Stigma Versus Secondary Disturbance
The appropriate way to handle shame associated with mental disturbance
I recently came across a video of anesthesiologist Dr. Kaveh discussing the stark generational differences in the mental health of patients undergoing surgery he has noticed over the last decade. Specifically, he lamented the apparent loneliness of the Gen-Z patients he observes; stating that they are commonly on SSRIs, benzodiazepines, and are self medicating with high doses of marijuana, among other things, presumably as a fallout of this loneliness. The result in the context of surgery is that these patients require much different doses of anesthetics as compared to patients of the same relative health status from a different generation. The part of the video which struck me most was when Dr. Kaveh remarked that Gen-Z is much more likely than older generations to reach for pharmaceuticals and recreational drugs for help with everything from sleep difficulties to depression and anxiety - and not just to “get over” their ailments, but “because of them.” This difference in wording, he notes, reflects the difference between recognizing a disturbance as something to set one's sights on overcoming versus internalizing it as a permanent aspect of one’s identity. In effect, he muses, “we are normalizing depression.”
Internalizing Disturbances as a Permanent Fixture of Identity
By a stroke of coincidence, I had just finished the previous section of this article while sitting in a lab waiting for my blood to be drawn when I noticed something that helps demonstrate this point. Taking advantage of a lull between patients, two phlebotomists worked together to reorganize their various work supplies in a stall adjacent to me. One said to the other, “I know that’s not really necessary, it’s just my OCD won’t have it any other way.” The pair shared a chuckle over this.
As I overheard this conversation keeping Dr. Kaveh's remarks about normalizing mental illness in mind, I considered the likelihood that anyone in that lab has an actual case of OCD. It is certainly possible, but I wager the person who cited OCD as the reason for their organizational methods is actually just someone with a preference for keeping their workplace tidy. But comments like this are everywhere now. Instead of explaining one’s actions in terms of preferences or goals, people often deflect to a mental illness or symptom thereof as the uncontrollable protagonist in their own stories. This seems indicative of a tendency in our society to limit responsibility for everything, even things we enjoy - you know, just in case someone else might take offense to it.
Mike isn’t a young man who is presently bothered by depressive tendencies hoping that a few months on Prozac and some counseling will help him reset to baseline, he’s a guy with no ability to control his depression when it decides to surface. Jill isn’t a girl who can desensitize herself to social situations in which she is usually very uncomfortable by exposing herself to them regularly, she is a person at the mercy of her anxiety, a permanent and unalterable fixture of her core identity. Susan isn’t a woman with strong preferences for excellence she feels too timid to reveal with confidence in a workplace setting where mandatory sensitivity training has convinced her these preferences are threatening to her co-workers, she’s a woman with OCD, and just can’t help the tendencies that come along with that fact.
How long until an entire generation is referred to collectively as a helpless mess? People in positions like Dr. Kaveh’s might say this day is fast approaching, if it’s not already here.
And that’s just fine! It’s great, in fact! See how comfortable these people are with admitting defeat and helplessness in the face of troublesome symptoms? That can only mean we’re on the righteous path of reducing the stigma long associated with these problems. There’s power in vulnerability, strength in weakness! The first step in healing is to publicly ruminate on your own private struggles. The second step is to expect, if not outright demand, that the entire world holds you in a warm embrace so that when you blurt out things that were once culturally off-putting and awkward, such as “I’m really anxious, like everyday I have a panic attack” the response is to reward you by singing the praises of your shortcomings, and your bravery for acknowledging them - to ready the road for you, rather than help ready you for the road.
Of course, nothing could be further from the truth. We humans are imperfect actors, each with unique genes and situations that catalyze unique responses to external stimuli; and there is nothing brave inherent to this acknowledgement. But each of us, and each of us alone, has control over the thoughts that govern our emotions and behaviors. One such line of thought is that which causes us to become upset about our imperfections.
Stigma vs Secondary Disturbance
The Me You Can’t See, an AppleTv series produced by Oprah and the first guy everyone pictures when they think of optimal mental health, Prince Harry, is just one example of a project which aims to “destigmatize a highly misunderstood subject and give hope to viewers who learn that they are not alone.”1 Taking this at face value, this project hopes to remove all shame from the experience of mental disturbance. Oprah explains, “Now more than ever, there is an immediate need to replace the shame surrounding mental health with wisdom, compassion, and honesty. Our series aims to spark that global conversation.”
Accepting oneself, imperfections and all, is as worthy a cause as it is doable. But expecting to be universally accepted by others, whether you suffer from psychological disturbances or not, is a fantasy.
As in the above anecdote of the phlebotomist at my local lab, the effort to reduce the stigma surrounding mental health problems has, ironically, merely transferred stigma on to normal personal preferences and the confidence to express such things unambiguously. For instance, having the understandable desire to keep a well-organized workspace must be downgraded to a flaw in order to be deemed socially tolerable. But this can be taken even further and applied to the quite normal desire to not be inundated with propaganda designed to normalize mental illness, let alone be directly faced with the fallout of this every time a “penis owner" watches women undress in the women's locker room. Just ask Riley Gaines.
Institutional attempts to reduce stigma reek of “We don’t know how to get rid of stigma or if, practically speaking, we should. But it sounds like a profitable way to virtue signal and the best we can do is try to move it from one place to another, so let’s go with that.” An image of a small child using a mop to smear a mess from the dirty side of the kitchen to the clean side of the kitchen comes to mind. “I cleaned!” they say when finished, when really all that's happened is the mess has been spread around.
On an individual level, disturbances resulting from the perception of stigma can be thought of as a secondary disturbance.2 Having a secondary disturbance simply means that an individual is disturbed by their disturbances. For example, they are ashamed that they are depressed. Shame comes secondary to their primary disturbance of depression. Parsing out secondary disturbance from primary disturbance is a critical step in clearing the path so that the primary cause of stress can be addressed more effectively. In situations where shame stemming from the perception of stigma associated with depression is the secondary disturbance, the troubled individual is wise to question what evidence exists that proves they must or should feel ashamed of their disturbances. Such irrational beliefs are extremely difficult to substantiate, and recognition of this helps to develop the kind of self-acceptance that fosters resilience.
Stigma, on the other hand, refers to the public disapproval of something, including mental conditions. Attempting to remove all stigma toward mental illness from the public sphere leads to normalizing the abnormal, stigmatizing the well-adjusted, and conditioning people to accept that their disturbances cannot be totally helped unless and until there is widespread public acceptance of them.
If everyone is abnormal, no one is abnormal…right?
A healthy society motivates individuals to acknowledge when their feelings and behaviors are abnormal and disruptive to their lives, to strive to adapt to conditions that promote prosocial norms, not surrender to the isolating and destructive manifestations of depression, anxiety, or delusion.
When you feel disturbed about your disturbances, your “safe space” is with your family, a supportive community, or perhaps a therapist with a healthy distaste for the establishment and an appreciation for the concept of secondary disturbance. Eventually, your safe space may even be your own internal world, but it is not the entire world at large.
Thanks for rucking with me. Please enjoy the music as you exit.
https://www.marieclaire.com/celebrity/a36394130/the-me-you-cant-see-apple-tv-details/
As defined by the branch of psychology known as rational emotive behavioral therapy (REBT)