Elaine R. Rotenberg, Ph.D.


For years, addiction and mental illness were not talked about in the same sentence. They were not considered part of the same family. They were not even treated as distant relatives. The fact is, that in the not too distant past, if someone called a mental health clinic for help, stating that they had depression and anxiety, and also a substance issue, they were often told to “get treatment for their substance issue first, including several months of documented sobriety, and then call back for help with the underlying mental health issue.” Unfortunately, that approach really missed the mark. For in fact, mental illness and substance use disorders often go hand and hand. Further, what they share is the profound veil of denial that accompanies both. When I think about denial and mental illness, I am reminded of the now often familiar “casserole story.”

It’s the story of two mothers…..each mother running day in and day out to visit her child in the hospital. One child was in the hospital recovering from a serious suicide attempt; the other child was in the hospital recovering from injuries sustained in a near-fatal car accident. The difference between those two mothers can be summed up in one word — CASSEROLE.

For the mother whose child was in the car accident, there were casseroles and meals, candy and flowers delivered every day.

For the mother whose child was recovering from a serious suicide attempt, there was nothing. No one even knew that that child was in the hospital. No one knew why he had missed school all week. No one knew that that child had a mental illness.

As a society we don’t like to talk about mental illness. We would rather talk about a loved one with cancer, diabetes, or heart disease than talk about bipolar disorder, clinical depression, schizophrenia, or any other mental illness.

Maybe it’s the word “mental?” Maybe its shame, or a belief that this illness is our fault.

Whenever I have the opportunity to discuss Substance Use Disorders, I find myself eager to shine a light on the prevalence of mental illness in our society. Why?

Because regardless of our discomfort and “dis- ease,” with mental illness, there is no avoiding the fact that people with mental illness are more likely to experience an alcohol or other substance use disorder than someone not affected by a mental illness.

The numbers speak for themselves: One quarter adults will experience a mental illness. Of those, 18% have a substance use disorder, compared to 6% who have no mental illness.

And it works the other way too….Among the 20 million adults in the United States who experience a substance use disorder, 50% will have a co-occurring mental illness.

Not talking about mental illness doesn’t make it go away. Not talking about it simply means that people will not get an appropriate diagnosis, and will not be directed to appropriate treatment.

BUT – even if people do not seek treatment, people will still suffer with the symptoms of their untreated illness, and will look for ways to cope. Oftentimes, these individuals will turn to drugs and alcohol to ease the pain of anxiety, depression, or to dull the voices that just won’t go away. And then the cycle has begun, and which comes first does not matter. What matters is the inextricable link between substance use and mental illness.

Unfortunately, so often denial is much easier for communities than addressing the issue of mental illness directly.

Why is that?

• Maybe it’s because by looking away, we can avoid taking responsibility for the lack of affordable services in our communities.
• Maybe it’s because by looking away, we can avoid facing the pain of mental illness that has impacted our own family, and our neighbors.
• Maybe it’s because by looking away, we can continue to pretend that mental illness is someone else’s problem.

By continuing to deny, we continue to perpetuate myths about mental illness. A few examples:

By continuing to deny, we continue to perpetuate myths about mental illness. A few examples:

Myth #1: People with mental illness are responsible for most violent crimes in our society
IS THIS TRUE? NO! The fact is – People with mental illness are 10 times more likely to be the victim of a crime than the perpetrator of a crime.

Myth #2: Talking to someone about suicide will increase the likelihood that they will make a suicide attempt.
IS THIS TRUE? NO! The fact is – Talking to someone about suicide can save a life.

Myth #3: Mental illness does not occur in children.

IS THIS TRUE? NO! The fact is – More than 50% of adult mental illness can be diagnosed before age 14. Unfortunately, less than one third of those children ever receive appropriate treatment.

Maybe a first step toward busting myths like these is teaching ordinary citizens, through initiatives like Mental Health First Aid
(MHFA) that turning toward and not running away from someone struggling with a mental illness or a substance use disorder, can save lives. Mental Health First Aid is an evidence-based educational program that has been taught in the United States since 2008; teaching people how to recognize a potential mental health or substance crisis. Mental Health First Aid teaches a 5 step plan for how to approach someone who is suffering, and explains how to direct that person to appropriate help. In Palm Beach County, Florida, Alpert Jewish Family and Children’s Service has spearheaded a county-wide coalition of 26 nationally certified instructors, representing 10 local agencies and the school district, who have already trained more than 1200 citizens. Efforts like these will be what it takes to blanket our country with awareness.

Mental illness is an illness, a treatable illness. So, who are the real afflicted? Those who are diagnosed? I think not. That label belongs to individuals and communities that deny, shun, and stigmatize mental illness in the first place, too often shaming individuals from seeking the treatment and support that they so desperately need.
Remember the boy whose mother didn’t receive a casserole? Perhaps had someone recognize his symptoms of anxiety and depression, he never would have wound up in that hospital bed in the first place.

Imagine how much better the lives of the boy, his mother, and our communities might be if we replace our denial of mental illness with affirmation and treatment.

Dr. Elaine Rotenberg has been the Clinical Director of the Alpert Jewish Family & Children’s Service and the Levine Jewish Residential & Family Service for the past 24 years. She is a licensed clinical psychologist, having received her BA degree in psychology and education from Brandeis University and both her Masters and Doctoral degrees in psychology from the University of Denver. Dr. Rotenberg completed her predoctoral fellowship in the psychiatry department of Yale University.