Coming Out About Mental Illness

Last Editorial Review: 1/31/2005

You've just been diagnosed with a mental illness. Now what? Here's how to tell the people you love.

By Sarah Albert
WebMD Feature

Reviewed By Brunilda Nazario

Getting a diagnosis for depression -- or any mental illness -- is no easy task, but getting validation and treatment can be a great relief.

The hard part for many people is telling family, friends, and other loved ones about the diagnosis, given the prevalence of stigma and ignorance in regards to mental illness. It's important that you take the disclosure process seriously, and protect yourself. The good news is you have control over who you tell, and WebMD can help guide you through the process. The following expert advice will also help you if you're the caregiver, partner, parent, or friend of someone with a mental illness.

Coming to Terms With Your Feelings

It's an unfortunate fact that not everyone is going to support your decision to seek treatment for a mental illness; some people may not even believe mental illnesses exist. "Society stigmatizes mental illness," says Joan A. Lang, MD, professor and chair of the department of psychiatry at Saint Louis University School of Medicine. This can make the process of telling people about your condition extremely challenging. "An awful lot of the trepidation stems from the fact that there is still a lot of stigma and people who are very ignorant and insensitive, but it also comes from internalized stigma."

As a result you should look at your own feelings about your mental health before you subject yourself to the ideas of others. Lang says patients who have feelings of guilt, shame, or a notion that they are somehow weakened for needing help can get hurt when others tout misconceptions and reinforce negative feelings.

"Our cultural understanding of mental illness is that you are just not trying hard enough. We never say that about cancer or heart disease," says Joyce Burland, PhD, director of the education, training, and peer support center at the National Alliance for the Mentally Ill (NAMI). "America thinks mental illness is something that can get self-corrected, and that is a vast misunderstanding."

Who to Tell About Mental Illness

There is no rule for who needs to know about your mental illness diagnosis, but sharing it with someone is probably a great way to get support. Lang says you should assess how disclosing your mental illness fits into your character -- for example, how private you usually are -- apart from the mental illness.

"Telling people is a very personal decision," says Burland. Mental illness is all around us; in fact, if you entered a room of 50 people, it's likely about eight people in the room would have a mental illness serious enough to require professional help, she says. "The silence helps maintain the ignorance about mental illness." But that doesn't mean that it is beneficial for you to open up indiscriminately about your mental health, to your detriment. "As an advocate I could say that it would be wonderful if everybody came out. But it is a very subjective decision and you have to consider the consequences."

Disclosure doesn't have to be all or nothing, says Lang. Weigh the risks and benefits involved with telling certain people. "Not everyone in the world needs to know if you struggle with diabetes or hypertension or some other illness. The same is true for mental illness," says Lang. You're in charge, and should think about what the payoff is if you share information about your mental health. For example, if you need to miss work to see a psychiatrist, you might want to tell your employer about what you are going through, says Lang.

Practice Makes Perfect

Lang says the next step is to practice telling people about your mental illness, ideally with your therapist if you have one. This way you can anticipate some of the issues, questions, and comments that might arise. Practicing might also help you clarify your own thinking about mental illness as well as help determine who to tell.

"We have imaginations for a reason -- to enable us to anticipate things that might happen and mentally rehearse ways that we might respond to those scenarios," Lang says.

Coping With Bad Reactions to Mental Illness

Lang points to two choices when faced with someone who reacts badly to your disclosure: you can agree to disagree or you can try to educate that person. Read some educational materials with friends and family, and discuss the content. The organization Families for Depression Awareness, offers brochures about how to help someone you love who is struggling with depression, along with other resources available online. The organization is currently developing a monitoring tool to help patients and families monitor their depression treatment.

"It's an educational tool that provides important information about depression, how family members can help someone with depression, and how to monitor treatment with a calendar and diary," says Julie Totten, the founder and president of Families for Depression Awareness. She says the tool, which should be available early next year, will also help you keep track of medication side effects and red flags, which should be shared with the therapist. "It also will be a tool to help families communicate."

NAMI promotes support groups and educational courses for people with mental illness and their families and friends. One program, called Family to Family, centers around the education of caregivers. The NAMI web site offers many useful educational resources as well as information about where to find free support groups and courses in your area, says Burland.

Keep in mind that some people might express concerns about your condition, and this isn't necessarily an act of judgment or rejection. Seriously consider the insights of your loved ones, who may be concerned about things such as suicide or substance abuse.

Supporting Friends and Family With Mental Illness

If someone you love tells you that they have a mental illness, think before you speak.

"Do an internal check of your own reaction instead of just flying off with your first impulsive reaction," says Lang. If you think your reaction may have to do with ignorance or lack of education on the topic -- or stigma -- talk to your doctor or a mental health professional before you start dolling out your own advice. Try to react the same way you would if you were told about a physical health problem that you don't know much about.

Avoid trying to be the hero or savior. Being empathic and understanding is one thing, but trying rescue someone is a completely different, says Lang. "You shouldn't try to fix them. This is something that is way beyond your capacity."

That doesn't mean you can't help. Experts agree that you can play an important role in the treatment of your friend or family member because you might notice things that a person in the grip of mental illness doesn't see or actively denies. This can be especially important for people who are not in treatment. Let's say your college roommate doesn't get out of bed, or you think he might be suicidal, and you're at a loss for what to do. Lang says you should tell him your concerns, but don't take responsibility for him. You can also enlist a parent or relative to help you.

If you are worried about someone who is in treatment, you can contact the mental health professional who is treating him or her, but the therapist can't share information with you and won't necessarily be able to keep your call confidential. "Any time you are a Good Samaritan you do run the risk of it backfiring and the patient feeling betrayed," says Lang. Most likely, however, they will ultimately understand that you were just trying to help them.

It's a difficult journey for everyone involved, but treatment -- and support from friends and family -- can go a long way to helping people recover, manage their conditions, and lead happy, healthy lives. "People with mental illnesses are heroines. We want people to see their family members with mental illness as the courageous people they are," Burland says.

SOURCES: Joan A. Lang, MD, professor and chair, department of psychiatry, Saint Louis University School of Medicine, St. Louis. Joyce Burland, PhD, director, education, training, and peer support center, National Alliance for the Mentally Ill (NAMI), Arlington, Va. Julie Totten, president and founder, Families for Depressive Awareness, Waltham, Mass.

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