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The "Invisibility" of Mental Illness

» Mental Health Library » Treatment Approaches » Psychoeducation » Featured Article

By Robert C. Ciampi, LCSW

Robert C. Ciampi, LCSW

Physical illness and disease has always been viewed differently from mental illness. With physical illness, many have pointed out, there is a quantifiable or measurable aspect in that a physician can see, with the right instrumentation, bodily processes that are impinged, torn, broken, swollen, invaded by a mass or tumor, penetrated by accident or violence, and other observable abnormalities to the body. Children understand from an early age that if they get a “boo boo” such as a scratch, cut, or scrape it can easily be remediated by a caring parent and with a simple band aid and a hug. In the case of a more severe trauma, we are taught that the skill of our doctors, nurses, and other healthcare workers, we will be diagnosed and treated at the appropriate level of care. We are also educated about preventative care such as having a healthy diet, the importance of regular exercise, and the avoidance of toxic elements to our bodies.  There seems to be no hesitation at all that when we get physically sick, are hurt, or have a disease, we seek immediate help with a phone call to our primary care physician or a specialist who will treat us. We will willingly take prescription medication for high blood pressure, high cholesterol, diabetes, thyroid issues, heart conditions, autoimmune problems, and pain with very little resistance. And the ill person will garner much attention and sympathy including prayers, flowers, get-well cards, wishes for a speedy recovery, and other acts of kindness. To be physically ill, friends, family, neighbors, coworkers, and sometimes even strangers will put in a special effort to help the sick person.  But what about the person suffering from mental illness? Why is there a disparity between the understanding of a person who is physically un-well and a person who is emotionally or mentally ill?
For quite some time, mental illness has been seen as a condition of a weak character, attention-seeking behaviors, and a “choice” to act in ways that were against social norms. For example, many people with depression were told to “snap out of it” or “if you’d only get a job you wouldn’t be depressed.” Those suffering from anxiety were seen as “nervous” people who were advised to “just calm down.” And those afflicted with bipolar illness or schizophrenia were considered to be just plain crazy. Why is this mindset still prevalent in our society today?

The argument I will make is that mental illness is less quantifiable and more qualitative in nature. Unlike having a broken leg that can be seen on an x-ray and treated by stabilizing the fracture with a cast, mental illness is “invisible” to the naked eye in that an instrument cannot actually see anxiety or depression or the accompanying pain associated with it. (Note: although it has been established that biologically speaking, mental illness involves neurons, synapses, reuptake inhibitors, and neurotransmitters in the brain, due to the complexity of these processes, it is outside the scope of this paper). It is assumed that a broken bone will produce pain and that it will take some time for it to heal and for the pain to subside. However, those who have never experienced the pain of a psychiatric illness, such as depression, do not understand that the pain can be greater than that of a person suffering from a broken bone. Yes, it hurts to have a mental illness.

It appears that the distinction between understanding the difference between a physical illness and a mental illness comes down to the fact that many physical illnesses can be observed by sight or through an instrument that can detect disease inside the body. Mental illness cannot be “seen” through a microscope or an MRI, but is often detected by behavioral aspects the person demonstrates. Physical illness and mental illness may both be referred to as a disease process, but behaviorally they can be opposite in presentation. A person who is physically sick may be seen as quiet, fatigued, and at rest, accepting their diagnosis and dutifully being compliant with their treatment plan. Someone with a mental illness may present as agitated, combative, and distrustful of the healthcare professionals and may be noncompliant with their treatment plan. This may be what people see and then view the physically ill person with sympathy and judge the mentally ill person with fear and disdain. To understand mental illness is not always easy, but it, nevertheless, is an illness like a physical illness. This is where the work needs to be done to help people understand that mental illness is a true illness that deserves the same level of compassion that is given to someone with a physical illness. We don’t think of a person battling cancer as being “crazy” for having their illness; why do we use that terminology with someone battling a mental illness?

A big part of the misunderstanding of mental illness is the barrier of stigma surrounding mental health. Whereas people will often reach out to someone with a physical illness, others tend to avoid someone with mental health issues. One dictionary definition of stigma is “a mark of “disgrace” associated with a particular circumstance, quality, or person.” It has been established that mental illness is seen as a “disgrace” whereas physical illness is viewed with compassion. People who suffer from mental illness do not want to be ill nor did they ask for their illness. It is a bodily disease like a physical illness only with a different presentation. Physical illness makes sense where a mental illness often seems illogical. Once this can be understood, I believe we will be a step closer to having parity between physical illness and mental illness. I like to think of the word stigma as Supporting Tolerance (for) Individuals Getting Mental-health Assistance. I believe that if more people can develop empathy and tolerance for those suffering from mental illness, we can be a step closer to changing this misguided mindset. With the stigma of mental health issues beginning to diminish and with super-star athletes, entertainers, iconic actors, and musicians finding the courage to talk about their mental health problems in public, perhaps in the not too distant future, physical illness and mental illness can be spoken about on the same level.

*This article may be reproduced by permission from Robert C. Ciampi, LCSW author of the book When to Call a Therapist (Scrivener, June 2019).

About the Author...

Robert C. Ciampi, LCSW has worn many “hats” in his professional career: clinician, therapist, supervisor, couples counselor, consultant, and now author. He earned a BA in psychology from Montclair State University and went on for his MSW at Rutgers University, both in New Jersey. After receiving his licensure as a clinical social worker, he worked in community mental health centers and hospitals working with individuals with serious and persistent mental illness as well as patients who were dually diagnosed with mental illness and substance abuse. Robert C. Ciampi, LCSW went on to work for a behavioral healthcare consulting firm which helped healthcare facilities reestablish themselves as well as coordinated a program that provided employee assistance help for problems in and out of the workplace. He was also the Director of psychiatric inpatient social work services at the largest hospital in New Jersey. He began a private practice in 2010 which focuses on clients needing assistance with anxiety, depression, anger management, assertiveness training, and other issues. He also sees clients for couples and marital counseling. His practice is in northern New Jersey.

Last Update: 3/24/2020

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