To De-Stigmatize Mental Illness Threshold Concepts Must Be Crossed
For the next eight weeks I get to teach a Family to Family Course for NAMI (National Alliance on Mental Illness). The Family to Family Class is an education program for family members and caregivers of individuals living with mental illness. The program is designed to provide family members and caregivers with the tools and resources they need to better understand and support their loved ones. In all honesty, I was a bit hesitant about teaching Family to Family this winter as I was afraid I’d be overwhelmed with school, work and life events but on our first evening together I got to witness the visible relief on participant’s faces when they found others who understood their reality, discovering they are not alone in this journey and my hesitancy ceased.
During our first class meeting we discussed the many well-intentioned but insulting comments we often receive when we mention our loved one lives with a mental illness. “Oh! I’m so sorry!” or “That’s awful!” or “You’re really brave to deal with that” are just a few of these very well meaning but not always helpful comments. Then there are the flashes of shock and concern that spread across someone’s face when we mention our family member’s illness. Something one class participant said that has stayed with me is, “It’s like they think our family member is dangerous or something. Like our family member is a danger to them.” In a way, it felt like coming home to sit at a table with others who get it, others who also regularly experience these comments or looks.
That’s not to say all of us at the table share the same exact experiences with our loved ones. Some of our loved ones are healthy and living full lives, their mental illness kept in check with medication and/or therapy. Some of our loved ones are barely hanging on to life, their mental illness wreaking havoc not only in their own life but in the lives of those who love them. Even with these varied experiences I think all of us sitting at that table understand that mental illness is a complex and misunderstood subject and that those living with mental illness continue to be stigmatized by well-meaning but frankly, ignorant, individuals. Individuals, who I now understand, have not crossed some threshold concepts regarding mental illness.
According to Meyer and Land, “a threshold concept can be considered as akin to a portal, opening up a new and previously inaccessible way of thinking about something. As a consequence of comprehending a threshold concept there may thus be a transformed internal view of subject matter, subject landscape, or even world view.” [1] Threshold concepts are transformative ideas that fundamentally change a person’s understanding of a subject. They are often difficult to grasp, taking time and possibly lived experience, and once understood, they open up new ways of thinking about a subject.
One key threshold concept in de-stigmatizing mental illness is understanding the biology and neuroscience of mental health conditions. Seeing a look of shock on someone’s face when I tell them I have experienced panic attacks or that my spouse lives with a serious mental illness makes me wonder if perhaps these individuals view mental illness as a personal weakness or character flaw rather than a medical condition that can (many times) be controlled with medication and therapy, much like other medical conditions. By crossing a threshold to understanding the biological and neurobiological basis of mental illness, individuals and societies can begin to see mental illness as a medical condition that requires treatment rather than a moral weakness.
Another threshold concept in de-stigmatizing mental illness is recognizing the impact of social and cultural factors on mental health. Poverty, discrimination, and other forms of social injustice can trigger or exacerbate mental health conditions. As the World Health Organization states, “Mental health is determined by a complex interplay between individual, social and environmental factors”[2] By understanding the social and cultural factors that contribute to mental health we can begin to make some changes toward a more equitable and inclusive society, addressing some of the root causes of mental illness.
Another important threshold concept in de-stigmatizing mental illness is recognizing the importance of empathy and compassion. In his book, Tattoos on the Heart: The Power of Boundless Compassion, Father Gregory Boyle says, “Here is what we seek: a compassion that can stand in awe at what others have to carry rather than stand in judgment at how they carry it.” [3] Every single day many who living with mental illness fight to be here, take medication, do the work of therapy, live with the fear that their illness might return. What if we could learn to be in awe of all they carry instead of judging how they carry it? I believe, crossing that threshold would be transformative for everyone, those living with mental illness and those living without a diagnosis.
