She could be dead. Sometimes she thinks she might as well have died.

 

Ava, who has been given an alias for her privacy, struggles with clinical mental illness, and her thoughts have taken her to the brink of suicide. She is plagued by depression, a disorder that many people don’t even believe in.

 

“No one around me believes that it’s real,” Ava said. “It’s hard to be experiencing something that doesn’t exist to other people, and I can’t even explain to them how I’m feeling or what’s happening because they’ll just blame it on me.”

 

Even though she is still alive and resuming life as normal, and no one except for a couple of her closest friends knows about her desire to die, her mind and emotions are in a state of decay. The things she feels on the worst of her bad days are impossible for anyone else to understand.

 

Ava’s illness inhibits the lives of many teenagers. Approximately one-fifth of adolescents aged 13-18 suffer from severe mental health problems, according to the National Alliance on Mental Illness. If this demographic is broken down, 11% of teenagers have a mood disorder, 10% have a behavioral disorder, and 8% have an anxiety disorder.

 

Mental illnesses are not simply caused by moodiness or inability to behave correctly. They have a biological origin in imbalances of hormones such as serotonin, dopamine, and norepinephrine, anomalies in brain circuitry, and environmental triggers.

 

These disorders vary greatly in severity, but ultimately, they are illnesses that come with a pain of much more depth and complexity than is often attributed to them. They can become a question of life or death.

 

Arguably the most significant barrier to improving the state of those with mental disorders is misunderstanding—social attitudes that cause many individuals to trap their illness inside of themselves, ashamed.

 

STIGMA

 

A deep-rooted and long-standing stigma lurks behind every victim of mental illness. There are claims that depression is self-inflicted or just feeling overly sorry for oneself, that obsessive compulsive disorder is just pickiness, that eating disorders are a pathetic result of giving into societal pressure, or that nothing a teenager has experienced in their short lifetime could possibly give them posttraumatic stress disorder. These statements lead many of those who are mentally unhealthy to internalize their illness.

 

Ava has shown symptoms of depression for almost five years, but only recently has she started receiving help in the form of therapy. “I just didn’t want [my family and friends] to always be worried about me and have to put my burden on top of theirs,” Ava said. “So that’s why I avoided telling people for so long, because I’m not their responsibility.”

 

Although Standley Lake clinician Carolyn Hull from the Jefferson Center for Mental Health referred Ava to someone who could prescribe her antidepressants after meeting with Ava weekly for an extended amount of time, Ava is still not receiving medical treatment outside of weekly therapy sessions.

 

Unlike a disease that affects any other body system, mental illnesses are so complex because they affect the brain—they affect personality, who a person is in the most fundamental way. They become much more personal than other illnesses.

 

Consequently, mental health issues are often perceived—both by outsiders and the victim himself—to be a weakness within the person suffering. Often, this blame leads to the idea that mental illness is completely made-up.

 

Ava’s family and boyfriend believe this is the case. “[My mom] doesn’t think it’s real, she thinks I’m just super stressed and have bad anxiety,” she said. “[My boyfriend] doesn’t think it’s real either. He thinks it’s his fault. I’m like, it’s not your job to make me happy. It kind of is, but if I’m not, you shouldn’t take that personally. I don’t have the capability to be happy.”

 

Her boyfriend assumes that if she wanted to, Ava could simply make the decision to be happy. However, psychiatrist Theodore Henderson, PhD, MD, said, “Mental illness is really a biological thing. It’s not a character flaw or personal weakness.”

 

Still, so many people who suffer from mental altercations do so in silence or are treated differently because of it.

 

Psychologist Kristin Rusk, PhD, attributes the stigma to a lack of knowledge. “It’s not something that is taught,” she said. “You have to take psychology class to really learn about that.”

 

Rusk argues that the presence of mental illness in the media can be partially to blame. “When mental illness gets so severe that it is a harm towards others, that’s when we hear about it, and it has a dangerous stigma associated with it through the media.” she said.

