The mental health field has a branding problem

brandingFor more than two centuries, the mental health field, and psychiatry in particular, has actively cultivated a “brand,” distinguishing itself as a remedy for societal ills, largely by adapting its philosophy and methods to the dominant social agenda. This began in 1793, when Dr. Philippe Pinel initiated reforms in the Salpêtriere and Bicêtre Hospitals in Paris where the insane were often held in chains. The field cast itself as moral reformer and protector of human rights, and thus mirrored the values promoted by the French Revolution and the Enlightenment.

When democratic societies needed ways to decide which of its citizens actually had free will and could act as autonomous subjects, the mental health field obliged with criteria for the insanity plea, protecting citizens from both dangerous minds as well as judicial systems unschooled in the limits of human reason. During darker moments in human history the mental

health field also complied, giving credence to the Eugenics movement, forced sterilization, and even the “extermination” of the mentally ill during the reign of Nazism. For better and worse, where society ventures, the mental health field followed.

By the late 20th century, branding formally entered the field when Eli Lilly hired Interbrand — the same company that created branding for Sony, Microsoft, Nikon, and Nintendo — to brand their new compound, flouxetine hydrochloride. This occurred at a time in US history when people were increasingly expected to function with limited support from the government, and health care was becoming a luxury item.

prozacFlouxetine hydorchloride was eventually branded Prozac, a name believed to sound both positive and professional. It was marketed as easy to prescribe, relatively safe, and nonaddictive — unlike Valium, which was once the most widely prescribed psychological medication and is highly addictive.

Prozac hit the markets in 1987, giving Eli Lilly two serendipitous advantages. First, direct-to-consumer advertising began in the United States in 1982, creating a new avenue for pharmaceutical companies to reach consumers. Second, Prozac was introduced when the National Institute of Mental Health was gearing up to launch The Decade of the Brain.

The 1990s were devoted to creating awareness about the biological underpinnings of mental illness. Eli Lilly contributed to the fanfare with eight million widely distributed brochures titled “Depression: What You Need to Know,” and 200,000 posters outlining the symptoms of depression and encouraging sufferers to seek treatment. Through such educational campaigns, Eli Lilly extended its branding of Prozac to include the branding of depression as a disease common to millions and easily treated with medications. The mental health field also organized around symptom checklists and pharmacological interventions.

Today the “selling” of mental disorders as chronic diseases that need medications for treatment is not only under attack, it also appears out of sync with the shifting social milieu. The emerging norm in society, much like the emerging trend in marketing, centers on forging connections, building relationships, and creating transparency. And in the mental health field, experts aren’t always perceived as transparent, and consumers have become more self-reliant, including conducting their own research through the Internet.

Consumers also have increased choices for the services they seek. In a crowded field of life coaches, personal trainers, massage therapists, acupuncturists, nutritionists, yoga teachers, spiritual guides, and alternative healers — along with internists, general practitioners, OB/GYNs and other medical specialists with access to information about psychopharmacology and prescription pads — the mental health field faces increased competition. Collectively, we are vying for the same consumers’ time, attention, and dollars.

Thanks to the Internet, people know more about options, consumer grievances, and the internal conflicts in mental health treatment. A brief visit to the blogosphere would show the mental health field has a number of disgruntled consumers and a questionable reputation. Although it is often said that stigma keeps people from accessing mental health services, I wonder if studies of the field’s reputation might also suggest it as a barrier to seeking treatment.

In a prior post, I quoted the scholar of international affairs, Dominique Moïsi from his book The Geopolitics of Emotion on his thoughts about 21st century globalization, which he characterized as emphasizing identity, thus marking an end to 20th century obsessions with ideology:

“In today’s world, ideology has been replaced by the struggle for identity. In the age of globalization, when everything and everybody are connected, it is important to assert one’s individuality.”

The mental health field seems caught somewhere between ideology and individualism, still promoting belief systems like the Diagnostic and Statistical Manual of Mental Disorders, or notions about chronic mental disorders that serve the ideology of mental illness as a disease more than people navigating a rapidly evolving marketplace as well as rapidly changing identities.

If mental health practitioners were to look at themselves as providers of a service within a crowded marketplace, and not as professionals within the larger network of healthcare, we might have a better sense of the “brand” that would lead to increased engagement with the people we hope to serve, and to opportunities for cross-fertilization with other care-focused professionals. I think such a shift is crucial, because how we see ourselves as practitioners impacts how other professionals and potential clients see us. Such a shift would also suggest questions we need to ask ourselves in today’s globalized marketplace: Are we trustworthy? Is it easy to forge connections with us? Are we transparent?

