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Mental health advocacy and activism have become prominent aspects of modern popular culture. Generally, this has manifested through calls to be more open about one’s mental health and seek treatment when appropriate. For the most part, this is a good thing. Statistically, mental health stigma has precipitously declined over the past two decades. In some cases, the popular culture surrounding mental health can undermine its ambitions. It often serves to ostracize the mentally ill, resulting in the further diminishment of their conditions. This isn’t a call to halt mental health advocacy. Instead, it is a call to enhance it through better public messaging and a better appreciation for social nuance in such messaging.

The popular cultural slogan of “being open” has a significant role to play. Being open is not, in itself, problematic. If someone is suffering from a mental health condition, one of the best things they can do is talk about it transparently with friends, family, and a professional. However, the prescription to “be open” about one mental illness isn’t stated with any qualifications. That is, when should we be open about our illness? Are there ever times when it isn’t a good idea to be open? And it’s this lack of guidance that is potentially undermining mental health advocacy.

Social exclusion for the mentally ill is still wide-spread

For a substantial percentage of individuals struggling with mental illness, it is either the case that poor socialization is a symptom of their ailment or one of the causes of their condition. “Poor socialization” can include struggling with picking up on social cues and/or behaving in ways that can appear standoffish to those unfamiliar with mental illness.

Research shows that such behavior results in the social exclusion of those suffering from mental illnesses. And this isn’t just the case for illnesses often perceived as “extreme,” such as personality disorders or psychotic disorders. This is the case with conditions as common as depression.

Given such poor socialization, qualifications should be made when making broad public pronouncements such as “be open.” Without qualification, someone who is poorly socialized may interpret this in a way that produces more outwardly problematic behavior, leading to a greater risk of exclusion from the social world. And the more excluded from the social world someone with a mental illness is, the worse their symptoms will become — which may ultimately lead to their further exclusion.

Mental health messaging needs nuance to live up to its self-professed standards.

One problem with the popular culture surrounding mental health advocacy is that it ignores this reality. The interpersonal life of someone with a mental illness, for instance, isn’t as simple as being open about it, going to a therapist, and then having everything resolved. Instead, it often entails the persistent worry that one might lose their friends, family, or job by doing so; more often than not, treatment consists of the tedium of finding the right provider and/or medication — which can take months or years.

Even though many now list their mental health conditions on their Twitter bios, the data suggests that the mentally ill are still largely socially ostracized. The reduction of stigma surrounding mental illness is, in many ways, merely a change in semantics. The way we publicly speak about mental illness has considerably improved, but what has not changed is how we treat the mentally ill in our day-to-day encounters with them. We can, and we ought to do better for the mentally ill. And the way we can help will require specific changes in how mental health is spoken about in popular culture.

“For some reason, certain individuals who have no experience working in mental health spaces force themselves in as though they just know better than everybody. There are so many experienced professionals that know exactly what’s needed, but they get shoved aside and shouted over by so-called activists,” said Scott M. Carter, clinical mental health counselor in Utah.

The mismatch between the encouragement of ‘being open’ and the reality of being socially ostracized

The qualifications that need to be made in public mental health proclamations must change the way others react to symptomatic individuals — in this respect, simply encouraging compassion and humanity. But on the side of making qualifications on “being open” about one’s mental condition, things get tricky. A health condition should not be treated as something to hide. The problem, however, is that despite all of the social activism that has increased over the past few decades, interpersonally, mentally ill people are still treated in such a way as to make hiding their condition optimal for social inclusion. It is this sort of treatment, in conjunction with the idea of openness about one’s condition, that is the problem.

It might help to tell the public that explicitly revealing your mental condition to new friends, co-workers, or potential romantic partners isn’t a great idea. Research shows that doing so increases the odds of social exclusion. Unfortunately, people find the prospect jarring –just like individuals with amputated limbs and other serious ailments, culture writ large seldom accommodate the social integration of those suffering from mental illness. For the slogan of “being open” about your condition to work in favor of its intention, doing so with trusted loved ones is a good start. Working with a therapist on introducing the topic to new people in one’s life is also much better.

Recent mental health advocacy should not be regarded as a semblance of progress. But it also should not be regarded as the end all be all in the fight against mental illness writ large. Being more specific in public messaging could have a profoundly beneficial impact on the current dismal state where those struggling with mental health conditions are disproportionately excluded from the social world. And in doing so, public messaging could empirically help reduce the disastrous consequences of social isolation among the mentally ill.