PTS3398 - SECTION 7: BARRIERS TO TREATMENT
Stigma Associated with Mental Illnesses
In the year 2022, there is still some stigma associated with mental illnesses. We have all probably heard people with mental illness labeled as “psycho” and mental illness remains the butt of jokes in popular culture. “Negative portrayals of people with mental illnesses fuel fear and mistrust and reinforce distorted perceptions,” and people sometimes associate mental illness with laziness or weakness. (Mayo Clinic, n.d)
Three General Categories of Sources of Stigma
Public stigma: The notion that a person will be perceived as weak, treated differently, or blamed for their problem, if he or she seeks help.
Self-Stigma: The person may actually feel weak, ashamed, and/or embarrassed.
Structural Stigma: Individuals with chronic symptoms of PTSD may believe that their careers will suffer if they take advantage of available psychological services.
Harmful Effects of Stigma.
With the current stigma attached to PTSD and other mental illnesses, those who fear being stereotyped, even if able may not seek out appropriate care. For some, living with the stigma may even be worse than living with the illness itself.
Some of the harmful effects of stigma include:
- Trying to pretend that nothing is wrong (pretending to be normal),
- Refusal to seek treatment,
- Rejection by family and friends,
- Work problems, insensitivity, or discrimination,
- Difficulty finding housing,
- Being subjected to physical violence or harassment, and
- Inadequate health insurance coverage for mental impairments or illnesses.
There is little argument that the cost of medical and mental health care in the United States is at an all time high. This means that those without health care insurance simply cannot afford treatment or treatment-related medications. For those with health care insurance, treatment and medications still may not be an option as qualified providers may be limited and co-pays for treatment and related medications may be too costly.
The Addiction Technology Transfer Center Office, reports “[people] with PTSD have among the highest rates of healthcare service use. Costs include psychiatric and non-psychiatric medical treatment costs, indirect workplace costs, mortality costs, and prescription drug costs.” With the high costs associated with treating mental illnesses, even those who seek treatment may not be able to afford appropriate, ongoing care.
Future Directions in PTSD Treatment
One of the important new voices in addressing PTSD treatment is researcher and psychiatrist Bessel van der Kolk. His focus has been on reprocessing the memories associated with trauma through body-based approaches, or what is called alternatively, "sensate focused" approaches.
His position is that cognitive and exposure based approaches have a less than perfect outcome for many people who suffer from PTSD due to the fact that these treatment approaches are missing important aspects of PTSD - memories that are stored in places that CBT and exposure therapy are poorly equipped to reach. Accordingly, his work focuses instead on helping clients to feel safe again in their own bodies through learning how to tolerate the physiological sensations that their body is experiencing.
Dr. van der Kolk's ideas have generated a measure of controversy in the mental health community, but have also generated important sources of support, including from emerging knowledge on neuroscience and advanced imaging studies. Clinicians who work with trauma may wish to review both Dr. van der Kolk's ideas and the criticisms leveled at those ideas to determine what information from his formulation of PTSD and its treatment may be incorporated into approaches currently being undertaken.
Future Use of Medications
While ongoing research continues for PTSD treatment options on the psychotherapy side of the picture, there is also ongoing research concerning the use of medications to treat - or support treatment - for PTSD. In 2021 Dr. David M. Kern and his associates conducted a meta-analysis involving over 137 million individuals and 15 medications that appeared to show either primary signals for effectiveness or potential signals for effectiveness.in providing protective effects for preventing the development of PTSD pursuant to traumatic experience.
One of the medications, Propanolol, has already been discussed. Dr. Kern and his associates affirmed what has already been noted - that there are mixed results with the use of this medication to prevent a traumatic experience from becoming PTSD.
A number of other medications, including medications typically used to treat Attention Deficit Hyperactivity Disorder and Substance Use Disorders, have shown some promising results. However, a great deal of additional research appears to be in order before more definitive and widely applicable medication options can be brought into an overall treatment approach. Clinicians who treat PTSD should remain on the alert for additional research results in this area.