Reasons for Denial: Going Beyond Stigma
After being diagnosed with a mental health illness and attending support groups and even peer support training, one area that is seldom explored in depth are the reasons why those diagnosed deny being mentally ill.
The primary reason for denial is “stigma.” Naturally, having a diagnoses with a mental illness can lead to negative associations, but the conversation seldom goes beyond this.
Stigma becomes a “blanket term” that ignores the fact that being aware of having a behavioral slash medical health illness can have a negative impact on self, identity and even one’s gender. When one accepts a diagnoses, one has to live with more than simply labels. One has to live with a reformed identity and sense of self that impacts, ability, identity and perception. There is much more than simply stigma that can make an acceptance of being mental ill difficult.
Below is a list of items that can drive individuals to live in denial of their mental illness. While there maybe more, this is at the very least a starting place.
It is not uncommon for those diagnosed with mental illnesses to deny having them. One of the chief reasons given for the refusal to accept the diagnoses is “Stigma.” It is repeated often as the primary reason for rejection, if not the only reason.
One of the problems with current mental health discourse is that stigma is used as a “blanket term” to cover the reasons for rejection. The discussion with patients and families seldom goes deeper. There are other reasons why someone would reject a mental health diagnosis other than stigma.
Examining the reasons why those designated mentally ill live in denial is key to assisting in the goal of acceptance. Rather than offer one reason, stigma, we can more effectively pin point the issues that prevent patience from seeking and sustaining treatment.
1. Stigma. It is obvious that stigma is a reason denial. The negative connotations of being mental ill are well known. It is clear that being identified as mental ill immediately brings to mind negative stereotypes. Being that there is so little discussed in the culture regarding mental illnesses, preconceptions, half-truth and out right ignorance concerning the subject have created unnecessary fear and anxiety that can become an obstacle to treatment.
2. Loss of control It is assumed that we have control over our decisions, behaviors and lives. One of the first things compromised when being mental ill is a loss of control. From changes in mood, temperament, personality, even up to and including sense of self and perception of reality, there is a fear that admitting to a behavioral/ medical health issue is an admission to not having full control of one’s though processes and actions.
3. Being Handicapped It can be very difficult for those diagnosed having to realize that they are in some ways “disabled.” The concept of partial or total loss of some function is a realization that can be a strong driver of denial. For a person previously perceived as able can be disorienting, if not disturbing, having to realized that they are living with a medical behavioral problem that requires special attention in order to function effectively.
4. Character Issues A diagnoses of a behavioral health issue brings issues of character, self-control and integrity to the forefront. There is the sense that a mental illness is strictly confined to behaviors that can be controlled by moral conviction, discipline and other factors that can be regulated by the individual independent of any outside assistance. To be seen as being mental ill is equal to being seen as a person lacking in values, morals and value as a person. It leads to a negative self-image.
5. Medication Having to be reliant on behavioral health medication for a life time is a difficult concept to grasp for some. The idea that there is no clear cut “cure” and that a life of dependence on medication can be stressful. There is also the stigma attached to taking psychiatric medication. In some select cases the potential side effects are a cause for both concern and fear regarding long term health. There is also the fear that being dependent on pharmaceuticals to manage mental illness is equal to substance abuse. For some there is a moral conflict regarding medication, even if such medication leads to improved outcomes. Some see medication as a “crutch” not a crucial part of handling and successfully managing mental health.
6. Refusal to accept the Psychiatric Community What is often ignored, or seldom openly discussed, is the apprehension, if not outright rejection of Psychiatry. Behavioral health is very much an “abstract” concept. It is the abstract nature of mental health that make it difficult for those who think in more concrete terms to accept. The complex nature of comprehending what mental health care actually is can be lost on some. Much of this stems from the lack of available scientific tested knowledge readily available to those who are mentally ill and those who care for them. Between acidotically received information, half truths and “pseudo psychiatry” as well as inaccurate to distorted information offered on social media and the world wide web, it can be difficult to discern what is accurate versus what is not. Also, there is still a great deal of “cynicism” in some social circles, groups, regions and ethnic groups that do not see any form of psychiatry as legitimate. Irrespective of income, educational background, race or region, there are those that reject all forms of therapy and behavioral medical health care as being serious and in fact “real.” It is something that can have dire negative impacts on recovery.
7. Concern what peers, family members, and the community will handle disclosure Even if one accepts being mental ill, there is the persistent fear concerning the reception one may receive when discussing having a mental illness or illnesses. Patients live in great fear due to how negatively family members, spouses and loved ones may treat those open about their diagnoses. This is particularly true in the work place. There is the very real and persistent concern of rejection by family members, loved ones and coworkers should their condition be known. This can be a strong reason why patients would rather live in denial than cope with the consequences of being identified as mental ill. This also includes possible excommunication from certain religious groups, communities and social groups. This also extends to loss of employment and diminished income as well.
8. Gender Issues For some men and woman being seen as mentally ill can be seen as impacting negatively identity related to gender. For men, mental illness can be seen as emasculating. Being perceived as not having the ability to handle difficult situations alone can harm a secure masculine self-image. Due to many factors, some men are hesitant to discuss emotions for fear of being seen as lesser than, or even seen as in some way being feminine or being seen as weak. For women a mental illness can play into negative stereotypes of woman as being overly emotional, hyper sensitive or fragile. Mental illness can do severe damage to a healthy sense of gender. When gender is impacted negatively, it can also impact a core sense of identity as well as value as a person.
9. Fear In mental health Ignorance is not bliss. In fact, lack of awareness regarding behavioral medical health can be lethal. For a myriad of reasons, from lack of value placed on mental health to time constrictions placed on mental health providers, patients and care providers and families are not being educated on even the most basic concepts. When it comes to health care information, it is literally every man, woman and child for him or herself.
