“I am afraid to go to therapy. I’m scared of what people will say if they find out. It’s so embarrassing.” People avoid seeking help for mental illnesses for reasons like these. So many wait until they are paralyzed by anxiety, depression, or PTSD before pursuing professional help. They have exhausted their family and friends. They don’t follow through on a medical or psychiatric evaluation until they can no longer function or are at risk of losing their job, their home, or an important relationship. Why is that? Why do people not give priority to their mental health? Why are they anxious about going to therapy? Primarily, it is because our society and culture perpetuate stigma against mental illnesses.

Mental health stigma

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The ancient use of the word “stigma” referred to having a permanent mark placed on one’s body. Specifically, it had to do with cruelly tattooing or branding a slave or criminal. Today, stigma refers to a quality or circumstance that is generally viewed as disgraceful or shameful. Criminals are no longer physically branded, but they are subjected to societal stigmatization. For the rest of their lives, individuals, communities, and institutions regard them as disgraced, or as having a cloud of shame over their head.

National Institute of Mental Health (NIMH)What is your reaction to reading this list? Fear? Disgust? Indifference? Discomfort? Do you want to push the feelings away and not think about them? Why do they come up in the first place? — **National Institute of Mental Health (NIMH)**
What is your reaction to reading this list? Fear? Disgust? Indifference? Discomfort? Do you want to push the feelings away and not think about them? Why do they come up in the first place?

What is mental health stigma? Generally, stigmatization of mental illnesses suggests personal weakness. Microcultures within religion, race, ethnicity, language, gender, and family contribute their own beliefs about mental illnesses and weakness, ranging from poor nutrition, not enough prayer, or a familial defect. Negative cultural beliefs about mental illnesses usually have unpleasant consequences for those showing signs of a mental illness or admitting to having one and asking for help. The range of consequences directly or indirectly marginalize the person living with mental illness as “less than” or “other.” For example, an otherwise brilliant and contributing employee is no longer given challenging projects, or an eligible bachelor or bachelorette is no longer such a great catch.

Simple Truths about Mental Illness

Mental illnesses are no different from having physical illnesses. They are non-discriminatory and are not contagious. Some ebb and flow. Some are present for one’s whole life. Some can lead to suicidal ideation or death by suicide if left untreated.

Certain factors increase the risk of having a mental illness: genetics, neglect, hormonal or chemical imbalances, and big and small traumatic experiences. A mental illness can affect anyone at any point in their life.

It can be visible or invisible. Not everyone who suffers with anxiety, depression, or bipolar disorder presents with all the symptoms or presents them in the same way. For example, you would never know a person lives with Persistent Depressive Disorder unless you lived with them or they told you. How would we know someone lives with the silent killers diabetes and hypertension unless they told us, or they had a medical emergency? Mental illness is similar to a range of medical illnesses that can be controlled by lifestyle modification, medication, or a combination of the two. How do we view people with organically occurring physical illnesses? Do we believe they are weak or inferior for having these physical illnesses? Why does our culture find it more acceptable to hear, “I have diabetes or high blood pressure,” than it does to hear, “I have anxiety,” or “I have depression”?

Reasons People Are Afraid to Go to Therapy

1. Fear of what others will think or say

This is not an irrational fear. Even one’s family and closest friends can judge mental illnesses harshly or put their own spin on it. As stated above, many cultures view mental illness as a personality defect or spiritual weakness. This belief is passed down from generation to generation and from parent to child. Perhaps it reveals itself through overtly characterizing people living with mental illness as losers, or maybe comes out as lighthearted joking about hiding crazy Uncle So-and-So in the basement when company comes over. The active or passive message is clear: fear mental illnesses, don’t tell anybody if you have one, and hide the obviously mentally ill. If you never have a mental illness, you are strong. If you cure one on your own or you keep it a secret, you are appreciated.

Consider this: What are you telling yourself when you say you’re worried about what people will think of you? You’re effectively saying that other people’s perception of you is more important than your health and happiness. Would your real friends or family want you to think that way if you were diagnosed with cancer, or would they urge you to seek treatment right away? Would they not be at your side all the way through? If this is not the case for you, you need better people in your life.

2. Denial of anything being wrong

Another reason for feeling awkward about going to therapy is that people don’t understand what is happening to them. Before the internet, information about mental illnesses was not at our fingertips. Rather than out themselves by asking questions or seeking help, people just suffered emotional pain, self-harmed, and killed themselves.

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Individuals, families, and communities fear what they don’t understand, and as mentioned previously, it is easier to understand diabetes than it is to understand a sudden, unprovoked panic attack. After all, how can you be depressed if you have everything you could possibly want, no one has died, and you have a better life than the vast majority of the world?

When something sounds irrational or does not fit our worldview or experience, it is easier to deny it and push it—and the person living with the mental illness—away.

3. Inaccurate information about psychiatry and therapy

Some people will resist psychiatric help or talk therapy because they don’t really know how it works. They think of padded rooms, straitjackets, cranky nurses, or sitting before a bored-looking therapist in a room. There is a lot of misinformation about mental illnesses and the many ways they are treated.

Look around you. Information may be even closer than you think. Is there a friend, family member, church member, or another person in your social network who has the information you need? Who do they know and what do they know? A recommendation from someone you trust will save you a lot of time and energy and remove some of your anxiety.

