Pain is the body's way of warning you that something is wrong and in need of attention. Most of us have learned ways to cope with minor or transient pain — sometimes simply by ignoring it. When the pain is severe or persistent, we generally seek help promptly from a physician.
Not so with the emotional pain that people experience as a consequence of mental illness. Although the vast majority of individuals with mental disorders eventually receive treatment for their problems, a recent study showed that many tolerate years of suffering before contacting a doctor.
"There are a lot of people who are in extraordinary pain that are just not getting treatment," says Ronald Kessler, a professor in the Department of Health Care Policy at Harvard Medical School and a coauthor of the study.
In large part, he attributes these delays to the fact that many people simply don't recognize the need for treatment. The sadness of depression or the worry of anxiety are written off as normal parts of daily life. They are viewed as "feelings" instead of symptoms of an underlying illness. "It takes people a long time to realize they have a problem," Kessler says. "Many people simply don't think anything is wrong."
The more explainable and normal a problem seems, the more likely it is to go unrecognized. Alcoholism and social phobia, for example, are more likely to go untreated than a condition such as schizophrenia: It's hard to ignore psychotic symptoms such as hallucinations. But individuals suffering from social phobias might attribute their symptoms to being "shy." Binge drinkers may discount their problem by calling themselves "social drinkers."
Symptoms of mental illness are also more likely to go unrecognized when they develop at a young age. "The earlier a problem starts, the slower people are to get treatment," Kessler says. This may happen because people who become ill when young have no healthy point of reference — they don't know what it feels like to be well.
In fact, a large share of mental illness diagnosed in adults actually starts during childhood or adolescence. According to data published by Kessler and coauthors this year, half of all lifetime cases of psychiatric illness start by age 14. For anxiety and impulse-control disorders, the median age of onset is 11.
The stigma that surrounds mental-health disorders probably contributes to delays in diagnosis and treatment as well. While physical health conditions are generally perceived as "accidents of life," mental-health disorders are often seen as a failure of character or will, and the people who suffer from them are frequently blamed for their problems.
As a result, even individuals who recognize that they have a problem may be hesitant to reach out for professional help. Some are embarrassed. Others fear that a diagnosis of a mental illness could have disastrous repercussions on their personal or professional life.
"People just don't want to talk about this stuff," Kessler says. When participants in the Archives of General Psychiatry study were asked why they didn't get help once they recognized they had a problem, the No. 1 response was, "I wanted to handle it on my own." Although financial concerns are often cited as a major barrier to mental-health treatment, less than half of the participants reported that as a reason for not seeking help.
Just as with physical disorders, delays in the diagnosis and treatment of mental-health disorders can have potentially serious consequences. "People end up with a lot of problems they don't need to have," Kessler says. "A substantial percentage of them get much worse."
Left untreated, many disorders naturally grow worse over time. A mild depression can become severe. An eating disorder can lead to life-threatening weight loss. New — or secondary — disorders can develop as well. Individuals who struggle with anxiety, for example, are at risk for depression. Some individuals with mental-health problems self-medicate with drugs and alcohol and wind up with substance abuse problems.
Unfortunately, simply getting to the doctor doesn't ensure immediate treatment. "There can be further delays after that and, in fact, there are," Kessler warns. Candidly talking to a physician about emotional symptoms is the best way to avoid those delays and ensure prompt treatment.
Most people wouldn't hesitate to talk to their doctor about physical pain caused by a broken bone or migraine. The sadness of depression and worry of anxiety shouldn't be any different.