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It’s not easy to open up about mental illness, but that’s what Masthead member Daria did on our Facebook group earlier this month. She shared her experience with bipolar disorder, touching off a powerful discussion about mental illness and social stigma. We’re continuing that conversation today. First, Scott Stossel, author of My Age of Anxiety, tells us about the exquisite challenge of writing about your own anxiety. Then I followed up with a few of the members who weighed in on Facebook, and asked them how they’ve felt misunderstood in their struggles with mental illness.

WE’RE GETTING BETTER AT TALKING ABOUT MENTAL ILLNESS

Scott Stossel, editor of The Atlantic magazine, has been researching anxiety for almost a decade. You can read his 2014 Atlantic cover story, “Surviving Anxiety,” adapted from his book. Since he started writing about it, Scott’s observed more openness in how people discuss their experiences with mental illness, and more sophistication in how the public understands it.

Caroline: Where does the public conversation around anxiety fall short?

Scott: The discussion around anxiety and mental health has evolved, even just in the time that I’ve been following it closely. But there is still a misunderstanding in common parlance about things like anxiety, depression, and bipolar disorder. Depression is not just being sad. Anxiety is not just being stressed out. They are true biological disorders that can be quite debilitating.

Caroline: How has all this changed since you started researching anxiety?

Scott: More and more, it’s common to refer to anxiety as a medical condition. The basic terms and concepts of anxiety, depression, bipolar disorder, and ADD are seeping into the general lexicon. Of course, that means that they get misused and thrown around all the time. People say they’re having panic attacks when they’re not, people say they have ADD when they just have a lot going on. But in some ways that’s evidence that these concepts are more familiar to people. They’ve been reified by the psychotherapeutic community and to some extent by popular culture. Did you ever see the TV show Monk? They turned someone suffering from OCD into the hero of the show.

Caroline: Why do you think we’re seeing this change?  

Scott: I think it’s largely the work of mental health advocacy groups, working hard to get out the message to erase the stigma. Recently there have also been many books like my own—quasi-memoirs about conditions like anxiety, addiction, depression. The bellwether was Kay Redfield Jamison. About 25 years ago, she wrote a book called An Unquiet Mind about her struggles with bipolar disorder. Here was this woman who was eminently successful as a psychiatric clinician and a researcher, and yet she was telling her story as a patient. That broke the dam.

Caroline: In your book, you talk about all the different definitions and cultural understandings of the word “anxiety.” How do you begin to write about something that people understand in such vastly different ways?

Scott: The more you dig into this topic, the more you realize that the definitions are all over the place. This was a real challenge because I wanted to make the book understandable to a lay reader, but I also wanted to capture the complexity of all the debates among readers and practitioners and historians of science. There were times when I would think, to feel like I’ve dealt comprehensively with anxiety, I need to write a 30-volume book.

It’s this nexus of genetics and hardwired biology, coming into play with life experience and culture. For example, there are studies that show that Nigerians in Nigeria have very low rates of schizophrenia, but Nigerians in the United States have disproportionately high rates of schizophrenia. Is that a purely cultural distinction because schizophrenia as a concept doesn’t have a lot of currency in Nigeria? Maybe hearing voices can be explained away as part of something else. Or is it that there is something inherently stressful about being an immigrant and a person of color in the United States that exacerbates schizophrenia?

The only hard-and-fast definition for anxiety is the one found in the Diagnostic and Statistical Manual, or the DSM. In order to have this particular psychological disorder, it says you must have this particular set of symptoms for a particular amount of time. But that’s ridiculous. You’ve created an arbitrary set of definitions when in reality all of this exists on a spectrum. Everyone experiences fear and anxiety to some degree. Where is the red line where it becomes a mental illness? Everyone experiences sadness and grief. Where does that tip over into disorder?

Caroline: Any prevailing theories that answer that question?

Scott: A lot of people say the line is when you experience persistent suffering that impedes your ability to function in daily life. I think that’s a good medical definition, because then the doctor can come in and evaluate and say, “Okay, how can we make you not suffer?”

Caroline: As an editor and a writer, what’s challenging about writing about mental illness?

Scott: Putting vulnerability out there is hard. I worked on the book for seven years. When I was in the throes of it, I assumed it would never come out. I genuinely thought they would cancel my contract. That feeling was almost necessary because I just kept thinking, “No one is ever going to read this. I’m just typing it for my editor, and I need to keep him entertained.” Then, finally, I was dealing with the copy edits and I realized, “Wait, this book is about to come out?”

