Eight Common Challenges to Accepting a Mental Health Problem

Eight Common Challenges to Accepting a Mental Health Problem:
Overcoming Obstacles to Recovery

Previously published on PsychologyToday.com

A family member is in a funk and hasn’t seemed himself in a long time. Or you haven’t been able to get on a crowded train all week due to breaking into a sweat. Maybe your friend keeps canceling plans and hasn’t gotten out of bed in several days. It might be clear to some that there is a mental health problem at hand. But there’s something inside the person that fosters doubt and delays taking action.

These examples speak to the challenging process of accepting a mental health problem. In my book on acceptance of mental health problems, I define acceptance as the process of recognizing and actively dealing with the symptoms and related challenges associated with a mental health problem.

In a previous blog post, I described the different facets of the acceptance process, and tips to accepting a mental health problem.

Here, I highlight the common challenges to acceptance in my research from my book, and how they can be overcome to bring a greater sense of recognition and self-care. These barriers can be internal (emotional, cognitive, behavioral, identity-related), relational, or more cultural-systemic.

1. Feelings can get in the way of acceptance.
The first barrier to acceptance is at the emotional level. In my research with people with mental health problems, many people described difficult feelings like shame and despair that get in the way of accepting a mental health problem. On the other hand, feelings like hope, pride, or even fear could motivate recognition of a mental health problem.

2. Certain actions or inactions might block acceptance.   
Another obstacle to acceptance can happen at a behavioral level. People I spoke with described avoidant and maladaptive behaviors that only led to greater denial. These inactions might include skipping appointments or social activities that bring a sense of wellness and connection. Scheduling positive activities and committing to them often helped with accepting and managing a mental health problem.  

3. Thoughts and beliefs can pose barriers to acceptance.
Cognitive challenges in acceptance can include things like a lack of clarity or negative thinking. Other cognitive processes that promote acceptance might include a sense of awareness and self-reflection. One person I interviewed spoke to this experience, seeing acceptance as, “Just thinking about what’s going on with me. Just knowing my issues, just knowing my problems, just knowing how I act on a regular basis, [helps] accept it.”

4. Ideas about your identity or sense of self may interfere with acceptance.    
I learned in my research that acceptance can be a process of identity development, involving integrating a new sense of oneself as a person with a mental health problem into one’s identity in a positive way. But if you have negative associations of people with mental health problems being inferior, then this can be a challenge to overcome. However, having a mental health problem can also lead to positive identities. These could include being a strong and resilient person for making it through. Or, serving as a role model or advocate for others with mental health problems.

5. Some relationships may not support acceptance.
Perhaps a key problem to accepting a mental health problem is a lack of acceptance and support from other people. “When other people don’t accept you as you are, it’s really hard to accept depression,” was how one person described this experience. People can engage in relationships with others who support recognizing and dealing with a mental health problem. This relational obstacle to acceptance also speaks to the need of the broader society to promote acceptance and eliminate stigma as a community, rather than expecting people with mental health problems to do the work of acceptance on their own. 

6. Cultural factors can inhibit acceptance.
Stigma can be particularly prominent depending on cultural values, beliefs, and practices. Take American culture, for example, where there are cultural stereotypes that people with mental health problems are violent. Or given our individualistic, productivity-oriented culture, beliefs can prevail that people with mental health problems are a “drain” on society. One woman described this in my book: “In America you’re not supposed to be depressed, and if you are, you’re supposed to snap out of it, pull yourself up by your bootstraps.” However, there might be other cultural supports or beliefs that offer resources and support that foster acceptance, like some biomedical treatments, or an emphasis on education and learning about mental health problems to spread awareness.

7. Religious beliefs might impede acceptance.
Depending on their religious and spiritual backgrounds, some people might feel they are being punished by God for their mental health problems, or that they could be cured through spiritual practices that might be ineffective or even harmful. In other cases, one’s religious community and practices might be a source of inclusion, encouragement, and healing that can be extraordinarily helpful to acceptance.