For me, lived experience is an impetus to moving across a threshold. Had I not experienced panic attacks and anxiety myself, I might not have had as much empathy for those experiencing other forms of mental illness. Had I not had a spouse with a mental health condition who I also know to be a fully functioning, wonderful human being, I might not have felt the urgency to learn more about mental illness. Had I not entered into therapy for my own anxiety or witnessed the care my spouse takes every single day to remain healthy I might not have experienced the work it takes to be in “liminal space,”[4] wrestling with a new concept, resolving conflicts in my understanding, and moving to a transformed way of seeing and experiencing the subject of mental illness.
I am encouraged that the framework of threshold concepts can be used to de-stigmatize mental illness, creating a more compassionate and empathetic world as we move across thresholds, understanding the experience of others and what they have to carry.
[1] Jan F.H. Meyer and Ray Land, eds., Overcoming Barriers to Student Understanding: Threshold concepts and troublesome knowledge. (New York, Routledge, 2003), pg. 3
[2] WHO. (2021) Mental health. Retrieved from https://www.who.int/health-topics/mental-health/
[3] Boyle, Gregory. 2011. Tattoos on the Heart: The Power of Boundless Compassion. 60840th edition. New York, NY: Free Press.
[4] Jan F.H. Meyer and Ray Land, eds., Overcoming Barriers to Student Understanding: Threshold concepts and troublesome knowledge. pg. 27, 29, 203
About the Author
Kally Elliott
Mom of four. Wanna-be Broadway star. PC(USA) pastor. Wife. Friend. Sometimes a hot mess. Sometimes somewhat together. Is this supposed to be a professional bio?9 responses to “To De-Stigmatize Mental Illness Threshold Concepts Must Be Crossed”
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Hi Kally, I love hearing about your vision and passion for de-stigmatizing mental health. You are really opening up threshold experiences for those who live with the challenges of supporting those with mental health diagnoses. It is an isolating place to land. You said, “In a way, it felt like coming home to sit at a table with others who get it, others who also regularly experience these comments or looks.” I wonder what that “coming home” feeling was like for you and how the new insights from that experience might influence your pastoral work?
This is such important work. Thank you for this post. “By crossing a threshold to understanding the biological and neurobiological basis of mental illness, individuals and societies can begin to see mental illness as a medical condition that requires treatment rather than a moral weakness.” I sat with this statement for a while. Growing up in a culture where any form of weakness (difference) is expected to be addressed by working hard and accomplishing more…that is the recipe for success when things don’t go exactly as planned. Mental illness really throws a wrench in that model. It is not something that you can just simply work harder at, and it will get better. It requires treatment as most illnesses do. It is something that, still in this day and age, is not talked about in many households because it is seen as a flaw. Yet we will seek treatment for other illnesses because there is no stigma attached to them. We have a ways to go to…I am glad that you are doing this work.
I seldom lead with that my daughter is mentally challenged. Okay…she has fetal alcohol syndrome, attachment disorders and can be a real obnoxious pain sometimes.
But when we adopted her, we knew that this was all part of the package deal. We never intended to NOT be parents at some point. So the reality that she may be with us to the end of her days is not outside the realm of possibility.
It becomes readily apparent that she is socially awkward, mentally immature (she is 22) and very quickly people “block” her number because of her numerous texts. She smothers people. Sigh…but she is learning. We have her in counseling and her counselor is learning about the tidal wave of texts that my daughter sends per day. From their I presume she will address this behavior and help her to set boundaries.
