Wood's Homes Blog

The elephant in the room: Why talking about mental health in families is so hard

May 23, 2019
By Dr. Angelique Jenney, Wood's Homes Research Chair in Children's Mental Health
The elephant in the room: Why talking about mental health in families is so hard

We like to think of home as where the heart is. In fact, I’ve written on that very topic in the past. But sometimes home can also be where the ‘hard’ is, and that is particularly true when adjusting or living with a family member who is experiencing a mental health issue. Part of what makes that experience so hard, is the perceived and very real threat of stigma that is attached to those labelled with a mental health issue.

Stigma has been around for centuries, with the word originating from early Greek to mean the mark on a person that labelled them in some way. The ‘stigma of mental illness’ refers to the devaluing of a person based on negative beliefs, attitudes and perceptions about ‘mental illness’ that mark a person as different from an accepted norm.

With the majority of mental health problems appearing in adolescence, and the importance of early intervention to prevent the progression of symptoms and other issues that might co-occur over time, it seems imperative that families are aware of the risks and know when and how to address it when something seems to be presenting a difficulty for their child. Sadly, stigma within the family is an often cited barrier to help-seeking, particularly when parents act as gatekeepers for a child’s access. Part of the issue resides in the feared ‘guilt by association’ wherein parents, children and siblings may also experience prejudice and discrimination and have similar negative stereotypes attached to their identities because of their close contact with or proximity to an individual with mental illness. This is particularly evident when genetics, parenting practices and family environments are blamed for the presence of mental health issues. No wonder people are worried about reaching out for help! 

Unfortunately, researchers such as Dr. Gina Samuels (2018) have found that stigma that originates within the family (such as those related to sexual orientation, substance use, criminality and mental health issues) can actually make home feel unsafe enough that youth feel the only safe option is to leave. This contributes to the additional risk factors of homelessness and transience for youth as evidenced by the hundreds of young people who come to our doors every year for help at our street services in Inglewood.

We know that there are serious implications when kids don’t get the help they need – not just for the kids themselves, but also for parents, siblings and the communities in which they live – from worsening symptoms, to strained relationships, to loss of productivity and economic and social resources and support. 

Erving Goffman in his classic 1963 text Stigma: Notes on the Management of Spoiled Identity stated, “We and those who do not depart negatively from the particular expectations at issue I shall call the normal,” a statement I found shockingly familiar from the narratives of children at Wood’s Homes as something they are most afraid of – interacting with ‘the normals’. What does that tell us about their sense of belonging in this world?

Goffman also talks about the experience of hardship as the gateway to empathy and a deeper understanding of self and others. As I have written about earlier, adversity is the only mechanism for the development of resiliency. We become stronger through our growth.

This recognition of the impact of stigma on well-being has led governments around the globe to create public awareness campaigns in hopes of reducing stigma and the barriers to help-seeking. Projects in New Zealand, Scotland, the United Kingdom and Canada provide resources and information to help families and professionals respond. Part of the Mental Health Commission’s work has been a series of school-based forums to break down stigma for youth within the environment where it’s most likely to be seen as problematic: School. Here is an example of this important work being done.

Despite this work, we as a society still have a long way to go. Individuals continue to indicate that they would feel ashamed if they had a mental illness; believe that most people with a mental illness don’t recover; and would hesitate before getting into an intimate relationship with someone with a mental health label. One way we are addressing this at Wood’s Homes is by engaging the whole family within our intervention services, knowing that families are impacted as a whole and that providing opportunities to talk about and normalize feelings and experiences within their families is an important first step.

Using quotes from various studies and interviews, Goffman illustrated something which was as alive and well then, as it is now.  He illustrated the ways in which individuals who perceived themselves as having a ‘Stigma’ spent much of their emotional life predicting or projecting the thoughts of others onto their condition.  In particular, this quote resonated with me in the ways in which individuals who are managing a mental health issue (either of their own or a close family member) spend valuable energy each and every day making decisions about whether “to display or not to display; to tell or not to tell; to let on or not to let on; to lie or not to lie; and in each case, to whom, how, when and where” (p.42).  This is an unnecessary burden to shoulder, and we as a society could do so much more to lessen it. 

What was particularly powerful is the illustration that those living with stigma often found multiple ways of experiencing belonging true to all human beings – they would either try to excel past, through or disprove their stigma, hide it, or form groups in which they could experience such belonging and sometimes even leadership (think groups for mental health advocacy such as the Canadian Alliance on Mental Illness and Mental Health) proving, once again, that we were not put on this earth to be alone, but rather it is a human condition to want to connect with others.  How might we be more inclusive as a society that individuals may not always feel the need to be ‘with their own kind’ to truly feel understood and accepted?

I think about the young people who come to Wood’s Homes who are worried about creating a story about their absence from school or their peers or even family members – often desperate to come up with a story that will not reveal the true nature of their issue.  Telling friends that you have been on a trip or gone to summer camp for example continues to set up children, as well as our society for failure in terms of normalizing, responding to and supporting mental health issues within our communities.

One of the narratives in Goffman’s book recalls a time when being blind meant being institutionalized with other individuals who were blind – living and working together away from friends and family.  Today we would consider such a thing as completely inhumane, ridiculous and unnecessary.  How much longer before we have a similar insight into the world of those who experience mental illness?  Today we have a National Children’s Mental Health Awareness Day, just one of the many steps of getting our society to a place where mental health is normalized and accepted.

Here are just a few ways that you can contribute to a changing dialogue:

  1. Find out more. This blog contains valuable links and resources with respect to fighting the stigma associated with mental health issues – check some of them out and see what you can learn about making change. Participate in any number of ongoing campaigns to reduce stigma. For example in doing research for this blog, I discovered this actual blue elephant campaign (no relation to my blog post title.)
  2. Learn how to respond to others. One of the biggest fears people have is of not knowing what to do say or do – as the What a Difference a Friend Makes Campaign maintains – ‘keep doing what you always have’ in terms of accepting your friends and family for the people that they are. They have created a series of clever (but dated) videos on what to do if you know your friend has a mental health issue with some quirky examples here.
  3. Reach out for yourself. Whether it’s your own issue, or that of a friend or family member – you aren’t alone and don’t need to be.  Contact a helpline, another friend or therapeutic professional for guidance on how to manage a mental health issue.
  4. Keep the lines of communication open. Check out this powerful ad by The Alberta Teacher’s Association. We need to practice asking the same question ‘Can we Talk’ as well as the most important answer, which should always be ‘yes’.

Still don’t know where to turn?  For all the ways that Wood’s Homes can help, please click here.