On Robin Williams And How We Talk About Mental Illness

Getting help is really, really hard.

Aug 12, 2014 at 9:30am | Leave a comment

It took me a minute yesterday to understand why my Twitter feed was suddenly whizzing by at 600 miles an hour with commentary about mental illness, and then my brain said: "Ah, of course, someone famous committed suicide."

Robin Williams is dead at 63, as a result of what appears to have been suicide. Robin Williams' death is terrible and heartbreaking, and my thoughts go out to his surviving family members and loved ones.

Two broad themes seem to be crossing my feed:

1. If you're sick or in need, get help. 

2. Support mentally ill people who reach out to you or express suicidal ideation. 

As someone who's going through a pretty extreme depressive episode right now, I want to articulate why both of these sentiments, while incredibly well-meant, aren't necessarily very helpful, and, critically, ignore the larger conversation we need to have: We need to fight mental health stigma so that people are not put in these terrible positions in the first place, and that means that we need to care about mental health all the time, not just in periods of crisis. 

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The "get help" iteration (if you need someone to talk to, though, please go here) is yet another reminder that we're supposed to fix ourselves. Get on it. Get help! This is your responsibility. Go talk to someone!

Some mentally ill people are in a place to do that, but it's a huge struggle. A huge, huge struggle that I can't even begin to convey to you if you haven't experienced depression. Simply making a phone call to request a referral takes days or weeks (I in fact still have a referral I haven't followed up on for THREE WEEKS because it involves picking up a phone and calling someone, which may not sound like a big deal to you, but is a huge deal for me).

We get it. Lots of us want help. We know you want us to have help and that you feel impotent and helpless in the face of what we're going through. But it's tragically not as simple as calling the doctor's office, for a huge number of reasons, starting with our own mental health conditions.

When your brain isn't working right, there are huge barriers to overcome -- from the depression that makes you sleep 20 hours a day to the paranoia or delusions that make it difficult for you to even consider that you might need help. When people are leaning on us to "get help," it can feel like yet another thing we're doing wrong. We're such failures that we can't even do this one simple thing. If we can't call the doctor, how can we hope to accomplish even bigger things, like showering, or eating, or feeding the cat? 

Coming out about getting help and how much it has helped is fantastic -- and there's a reason I talk as openly as I can about seeking mental health services. But I also don't judge those who are not in a position to get help because of their mental health, or because of other obstacles: Because they can't access treatment. Because they might lose their jobs if their mental health conditions become publicly known. Because they're afraid of the consequences among family and friends. 

Getting help is really, really hard, and platitudes from people who have never experienced mental health problems whenever a catastrophe erupts don't really make me feel good. Fellow mentally ill people talking about their experiences with seeking treatment are a bit different -- not least because they bring up the issue all the time, not just when it's in the news. But it's kind of overwhelming when suddenly everyone everywhere is erupting with calls to "get help" after a celebrity suicide. 

The idea that people should support their depressed friends is also hugely important, obviously. If you have a friend who is experiencing or expressing suicidal thoughts, heck yes you should do whatever you can. Be a friendly ear. Bring food by. Make sure your friend knows that she is loved and supported and offer concrete help: Do you need help cleaning? Would you like a ride somewhere? 

Listen to the needs your friend articulates, and respect them. If you're not sure about what to do, talk to a counselor and ask for advice on how you can support, or consult another mentally ill person. 

Be patient, too, and be aware that depression can be horrific and ensnarling and nasty. Sometimes depression makes you mean. Sometimes it makes you apathetic. Sometimes it makes you unable to deal with anything at all, even the smallest of things. Sometimes being friends with a person going through depression means just being there -- and it definitely means not playing therapist

But here's the thing: People are mentally ill all the time. People are depressed all the time. Even if people are not actively experiencing a mental health crisis, they're living with mental health conditions. Mental illness is not something you get over or heal from. It's something you manage, to varying degrees, and it's always part of your life, and it expresses in varied ways. 

Maybe for some people it's years of stability on medications with therapy and other treatments. Maybe other people are struggling to find an even keel. Maybe someone else is undiagnosed and untreated and trying to figure out what is happening to her. 

An estimated 20% of people experience symptoms of mental illness at any given time. Put in another context, that means that in a room full of people, one in five of them is having mental health problems, from the mild to the severe. Many of those problems are not evident, and mentally ill people are reluctant to come out -- because we live in a society with a huge mental health stigma, where they understand the ramifications of coming out.

It's not like we're going to wear little badges to tell you we have bipolar disorder, or schizophrenia, or depression, or any number of other mental health conditions.  

And every time you're in a mixed group of people and you assume that no one there has a mental health condition or has struggled with mental illness in the past, you contribute to that stigma. Maybe it's with a casual comment you make. Maybe it's when you talk about "them" under the assumption that none of us are in the room. Maybe it's with a snide joke about mental health. 

You have the ability to create a supportive nonjudgmental environment for people with mental health conditions, and it's up to you to make that happen. Not in the midst of a crisis, when someone who has been struggling with a mental health condition reaches a critical boiling point, but all the time. Because we need support all the time, not just during periods when you see us being outwardly mentally ill because we can no longer hide it, or because we're desperate for help. 

It's up to you to create a world in which there is no mental health stigma, where people who are mentally ill feel comfortable expressing it and know that in a mixed group, no one will make awful comments about mental health issues. It's up to you to create a world where celebrity suicides aren't accompanied with tremendous pressure on mentally ill people to fix ourselves. It's up to you to create a world where whenever a mass shooting happens, you don't automatically assume that the killer had a mental health condition. 

It's up to you to create a world where people can openly discuss mental health issues, rather than fearing huge social consequences. 

For a crazy person, I am extraordinarily lucky: I have great health insurance (now) with a provider known for excellent mental health programs. I work in an industry where it is okay to be out about mental illness, at least to some extent, with employers and coworkers who are incredibly supportive. Not everyone has those privileges, and it's those people I think of on a daily basis when I advocate for better handling of mental health issues not just in terms of policy, but society. 

Because society frames how we handle mental health, and mental health doesn't magically become an issue only when someone well-known commits suicide. It's an issue all the time.

We're still here, long after the news story is over.