With that being said, my daughter decided to make me a custard pie and sushi burritos (it is a thing in Colorado). I was surprised and amazed that she took on this new project. She was thrilled when the pie turned a golden brown, and tasted wonderful. AHA…I am watching her grow into a young woman. Ups/Downs she is mine, she is God. Thanks for being a person to helps people like my daughter….Shalom…Russ
Thank you for prioritizing mental illness. Stigma and marginalization is real and your volunteering for the live coaching last week was great to hear your dream of ministering to the mentally ill. I am sure I don’t have to tell you how much that is needed in our society but also in our churches! I have a child with a cognitive disability, autism, and the horrible encounters he and vicariously I’ve had within the church walls has been very hard. I realize I’m starting to sound really critical of the church, and I promise I am not “hard” against it, I’ve had to work through a lot, but have to say teaching compassion and educating is a must with the invisible illnesses. My child looks like every other child so the way he was treated when he didn’t behave like other children was heart breaking, as well as the “looks, or judgements” I experienced as his failure of a mom! Ugh…I liken it to the looks of “is your family dangerous” comments you experienced. I once had just finished preaching and was shaking hands after church and I saw my 9 year old child standing with one of the Sunday school teachers waiting for me and he was crying. I called them over and here was what the lady said..”does your son not know how to tie his shoes?” I broke in that moment, the judgement on me is one thing, but seeing my son at church feeling shamed and harassed was not ok. I talked through this situation with the teacher (who knew he had autism) and stated of all the things in the world that are out of my son’s comfort zone, tying his own shoes are at the bottom of the priority list and he should not have to be held after class at church to struggle through this. I don’t think she heard me, but I had 2 responses, 1. I never sent him to church with laced shoes again, and 2. I spoke with church leadership on the marginalization of special needs children in church which led to a mandatory training session for anyone working with children with an Autism expert! That was a healing threshold moment for me, speaking my truth and calling the church to a higher level of acceptance and compassion through education! Go Kally Go! So many with mental illness have experienced stigmatization and church is not different, thank you for speaking up, for being your husbands ally and using your voice in this world. I don’t have a question for you, just a full on “YES, YES, YES!” for you.
Beautiful Kally! Just beautiful! It warms my heart that you are teaching the Family to Family Class. You have book knowledge, your own experience and a compassionate heart! Therefore, you are a rare gem! I will pray for you as you move forward in your teaching. I’ve placed Tattoos on the Heart on my reading list. Keep up the great work Kally! 😊
Thank you for sharing your experience with mental illness. I have two very close friends who struggle with mental illness. The courage and strength that they have from day to day is so inspiring. God has done some incredible things through their lives to minister to the lives of others. Praying that your healing process (knee) is going well.
Hey Kally,
Thanks for your thoughts on this. Your third ‘threshold concept’ as it relates to the importance of compassion speaks to a larger and critical issue to me that must be addressed by the church: how ‘Christians’ view people in general. No doubt this would include those suffering with mental health challenges, but churches seem gifted in judging & critiquing the homeless (often dealing with mental health issues), the addicted, the prodigals, those who hold different political perspectives, the broken….essentially everyone outside the church and many inside the walls who don’t ‘do Christianity’ ‘good enough’ (good enough being defined as ‘like me’). In my view, the church needs to start seeing people differently…..like God does…that is: lovingly. While I would likely add a few other truths to compliment Father Boyle’s teaching, I believe he has some important lessons to teach the church as it relates to seeing all people–which would include those suffering with the stigma of mental illness.
That’s brilliant, Kally! I’m intrigued by your idea of connecting the threshold concept to mental health issues. Stigma on mental health issues still often occurs, even in the church. I think it’s significant for church servants like me to also learn about this issue more deeply. Concerning my NPO, namely how husbands and wives struggle with mental health issues in their marital relationship. Thanks again, Kally. It was an AHA moment for me while reading your writing.
Thank you for your thoughts Kally!
you state:
As the World Health Organization states, “Mental health is determined by a complex interplay between individual, social and environmental factors”
I am curious what your thoughts are on how environmental factors play apart with children and youth who are surrounded by peers who (for the most part) are ignorant of mental illness. The impact of the environment is a big one. I have had teachers who have been aware of my daughters special needs but her peers are not. My daughter is growing in establishing and maintaining relationships. It is painful to see how much hurt has come as she has attempted to make friends over the years and other youth have viewed my daughter as “different.” This isn’t easy.
I appreciate your non judgmental position.