Front Matter

About the Author

Acknowledgments

Foreword

Daniel H. Gillison Jr.

1 Introduction

2 What Is Mental Illness?

3 Mental Illness Is Common

4 Is Mental Illness a Myth?

5 Mental Illness Is Real

6 Mental Illness Is Serious

7 Mental Illness Is Nobody’s Fault

8 Mental Illness Is Treatable

9 Mental Illness Is Our Teacher

10 Afterword: A Vision of Unity

Index

Daniel B. Morehead, M.D., is a psychiatrist in private practice in Austin, Texas, and Boston, Massachusetts. He speaks regularly for mental health advocacy and is clinical assistant professor of psychiatry at Tufts University Medical Center. He is also former assistant residency director at the Menninger Clinic, where he received the William C. Menninger Teaching Award. He is board certified in General Psychiatry and Neuropsychiatry and maintains interests in brain science, psychotherapy, and spirituality.

This book began many years ago with a talk for a local faith community (requested by my wife, who happened to be a minister there). Four people attended. The next occasion occurred at a community mental health conference, where organizers were surprised to receive a capacity crowd of 800 attendees. And so I would first like to thank Rev. Carol Morehead and Fonda Latham, M.S.W., the accomplished leaders who initiated my participation in their advocacy programs. In a similar way, I am grateful to Karen Ranus of NAMI, Kay Warren of Saddleback Church, Barbara Johnson, John McFarland, J.D., Carol and Don Hollins, Douglas Brown, Dan Chun, M.Div., Laura Roberts M.D., and many others for taking a chance on my ability to advocate and giving me opportunities to do so.

The generous people who reviewed the manuscript for this book surely deserve some special (yet to be specified) reward: JT. Kittridge, Charles Morehead, David Morehead, M.D., Marcia Morehead, M.S.W., Andy Montgomery, Manley Clodfelter, M.D., Kim Paffenroth, Ph.D., Don Stephenson, Lisa Madsen, M.D., Allan Cole, Ph.D., Steve Sonnenberg, M.D., and Paul Summergrad, M.D. The later two, along with Glen Gabbard, M.D., have offered vital mentoring and encouragement along the way, for which I will always be grateful. Doug Beach of NAMI has been especially energetic in his support and encouragement, and for me represents the tireless efforts of so many advocates over so many years, efforts that continue to bear fruit.

All advocacy springs from the work of those who have gone before us: Those who have experienced mental illness, their families, advocates, and helpers and treaters of all kinds (from caretakers to doctors and nurses). All of us who care about mental health owe them a profound debt. Personally, I will be forever indebted to my own patients, who have been the most patient and humble of teachers. Most of all, I want to acknowledge the scientists whose work provides the foundation for this book. Nothing in the text that follows is truly original; everything is drawn from the patient and painstaking work of numberless researchers in the fields of psychiatry, medicine, psychology, sociology, and spirituality. A few of them are famous, but we owe just as much to those whose names we will never know. All of them have devoted numberless hours and care to the vast edifice of research and clinical experience that now rises before us in the field of mental health. This achievement—truly scientific, humane understanding and treatment of mental illness—will fill us with joy and optimism, if only we have the eyes to see it.

Daniel B. Morehead, M.D.

In 1979, a small but determined group of mothers desperate to help their children convened around a kitchen table in Madison, Wisconsin. Each parent had a child living with a mental illness and little support at the time to help their children, and themselves, so they turned to one another for comfort.

What they found was much more.

The dedicated group of parents exchanged what they had learned about mental illness, listened to one another as they talked through the painful challenges they faced, and planted seeds of a community rooted in their shared experiences. They eventually came to understand that it’s okay to not be okay—and that what they were going through was more normal than they previously believed.

Realizing others could benefit from a similar peer model, the families transformed this inaugural kitchen table convening into what is now known as NAMI, the National Alliance on Mental Illness. NAMI is now a far-reaching network of more than 600 local affiliates. Along the way, NAMI created a roadmap to raising awareness about mental illness that focuses on education, community, and empathy.

We continue to use this model at NAMI. As CEO, I’ve seen firsthand how far the medical and advocacy communities have come in raising awareness about mental illness. But the business of changing hearts and minds on this issue is hard work, and there is still much to be done to overcome the stigma, shame, and discrimination that prevents people from accepting that mental illness is real and treatable.

That’s why I could not be more grateful for Dr. Dan Morehead’s book, and especially at this moment in history. The COVID-19 pandemic and the impacts of physical distancing and quarantining—science-based measures for preventing infection—have likewise taken a toll on the mental health community and people’s ability to access and lean on their support systems for help. As mental health providers see an unprecedented spike in people seeking mental health care and as uncertainty remains about the long-lasting effects of the public health crisis, now more than ever we must understand how to educate, build community, and promote empathy about mental illness even as we live in isolation.

