’s not get caught in the minutiae of it.”

If you feel comfortable talking about your own experience with mental health, by all means, do so

Self-advocacy can be very powerful. It reaches people who are going through similar experiences as well as the general public. Solomon believes that people equipped to share their experiences should do so: “The most moving letter I ever received in a way was one that was only a sentence long, and it came from someone who didn’t sign his name. He just wrote me a postcard and said, ‘I was going to kill myself, but I read your book and changed my mind.’ And really, I thought, okay, if nobody else ever reads anything I’ve written, I’ve done some good in the world. It’s very important just to keep writing about these things, because I think there’s a trickle-down effect, and that the vocabulary that goes into serious books actually makes its way into the common experience — at least a little bit of it does — and makes it easier to talk about all of these things.” SolomonWax, as well as Temple Grandin, below, have all become public figures for mental health advocacy through sharing their own experiences.

Don’t define a person by his/her mental illnesses

Just as a tumor need not define a person, the same goes for mental illness. Although the line between mental health and the “rest” of a person is somewhat blurry, experts say the distinction is necessary. Says Insel: “We need to talk about mental disorders the way we talk about other medical disorders. We generally don’t let having a medical illness define a person’s identity, yet we are very cautious about revealing mental illness because it will somehow define a person’s competence or even suggest dangerousness.” Caddick agrees: “There’s a lot of things that go on in the brain, and just because one thing goes wrong doesn’t mean that everything’s going wrong.”

Separate the person from the problem

Continuing from the last, Insel and Patel both recommend avoiding language that identifies people only by their mental health problems. Says Insel, speak of “someone with schizophrenia,” not “the schizophrenic.” (Although, he points out, people with autism do often ask to be referred to as “autistic.”) Making this distinction clear, says Patel, honors and respects the individual. “What you’re really saying is, this is something that’s not part of a person; it’s something the person is suffering from or is living with, and it’s a different thing from the person.”

Sometimes the problem isn’t that we’re using the wrong words, but that we’re not talking at all

Sometimes it just starts with speaking up. In Solomon’s words: “Wittgenstein said, ‘All I know is what I have words for.’ And I think that if you don’t have the words for it, you can’t explain to somebody else what your need is. To some degree, you can’t even explain to yourself what your need is. And so you can’t get better.” But, as suicide prevention advocate Chris Le knows well, there are challenges to talking about suicide and depression. Organizations aiming to raise awareness about depression and suicide have to wrangle with suicide contagion, or copycat suicides that can be sparked by media attention, especially in young people. Le, though, feels strongly that promoting dialogue ultimately helps. One simple solution, he says, is to keep it personal: “Reach out to your friends. If you’re down, talk to somebody, because remember that one time that your friend was down, and you talked to them, and they felt a little better? So reach out, support people, talk about your emotions and get comfortable with them.”

Recognize the amazing contributions of people with mental health differences

Says autism activist Temple Grandin: “If it weren’t for a little bit of autism, we wouldn’t have any phones to talk on.” She describes the tech community as filled with autistic pioneers. “Einstein definitely was; he had no language until age three. How about Steve Jobs? I’ll only mention the dead ones by name. The live ones, you’ll have to look them up on the Internet.” Of depression, Grandin says: “The organizations involved with depression need to be emphasizing how many really creative people, people whose books we love, whose movies we love, their arts, have had a lot of problems with depression. See, a little bit of those genetics makes you sensitive, makes you emotional, makes you sensitive — and that makes you creative in a certain way.”

Humor helps

Humor, some say, is the best medicine for your brain. Says comedian Wax: “If you surround [your message] with comedy, you have an entrée into their psyche. People love novelty, so for me it’s sort of foreplay: I’m softening them up, and then you can deliver as dark as you want. But if you whine, if you whine about being a woman or being black, good luck. Everybody smells it. But it’s true. People are liberated by laughing at themselves.”

Featured illustration via iStockphoto.

Join the conversation! 11 Comments

  1. I’ve been living with some conditions all of my life although I just got diagnosed a year ago. So far, I haven’t faced any stigma/discrimination. In fact, people see my PTSD service dog and are more accepting of us/nicer. While I’m not grateful for my conditions, knowing that I have them has helped me feel better about not achieving as much as my peers. “Of course work and friendships didn’t work out.” Maybe that sounds terrible, but for me, it’s a kind of weight off of my shoulders. I can forgive myself for my failures because they are part of a condition beyond my control.

    Anyways, I have had someone accuse me of trying to attack a school because I have depression. It was to the point that I was being harassed whenever I left my home. It still troubles me and I’m still finding ways to deal with it when there’s no legal or social recourse for me.

