May is mental health awareness month, full of associated hashtags and promotional campaigns. The National Alliance on Mental Illness has called on Americans to “become inspired, informed, and involved.” The Republican Congresswoman Lynn Jenkins, who helped create the Mental Health First Aid Act, has stated publicly that May is “the perfect time to break the silence and discuss what we can do to move mental health in America forward.” Others are encouraging folks to “talk to their doctors.”

In an effort to help citizens of all countries become informed, break the silence, and be armed with information to bring to their next doctor’s appointments, the following are seven things one should be aware of during this month of #mentalhealthawareness.

1. Poverty, inequality and discrimination can lead to serious difficulties coping with life.

There is now strong evidence that poverty can directly lead to mental health diagnoses, such as depression or schizophrenia, and usually is associated with more severe and longer lasting difficulties. In fact, individuals under the poverty line are eight times more likely to get a diagnosis of schizophrenia than those not impoverished.

Similarly, individuals of color are consistently shown across numerous geographical locations to have higher rates of diagnosable mental health difficulties, including depression and psychosis. In some cases, women are diagnosed and drugged at twice the rate of men. Homosexuals have substantially higher rates of suicidality, anxiety and depression, while almost half of all transgender individuals have attempted suicide.

Being different in a world that aspires to a white, Anglo-Saxon, male ideal appears to be pretty hard.

2. Bullying can lead to serious difficulties coping with life.

Though it’s had its share of critics, the Netflix series “13 Reasons Why” has certainly made the public aware of the profound consequences that bullying can have on a child. This, of course, follows on the heels of several high-profile deaths of real life adolescents who decided to end things after unbearable chronic taunts and cruelty from their peers.

Aside from increased risk of suicide, bullying is associated with worse academic achievement, PTSD, panic disorder, agoraphobia, depression and psychosis.

Being marginalized, rejected and tortured by peers at an age wherein social acceptance is of primary importance is unbearable for many.

3. Sexual assault and war can lead to serious difficulties coping with life.

Sexual assault is consistently linked, across genders, to suicide, PTSD, anxiety, depression, eating and sleep problems, and personality disorder diagnoses. More than half of women diagnosed with a severe mental illness, such as schizophrenia or bipolar disorder, have a history of rape or attempted rape. For some reason, this apparently comes as a shock to mental health researchers.

The diagnosis of PTSD originally was created to attempt to capture the presentation of veterans returning from war. Suicidality, traumatization and chronic difficulties in coping with a return to civilization tends to be disproportionately high among US veterans. According to the perspective of some veterans, this is largely due to the lack of respect for soldiers and the lack of support within the US, which leaves them feeling despondent, lost and alone, in addition to coping with the horrors of perceived unjust wars with seemingly no end.

Being ignored, disrespected, unsupported and marginalized after experiencing some of the worst of human nature can, for some, lead to an engulfment of hopelessness and terror no pill will ever fix.

4. Living in a sick and cruel world can lead to serious difficulties coping with life.

“It is no measure of health to be well adjusted to a profoundly sick society.” — Jiddu Krishnamurti

Mental illness diagnoses are categories that a group of white upper-class, mostly men have voted upon to include in a book that defines what is acceptable social behavior and that which is not. In other words, people who do not fit in, are perhaps anti-authoritarian, rebellious or fight back against the status quo, are not only more likely to be labeled as sick, but also are more likely to feel angry, hopeless, oppressed, trapped and overwhelmed. At this point, almost 60 million people in the US can be described in pathologizing ways (i.e., as “mentally ill”) and are deemed abnormal for what for the last 60 million years was considered part of being human: suffering.

In an article titled “Societies, not individuals, are mentally ill,” the author asks the question: “What if the rules, expectations and mores of societies and the institutions within them are bizarre, sociopathic and irrational?” Indeed, what if? Who’s really sane then?

