Our mental illness epidemic has weighed heavily on my heart for years but I have never taken the time to write about it until I saw an Associated Press article about military suicides. I am profoundly saddened by the revelation that so many of our honorable servicemen and women who help sustain the niceties I take for granted would take their own lives in response to the tragedy and pain they endure in silence. This is a national calamity, and it appears we have failed them in some way. Were adequate and appropriate mental health resources available to them, and if so, did they ever feel the social freedom to avail themselves of these resources? Has our society established a standard whereby it is dishonorable and "weak" to seek support for mental strain? Have we been complicit in a tacit conspiracy to shroud their suffering in secrecy? There really is no debate because I know we are guilty of all. In the United States, "mental illness" is a dirty word. We marginalize, we mock, we demean people with mental disorders. But the truth is, at some point in time, nearly every one of us suffers from mental illness. It is as ubiquitous as the air we breathe.
Mental disorders aren't merely schizophrenia, bipolar disorder or severe depression. In my view and experience, they are a continuum of emotions ranging from stress and mild anxiety to debilitating manic depression. In 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated our adult prevalence of any mental illness at 19.6 percent. SAMHSA defined any mental illness as "currently or at any time in the past year having had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within the Diagnostic and Statistical Manual of Mental Disorder." I believe, 19.6 percent is a severe underestimate of our public health burden of mental illness. These data likely fail to capture common stories of mental illness residing outside our ill-informed stereotypes, limited definitions and stigmatizing misperceptions about mental illness. For example, statistics don't fully capture the root causes of scores and scores of homicides in our inner cities, nor the genesis of our epidemic proportions of tension headaches, back pain, fatigue and exhaustion from chronic diseases like hypertension, obesity and heart disease. These chronic diseases are nearly all derived from living in a society that demands much for survival, achievement and status. I also know the data do not capture my own fleeting bouts of anxiety as a deadline approaches when I am ill-prepared, or the sadness and despair I feel after listening to patient after patient relate their stories about the shame and secrecy enveloping their HIV or hepatitis diagnoses. Luckily, I know how to cope with these emotional vicissitudes -- a call to a friend to discuss my frustrations, a bike ride, a quick run or a 10-minute meditation in which I sit alone quietly to breathe slowly and deeply, to pray, to focus on gratitude. But too often, rather than turning to similar personal interventions, we subconsciously dismiss the source of our emotional strain -- be it fear, anxiety or pain -- and mollify these discomforts with swift and temporary solutions like polypharmacy, food, alcohol, tobacco or other substances. These make us feel whole again for an instant. Then the effects wane and the cycle repeats. To me this is all mental illness hushed by our public health definitions and societal perceptions of what it means to be mentally ill.
Our demand for a public health response to mental illness waxes and wanes in parallel with our fickle engagement in these isolated conversations following tragic events. The recent tragedy at Sandy Hook has the medical and public health communities once again openly discussing the moral imperative and urgency for intervention and more comprehensive approach to gun violence and mental illness. We know the two are inextricably linked. This time I hope the conversation will be sustained because we can no longer afford to hide behind the shame and stigma of an epidemic so pervasive as mental illness. As I read the article about suicide among our servicemen and thought about how taboo the subject is, I realized we are a nation of" stigmatizers." We stigmatize many things. Stigma is born from community perception and judgment, and it is of our own doing. We are swift to label and marginalize the groups that most urgently require our empathy, understanding and compassion. I see the effects of our judgments in my infectious disease practice, and I also see it with mental disorders. In our society, seeking support for mental illness is a sign of weakness rather than a necessary gesture for self care and preservation. Recently I suggested to one of my most beloved friends that he seek counseling as a mechanism to resolve a few difficult and emotionally painful issues. His response, somewhat in jest, was basically, "I am a man. I don't do that." His opinion is widely held, particularly among men, and sadly is likely deeply ingrained in our military personnel. Perpetuating the notion that to seek counseling signifies weakness is among our gravest societal mistakes. It is contributing to our public health crisis. As I learned during my studies with Dr. Jim Gordon at the Center for Mind Body Medicine, counseling assumes many forms and is a powerful and severely underutilized wellness intervention!
These days, we talk incessantly about living well and achieving life balance, yet we wear masks to hide our pain. No matter who you are, true wellness can never be achieved behind these and without facing our pain and stressors. The revelation of the loss of life from suicide among members of our military should assist us in maintaining a renewed urgency to devise a public health approach to mental disorders. Their decisions to end life rather than stay with us and engage are a poignant reminder about our urgent need to raise awareness, discuss these issues aloud and proactively change the national perception about mental disorders. To our honorable men and women who took their own lives, thank you for your service and may you rest in peace. For your sakes, I hope we can learn from the lesson you are teaching us and commit to do better and do whatever is necessary to be mentally well.
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Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.