There is stigma attached to mental illness and substance use. The media, unfortunately, perpetuate stigma by spreading misinformation.
For example, every time a school shooting occurs, the media attributes it to (or at least references) mental illness. Journalists first, and then social media trolls sensationalize news stories about the shooter’s eccentricities and all the signs that were missed. Upon learning that the shooter was having problems at home and didn’t get along with his peers, one might suspect mental illness. And suspicion becomes certainty when mental illness is viewed as the only plausible rationale behind the senseless violence. (It’s also rationalized that ‘normal’ people don’t shoot each other for no reason. So when there is no apparent motive, mental illness is blamed.)
Next, mainstream media circulates the story about the depressed kid turned killer. The message received is “mental illness is dangerous” or “people with mental disorders are criminals.” This misinformation is absorbed and regurgitated in society, online and off, and misconceptions about mental illness persevere.
Unfortunately, misconceptions about mental illness are common, and not just with the media. Even healthcare workers, including mental health professionals, believe common myths.
In this post, I will address some common myths and misconceptions about mental illness.
Ignorance is the root of stigma. The more you know, the less you fear, and the less you’ll stigmatize. Read on to learn about myth versus fact.
9 Myths & Misconceptions About Mental Illness
1. Bad parenting causes mental illness.
Even today, there is no single identified cause that explains mental illness.
However, there are multiple known risk factors (biological, environmental, and social) that contribute to the development of mental disorders. Having a genetic predisposition to mental illness is the biggest risk factor. Genetics largely determine if a person will develop schizophrenia, depression, substance use disorder, etc. About 40-60% of mental illness is determined by biology.
Physiological factors (such as structural differences or chemical abnormalities in the brain) are another risk factor. Additional biological risk factors include prenatal damage, brain injury or defects, illness or exposure to toxins, and damage from drug and alcohol use.
Environmental and social factors include fetal exposure to a toxin and childhood trauma, among others.
Childhood abuse and neglect undoubtedly fall into the ‘bad parenting’ category. What’s more, adverse childhood experiences (ACEs) are associated with chronic disease, obesity, decreased immune function, substance use, and mental illness in adulthood.
While childhood abuse, neglect, and even spanking are linked to poorer mental health outcomes, bad parenting does not cause mental illness. Bad parenting can be a risk factor, depending on severity and impact, as well as the presence or absence of protective factors. (Protective factors include resiliency, health, feeling safe at home, etc.) Also, ‘bad’ parenting is somewhat subjective.
Generally, the more risk factors (and fewer protective factors) a person has, the more likely they are to develop a mental illness.
2. Mental illness is not a medical disease.
Heart disease affects the heart. Colon cancer affects the colon. Autoimmune disorders affect the immune system. Brain disorders (i.e. mental illness, addiction, brain cancer, dementia, Parkinson’s, Alzheimer’s, etc.) affect the brain.
Like other organs, the brain is susceptible to disease. Brain disease manifests as changes in behaviors, thoughts, memory/processing, speech, emotional regulation, judgment, and more. Because your brain is the body’s control system, brain disease may also impact balance, muscle coordination, the ability to use your sense of taste, smell, touch, etc.
You cannot ‘see’ mental health symptoms the way you can see some physical health symptoms (such a rash or a broken bone), but you also don’t see most physical health symptoms.
When you have a headache, no one else can see it. You don’t even know what’s happening to the neurotransmitters and synapses across the lobes in your brain. You’re solely responsible for describing the pain to your doctor so they can prescribe the right treatment.
In reality, there’s not such a huge distinction between so-called physical and mental illnesses. They can both be painful and debilitating, and may require medical treatment.
3. All sociopaths are dangerous.
The term ‘sociopath’ (or psychopath) is frequently associated with serial killers. The reality is that you probably know a sociopath and they aren’t a murderer.
In fact, ‘sociopathy’ and ‘psychopathy’ are no longer recognized as diagnoses in the mental health world due to negative connotations. The diagnosis became associated with a sterotypical portrayal of a psychopath as a ruthless and insane serial killer. The stereotype is perpetuated by filmakers and TV producers and continues to show up in movies and series even today, despite the glaring inaccuracies with the diagnosis.
The correct term is antisocial personality disorder (ASPD), a mental illness characterized by an ongoing disregard for and violation of the rights of others. An individual with ASPD may also be exceptionally charismatic. (Some of the most charming and engaging clients I’ve ever worked with had ASPD.)
However, research indicates that an individual with ASPD is more likely to become involved in criminal activity,to have a substance use disorder, and to be aggressive; about 50% of individuals with ASPD have some sort of criminal record.
While it’s a misconception to say all individuals with ASPD are dangerous, the link between ASPD and crime is not unfounded.
