Coming Out of the Closet About Mental Illness

Dear Mr. Manners: My wife is being treated for a severe mental health condition that often means she’ll bow out of social events at the last minute. We’ve been reluctant to let even our closest friends know of her diagnosis because of the stigma so now many of them think she is either rude or flakey. When does one let others know? And how much is appropriate to reveal? — Anonymous

A: I’m so sorry to hear about your wife’s illness. I’m sure you’re both facing some tough challenges. It’s worth remembering, however, that the social stigma around mental illness has lessened considerable in the past two decades as more and more of us accept a“neurobiological” understanding of these conditions, rather than blaming family members or someone else, as Dr. Marvin Swartz, a professor of psychiatry at Duke University Health System, explained to me last week. At the same time, there are more and more advocacy groups helping patients and their families to come out and garner much needed support. (Check out theNational Alliance for Mental Illness and Mental Health America.)

As I often do, I posted your question on my Facebook wall to see what others had to say and, as usual, found much wisdom:

  • “I have physical issues along with PTSD and severe depression that cause me to either not make plans, cancel plans or leave early. In the beginning I lost a lot of friends because of it. Now I don’t worry about it. I only plan with those who totally understand. She’s lucky to have a partner. I am doing this alone.”
  • “If you acknowledge your own problems once in a while – so will the good people around you. And that way we become closer and better friends. It’s not such a big deal that none of us is perfect. We are pretty awesome anyway.”
  • “I think you disclose if you feel like it will help both of you… i.e. to someone who is going to be supportive and helpful. AND obviously you need her permission as well. But it’s also perfectly acceptable to say she’s ill and can’t make it. You don’t need to supply a diagnosis.”

For those considering disclosure:

  1. REMEMBER, YOU’RE IN CONTROL: While, there are no hard and fast rules for revealing a mental health condition, it’s often helpful to remind yourself that while you can’t always control the condition you can choose whether to disclose it or not.
  2. GET PERMISSION: Any family member who is considering revealing the mental health diagnosis of a spouse or other relative must get permission before doing so. As Dr. Swartz told me: “It’s not okay without their approval.”
  3. THERE’S NO TAKING IT BACK: Remember that once revealed, major announcements cannot be retracted and that while stigma has lessened, it has not evaporated completely. If you tell a friend, let her know whether this news is meant to be kept private – or not.
  4. BEING VAGUE IS OK: You don’t need to supply a diagnosis. In fact, Dr. Swartz suggests not getting overly specific and using catchall conditions like depression and anxiety. He suggests: “My wife has been having trouble with depression and sometimes hits particular tough spots. She was feeling particularly bad the other night and I’m sorry we had to cancel our plans.”

If you’re the friend or relative being confided in:

  1. RESPECT PRIVACY: Be sure to respect the trust and confidence extended to you. Do not share the news with others unless you’ve gotten permission.
  2. DO NOT SUCCUMB TO THE STIGMA: Respond as you would if a friend told you he had heart disease or diabetes; a condition is a condition is a condition. Ask how you can help, while giving as much emotional support as possible. Dr. Swartz notes that it’s a common reaction to withdraw – so do your best not to. He adds: “Often family members will say if my loved one had cancer they’d bring a covered dish over and ask how they are. With mental health conditions you don’t get the same support.”
  3. SUPPORT THE SUPPORTERS: Be sure to provide support and encouragement to caregivers, too. They may be just as much in need. Ask: “How are you doing with your wife’s illness?” and then follow his social prompts.

In fact, that last point raises the importance of taking care of the caregiver (that’s you!). Family members often feel isolated or ashamed. Speak up about your own needs and, if helpful, don’t be reluctant to seek professional help – for yourself. As Dr. Swartz said: “I often want to touch base with family members to make sure they have the resources they need to take care of themselves with supporting a loved one.”

Every Thursday, Steven Petrow, the author of five etiquette books, and the forthcoming “Mind Your Digital Manners,” addresses questions about medical manners. Send your question to Follow him on Or Twitter:

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