I’ve taken thousands of family histories over the last 15 years, and it seems that certain conditions appear in almost every evaluation: diabetes, heart disease, mental health issues. What I find interesting is that mental health issues are often mentioned last, almost as an aside. By their change in tone and demeanor, I often get the impression that patients are embarrassed to mention this component of their family history, though, ironically, it is one that often appears to be the most concerning to them.
It’s a long standing fact that mental health issues are stigmatized. I have little doubt this is why a patient’s voice becomes hushed or rushed when detailing a diagnoses of depression in a parent or schizophrenia in an aunt.
Perhaps the stigma is linked to a low prevalence. After all, rare or different is often ostracized. In 2014, approximately 1 in 5 adults in the US — 43.8 million, or 18.5% — was quoted to experience mental illness in a given year. Yet in 2012, 29.1 million Americans, or 9.3% of the population, had diabetes.
Okay. . . there goes that theory.
Perhaps it is the financial burden of the condition. After all, serious mental illness costs America $193.2 billion in lost earnings per year. But wait, the total costs of diagnosed diabetes in the United States in 2012 was $245 billion.
Hmm. So that’s not it.
Some may believe that those with mental health issues brought the condition on themselves, that perhaps they did not take proper care of their own health or circumstances. Yet the inheritance of mental health issues is the same as diabetes and heart disease. All of these diseases are considered multifactorial, meaning both genetics and environmental factors play a role in their development.
Think of it this way:
Imagine patient #1 has a jar filled with five clear marbles. That is their genetic predisposition. Now imagine adding five blue marbles. These blue marbles represent influences from the environment, perhaps due to the loss of a job or the death of a pet. The jar is not yet overflowing thus the person is not yet showing signs of mental illness.
Now imagine patient #2 has a jar filled with 20 clear marbles. Adding five blue marbles then causes the jar to overflow in the form of depression or anxiety.
We all start with a different number of clear marbles and all add some number of blue marbles to our jars. The thing is, for the most part the situations that cause us to have those marbles, be it genetics or environmental situations, are typically not in our control.
So, why the stigma? Especially when you think of other conditions, such as diabetes and heart disease, which while multifactorial, are often dependent on environmental factors that a person elects to do, such as a poor diet or lack of exercise. If anything would hold a stigma, you would think it would be the conditions which a person has more control over.
When I read the draft of my post to my husband, i.e., everything written above this point, he proposed another theory. “Maybe it’s because mental health isn’t as well understood. I mean, I can tell you what the symptoms and risk factors are for heart disease and diabetes. But I can’t do that for depression or any other mental health issues.”
I chewed on this for the night and came to the following conclusion: Perhaps my lovely engineer of a husband, who has no training in biology or psychology, is onto something. We know what a heart is and how it functions. The same is true for the pancreas. While they are each, in their own right, marvelous organs, they are also somehow more tangible than what is affected by mental illness. It’s not the brain per say, but the mind. And there is so much we simply do not understand about either.
Regardless of the reason, mental health issues are common and are nothing to be ashamed of. If you are experiencing any symptoms, seek help.
And avoid the double cheeseburger.