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Most of the stigma associated with
psychiatric illness is based on myth. Here are ten
common myths about psychiatric disorders:
- Myth #1: There is No Such Thing as Mental Illness
There are some irresponsible, outspoken individuals who have made a
career of criticizing psychiatry. They are entertaining and controversial,
and they frequently appear on daytime talk shows and misinform the public
about the nature of psychiatric disorders. They either ignore or distort
the scientific literature, and they argue that psychiatric illness does
not exist because the exact biological defect or "chemical
imbalance" has not been identified. They fail to point out that
science has not discovered the exact biologic cause of fever, yet this
does not make it any less of a malady.
The unfortunate result of this negative propaganda is that you may be
made to feel guilty about having your illness. The comments of friends,
family members, or coworkers who tell you to just "snap out" of
your depression or anxiety are hurtful, because these comments suggest
that by not snapping out of it you are doing something wrong. The implied
message is that you must be causing your own symptoms, and that you have a
weakness of character. The other implied message is that psychiatric
symptoms are not as legitimate as physical symptoms.
Psychiatric disorders are every bit as real as other medical disorders.
The symptoms have a typical course and outcome, they run in families and
are partially genetically determined, and they respond to specific
treatments. In short, except for diagnostic blood tests or x-rays, they
are no different than other medical disorders. (top)
- Myth #2: Few People Have Psychiatric Disorders
Because of the stigma associated with mental illness, few people discuss their emotional problems.
However, two large studies of thousands of people from the general
population found that between 1/3 to 1/2 of Americans have experienced a
clinically significant episode of emotional or nerve problems at some
point in their lives that would be diagnosed as a psychiatric disorder.
Thirty thousand people in this country kill themselves every year. Ten
times that many attempt suicide; and millions more have problems with
clinical depression, anxiety or abuse of alcohol and drugs.
Unfortunately, as the recent Surgeon General's report indicated,
psychiatric disorders are very common. (top)
- Myth #3: If You Have a Psychiatric Disorder You Must
Be Crazy
It is easy to get this impression from newspapers, television or
movies. The media primarily focuses on the outrageous, violent, bizarre,
or revolting. A simple major depression or panic disorder is boring. But a
psychotic postpartum depression in which a mother kills her newborn
because she believes it is the devil's child is front page news. Consider
that approximately 1 out of 5 people suffer a psychiatric disorder during
a year. Think of the people you know. About one-fifth have had a
psychiatric disorder during the past 12 months. Are they "crazy"
in the way that you are afraid people will think you are? (top)
- Myth #4: People Will Think Less of Me
This may or may not be true. A few people might actually think this
way. However, to most people, the greatest influence on their opinion will
be your behavior, not your diagnosis. When you feel better, and begin to
act like the "old you," they will treat you like the "old
you." It is the same as recovering from a physical illness. The
recovery phase from a heart attack often involves "kid glove"
treatment from friends and family, until they see the person return to his
previous level of functioning. (top)
- Myth #5: People With Psychiatric Disorders Are Violent
Go back and re-read myth #3. (top)
- Myth #6: Psychiatric Diagnoses Are Unreliable
This used to be true. In the past fifteen years, diagnostic reliability
has improved. However, in high profile criminal cases, different
psychiatrists sometimes make different psychiatric diagnoses. It is therefore easy to
get the impression that no two psychiatrists ever agree about a diagnosis,
but that is inaccurate. The reliability of psychiatric diagnoses is no
better or worse than the reliability of other medical diagnoses. (top)
- Myth #7: Psychiatric Diagnoses Are Not Valid
and Do Not Represent
"Real" Problems
Some critics of psychiatry misrepresent how psychiatric disorders are
diagnosed. They suggest that people with everyday problems in living or
normal reactions to upsetting events are inappropriately diagnosed as
mentally ill and put on "mind altering" drugs. Study after study
shows that people with untreated psychiatric disorders die earlier, and
function more poorly, than individuals without these disorders. Thousands
of studies show that treatment works. Studies comparing psychotherapy or
medication to placebo treatments show that the real treatments do much
better. Studies of twins and adoptees demonstrate that there is a strong
genetic component to psychiatric disorders. And studies of the biology of
mental illness consistently show that the brains of some individuals with
psychiatric disorders are different from the brains of healthy people.
Thus, there is no doubt that psychiatric disorders are as real as other
medical disorders. (top)
- Myth #8: Everyone Has a Mental Disorder and Should See a Shrink
Anxiety, irritability and sadness are normal human emotions. Having a
nightmare after an upsetting event and feeling anxious about saying
something stupid when speaking before a group of people are also normal
thoughts and reactions. They are not diagnoses requiring treatment. The
line between normality and pathology is, admittedly, sometimes fuzzy. This
is true for both medical as well as psychiatric disorders. Consider
whether someone without any symptoms or complaints, but with high blood
pressure or high cholesterol levels, has a medical disorder.
The boundary between normality and mental illness is defined by the
duration of the symptoms, the intensity of the symptoms, and the distress
and impairment caused by the symptoms. It is normal to feel depressed
after a long relationship ends. But it is abnormal if the symptoms persist
for weeks or months, and they continue to interfere with work performance
or performing chores around the house. There may have been a time 40 years
ago when psychiatrists thought that everyone was a little neurotic and
could benefit from therapy. Today, there are explicit rules for making
psychiatric diagnoses. One of the rules is that the symptoms cause
significant distress or impairment in functioning. Thus, while research
suggests that a large percentage of people have suffered from a
psychiatric disorder at some time in their lives, this same research finds
that at least half the population have never had a psychiatric disorder. (top)
- Myth #9: There Are Blood Tests to Make Psychiatric Diagnoses
There is no doubt that major psychiatric disorders are brain diseases,
and are due to "chemical imbalances" in the brain. Countless
studies show differences on blood tests and brain scans (MRI, CT scans)
between people with psychiatric difficulties and those without. However,
none of these test differences are great enough or consistent enough to be
used to aid the diagnostic process. There are no blood tests or x-rays
that make accurate psychiatric diagnoses yet. (top)
- Myth #10: Therapists Analyze Everything You Say and Do
Mental health professionals pay close attention to what people say and
how they act. That is what they are paid to do. In fact, it is what they
have to do in order to be of help. Observation is important because
diagnostic clues can be found in how rapidly someone talks, how restless
they are while sitting in a chair, how well they can concentrate during an
interview, etc. However, the observations made by the mental health
professional are no different that the observations everyone makes during
their daily interactions with friends, family and co-workers. The
professional, though, recognizes the link between these observations and
specific diagnoses. (top)
Information in this section is provided by Rhode Island
Hospital psychiatrist Mark Zimmerman, MD. The psychiatry department's
services include the MIDAS Project,
an ongoing clinical research study involving the
integration of research assessment methods into routine clinical practice.
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