4. Mental illness can be overcome with willpower.
This is 100% myth. The notion that mental illness can be overcome with willpower goes hand-in-hand with the belief that mental illness is not a ‘real’ medical condition.
A mental disorder typically requires treatment, such as medication and therapy, and ongoing illness management.
All the willpower in the world will not help someone overcome heart disease. And it does not work that way with mental illness either.
5. Addiction is a choice.
Substance use disorder is no more of a choice than diabetes or cancer. Like most diseases, addiction develops when a combination of genetic, physiological, psychological, and environmental factors are present. Lifestyle choices also play a role. Unfortunately, the myth that addiction is a moral failing persists.
An individual who has an addiction receives more blame than someone with a heart condition, even though lifestyle choices heavily impact both disorders. I have even heard the argument that addicts who overdose should not be revived because it was their ‘choice’ to use. If that is the logic, then should we stop providing life saving care to someone who is obese when they have a heart attack or to a smoker with lung cancer? Of course not.
At times, we all make poor decisions. For someone with a predisposition for addiction, the choice to drink may lead to alcohol use disorder. For the person with a predisposition for diabetes, eating an unhealthy diet or living a sedentary lifestyle will result in consequences.
Furthermore, once a person develops a substance use disorder, physiological and structural changes in the brain dissolve the element of choice. The brain misinterprets a craving for drugs or alcohol. (Remember the last time you experienced extreme thirst? That is what it is like to be addicted to something.)
Having a substance use disorder is miserable, lonely, and shameful. No one chooses that.
6. People with mental illness are violent.
Having a mental illness does not make someone more likely to commit a crime or act of violence, especially if that person is following treatment recommendations for psychotherapy, medication, etc. Rather, biolocial, psychological, and environmental factors are associated with violent behavior. In the general population, younger males in lower socioeconomic classes with lower levels of education and employment are the most likely to engage in violent acts, not persons with mental illness.
While the media would have us believe that mental illness is at the root of every mass shooting, this isn’t the case. Most people with mental health problems do not commit violent acts or crimes, and most violent acts are not committed by people with mental illness. It’s also true that persons with severe mental illness are more likely to be victims of crime.
Moreover, individuals with mental illness are more likely to die by suicide. Persons with schizophrenia have higher rates of suicide than the general population. Depression, bipolar disorder, and borderline personality disorder are also linked to suicide.
A mental disorder is a medical condition; having weak morals is a personality trait, and while it seems mentally sick, it’s not fair to compare a lack of morals to a condition like depression or anxiety.
7. Mental illness is the same thing as mental retardation.
I am friends with a nurse who did not know the difference (until I pointed it out). A person with a mental illness may seem less intelligent due to various factors, but mental illness is not comparable to mental retardation. Today, we refer to mental retardation as intellectual disability (due to the negative connotations attached to the word ‘retarded’).
A person with an intellectual disability (ID) struggles to understand, comprehend, and/or form memories. A person with mental illness, on the other hand, may have superior intelligence, but could seem slow due to distractions brought on by their illness. (For example, it is difficult to focus on a conversation when you’re having racing thoughts or hearing voices.)
8. A person with schizophrenia has multiple personalities.
A person with schizophrenia may hear voices and even respond to what they hear, but they do not have multiple personalities. Multiple personality disorder (MPD), on the other hand, is associated with distinct personalities.
Today, MPD is referred to as dissociative identity disorder (DID). A person with DID has at least two distinct personality states, and suffers from gaps in memory. The prevalence of DID is largely unknown, but it’s estimated that 1-2% of Americans have DID. DID occurs so rarely that its existence was once disputed in the scientific community. There is a strong correlation between DID and childhood trauma and abuse.
With schizophrenia, the voices may be distinct, have their own names, and can be experienced as different personalities (male, female, child adult, friendly, cruel, etc.) or entities, but someone with schizophrenia has only one personality. Dissociation is not a typical symptom of schizophrenia.
In addition to auditory hallucinations, someone with schizophrenia may experience visual hallucinations, delusions, disorganized thoughts, cognitive deficits, and/or what’s referred to as negative symptoms. A negative symptom is a lack of something that is typically present in someone without schizophrenia. For example, a person with schizophrenia may be socially withdrawn or he/she may seem very flat, or without emotion.
9. Alcohol makes you depressed because it is a depressant.
Part Myth, Part Misconception!
Yes, alcohol is a depressant. but as a depressant, it depresses your central nervous system, leading to slurred speech, trouble with coordination, etc. The intoxicating effects of alcohol are not symptoms of depression.
However, heavy alcohol use is associated with depression and other mental disorders. Someone who has depression or anxiety may drink to self-medicate. Alternatively, someone with an alcohol use disorder may develop depression, as alcohol upsets the chemical balance in the brain. What’s more, a person may regret the things they do while intoxicated, leading to intense guilt, shame, and/or hopelessness.
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