Soar High: The Shame & Stigma (Mental Health Awarness Week)

Written by Andi Bazaar, Gryffen Seth | May 17, 2023

“The big revolving around mental health involves removing the silence that has coated the community, leaving people vulnerable with stigma.” — Gryffen Seth

“I think we as a society waste a lot of time trying to stop people from killing themselves as opposed to exploring why they want to die in the first place."

Suicide is not an easy topic to discuss when mental illness is not seen as a real disease, so many people struggling with mental health rarely open up because of the stigma attached to mental health suicide pevention.

Its even harder to open up about suicide in churches because some people think the topic is too heavy for children and when you’re older all you get is Bible verses and how “You’re one of God’s strongest soldier."

While you may think, "I'm praying for you" feels like the right thing to say for people struggling it isn't a solution.

Thing is, we can’t afford to ignore the topic just because it’s hard to talk about! Contrary to popular belief talking about suicide does not make things worse honest, open communication can do just the opposite.

It’s difficult to imagine what led a loved one that seemed to have it all, to commit suicide. There are no clear warning signs and while there’re many factors that lead to this tragic event the one thing that remains certain is severe depression from unspoken traumatic events.

"Sometimes people attempt suicide not so much because they really want to die, but because they simply don't know how to get help. Suicide attempts are not a cry for attention but a cry for help, it becomes a way to demonstrate to the world just how much they are hurting."

While it might have appeared that someone had everything to live for, it probably didn't feel that way to them. You may never know why a person committed suicide.

So until mental illness is seen as physical illness of the brain the world will continue to lose beautiful people and talents.

With this said, I hope we as humans become intentional in recognizing suicide behavior and actively work on listening to people with no judgment when they open up about their suicidal thoughts.

I hope as we raise our kind children we not only teach them how to heal physically but emotionally as well and I pray to God we are kind enough to apologize to our children when we’re wrong because the one emotional abusive trait parents have is holding power over accountability.

If you suffer from depression and anxiety, don’t let your mind deceive you. You’re beautifully and wonderfully made, you’re loved and your smile makes the world a better place.

THE SHAME AND STIGMA OF SUFFERING FROM MENTAL ILLNESS

As you all know I’m outspoken about a lot, but somehow I still feel shame when I publicly speak about being depressed or anxious.

I worry that people will think that I want attention, I remember being in my 20s, thinking dangerous things like “If you really want to kill yourself, then stop talking about it and do it.”

Of course I was talking to myself. Me who could laugh it off, me who was strong.

But there is no shame in being sick with anything. Whether it be cancer, HIV, a cold, syphilis, headache etc. So why give meatballs illness a power it doesn’t deserve: secrecy, i stays in the dark and festers and it makes you its plaything.

In the grand scheme of things I know I’m not going to change anything, I’m not delusional. I try not to be a egocentric but I do believe that talking about openly does do work in diminishing the power that the shame has over you

Shame to even go out and get help and when you do get help perhaps through an intervention, you are ashamed of accepting it.

I get a call from the crisis line every other day to make sure that I’m okay, to make sure that I haven’t killed myself yet and I’m ashamed of it.

I know that this shame doesn’t make any sense, but I’m still unlearning. As a person who has been diagnosed with severe depression, generalised anxiety and ADHD I have a lot on my plate.

I’ve gone to the extreme of trying cold water therapy (and you know black people cant stand the goddamn cold!!) because my mental health has never been this bad. I’ve been catatonic before but this is sinister because I can still laugh while I plan my suicide.

"I'm not looking for sympathy, I’m sharing this to do my bit in normalising the conversation about mental illness without guilt or shame."

STIGMA ABOUT MENTAL HEALTH

The big revolving around mental health involves removing the silence that has coated the community, leaving people vulnerable with stigma.

MAJOR ISSUES ARE:

• do people mind about their mental health?
• are people aware of the red flags around mental health?
• are there good measures structured to counter the warning signs in mental health?
• do people understand depression and aware of the possible stressors that may escalate to finally interfere with general wellness?

HOW EFFECTIVE ARE "MYTHS & FACTS" STRATEGIES AT REDUCING MENTAL HEALTH STIGMA?

A new study suggests that these "campaigns are at best ineffective and may increase mental Illness stigma."

HERE’S AN ARTICLE ON THIS AWESOME STUDY:

The "myths & facts" strategy is used by popular mental health campaigns, this strategy presents "myths" about mental illness and "facts" that correct these myths.

In this study, the authors tested whether correcting harmful myths about mental illness on an anti-stigma flyer. Surprisingly, the "Myths & Facts" strategy either did nothing to decrease myths about mental illness or

"Myths & Facts" actually increased stigma toward mental illness after 30 minutes of being presented. However, this effect was not present at 2-day and 7-day followup

WHAT EXPLAINS WHY "MYTHS & FACTS" STRATEGIES DON'T WORK WHEN PRESENTED ON FLYERS?

"Inherent in this strategy is the need to first present inaccurate information to then provide the correction," which raises the chance ppl who never held the misperceptions might adopt them.

