I’d like to applaud the spirit of the recent article, “Let’s change the conversation about suicide.” At the same time, overcoming stigma and encouraging people to seek help will require more than what the article mentioned.
Stigma is more than an attitude. It is an institutionalized view supported by current models of health care and insurance coverage, both public and private. While medicine can make a life-saving difference in the treatment of depression, we should not be so eager to view suicide attempts and other “mental health issues” from a strictly medical point of view, as professional standards and insurance coverage require.
Consider the trade-offs for any person seeking help. First, I become a patient with an illness, rather than a person facing a problem. I then consult with an expert who is paid to diagnose what I have and to understand me within an hour or two in ways that I might or might not agree with. If I agree with the expert, I am considered insightful. If I express disagreement, my diagnosis is likely to become more serious, including denigration of my “personality.” If I am fortunate enough to avoid this difficulty, I still often face “treatment” that involves some pressure to change my view or even my values, in favor of the view or values of the expert.
All of this is recorded into an official document that I have no permission to disagree with or to edit. That document then has its own life, claiming to be the real truth about me, more accurate than anything I say about myself. It will be focused on my diagnosis, usually ignoring the rest of me, including my strengths, abilities and successes in coping with problems.
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After more than 40 years as a licensed mental health professional, I know we can do much better at changing the conversation.
▪ Let’s find ways to be more curious and less certain about other people.
▪ Let’s help insurance companies to be less dominated by medical ways of thinking about people and problems they face.
▪ Let’s change record-keeping forms that shrink people down to nothing more than a denigrating list of problems.
Let’s acknowledge that suicide and mental health problems don’t come out of nowhere, and that seeing them as strictly personal will disguise the larger social problems like poverty and poor education that breed them.
Yes, let’s change the conversation, and let’s start with the conversation among professionals and insurance companies.
Kevin Geraghty is a licensed clinical social worker who has practiced in Boise for over 30 years.