But once you share your experiences with mental illness—as it sounds like our Masthead members are doing—it elicits this incredible sense of community. People seek you out because they feel so connected. So many people have written to me from multiple countries saying, “This book made me feel less alone, or even cured my anxiety.” Or, “I read it before I get on a plane.” I’m like, why doesn’t it work for me? I wrote it! I can’t read it before I get on a plane and cure my anxiety.

Caroline: What has it been like to come out with mental illness in pretty much the most public way possible?

Scott: I assumed I was pretty good at hiding my anxiety, but I didn’t know how good. When the article came out, my colleagues were all like, “We knew you were crazy, we didn’t think you were crazy in that particular way!” One of them said, “So does this mean we have to laugh at your stupid jokes during editorial meetings?” I told her, please don’t do anything different. In a weird way, it was a protracted form of exposure therapy. One of my anxieties, like many people, is public speaking. Suddenly I was doing national TV shows and radio shows, talking in front of big audiences, exposing myself to the thing I fear most. The honest truth is, I have so many people writing to me about their own experiences and that is incredibly gratifying. It makes me feel like I did something right.

THREE MEMBERS SHARE THEIR STORIES

After our members opened up about their personal experiences with bipolar disorder on our Facebook group, I asked them if they felt the mental illness in their lives is misunderstood. Their openness about their experiences resonates with Scott’s perception that this conversation has grown more public, but they each identified several aspects of the public understanding of mental illness that could be improved.

Mike: My son was initially diagnosed with bipolar disorder, and then later the doctors settled on a mix of depression, anxiety, and severe ADHD. I could easily name a dozen ways that mental illness is misunderstood by people around me. The most frustrating for me is the lack of understanding and empathy in the school system.

Living in the Northeast, in very liberal, and theoretically educated, areas, I expected to have support across the board. But in my experience, only about a quarter of teachers and staff, mostly younger, have any understanding of how to deal with these issues. When I met with my son’s high school math teacher to discuss my son’s issues in that class, he said he didn’t care what his “excuses” were. The dean and social worker in the room were silent. Most teachers just gave eye-rolls. Teachers who started out sympathetic would turn on us if my son acted out in their class, as if they felt betrayed that he showed symptoms in their room after they had been so understanding. The idea that doctors over-prescribe these medications has transformed into a belief that all kids on these meds have been prescribed them because the parent just can’t discipline them properly.

Kim: I was an equity partner in one of the world’s largest law firms when I was diagnosed with bipolar II. It was, in retrospect, the best thing that ever happened to me. It’s not fun to be bipolar. It is very tiring, and it leaves the sufferer searching, constantly, for solutions. When a doctor tells you that your disease is treatable, and that 10 million of your fellow Americans will suffer from it over the course of their adult lives, you feel intense relief.

But every time there is a mass shooting in the U.S., someone inevitably asks whether the shooter was mentally ill. This question drives me crazy! It assumes, wrongly, that bipolar people are more likely to be mass shooters than others and that untreated bipolar people are volatile, violent, and psychopathic. Most bipolar people walk through life without anyone knowing. Many of us are quite successful because we “suffer” from boundless energy as well the “side effect” of gregariousness and ebullience. There are millions of us on any given day, happily going about, not shooting anyone. Just like diabetics. But when the news media use our disease to explain everything from minor disagreeable events to mass murder, then we are not like diabetics anymore. We are scapegoats. And that’s the best way to make sure sick people don’t seek help.

Daria: I was officially diagnosed with bipolar disorder in January of 2007. I say “officially” because I can see the symptoms started during puberty. I had fits of rage, extreme mood swings, and many inappropriate relationships with older men. In 2010, I had a manic episode that turned into an arrest.

One misconception about mental illness that has directly affected me is the fact that people think you can only have another episode if you stop taking your medicine. When I went manic in 2010, I was taking my meds. But I still got sick. By the time people noticed, I was too sick to realize I was sick, so I wouldn't voluntarily check myself into the hospital. When I finally came back, people just assumed I wasn’t taking my medicine. My church—where I am a teacher—required teachers to sign a statement saying they were taking their medication as ordered by their physician. I quit attending church for a while and then didn't return to teaching for several more years.

TODAY’S WRAP UP

  • Question of the day: Do you agree that the public understanding of mental illness is getting better? Or do we still have work to do?
  • Your feedback: Let us know how we’re doing today. Take a few moments to fill out our survey.
  • What’s coming: Tomorrow, we have something special for you. As part of our series on Facebook, Masthead members will get exclusive, early access to a deep dive into the problems the world's biggest social network is facing in one of its toughest markets, Germany.

Caroline Kitchener

ASSOCIATE EDITOR,
MASTHEAD

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