As we head into a month of Staff Perspective blogs focusing on the stigma around mental health, I struggled to come up with an angle that had not been addressed, either in previous blogs by CDP staff or in a myriad of other venues. The construct of stigma around mental health is well researched and many have written on the root of the stigma, why the military may be particularly plagued by stigma and potential directions to go in reduction efforts. Despite the attention around reducing stigma and increasing acceptance of behavioral health, we know that a high number of those with persistent mental illness and substance use disorders do not receive treatment. A variety of factors contribute to lack of appropriate care, including stigma, concerns about the opinion of others and the belief that poor mental health is a weakness, rather than a serious health condition that can improve with appropriate care.
Efforts are being made within the civilian and military populations to address the stigma and encourage individuals to seek care. One such effort is changing the language that is used around all behavioral health concerns (for example: died by suicide versus committed suicide, person with schizophrenia versus schizophrenic). These small changes can have lasting impact. Another shift in language I have seen in my private practice and in the media, is the use of humor around mental health conditions and care. This use of humor has caused me to pause and wonder if it is in fact helpful in increasing the acceptance of mental health as a health condition, or if it has a detrimental effect on helping those who need care.
Recently, I saw a meme that referenced being placed on a 72-hour psychiatric hold (in my state, an Emergency Detention Order) as a way of escaping life and getting a vacation. While intending to be funny, the message it may convey is that to be taken seriously, court involvement is needed. Taking care of our mental health should be normalized and prioritized. It shouldn’t require an acute hospitalization to take a break and address our mental health needs.
A second use of humor in social media is the concept of a “grippy sock” vacation. Again, this language downplays the seriousness of mental illness and the importance of care. The intention behind these references may be to destigmatize mental illness and to promote a sense of togetherness through shared experiences, but is that the message that is received? These jokes may leave those experiencing mental health concerns more isolated because their health concerns are the topic of jokes and therefore increasing the internalized stigma they may feel. Individuals in crises may not feel comfortable talking to others if they feel their concerns are likely to be minimized by jokes and banter.
Is humor appropriate when talking about/addressing behavioral health? Maybe. Depending on the audience and the situation, using humor may help normalize self-care and reduce stigma around seeking care. As when using humor as part of treatment or when discussing behavioral health in general, it can be difficult to know how the humor will be received. While I have found humor to be an effective tool in treatment, it can also have a negative impact when there is an error in communication. This is especially true if there are cultural differences to consider.
Allowing the patient to lead the way regarding humor can be the best approach. The patient’s use of humor, especially when talking about their own mental health, can give insight into potential internalized stigma. Many years ago, an airman told me that clinicians were referred to as “wizards” and that they would say “I’m going to see my wizard” when referring to counseling appointments. Personally, I thought being called a wizard was way cooler than being called a counselor or shrink, but it did give insight into the perception that what happened in counseling was seemingly magical, rather than an evidence-based treatment. While much of therapy relies on building a strong therapeutic alliance and that piece isn’t science, the Evidence-Based Psychotherapies (EBPs) we use to treat disorders are based in science. Addressing the science behind EBPs may be helpful in demystifying counseling.
Another use of humor I experienced in my practice was working with a National Guard recruiter who had shared with those in his recruiting station that he was seeing a counselor as a way of normalizing behavioral health for those under his command. If he was having a particularly rough day/week, he would tell them that he hadn’t seen his counselor that week, so they needed to back off. Again, this use of humor was initiated by the patient and was used by him to help de-stigmatize seeking behavioral health care with other soldiers.
Stigma is a complex phenomenon with no easy solution, as shown by the number of blogs and articles on the topic. Using humor in certain situations can be one of the tools used, but care should be given to its use to ensure that it does not perpetuate stereotypes or minimize a person’s experience. Many mental health diagnoses have widely accepted stereotypes that may or may not be accurate and may make it less likely someone would want to be associated with that diagnosis. Jokes designed to create an atmosphere of inclusion, may in fact make it less likely someone would want to connect around a mental health diagnosis.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Christy Collette, LMHC, is a Program Associate for the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, she is coordinating the expansion of the Star Behavioral Health Providers into new states across the nation. SBHP trains civilian behavioral health providers to work with Service members, veterans and their families.