5. Child abuse can lead to serious difficulties coping with life.

Children rely on their caretakers for lessons on how to live in the world, how to interact with others and to survive. When one or more caretakers hurts a child, relies on them to meet their own emotional needs, gaslights them, criticizes them, ignores them, or uses them to hold the parents’ marital problems, it has deep and often lasting effects.

Child abuse leads to a litany of problems. Diagnoses associated with chronic developmental trauma include separation anxiety disorder, oppositional defiant disorder, phobic disorders, PTSD, ADHD, impulse control disorders, dissociative disorders, affective disorders, substance abuse disorders, eating disorders, somatic disorders, sexual disorders, personality disorders and psychotic disorders. Basically, the entire DSM is associated with childhood adversity.

Also of note: Almost every person in the criminal legal system has a history of child abuse, especially those with violent offenses. And they’re mostly people of color. How about we start talking about that?

6. The mental health system is built on lies and fails at least as often as it succeeds.

When an individual experiences chronic racism, discrimination, oppression, abuse or marginalization, what happens when they ask for help with their suffering? All too often they are told they’re sick and have a brain disease. Their life histories are largely ignored and doctors immediately set to fixing the “problem” that is assumed to exist within an individual. If a bridge collapses, do we say the cars crashed because they’re broken, or do we immediately set to closing down and fixing the bridge?

This is not just a matter of mundane perspective or ideology. The current framework for addressing human suffering has major consequences. In fact, the biological illness model perpetuated by anti-stigma campaigns is actually associated with increased prejudice and decreased empathy. Even doctors resort to thoughts of wanting to kill themselves when they believe that their emotional struggles are the result of neurons over which they have no control.

Further, assured claims of chemical imbalances or neurological causes of emotional suffering are not supported by the evidence, despite decades dedicated to finding just that. We are being told lies every time an ad or professional tells us that we know that some disorder or experience has a neurochemical or genetic base. We know nothing of the sort.

While there has been some evidence of familial patterns, brain differences and even specific related genes to particular disorders, none of these findings can be separated from the influences of the environment on genes and brains. This is particularly problematic when considering that pharmaceutical interventions are so widely accepted due to the belief that they are a necessary tool for addressing a fundamentally biological problem.

The complexity of how effective versus harmful many of these drugs are is beyond the scope of this article (but please see here, here and here).

Lastly, mental health interventions are not the panacea that society is led to believe they are. There is little convincing non-biased evidence that psychotherapy works for the majority of people. Cognitive-behavioral therapy, the gold-standard of psychological intervention, is, at best, only helpful for about 25 percent of individuals, most of whom return to experiencing their distress a year after treatment ends. Of course, therapy is helpful for many, but it is not for everyone.

But, beyond outpatient psychotherapy, results get even worse. There is evidence that admission to a mental health facility is actually associated with increased traumatization and suicide. In other words, while some may certainly benefit from hospitalization, even against their will, many will be traumatized by the experience and some may even be more likely to complete suicide upon discharge.

7. There are other ways to heal and grow from life’s adversities.

Other cultures have long perceived experiences that get labeled as “mentally ill” from a collective and/or spiritual perspective. In fact, countries with little influence from Western lifestyles have better trajectories for some of the most severe of difficulties.

Individuals who themselves have struggled and experienced crisis have developed respite centers, crisis response protocols, support groups and information resources that many find to be more helpful than the mental health system ever was. Yoga and exercise appear to be at least as effective as professional mental health services for many. And consistently healthy, supportive human relationships have been shown to be the most common healing factor, no matter what a person is struggling with.

Let this month of mental health awareness be a time to really break the silence, talk openly to doctors and become inspired and involved.

#Iamnotashamed of the things I’ve been through in life and had no control over.

#Iamnotashamed of what others have done to me and how hard I’ve fought to survive.

#Iamnotashamed of being creative, sensitive or different.

#Iamnotashamed of being human and having emotions.

#Iamnotashamed of refusing to believe that I am ill for any of the above.