 

Stigmatization not only causes a fear to pursue medical help in the face of possible mental disorders, but it also is anathemic to those suffering.

 

Hailey, another student who chose to remain unidentified, has been diagnosed with a myriad of mental disorders that includes major depressive disorder, generalized anxiety disorder, anorexia, insomnia, and PTSD. “It kind of makes you feel like you’re ‘less than’ a lot of the time,” Hailey said. “Like having mental illnesses makes you softer than others around you or you shouldn't be treated as well as everyone around you.”

 

ROOTS OF THE STIGMA

 

The stigma of mental health can principally be credited to the fear of what mental disorders are capable of and the inability to fully cognize them—nobody can get inside someone else’s head. Even afflicted individuals have difficulty comprehending their own mental pain. The intrinsic complexity of neurological illnesses causes natural unease that comes with anything unknown.

 

“That unpredictability and the variability of mental illness is tricky,” Rusk said. “It’s not clearly defined and understood.”

 

“[There is also] the ‘What’s wrong with me?’ phenomena,” Rusk continued. “People have this shame about having emotional problems. It can be a huge barrier to accessing support.”

 

“I think [people who have no experience with mental illness] have issues believing forces besides things that happen to you can make you sad,” Ava said. “[People ask,] ‘Well, what made you sad?’ And it’s like, nothing specific happened to me that made me sad, I just got sad. They don’t understand that I just feel sad all the time.”

 

Apart from being difficult to understand, mental illness is by no means simple to treat. There is no standard treatment because each case is so unique, but it is usually best to use a combination of medication, support groups, or counseling such as cognitive behavioral therapy, which changes negative thought patterns and is most commonly used to treat depression.

 

Using medication for mental disorders is often met with criticism, however. Anti-depressants, for example, often make patients feel ashamed that they ‘have to take pills to be happy’ or that their happiness is fake. Many parents express concern about the side effects, and it is a commonly-held belief that medications are overprescribed.

 

But medication helps in a majority of cases because mental disorders are neurobiological. Some people take medication over the length of their entire life; their brains need extra stability in maintaining emotional and behavioral well-being.

 

Ultimately, recovery is not quick, and it requires dedication and hard work. Some people diagnosed with mental disorders get frustrated when they don’t see results. “A lot of the patients I treat are patients who have failed medications and have gone to three, four, five other doctors,” Dr. Henderson said, “So a lot of them come to me hopeless.”

 

The breadth and intricacy of any mental disorder ultimately contributes greatly to the overall suffering that comes with problems of mental health.

 

The stigma, in a way, has become paradoxical; it is shamed and somewhat taboo, and yet there is a simultaneous popularity of claiming to have mental disorders.

 

DOWNPLAY AND FASHIONABILITY

 

It is common for teenagers to mistake normal stress for an anxiety disorder. OCD has become a popular way of explaining quirks. Many people throw the word “depression” around lightly; trending social media phrases such as, “stressed, depressed, but well-dressed,” lend the idea that anyone who experiences prolonged sadness has depression.

 

Many would argue that these phrases and comments are meant lightly, but, regardless, the use of such a loaded term about a major illness can be hurtful to those who actually are clinically depressed.

 

“It’s become kind of fashionable to say, ‘Yeah, I have OCD.’” Rusk said. “It’s like a fad, and that’s dismissive also, very much so. We don’t take it seriously and I think that that discounts the pain and the true angst, that it can become disabling for a lot of people. It can be demeaning.”

 

To Hailey, this trend is difficult to escape from. “I think everyone in high school has this mindset like we’re all depressed and we’ve all been depressed at some point,” she said. “And, sure, a lot of people in high school have experienced a lot of negative things and we’re going through a lot of rough things in our life, but I don’t think everyone in high school has experienced depression to its fullest extent or anxiety to its fullest extent. I feel like it can be hard to talk to someone about it because they try to relate, and then they make your problems feel really insignificant.”