With Science Over Stigma: Education and Advocacy for Mental Illness, Dr. Morehead’s work at the intersection of brain science, psychotherapy, and spirituality is on full display and comes together in a book perfectly designed to help health professionals educate and advocate while also being accessible to all readers. This is so very important, as we can all stand to benefit from increasing our understanding of mental illness and its reach and impact.

Early in the book, Dr. Morehead illustrates for us how common and far-reaching mental illness is. Mental illness is so common, that whether we realize it or not, we are all impacted by it — if not directly, then through someone we love, care about, live near, or work with. Today, one in five U.S. adults experiences mental illness, with anxiety disorders, depression, and posttraumatic stress disorder being among the most common. One in 20 U.S. adults lives with serious mental illness. In fact, at least 8.4 million Americans provide care to an adult with emotional or mental illness and, on average, spend 32 hours per week providing unpaid care.

The individual and family impact of mental illness produces a ripple effect in our communities. More than one in three people incarcerated in state and federal prisons have been diagnosed with a mental illness, and seven out of 10 youth in the juvenile justice system have at least one mental health condition. Furthermore, more than one in five people who experience homelessness, and one in eight of all visits to emergency rooms, in the United States are related to mental health and substance use disorders.

And yet, even with such far-reaching impacts, nearly 60 percent of adults with a mental illness did not receive mental health services in the previous year.¹ So while over the past few decades there has been tremendous scientific progress, as Dr. Morehead details throughout this book, the science community cannot alone improve outcomes for people living with mental illness. Scientific advances must be supported with social progress and by overcoming the stigma associated with mental illness. With that said, perhaps the most important takeaway from this book is this: You are not alone, and suffering from mental illness is nobody’s fault (see Chapter 6, “Mental Illness Is Serious,” and Chapter 7, “Mental Illness Is Nobody’s Fault”). We are all in this together, and we all have a responsibility to fight this fight against stigma.

The good news: There’s strength in numbers, and together can we increase the visibility of mental illness and decrease stigma. Dr. Morehead understands that because of the nature and ubiquity of mental illness, this requires a multimodal approach that must include improved individual clinical treatment and patient care, as led by the medical community and health care providers. But overcoming stigma also requires strong community-based advocacy.

Thousands of trained NAMI volunteers host peer-led programs and support groups, which include NAMI Family-to-Family, NAMI Basics, NAMI Homefront, and NAMI Provider. These programs offer training and support to caregivers, families, military service members and veterans, and mental health professionals, because it’s imperative that we all become advocates—from family members, friends, and neighbors; to doctors, health care providers, and health insurance companies; to grasstops and grassroots organizers and organizations, community leaders, judges, and legislators at all levels of government. Each of us has a role to play.

In the past few years, we’ve seen how well a multimodal approach to overcoming stigma works. Tremendous improvements in the availability of mental health treatment have been accompanied and enhanced by a momentous cultural breakthrough.

When Prince Harry stepped outside of royal tradition and opened up about his decades-long mental health struggle and how he dealt with it, his story made headline news.² The world took notice again when last summer, former First Lady Michelle Obama shared on her podcast that she was experiencing low-grade depression and how quarantining from COVID-19 and social and civil unrest had left her feeling “too low.”³

But we can also look a little closer to home to bear witness to the sea change in attitudes toward mental illness and health, as young people across the country have been among our best teachers (see Chapter 8, “Mental Illness Is Treatable”). As Dr. Morehead points out and suggests, mental illness usually begins early in life—when people are teenagers or young adults—and that deep wisdom lies in the excruciatingly painful experiences of coming of age while suffering from mental illness. And it’s true. Social media provides an accessible and often free platform to educate, build community, and express empathy. Young people regularly turn to social media to express themselves, and they have not precluded talking openly about their own mental health struggles, sharing their therapist’s advice, or expressing when they too are suffering through acute symptoms associated with mental illness on these platforms. As a result, these candid exchanges are lifesaving.

There is a valuable lesson to be learned from this transformative cultural shift, and that is, we must all be available to give one another grace: the grace to acknowledge that we or someone we love or care about is suffering from a mental illness; the grace to give ourselves an opportunity to learn more about mental health and the impact of mental illness; and the grace to build support systems and get the help we need and deserve.

It has not been easy to shift an entire culture on this issue. This cultural progress did not come without improved early-intervention methods, people increasingly having frank conversations with their health care providers about their mental health as a matter of course, and providers incorporating treatment into their patients’ health care plans.

And that speaks to what this book does best, which is to reaffirm that combating mental illness is a systemwide effort. And if there’s one thing I know for sure is that it will take all of us pulling the levers of science, policy, medicine, and culture to pierce the veil of stigma, shame, and discrimination that surrounds mental illness.

Daniel H. Gillison