Ooh! What a scary introduction to mental illness. I was 19, and out of nowhere, I had just been hospitalized for my first mania. I hadn’t slept for four straight days. Over that time, I became filled with energy. First, I was the life of the party. Then, I became obnoxious and irritable. And finally, after having not slept for so long, I was detached from reality. By the time my parents came to take me for help, I actually thought I was going to travel back in time to fix it so they never got divorced.
When I was in the hospital, I was coming back down to earth, and I was also starting to realize that my life was going to be very different with my new bipolar diagnosis. My psychiatrist wasn’t the only one scaring the heck out of me. My family warned me that if I spoke about my mental illness, I would lose all of my friends. So, I did what I was told, and I kept it secret.
Now, this surprised everybody because I’m actually a chronic oversharer. (Laughter) But I kept that secret for almost a year until the stress became unbearable, and I got sick again. I had felt so much shame from hiding. I realized then that for me, saying nothing wasn’t the best approach, and from then on, I was open.
Now I’m a pro when it comes to talking about mental health. I travel the country teaching people and organizations how to do it. Wherever I go, I tell everyone, “I have bipolar disorder.” I put it in my bio, I share it at cocktail parties, I’ve told people on first dates … I’ll probably tell you I have bipolar disorder at least a dozen times by the end of this talk.
But even after over a decade of doing this, it’s still hard to figure out the best way to talk about mental health. It’s a very sensitive topic, and there are so many ways that we can accidentally offend people. Our conversations get loaded with assumptions, paternalism, and stigma.
Assumptions – Assumptions happen when we think we understand something but we actually don’t. People make all sorts of assumptions when it comes to mental health. It happens when supportive friends say things like “I’ve been there” or “I know what you’re going through,” or if I told someone that I knew what it was like for them to have bipolar disorder just because I also have bipolar disorder. But the truth is everyone is unique. Two people can have the same exact diagnosis but very different experiences, beliefs, and values. We may think that we’re empathizing when we say things like “I understand,” but we might be inadvertently offending people by assuming we know their story.
And then, there’s paternalism. Paternalism happens when we tell someone what’s best for them. We may think we’re being helpful when we’re suggesting a treatment option or a resource, but it can become very disempowering if we do it in a way that treats someone like they can’t manage their mental health condition on their own.
An example is when a college student takes a medical leave of absence so they can take care of their mental health. A lot of times, they have to seek approval to return back to school, and many universities actually require that they share their medical records and the treatment files and possibly periodic updates about how their treatment is going. Now, the reason that schools do this is they want to be able to be supportive and welcome the person back to school and make sure they’ll be able to do well when they get back to school. But this process of monitoring can actually become very disempowering if the student feels like they’re not in a position to manage their own care. So, even when we try to be supportive, this inadvertent paternalism can push us apart.
And what about stigma? Stigma happens when people have negative attitudes toward mental health. I have seen faces sink and attitudes shift the moment people learn I have bipolar disorder. “Incompetent.” “Dangerous.” “Unreliable.” These are some of the first thoughts that people associate with mental illness. One memorable time that I experienced stigma happened before I ever got sick with bipolar disorder, when I took an abnormal psychology class. And I actually took that class the semester before I first got sick. One person in my group of friends made fun of every single mental health diagnosis that came up and mocked every single treatment, and that person was actually me. I made those comments just before my mental health problem first emerged. And I’ll never forget what it felt like to be sitting in a hospital, just a few months later, wondering if people were saying the same things about me.
I share that story now for the same reason that I share it in my trainings: because I want you to feel comfortable when you see me here talking about my mental illness. When people hear me say that I have a mental illness, they often get worried that they’re going to say the wrong thing or they’re going to offend me. And I want you to know I’m not going to judge you for anything you say. Even when we have the best intentions, the assumptions and the paternalism and the stigma can make us say offensive things, and the reality is no matter what upsetting things we say, we are all in this together.
Over 40 million Americans have a diagnosable mental health problem each year, and close to half of us will experience one at some point in our lives. Even if we don’t ever qualify for a clinical mental health diagnosis, we still all know what it’s like to feel sad or worried or overwhelmed. Our bad days don’t all end in hospitalizations, but we still all know what it’s like to have a bad day. We have to learn how to connect and have important conversations about mental health without offending each other. Families need to talk with each other about treatment plans and living arrangements and lifestyle choices. Companies need to engage their employees so they can accommodate their needs, maximize their productivity, and build resilient cultures that are ready for their bad days. Colleges need to know how to refer their students to mental health services, place them on leaves of absence, and welcome them back to school while empowering those students during every step of their journey to take care of their mental health. These are just a few of the many important conversations we have to have, but we can’t have them if we’re afraid to broach the subject.