"Myths & Facts" strategies may also increase cognitive load. In other words, it's hard for people to remember what is a myth about mental illness (vs) what is a fact when given so much information.

THE STUDY DOES HAVE LIMITATIONS:

-It's possible "myths & facts" strategies work in other contexts like giving a talk, sharing lived experience or correcting others.
-The "Myths & Facts" flyer only discussed mental illness (vs) looking at diagnosis-specific myths.

TAKEAWAYS OF THIS STUDY:

• "Myths And Facts" flyers are likely ineffective at reducing mental illness stigma.
• If you’ve used this strategy before, don’t feel bad (I have too) now we can be more effective!
• Rather than focusing on myths, focus on recovery-oriented messages.

NARCISSISM
⚠️ Trigger Warnings: Narcissism, Symptoms ⚠️

This part explores the concept of narcissism, its role in mental disorders and addresses misunderstandings around it also this includes stigma.

As always, subjective understanding may differ.

Before we go forward it is helpful to separate "narcissism" a set of defences, thoughts and behaviors from "narcissistic personality disorder" a diagnosis based on the enduring and overwhelming effect of this on daily life.

A little history the myth of Narcissus in Greek mythology tells the story of its beautiful namesake, revered for his beauty. After rejection from a wanted love became intoxicated with is own reflection, drowning in his pursuit of it.

Most of the popular understanding of narcissism hinges on the idea of a "large ego" or indeed, obsession with one's self. From a psychological standpoint, this is not incorrect but misses the crucial driving force. It is not love for ones self, but thinly veiled loathing.

We will return to the story of Narcissus later, as often the mythology captures tenets of the truth as we understand it but to truly understand how difficult narcissism can be for both the person and their peers, we need to delve deeper.

As always, narcissism has multiple explanations with different levels of agreement. In mental health, we choose to make categorical definitions based on the presence and severity of symptoms (especially when talking about "disorder") so let's start with the defence.

When we consider narcissistic defenses, they are all about the ego protecting itself and finding love in itself due to a fear or inability to relate to others. This can be due to a number of factors, but is generally argued to occur at a very young age.

As per my chapter on EUPD, most aspects of the more powerful and enduring elements of personality are laid down in the infantile years. Narcissism like EUPD is tied closely to early attachments and their relationship to safety.

The inability to bond with external "objects" in a "healthy way" (i.e secure relationships with care givers,) means that the infant must turn its "love" onto itself, which is a stormy place filled with threats of annihilation and obsession.

The infant is caught in a place where it must believe its own grandiose power to influence the world around it but at the same time feels a deep sense of shame and insecurity about itself, this is a balance of internal drives which becomes very fragile.

As all internal drives must relate to the outside world and are shaped by them, the power sought within the love for the self must be expressed externally and this is the belief of being special compared to others and seeing others as subservient to self.

This is not a categorically conscious belief or behaviour, but arguably one of an unconscious place, quick, enduring and not designed to be hurtful to others but to protect the infant (and later adult) from perceived annihilation in its absence.

Remember, the unconscious mind is not rational it sees any threat to the ego as death. So even the slightest challenge to the fragile psychic structure it has built is received as a huge danger. In adult life, we can loosely link this to hypersensitivity to criticism.

Thinking of a narcissitic personality structure as a dynamic function, i.e something constantly rebuilt and remodelled on a basic template helps to understand its role. It is a malleable defense to the outside and internal world "an ego defense."

Put simply, any threat to the love of oneself a castle built on deep insecurity about a fear of being unloveable becomes tragic and threatening. Thus the defense must be strong, violent and hypervigilant. This is torture for the person.

To put it more clearly, it is a problem of object relations. An object, in psychology is an internal representation of an external or internal thing and whole object is seen as it is, a whole human and a part object as to what a human may serve.

Narcissism often relies on "part-object" relations (i.e this person can be this to me because the difficulty in forming "whole object" relations, stemming back to early rejection, means that tolerating potential rejection or less than admiration is intolerable.)

Thus, the narcissistic defense is all about setting ones self in a place of godliness, immune to rejection, wanted by all. When you consider the root cause is a hidden feeling of immense failure, ugliness and isolation, this makes sense.

When we think of the "defenses" involved we classically reduce these to projection and splitting. Projection is to take ones own negative perceptions of the self and place them onto others (i.e you are hateful, ugly" because (I am.")

Splitting as discussed in EUPD chapter is also a function of infantile defenses, splitting the good and bad parts of the world off including the good and bad parts of the self, to make them tolerable. The bad in the self is excised and the good of the world is taken in.

In narcissism, the bad is so feared that anything not feeding the ego is bad, and must be projected, split off and removed from consciousness. The inability to do so or external barriers against it are met with great pain.

Once again, although the pain is conscious the splitting and projection are not the person has no idea the deep reason for their pain but may feel rejected or undermined which give clues to the deep internal state.