    I guess what I would add to this conversation is that I think there’s a need for guidelines to help people talk constructively about this (beyond what is suggested here). I didn’t even know how to describe what happened to me. I didn’t even realize that I was having “flashbacks” or “panic attacks.” And I, for one, get tired of hearing certain phrases out of people’s mouths.

    I don’t know exactly how to get this out there, but people should know the categories of torture/abuse, so that they can report what is happening to them or another. They should get realistic descriptions of how symptoms manifest (what does a flashback feel like? a panic attack? not every depressed person looks “depressed” Using the internet/games too much, overworking, shrugging off things that should affect them emotionally/emotional numbness, etc are also signs of depression.) Finally people should know what should and shouldn’t be said. For example, people do not attempt suicide for attention. Ignoring them doesn’t help at all. Drugs are not a cure for many mental illnesses. I take drugs and they are working, but it doesn’t mean that I’m “cured” of PTSD and feel “not depressed.” It’s still there and always will be – it’s just controlled. Like taking insulin for diabetes. People who are suicidal do not need to hear how “selfish” they are. Telling them another “bad” thing about themselves will just push them further to the edge. Also, it’s “selfish” for family to want them to live even if they are in intense pain. Instead, they should know that their suicide will impact others, but that they shouldn’t feel guilty for how they feel. Instead, they need to work towards another solution.

    It’s also not helpful to say “things could be worse” and then tell me about some genocide (or something along those lines). What is no big deal to one person can really impact another because of history/circumstances and their personal resiliency. The death of my dog could hurt as much or more than the death of your child would hurt you (for example). Instead of comparisons which don’t help and make me feel “wrong” for feeling how I do, just accept the pain that is expressed and deal with it as is.

    They should realize that a depressed person may not be capable of seeing the good in their lives. Tehy should encourage them to do BOTH therapy and drugs. Drugs don’t fix underlying problems like “I’m in an abusive relationship.” Therapy attacks that half.

    I guess I’m also tired of people being surprised that I need a dog/there’s anything wrong with me. They should know that mental illness is hard to spot and I don’t have symptoms visible every second of everyday. That’s why you really have to look. And if you haven’t heard from someone for a while, you should check in on them.

    I know I’m rambling, but there’s just so much that needs to be said

  2. This is an excellent article and so worthwhile. Let’s break down the stigmas. I myself have come out of the closet:

    • beautiful perspective and article rebellesociety. thank you for sharing. it’s such a good lesson in not judging others and having compassion.

  3. It would be worthwhile if an “initial mental health visit” was as routinely scheduled by insurance as is the common “initial physical health visit”. If everyone (or most people) experience something, there could be no stigma. With that screening process, it could possibly be easier for people to continue on as they see fit. Going to see someone because of troublesome thoughts should be as routine as going to see someone because of troublesome pain or headaches. Expecting students to step forward in school or people with mental illness to suddenly overcome the symptoms and seek help is wishful thinking. In my opinion, this is the only way we are going to reduce or end mass shootings. It is not about guns as much as the mental trauma being suffered by the people that end up resorting to the guns. I lead by example by letting people know that I see a therapist and attend a group. If sports or fitness coaching is good, then so is quality of life coaching.

  4. Wonderful TED talk … why I talk about having bipolar disorder? So that others can understand that I have a medical illness that does not define me as a person, but can shed light on what stage of the disease process I am currently experiencing. Hiding a mental illness is exhausting and nearly led to my death may years ago. Letting it out in the open has cost friends and employers. But I wouldn’t change a thing.

    Phoebe Pond-Hart, RN

    Here is a couple of recent posts from my FB account where I share openly with those that follow:

    Friends and Family, 02/21/14

    As many of you know, I was diagnosed 18 years ago with Bipolar Disorder Type 1 after a lifetime of misdiagnoses. Since then I have been successfully treated with medication and therapy. One of the difficult things about a chronic disease like BPD1 is that there comes a time that the line of treatment no longer works, and a new one must be started. This is physically and emotionally painful to be weened from one set of medications and started on another. And it is where I am for a 3rd time in the maintenance of my disease. Over the next months I will be going through this process and hope to come out brighter and stronger after. If I miss an email or post, be patient as my concentration and emotional state are erratic at this time and if you need to reach me, call. If I cry, don’t worry I’ll start laughing before you can blink. Just go along, I can be rather entertaining

    My hope is that the new set of medications will not dampen my jello nailing, random organizing and cleaning, or creative boxing. But each set of changes to the chemicals cause a change in personality … it is something that cannot be helped and a main reason why so many with mental illness do not take their medications. I am prepared for whatever may come, as I am fortunate to have the support of my family and my friends who stay and ride the roller coaster with me. Holding my hand as needed.