For many of us practitioners, we see ourselves as healers and social reformers, devoting our lives to the betterment of others. We not only provide treatment, but also psychoeducation. We are specially trained to support people in crisis, despair, and feelings of chronic ‘stuckness’. Along with diagnosing disorders, we create safe spaces for self-exploration and growth. And perhaps part of our “branding” should relay these core values, knowledge bases, and the spaces and opportunities we create and not just disorders treated and methods used. Such a move would likely benefit the field, especially if we collectively became more transparent about how we see our role in society.

Transparency is important. Transparency relates not only to trust, but also to the issue of social responsibility. Again, quoting Moïsi:

“In a transparent world the poor are no longer ignorant of the world of the rich, and the rich have lost the privilege of denial. They may choose to ignore the tragedies of the developing world, but it is a choice they must make consciously and, increasingly, at their own peril. ‘Not to act is to act,’ the theologian Dietrich Bonhoeffer used to say. Today not to intervene to alleviate the sufferings of the world is a form of intervention.”

Given the damning statistics often quoted about the number of people in need of mental health care, and the relatively limited number of people who actually receive treatment, this issue of transparency needs to be taken seriously. There is a profound and unmet need for our services. And yet, often concerns and arguments within the field are more directed towards scientific reliability and validity than providing mental health care for all. Yes, having reliable and valid treatments matter, but perhaps we should show at least equal concern for how we can create services that treat the most people.

By their very nature, mental illness and ongoing states of psychological distress are isolating, increasing the likelihood of lost social support, unemployment, and in turn, poverty. In a social milieu that values transparency, connection, and shared networks, having a mental disorder or suffering chronic psychological distress can be especially alienating. As mental health professionals, we know this. We also know people have a hard time seeking support when they need it the most. Thus, rather than expecting people to seek mental health treatment, perhaps it is time to acknowledge the mental health field’s social responsibility for getting services to people when they are most in need and in ways they would be most receptive to receiving.

Such an approach can also lead to better outcomes. For example, a study conducted jointly by the RAND Corporation and UCLA, and with several community partners, showed community-based efforts led to the improved treatment of depression by taking services to where people congregated, including barber shops and churches. According to the RAND press release:

“People who received help as a part of the community-led effort to improve depression care were able to do a better job navigating through the daily challenges of life,” said psychiatrist Kenneth Wells, the project’s lead RAND investigator. “People became more stable in their lives and were at lower risk of facing a personal crisis, such as experiencing poor quality of life or becoming homeless.”

And when treatment occurs within clinical settings, rather than approaching mental illness like internists or general practitioners who focus on treating diseases and a set population of patients, perhaps a better model would be the emergency department (without the chaos, noise, and sterile atmospheres), where addressing the most acutely ill or traumatized is prioritized, along with the commitment to serve everyone and at all hours. Creating such systems of care would also recognize that it is not only disorders that we treat, but also the wounds associated with violence, chronic stress, neglect, and inadequate support, which research like the Adverse Childhood Experiences Study shows are often root causes of mental distress and disorders.

If we think of the mental health field as a company, we might then ask who we are more like — BP and Exxon, attempting to clean up their bad reputations as well as deathly oil spills? or Whole Foods, Google, or even Kaiser Permanente, taking seriously their consumers’ opinions as well as acknowledging their responsibility to society? Granted, even these feel-good companies have their faults, but as consumers we have the power of both voice and choice with regards to the services and products they provide: We can complain and we can seek other opportunities. At the very least, the mental health field owes its consumers the acknowledgement that they have voice and choice — and that we take both seriously.

© 2013 Laura K Kerr, PhD. All rights reserved.

Laura K. Kerr, PhD, IMFT is a mental health scholar and registered marriage & family therapist intern in the San Francisco Bay Area. For more information, visit her website.

12 responses

  1. American culture is infused with a very narrow, simplistic and positivist view of humans. Conscious “mind over matter” – is the core belief. That is also the core premise of all magical thinking, religions and supernatural beliefs.

    If talking/words and will power worked – there would be no problem. We know know these are neurological disorders, mainly cased by genetics and childhood trauma. Pretty mechanical. The medical science is not even out of it’s infancy. By comparison, we have pretty much known the mechanics of heart disease for 60+ years but effective treatments are still decades away. The brain is a LOT more complex.

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    • You make sound points. And yet so much of what is identified as “mental illness” results from conditions that could be avoided — as you mention, childhood trauma. I say: let’s not wait for 60+ years for the science to get better. Let’s make a more humane world NOW.
      Thanks for your reply.

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  2. Thank you for articulating so well, the experience and perspective that many of us in the field hold, but are unable to voice loudly enough to be heard in a meaningful way. Daily we work with people at our agency whose hearts have been wounded and emotions and rights are ignored by the very people entrusted to help and heal them. Change is possible, but it has to start with us and within us. We serve people that have a right and a need to the same compassion and sensitivity that we would give to members of our families. The people we serve are not patients, they are our neighbors.