And that’s where conflict resolution comes in. I spent years searching for tools to help people communicate about mental health before I finally discovered mediation. Mediation is a type of conflict resolution. When I trained to become a mediator, I learned how to support people in working out their own agreements to resolve a conflict. Mediators don’t give advice. We don’t make suggestions, and we don’t tell people what to do. Mediators don’t take sides. Instead, we just listen and validate
people’s perspectives and ask open-ended questions. Mediators provide a structure – a place and a time to have the conversation. Mediators help people get past their barriers so they can have a dialogue.
So, how do we apply the skills of conflict resolution to talking about mental health? We have to make room for the other story. That is the biggest lesson from conflict resolution and the key takeaway from this talk. We have to make room to listen to other people’s perspectives. When we make room for the other story, we can overcome the obstacles of assumptions and paternalism and stigma.
Making room means that we stop assuming we know what’s going on when it comes to mental health and we start asking questions. When I was in grad school, I had a roommate who was very supportive and wanted to help me with my mental health problem, but the only problem was he didn’t tell me. He never told me he was doing anything to try to help me. So I met him, and I told him I have bipolar disorder and I worked very hard to protect my sleep. And unbeknownst to me, he would brush his teeth at night but wouldn’t run the water, even though he needed to, because he didn’t want to wake me up with the noise from the faucet and the sink. And the truth is I didn’t need him to do this. So this went on for months and months until finally, you know, he built up some resentment and actually felt like I owed him something because he had been sacrificing the running water from the sink at night. And we finally had a confrontation about it, and we worked it out. But, you know, you’ve got to wonder: What if he’d just asked me when I told him I had bipolar disorder? What if he asked me, “What does it mean that you have bipolar disorder? Do you want my help in protecting your sleep? And how can I help you protect your sleep?” When we ask questions instead of making assumptions, then we make room for the other story.
Now, making room for the other story also means that we have to replace our paternalism with respect for people’s choices. Whether you are a mental health professional or a person living with a mental health condition or a supporter or all of the above, we all have our own answers when it comes to mental health. Too often, we spend our time telling people our answers instead of trying to learn from theirs. We tell people what we believe is the right treatment or the right resource because we’re trying to help, but we forget that even the experts debate everything, from diagnosis to treatment. There are no perfect answers in mental health that work for everybody. And without those universal answers, what we’re left with are personal choices. We have to learn to embrace the fact that there are all these choices and respect the choices that people make. That means we have to say things like, “I know this is your choice. Can you help me understand what’s important to you when you’re making that choice?” Or, “You’re making a different choice than I would. Can you help me understand why this is the right choice for you?” When we frame our conversations as discussions about people’s personal choices, well, then we empower people. We make room for their story.
The last thing I’m going to talk about in making room for the other story is we have to face the stigma head-on. We have to acknowledge that some people do have negative attitudes about mental health, and this makes it hard for us to have conversations about it. When I train managers to talk to employees about mental health, we can’t pretend that it’s an easy or simple thing for those employees to go to their human resources department and tell them that they have a mental health need or to use their employee assistance plan to access short-term therapy. The scary reality is that it can be hard to disclose a mental health condition, and people get worried that their boss or their coworker might see them differently. We can’t afford to dismiss the stigma or ignore the fact that it exists. When we make room for the fact that there really is the stigma, then we’re making room for the stories of people working to overcome that stigma.
Everyone has a story when it comes to mental health. I started this talk by sharing a scary statement from my psychiatrist in the hospital, warning me about the stigma of mental illness and encouraging me to hide. Now let me try to make room for what might have been his other story. Maybe he had spent years working with lots of patients who had been open about their mental illness and experienced a lot of problems because of the stigma. Or maybe he was one of the countless professionals who are thriving at their jobs but also privately managing a mental health condition. Maybe he was telling me the same advice he follows every day.
And what about the people who make fun of mental illness? What might be their other story? Well, maybe they’re like I was when I took that abnormal psychology class. Maybe they don’t even realize it yet, but they’re fighting every day to resist the pull into their own internal instability, and maybe one day they’ll even be on a stage like this one, telling their story. We have to make room for all of these stories when we’re talking about mental health. We have to ask questions instead of making assumptions, we have to respect choices instead of being paternalistic, and we have to face the stigma head-on. When we do all these things, we can connect without offending each other. And we definitely have it in us to connect. No matter how different we are, we all have bad days, and if we make room for everyone’s unique story, then we can take a step back together and see that we’re all part of a single big picture, one community of people trying their best to have fewer bad days.