 

“The other thing that I think is really scary with adolescents as young as 11 and 12 is that they start throwing around the suicide word,” Dr. Henderson said. “It’s hard to tell when someone really means it or they’re just doing the culturally accepted way of expressing, ‘I had a bad day,’ or, ‘My boyfriend broke up with me,’ or, ‘My girlfriend was talking to some other guy.’”

 

Another obstacle to understanding and empathy is the fact that it is often hard for most people to distinguish between being human and being genuinely mentally ill. It isn’t black and white. Everyone is allowed to feel lonely or helpless or scared at times—it is something everybody inevitably deals with.

 

When emotions and behaviors start to prevent an individual from functioning normally, this is usually when it becomes obvious there is something more going on.

 

And mental illness isn’t just destructive for the people who have it. Undoubtedly, it is also incredibly hard on the people close to someone with mental health issues to see someone they care about suffering in such an abstract way.

 

Sometimes, this second-hand pain is expressed in a manner that seems unsupportive: getting annoyed with someone for “moping around” so much, for being overly-dramatic, for being picky.

 

Doctors and therapists feel the impact of dealing with such an emotional problem. “It impacts me dramatically, and I think because I have that empathy,” Rusk said. “And with that empathy comes the burden of that pain. So it has required me to be very balanced as far as my own self-care.”

 

On the subject of it being difficult for people to handle the illness in a loved one, Rusk said, “I think that becomes so scary and unpredictable that people kind of shy away when people are having emotional problems. It is so critical just to ask that question, ‘What do you need right now? How can I be of support?’”

 

“We have to have that respect and sensitivity towards recognizing that we will never fully appreciate their reality, their pain,” Rusk continued. “But I think that we can still try to understand, we can still ask questions and we can still want to understand. And I think that’s the key: just wanting to be present, wanting to listen.”

 

The emotional weight of mental illness lends itself to the idea that, perhaps, the best way of overcoming societal misunderstanding is for people to try to understand what goes on inside a mentally ill brain.

 

WHAT IT FEELS LIKE

 

The intensity and cacophony of pain can never be fully understood by someone who has not experienced it. The emotional aching is extremely tough to deal with. After all, Advil doesn’t help.

 

Often times, it isn’t until something really scary slips out that people notice what is going on inside the minds of affected adolescents. In Ava’s case, her teachers and friends only recently became aware of her depression. “I told [my teacher] that I wanted to die, and she didn’t like that,” Ava said. “She cried. I felt like crap.”

 

What is essential for people to understand is the onslaught of competing emotions that come into play. Self-hate for having unreasonable feelings or for wallowing in self-pity or not getting better with therapy. Fear of never getting better, fear that people (especially in high school) think you’re psychotic, fear of yourself. Numbness. Hopelessness that comes in the worst moments and makes recovery seem impossible. Panic. Knowing that no one else can ever know exactly your feelings and thoughts.

 

The burden of carrying this weight around every day in a normal routine is, needless to say, exhausting. It leads to a lack of purpose and motivation. “I don’t find purpose behind anything anymore,” Ava said. “That’s why it’s so hard for me to do homework or go to practice because I’ll just die in the end.”

 

The misperceptions people have of mental disorder drives people deeper into their illness and supports the idea that no one understands. Hailey, especially as a teen with PTSD, knows how much these illnesses can be perceived as no big deal. “It’s really irritating because I don’t think people really understand the weight of what PTSD really does to people,” Hailey said. “You have nightmares every night if you’re not treating it with medication, and you have flashbacks that leave you paralyzed in public and it's a lot heavier than what people take it to be.”

 

Some people resort to self-harm as a way of manifesting their internal pain, distracting themselves with physical pain. “It is a coping strategy for them to sort through these intense emotions that they’re not able to articulate or handle in any other way,” Rusk said. “And it can be a way to calm a lot of the intensity of their internal pain, by making it a source of true, observable pain, physical pain that compartmentalizes some of the emotional pain. And it can be a source of ‘I can heal this much more easily.’”