    This will be a difficult and major medication change, so for this time, I am keeping my hands and feet inside the ride. Thank you in advance for your patience and positive thoughts.

    Good morning family and friends. Update on the progress of medication change. With any of the psychiatric medication changes, there are side effects that are initial and then fade. For me it’s migraines and compulsions. Usually to get through these I smoke. So for the first time in 4.5 years I have been smoking during this past week. Now that the side effects are residing, I have quit. The first new medication has seemed to do well. No longer compulsively eating, racing thoughts have stopped and the olfactory hallucinations are gone. I am sleeping better and my mind is clearer. This is still a process of finding just the right balance, but feel as if there is a lightness of being that has been gone for 4 years. From my previous post I received private messages from friends of friends (people I do no know) that really helped to continue to give me courage to share what it is like to deal with a chronic illness like bipolar disorder. As long as mental illness is the “elephant in the room” that no one will own, it will be filled with myths and stigma. It was pointed out that I could loose current and future employment because of sharing that I have BPD, this is true. But to combat ignorance and fear, there is only truth.

    So far, so good. Thank you all for your wonderful love and positive thought. There are no words to expressive how grateful to each of you.

    PS – a big shout out to the the program Blue Bloods for last nights episode. They highlighted the difficulties that BPD has within the system. And did a good job.

  5. We certainly need the vocabulary. But we also need more people sharing their stories so others will start talking — and seeking help. Since doing my TEDxBloomington talk almost a year ago, I’ve received messages from around the world saying “thank you for sharing your story.” It’s amazing how many people don’t recognize what they are dealing with until they see and hear “depression” as experienced by someone else.

    Keep talking.

    Here is a link to my TEDx talk.

  6. Mental illnesses is a crash between our inner world and the world we share with everyone else. I strongly believe that the mind contains the cures for the mental illnesses itself has produced.

    Whether it be bi-polar, depression or even schitzophrenia..
    I myself suffered from panic/anxiety attacks over a shorter period of time, but after a lot of research I started understanding WHY I was having them and then developed my own cure aswell.. a cure personalized to myself as much as the anxiety was.

    Take schitophrenia for example, a collection of mental issues where the trigger effect is that of seeing and hearing voices.
    In the western society such invididuals are considered mad, crazy and dangerous.
    From what I’ve learned about it is that schitzophrenic people has a higher concentration of the molecule DMT in their brains. DMT aka The Spirit Molecule is most known for allowing people to enter the spiritual realm of our reality.. or hallucinate grandly as sceptics who never did much else but be sceptical would have us believe. DMT is something all living creatures has, but it is only produced on a massive enough scale to cause effects to the living creatures 2 times in their lifetime.. the moment where the fetus actually becomes a fetus in the mothers womb.. and the moments before the brain and body dies…

    People who are schitzophrenic is countries such as mongolia are are taught that they are shamans.. and are taught how to use their “shitzophrenic” powers if u want.. instead of being used by them. And they live happy lives as anyone else with this so called “illness” .. see? It’s a cultural thing, as with any other mental illness.. If we treated mentally ill people as mentally blessed people we’d cure every damn suffering caused by such things.

  7. Off all the Ted talks I have seen (and I have seen a lot) This is the one I most see, share, and talk about.
    -Hector Manuel Ramirez

  8. How should we talk about mental health and how can we remove the stigma?

    This is a big question, and finding a solution can appear very daunting. But don’t worry.

    We CAN achieve this through a positive attitude and outlook, by working together Collaboratively, with Integrity, and taking Accountability and Service to another level in search of Excellence. What fantastic Values.

    This is a great opportunity for us all to embrace the CAN Values to better understand ourselves and others in a whole different way.

    Our minds are our greatest assets.

    By changing behaviours, this will open up a new world of possibilities.

    Can we please all Respect and Acknowledge each others differences, Accept that this is who we are, Adapt and then Educate?

    Take care

  9. Last September I was honored to have the opportunity to talk about my own struggles with mental illness and epilepsy at TEDxYerevan. Much of Andrew Solomon’s descriptions of his own personal hell certainly hit home. I was so moved by his honesty and courage to tell his story. You can watch my TEDx talk here:

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Photo: Ryan Lash

About Thu-Huong Ha

Thu-Huong Ha writes and edits for TED. She likes to eat and learn, at times in tandem.


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