I invite you to be a conscientious consumer and do your own research. Therapists and counselors, including me, offer free consultations and will direct you to the right person. Also, forget about the therapy office and the coach. You now have options. Online therapy, virtual therapy, teletherapy, and telemedicine are becoming extremely popular, especially since the social distancing caused by the coronavirus pandemic. Since 2017, I have worked as an online therapist in California, and in my nursing career, I’ve worked as a telephone advice nurse for medical patients. I am happy to answer your questions about how teletherapy might help you.

“You don’t want to be the reason someone doesn’t seek help and gives up hope.”

4. Fear of entering the medical system and losing control

The thought of being diagnosed with a mental illness is upsetting. The diagnosis becomes a part of our medical record. In the United States, we have the Health Insurance Portability and Accountability Act (HIPAA) that ensures safe, coordinated care across the health system. It also regulates the sharing of medical information. What may be unavoidable is an increase in medical insurance premiums because now we have a pre-existing condition. For these reasons people under-report mental health symptoms. They ignore their symptoms or treat them with home remedies, diet, and exercise.

To be sure poor nutrition, a sedentary lifestyle, and poor sleep hygiene contribute to dark moods, nervousness, cloudy thinking, lack of motivation, and fatigue. Everyone should eat a nutritious diet, exercise regularly, sleep enough to feel refreshed, and have a practice that rejuvenates them spiritually—be it yoga, meditation, walking, reading a holy book, or journaling.

Be mindful, however, that this approach does not work for everyone.

Symptoms of a mood disorder like anxiety or depression can improve with conscious health choices, but do not allow fear and shame to prolong emotional pain and the risk of self-harm. Seek help and direction from a medical doctor, psychologist, and therapist if you suspect the onset of a mental issue. They will collaborate with you on using the remedies you strongly believe are helpful. Having an informed ally at your side is powerful.

Fight Mental Health Stigma and Save Lives

Each of us play an influential role in society. Our speech and behavior help to maintain norms, values, and beliefs that our society has agreed upon. As time, knowledge, and understanding accrue, these social constructs change slowly or not at all. However, they evolve and serve the common good faster when conscious people exert their will. A collective of individuals exerting their personal and political will can gradually change mental health stigma and save lives. What can we do personally to help?

1. Things not to say to people living with a mental illness

Words and actions are powerful and can encourage someone to get help or make them feel scared to go to therapy. We should avoid words like “crazy,” “insane,” “loser,” or “psychotic” in our silent thoughts because eventually we will say them aloud. Just imagine someone describing you or a family member with such terms. Would it lift you up or beat you down?

People living with a mental illness already fear being labeled, much less unfairly labeled. They are people first. They are not their illness. While working with their patients, nurses don’t say, “The diabetic in room 222.” We have learned to dignify the person first. So, we would say, “The lady with diabetes in room 222.” It’s subtle, but it makes a huge difference in how we treat people living with illnesses. In therapy, people who feel stigmatized for a mental illness practice externalizing the illness until it becomes a habit. They are encouraged to say, “I live with depression” rather than “I am depressed.”

2. Things to say to people living with mental illness

What do you say to someone who complains of symptoms of mental illness but who will not seek treatment for fear of what people will say about them? You might try this line of argument:

First, encourage them to talk with their primary doctor, stressing that that is what they are there for and all conversations are confidential. If you know a mental health professional like a therapist or counselor, you might refer them to that person.

If that doesn’t work, provide a comparison. What if you broke your leg? What would you do? Wouldn’t you go to the hospital and have a fracture doctor give you some pain medication and set your leg? Then he would give you crutches, prescribe pain medication, and arrange physical therapy sessions before sending you home. You would gladly accept the doctor’s help, right?

At home, wouldn’t you use the crutches to get around and use the pain medication as necessary? You would go to physical therapy and gradually increase your range of motion and strengthen your leg. With enough time, you would be walking with barely any evidence that you had broken your leg in the first place.

It is the same process when treating emotional and mental issues. A therapist or psychiatrist helps stabilize your symptoms. After that, they work with you on a plan to help you manage your symptoms and feel better than you do now. All of it is done confidentially.

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4. How to be an advocate

Starting today, do at least one of the following:

Track your thoughts and change any stigmatizing views, beliefs, or attitudes.
Track your language and mindfully change any verbal or non-verbal communication that is demeaning or unhelpful. You don’t want to be the reason someone doesn’t seek help and gives up hope.
Be an example to others by not participating in stigmatizing name-calling or belittling of people living with mental illnesses.

5. Can mental illness be cured?

Truthfully, some mental health challenges will never fully go away. It is disappointing to learn this. It is made more devastating when you add stigma to it. Just as when facing a lifelong physical illness, it takes time to process the news, grieve, accept, adjust, and learn to daily manage a mental illness. It is normal to feel sad about the loss of good health. It takes determination and courage to continue living as full a life as possible with a mental health issue. Meeting with an experienced and understanding therapist can help us adjust more quickly to your new circumstances.

How do I find a therapist?

Do you have concerns about your mental health or that of someone else? Are you afraid or embarrassed to ask for help? It might be useful to clarify your thoughts with a counselor or therapist in California? Book a free 15-minute phone consultation, and I will help you find the right person for your needs.

WHY AM I AFRAID TO GO TO THERAPY?