 

It is difficult for a lot of people to sympathize with self-harm. It seems useless and some say it only seeks attention. “It absolutely can be a way to fit in—‘Oh yeah, I cut’—and try to find a way to belong or get that social attention,” Rusk said. Because this behavior sometimes comes from people who are not dealing with deep mental strife, this further complicates the moral and emotional questioning behind self-harm.

 

“But then, for folks that are doing it because of true mental illness issues, they would not be sharing their cutting behavior,” Rusk went on to say. “This is a source of great shame.”

 

There is a point, though, where self-harm, as well as other coping methods, are not strong enough to counteract the agony.

 

Ava used to self-harm, but recently quit. “Cutting myself just wasn’t feeling bad enough anymore, so I would start using alcohol wipes and lighters,” Ava said. “And I was like, this literally is not doing anything, the only thing that is gonna make me feel better is dying. That’s it. It’s hard, it’s so hard to feel like that at night and then cry yourself to sleep and get up the next day and go to school, just back into the system and doing it all over again.”

 

Now, Ava’s respite is sleep. “I like sleeping so much because when I’m sleeping, I don’t have to think about life,” she said.

 

Where coping methods fall short, suicide promises a quick way to end all suffering forever.

 

Why do people commit suicide? This question is a source of major contention and electrified arguments. In our society, suicide is predominantly seen as a way of escaping temporary problems, selfish.

 

But Ava became stern when asked about the supposed selfishness of suicide: “No one kills themselves for attention. They’ll be dead. If someone kills themselves, it’s because they truly believe that life would be better for everyone else if they weren’t there.”

 

Ava has been suicidal for a while, but has discarded suicide as an option because she couldn’t stand to be the source of her family’s grief. “The desire to die is still there but the desire to kill myself...I would just feel too much guilt and blame with that,” she said.

 

As with many mental illnesses, nobody can understand the initial instinct to kill oneself unless they have been in that place themselves. People are driven to suicidal thoughts and actions when they can no longer stand the state of pain they are perpetually stuck in, when they feel as if they are such bad people that the world would be better off without them in it—when they are simply searching for anything, anything, to end their intense pain.

 

Every mental illness is different for each person, so there is a limit to how well people can articulate their every thought in attempt to make others understand why they cry every night, why they need to keep their house as clean as possible, why they binge and purge, why they have anxiety attacks, why they have trouble focusing in class. But a sincere attempt at understanding is essential in learning to accept the severity of mental illness, and making improvements in how it is handled.

 

MENTAL HEALTH MOVING FORWARD

 

Kristin Rusk has seen the emergence of programs in schools that mirror LINK at Standley Lake. “It’s a beautiful model to kind of get that, at least at the beginning of high school, and kind of destigmatize some of this emotional stuff that can lead into heavier duty mental health issues,” Rusk said.

 

However, it seems that LINK in many ways falls short because students are not comfortable talking about these topics and their own experiences in front of an entire study hall class. There is no easy solution, but perhaps splitting up freshmen into small groups of their choosing, so that they are relatively comfortable disclosing information, and having LINK Leaders take an oath of confidentiality as therapists and counselors do, would lead to more open discussion.

 

Rusk proposed, “Maybe it is through even them having do some mental health assessments,” as a way of making mental health education more effective.

 

“If there was more empathy, sympathy, and understanding in school systems I think it wouldn’t be as big of a problem as it is now,” Ava said.

 

It must be remembered that mental illness is not anyone’s identity. It can seem consuming, but there is always a person under their symptoms, someone with hobbies and pet peeves and fears and dreams. When asked what she wants to do in the future, Ava replied, “I want to travel and see the world.”

 

The anonymity in this article only reinforces how deep the stigma really goes. It is imperative to empathize, and to understand how the mind can decay into a wasteland of hopeless thoughts, how destructive mental illnesses are, and how detrimental the lack of understanding and support really is.