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    • Thank you for articulating the “heart” of the matter. Perhaps one of the central questions we need to be thinking about as practitioners is how to create conditions that address the potential impact of vicarious traumatization and compassion fatigue that can impact even those of us who are highly committed to our work.

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  3. It’s astonishing to me that ACEs research, conducted in the mid-90s, is still not widely disseminated in the mainstream. This morning I listened to an MD give a TEDMED talk (http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html) about how he is devoting his life to researching “insulin resistance” as the root cause of obesity. Not a single mention was made of ACEs. Keep researching, writing and publishing; it’s desperately needed.

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    • I share your astonishment, Mr. Brady. I’m on a personal mission to get the ACE information to be more widely known. I have no idea why there is so much resistance.

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  4. “And when treatment occurs within clinical settings, rather than approaching mental illness like internists or general practitioners who focus on treating diseases and a set population of patients, perhaps a better model would be the emergency department (without the chaos, noise, and sterile atmospheres), where addressing the most acutely ill or traumatized is prioritized, along with the commitment to serve everyone and at all hours.”

    There’s an idea: An EER or an Emotional Emergency Room. A bricks-and-mortar place where people whose hearts are hurting (but not in attack mode) and whose brains are misfiring chemicals can go to be witnessed, to be treated with gentleness and clarity. To perhaps be matched with a practitioner of something like acupressure, reiki, hypnosis, etc., or a real M.D. who could give a test to access chemistry imbalance and prescribe a pill to even things out.

    How do I request something like this? I suppose I could go find some land, build a building, find practitioners to buy in, find not INsurance but OUTsurance (as in outside-the-box companies that could collect and hold premiums for this kind of outside-the-old-paradigm-”medical care”) companies to manage costs/fees/payments.

    This was a very brave article–to write and to read. Here’s to some collective courage on the part of all of us.

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    • I am so glad you are receptive to this model of mental health care. I like your expansion on the idea to include different sorts of healing practitioners. I am also a big fan of peer support. It’s a good time to start thinking out of the box.
      Thanks so much for your thoughtful reply.

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    • What a wonderful idea….beyond that, what a COMMON SENSE, feasible suggestion. I truly believe that centers such as this could save lives, if they were established and administered properly. Thank you.

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  5. I must say that this article struck a cord with me. In the past several years, I have experienced abuses and neglect within the mental health community which I find staggering. I am grateful to the author of this article, and hope that it may be a “step in the right direction.” First, I have experienced the ways in which segments of the mental health community have become a huge force in the family court system. They prey upon families in crisis, charging exorbitant fees that frequently bankrupt litigants. Members of the mental health community utilize bogus and dangerous “parental alienation” theories to wrest children away from mothers and hand them over to abusers. Some members of the mental health community write articles about the serious damages that are caused by these practices, yet the “powers that be” allow them to continue and do nothing to stop it. Victims of these practices write to state licensing agencies and the governing bodies of the mental health community and are repeatedly brushed off or ignored completely.

    Next….my 22 year old daughter who was once a kind, sweet, intelligent young lady, began exhibiting bizarre and uncharacteristic behaviors after she turned 18. Between the ages of 20-22, she had repeated multiple “emergency” admissions for suicide attempts. She was held for the standard 72 hours, given a bottle of Xanax, then sent back out on the streets….with no follow up. During one of her last hospitalizations, I called the facility to speak with her treating doctor….I wanted him to know that my sister and mother both had schizophrenia, and I believed my daughter was exhibiting the symptoms. The nurse took my name and number….I never got a call back and the second her 72 hours were up, she was right back on the street. Her father and I were repeatedly told that, since she was over 18, “no one” could force her to get the help she so desperately needed. She started self medicating with illegal drugs about a year ago. Mental health professionals ignored the current research that warned my daughter would likely complete suicide. Three weeks ago, our lovely daughter put a gun to her head and pulled the trigger. She did, in fact, “complete” the suicide.

    Why are limited mental health resources being gouged in the family court system, where they cause serious harm….then are not available to people like my daughter, who, I believe, could have been HELPED and would likely still be alive if someone would have listened and provided appropriate testing and treatment?

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    • I am so sorry for your tragic loss of your daughter. I am utterly speechless in the face of your loss. So much suffering for all of you. My heart goes out to you. It’s so hard to sit with the thought that the situation could have unfolded so differently.

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      • Thank you. I’m trying to not get caught in the spiral of the “Woulda, shoulda, coulda”…..What’s done is done and it’s not going to change the outcome for my daughter. However, my experiences with “the system” have been so abhorrent…and I’m hearing similar experiences repeated over and over and over again…I know this is not an isolated case. I do not want other human beings to go through this, especially knowing that there are feasible solutions that WILL work. I appreciate your work toward change.

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