Mental Illness and Stigma

Otto F. Wahl begins his book, Telling is Ricky Business“…that someone with mental illness is not expected to have feelings or experience emotional hurt, is a perfect example of the kinds of inaccurate public expectations that constitute mental illness stigma.

The 90’s were “The Decade of the Brain,” but “it is still socially acceptable for cartoonist, policy makers, health-care professionals, and the public at large to mock, stereotype, avoid and otherwise denigrate people who experience mental illnesses” (Laura Lee Hall, PhD) such as depression, bipolar, schizophrenia and other neurobiological brain illnesses

Mental illness is common, but misunderstood. Even with significant biomedical advances and innovations in community treatment approaches, the message of hope has not filtered down to the everyday workplace, on the street and the health-care professional. Media coverage of those with mental illness is mainly stigmatizing and discriminatory.

Stigma. What is it? It is a “mark of shame or discredit” according to Webster’s Dictionary. The word originated in ancient Greece. It referred to bodily stigma designed to reveal the inferior moral and social status of individuals: slaves, criminals, traitors, etc. These “blemished” people were imprisoned, mutilated, branded and burned to signify their undesirability. Personal, psychological and social attributes are current stigmatizing characteristics. (Erving Goffman, Stigma). It is a devaluation of the person.

Rev. Dr. Chris Summerville, a consumer and executive director of the Manitoba Schizophrenia Society states the “formula for stigma:” lack of information about the illness is replaced by myths and misunderstandings. Add to this lack of exposure and association and trusting a relationship with the person, rather than focusing just on an illness. Multiply these two factors by fear of the unknown, apprehension. The result is stigma in which the person with mental illness is not afforded the same rights and pleasures of citizenship. But Summerville goes one step further. You can’t just stop with stigma. The hurt and discenfranchisement does not stop there. The end result of stigma is always discrimination.

Discrimination is relating to and treating the person with mental illness with prejudice, which can result in decreased opportunities for housing, jobs, and access to medication, social supports and full citizenship. The focus is on disability rather than ability. Stigma and discrimination hurts, punishes and diminishes people. It harms and undermines all relationships. It appears in behaviour, language, attitude and in tone of voice. It happens even when we don’t mean it.

Stigma and discrimination are a reality in our society. These are a major barrier to recovery and limit the available opportunities, and undermine self-esteem of the people affected.

Tracy Trudeau, PhD, Board Member of the Mood Disorders Society of Canada states,

1. Ill parents who are untreated, or are treated but "stigmatized", are less able or likely to seek help for a child showing symptoms. As an example, in my study 1 in 4 adolescents were discharged against medical advice (AMA) at least once in their treatment histories. This was primarily due to parental denial and stigma around treatment and ultimately acceptance of the diagnosis.

2. Treatment adherence (and lack thereof) is directly related to stigma).

3. Stigma and discrimination can be addressed with helpers' regular use of direct, blunt, and lay terminology to explain to family and patients the realities of life management of mood disorders.

4. Ethnic minorities who need treatment for mood disorders may be at a double disadvantage. This may be due to several reasons: Preconceived notions of mental illness within the respective culture; the tendency for some cultures to be stereotyped (i.e. Native person with a chronic substance abuse problem may actually have an underlying and untreated illness, but is repeatedly sent for detox without thorough examination into psychiatric history).

5. Much like racism, discrimination against people who have had histories of psychiatric illness is difficult to resolve until the 'unaffected' believe the issue is important enough for them to become interested in, and therefore defend. Martin Luther King and others before him organized a monumental grass roots movement among black people, but it was not until the white and middle class majority 'bought in' to the importance of the message that true progress was made. So too will be the journey with mental illness.

In a recent study, 84% mentioned social and family relationships as the most frequent area affected. 78% said stigma affected their employment. 33% mentioned not being included in their community. Mental health consumers said the stigma associated with having a mental illness is more difficult to live with than the mental illness itself. (Violence Against People with Serious Mental Health Problems, Canadian Mental Health Association)

The mental health movement seeks to:

  • Teach that mental illnesses are treatable.
  • People with mental illness can recover and lead productive lives in society.
  • Fight the stigma and ignorance which surrounds mental illness.
  • Expose discrimination and promote full citizenship for those affected by mental illness.
  • Seeks to work in partnership with others in designing structural and systems changes to change attitudes and actions towards mental illness.

One such project was the 1996 World Psychiatric Association’s worldwide Programme to Fight Stigma and Discrimination. Some of the aims of the program were:

  • Improve public information about mental illness.
  • Facilitate community involvement.
  • Enhance knowledge of mental health and heath-care workers about mental illness and its treatment.
  • Educate and support family members and consumers.
  • Change legislation and ensure equitable coverage and parity in health-care coverage.

Chris Summerville, D.Min

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