Dr. Patricia Farrell on Medika Life

Psychotherapy’s Got an Unpleasant Image Problem

Too often, going to therapy is seen as admitting you’re flawed, weak, or should be “sent to Coventry,” and then there’s religion.

The experience I have had is that once you start talking about [experiencing a mental health struggle], you realize that actually you’re part of quite a big club. — Prince Harry

The COVID-19 pandemic is extremely stressful and has more victims than those lying in beds or graves; it has mental health problems and stigma. Why stigma?

The question of mental health and receiving psychotherapeutic treatment has always carried with it an element of stigma. Those with any mental health issues were berated, isolated, or laughed at with impunity. Often, the village idiot was someone with a mental illness.

Now, mental health issues have grown exponentially not only in the general population of all countries but also in their healthcare staff. And it is also in healthcare and law enforcement where discussion of mental health problems is verboten.

Jobs depend on mental stability, and too often, those in medicine or law are expected to be extraordinary individuals who are impervious to any suggestions of mental difficulties. Admitting to the stresses of the job during a pandemic is not expected or encouraged.

The refusal to accept the need for mental healthcare in medical professionals has led to breakdowns with tragic results as detailed in physicians’ suicides. But, in some countries, like China, the reluctance to seek mental healthcare during any time has been strongly supported by the culture.

In this study, a significant proportion of participants experienced anxiety, depression, and insomnia symptoms, and more than 70% reported psychological distress. In a previous study during the acute SARS outbreak, 89% of health care workers who were in high-risk situations reported psychological symptoms.

The full impact of the psychological toll on the citizens and the professionals resulted in China’s surveys of their needs and how to respond to them.

Mental health hotlines were quickly established across China and provided the public with counseling and psychological services. The telephone and Internet have been widely used to deliver mental health care services, and social media platforms (e.g., WeChat, Weibo) have been used to share strategies, guidelines, and education programs for managing potential mental distress.

In addition, a series of self-help handbooks for psychological care associated with COVID-19 have been published by the China Association for Mental Health, medical institutions, and universities.

According to the World Health Organization, there are nine therapists for every 100K people in China. The need may be great, but the lack of therapists tells how psychotherapy is viewed in the country. Who would enter a profession where patients refused to come to you?

Laws in China, which poorly define psychotherapy, but carry restrictions and deny anyone the right to be called a psychologist, are facing pushback by people in need. Now, the pandemic has only increased the need for services.

Photo by Volkan Olmez

China Is Not Alone in Denying Mental Health Needs

When I was a doctoral student in New York City, another student in my peer group brought up a distressing situation for discussion. He was trying to offer services to his NYC community of Orthodox Jews and realized it was more than he could handle.

Rather than take mentally ill members of the community for psychological or psychiatric services, parents often kept the individual locked in a room. This would go on for years sometimes.

In recent years, numerous efforts have been made to address the stigma in the Orthodox community, where the fear of harming marriage prospects has drawn a curtain of secrecy around those suffering from mental illness.

Since that time, things have changed, but it may not be the case in all religious communities worldwide. Some societies see the mentally ill as possessed of a devil, others as touched with special powers. Would this person need a psychologist or a preacher?

I worked in a psychiatric hospital where a patient told me a nurse said he should fast to cure his schizophrenia. He already believed that he was suffering because of some sin he had committed. Now, she told him that was true, and he needed to pray, too. This was not an unusual case.

Visitors came onto a unit at another psychiatric hospital and performed repeated exorcisms with or without staff knowledge. One patient, after three exorcisms, told them to stop it.

Photo by Mohamed Nohassi

Admitting to Our Humanity

The term “No one’s perfect” is surely the case because, if we were, would we be human? Even bots aren’t perfect, yet we think we can make them into perfection personified. We program them to be careful listeners and do work similar to therapists. Is that a good thing or yet another problem?

Our foibles make us who we are, and perfection may not be what we want or need. What we want is to be understood, accepted, and helped when we need help.

Algorithms can’t ask for help, but we can, so we’re better than the bots that are seen as performing yet another human task and doing it well.

Destigmatizing psychotherapy and mental health disorders has to be job #1, and we need to do it quickly, and the therapy has to be effective. We can teach people new behaviors and ways of approaching difficulties and to accept that none of us is invulnerable.

And we need to admit our powerlessness sometimes. But belief systems aren’t always easily fixed, but that doesn’t mean we should give up.

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Pat Farrell PhD
Pat Farrell PhDhttps://medium.com/@drpatfarrell
I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.


Medika Editor: Mental Health

I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

Patricia also acts in an editorial capacity for Medika's mental health articles, providing invaluable input on a wide range of mental health issues.

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