8. Systemic factors can also hinder acceptance.
Lastly, it’s important to note that institutional factors at the systemic level can interfere with acceptance. People might be ostracized at work or school for their mental health problem. They may be failed by the policies in health care or local politics in their region. Access to adequate resources in these contexts can be transformative to boosting acceptance of a mental health problem and offering the right tools to do so.

The process of acceptance can be complex, involving a number of challenges that arise at different times for different people. But with each barrier can come an adjacent facilitator to the acceptance process, whether emotional, behavioral, relational, cultural, or otherwise.

Reference

Mizock, L., & Russinova, Z. (2016). Acceptance of mental illness: Promoting recovery among culturally diverse groups. New York, NY: Oxford University Press. 

Five Tips to Accept a Mental Health Problem

Five Tips to Accept a Mental Health Problem:
Develop Self-Awareness with Lessons from the Research

(Originally published on PsychologyToday.com)

"Understanding is the first step to acceptance, and only with acceptance can there be recovery,” Dumbledore, the headmaster wizard once said in the Harry Potter series.  With this quote, author J.K. Rowling tapped into a core truth in the acceptance of a mental health problem… acceptance is key to managing mental health challenges. 

My research has found that acceptance is not a simple outcome that is either there or not there. Instead, acceptance is a dynamic process that involves several factors that develop over time. This process requires moving from a passive state of denial to an active position of agency.

How is it done? Here are some central lessons based on research on acceptance.

1. Develop an awareness of the mental health problem and beliefs that support it.The process of acceptance of a mental health problem includes a cognitive piece. Insight is needed to understand that a mental health problem is taking place. Symptoms can get in the way of thinking clearly about what is happening, and they could be lessened through treatment. Or if denial is a problem, it is important to understand what beliefs might add to it. That you can’t live a life of hope and meaning in the face a mental health problem? That you won’t be able to pursue your dreams or feel accepted by others? These beliefs can be challenged in order to better recognize the problem.

2. Create a positive sense of self in the face of a mental health problem. Research has shown that acceptance is also a process of identity development that involves moving past stigma. Why would you accept a mental health problem if you feel society might shun you for having one? Stigma needs to be disputed to allow for a new sense of self to emerge. You can still be a fantastic worker, parent, friend, or community member even with a mental health problem. A mental health problem doesn’t need to define a person, or become central to your identity. However, it does need to be integrated as a part of who you are.

3. Engage in activities that support acceptance. There is also a behavioral aspect to this process. Engaging in certain activities can reflect and reinforce acceptance of a mental health problem. These might be treatment-oriented activities, like taking medication or attending therapy. You might also keep an active schedule and build in positive activities to look forward to during the week. A range of behaviors can keep the mental health problem from taking over and make accepting the problem easier.

4. Focus on relationships that promote acceptance. Supportive relationships are particularly helpful to accepting a mental health problem. Some people may not accept the mental health problem because of their own stigmatizing beliefs. Some people might also benefit from ignoring the problem, or simply be unprepared to accept it. On the other hand, many friends, providers, family members, and others might recognize the presence of a mental health problem and support the management of it. They might offer non-judgmental listening, company to appointments, or general encouragement. Acceptance can be supported by relationships with people who acknowledge the mental health problem.

5. Pursue emotional experiences that boost acceptance. Research shows that people also describe the process of acceptance as an emotional experience. This might involve making room for grief and pain and moving past shame. On a positive side, acceptance can also involve sustaining a sense of happiness and hope. The acceptance process can certainly involve some work, but it can also be a joyful experience that leads to a greater sense of peace.

These tips include a number of aspects of acceptance that take place within the individual. However, acceptance shouldn’t be seen as the sole responsibility of the person, but a process that includes the effort of the general public to overcome stigma and foster mental wellness in our communities. Acceptance is a process that can’t and shouldn’t be done alone.

Reference

Mizock, L., & Russinova, Z. (2016). Acceptance of mental illness: Promoting recovery among culturally diverse groups. New York, NY: Oxford University Press.