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\u2019s faces when they found others who understood their reality, discovering they are not alone in this journey and my hesitancy ceased.<\/p>\n
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.”\u00a0In 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.<\/p>\n
That\u2019s 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.<\/p>\n
According to Meyer and Land, \u201ca 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.\u201d [1] Threshold concepts are transformative ideas that fundamentally change a person\u2019s 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.<\/p>\n
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\u2019s 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.<\/p>\n
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, \u201cMental health is determined by a complex interplay between individual, social and environmental factors\u201d[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.<\/p>\n
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<\/em>, Father Gregory Boyle says, \u201cHere 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.\u201d [3] \u00a0Every 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.<\/p>\n 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 \u201climinal space,\u201d[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.<\/p>\n 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.<\/p>\n