So if we consider this way of defending one's self against the world and the deeper self-loathing and fear, we realise it is very fragile but like any enduring defense, quickly erected and how we see people with narcissistic personalities or enhanced defenses are those of being "selfish, egotistical, arrogant" but one must realise this is a matter of survival regardless of the consequences on others.

This does not mean those acting on the defense are not liable for their actions, once they learn them, but their motivations are often unclear to them. Unfortunately, the role of being a part object can also be very painful so finding help is important.

So let us now turn back to the concept of Narcissistic personality disorder, an idea now dated by the introduction of the new categorisation of a general "personality disorder" introduced in the ICD 11 which removes previous subcategories.

Myself, I am still very much unsure of how practical this will be in helping to understand a persons needs but can understand the motivation behind it as well as many of the conceptual arguments. As long as we can understand the nature beneath a general label, it has use.

How we define the difference between a personality and a "disordered" personality depends on the nature and severity of relationships to the world and self, functional problems as a result, and harm. For NPD, we can use the DSM-5 definitions quite well (abridged)

"a pervasive pattern of grandiosity (in fantasy of behaviour), need for admiration and lack of empathy beginning in childhood or early adulthood and present in a variety of contexts as indicated by 5 + of :

• grandiose sense of self importance and exaggeration of achievement.
• preoccupation with fantasy of unlimited success.
• belief in being special and limits relationships to those of "equal measure"
• requires excessive admiration.
• sense of entitlement.
• interpersonally exploitative (uses others)
• lacks empathy.
• envious of others, believes others are envious of them.
• shows arrogant attitude.

IMMEDIATELY WE CAN SEE 3 THINGS

• Most of these symptoms can be understood in the view of an insecure and terrified ego needing to be loved.
• The effect on society is held deeply in the symptoms.
• Not just one symptom = disorder.

So thinking back we can already see the role of the ego needing to love itself primarily being exercised in the symptoms categorised here (i.e the need for admiration, fear of rejection, use of people as part-objects, all speak of deep insecurity.)

We often use insecurity as an insult and unfortunately this is quite a loaded cannon, as it is often correct but also may be a projection of ones own feelings.

Life for people with NPD can be extremely challenging, the oft look for positions of power and careers/partners that will fit their need for esteem but in doing so bring themselves to a position of enduring public judgement and risk.

One odd element of psychic defenses is that they often create the very threats they wish to defend against, thus a person with low self esteem will seek a career in something where they are mainly valued on an aesthetic element.

In the short term this could be great for their self-esteem, but the fragility of it means the chance of rejection is high. This is true across many career fields and to an extent, narcissism can be a driver of success if it does not cause disorder.

SO WHY MEDICALISE IT?

For the same reason any other psychological disorder is, because often it needs help. People with NPD are often in great pain or cause pain to others and will often ask for help for other reasons (depression etc.)

The mainstay of treatments is talking therapy, hoping to address the underlying psychic structures. However, the person with NPD once realising the impact of their behaviours can choose to make different choices.

This will be hard, as the defensive structure will perceive any step down as annihilation so progress can be slow.

ONE LAST NOTE ON STIGMA

Within all of mental health, it seems that only NPD is the one always insulted in society regardless of people's understanding. It seems okay to call people "a narcissist" as if it is some great sin and yet when you understand it you understand they are in great pain and attempting, however unhelpfully to remove this.

Unfortunately, the very hate they fear is often brought back on upon them so the defenses thicken and react more strongly.

Examples of such can be the "alpha-male" stereotype where a deep fear of rejection leads to the creation of a fantasy self of huge strength, wealth and power, fragile and sensitive to rejection, hurting themselves and others in the process.

In an ideal world, the one I choose to work in we must try to help these people make it known to them that they can be loved and that they can find peace in themselves.

Of course, I have presented the above from a limited view point and people will have very polarised views given their experiences. None of what I am saying suggests I validate any behaviour causing people pain, I am just trying to help people understand it and to return to Narcissus he simply wanted to be loved so much so that rejection made his love for himself destroy him.

Such is narcissism, maybe if narcissus could be shown he has value, he would have avoided the river.

SOURCES:

• ICD11/10
• DSMV
• OTSP
• Psychoanalytic Diagnosis
• Lots of Freud
• A Bit of Melanie Klein
• Symptoms In the Mind
• My Clinical Experience

A SPECIAL THANKS TO:

• Andi Bazaar (Writer)
• Yevhn Gertz (Director Photography)
• Dr Oliver Schofield, MD (Consulting)
• Dr Seth Gryffen, MD (Consulting/Co-writer)
• Timothée Freimann schofield (Photographed)
• Clayton Euridicé Schofield (Editor/Journalist)
• Scott Wynné Schofield (Publisher)
• Henrie Louis Friedrich (Analyst)
• Jwan Höffler Conwall (Art Interior Design)
• Hugo-licharre Freimann (Ass Director)
• Shot at GQ’s Studios by José Schenkkan and Benjamin Schenkkan Joseph
• In appearance by "Pierro-luccá Schofield" (Model)