Mental illness and stigma

I’ve worked as a case manager and therapist with people who have chronic mental illnesses for over thirty years, and have learned a lot from them about the varieties of human experience. I’ve learned not to be quick to judge. I’ve observed over the years that many folks tend to stereotype mentally ill people, not realizing that each of them is as unique a human being as they themselves are. Some mentally ill people are of below-average intelligence, most have normal intelligence, and others are brilliant. Some are insightful about their need for treatment, others are in deep denial. Some are kind and some are mean-spirited. Some are potentially dangerous to others, most are not. In my experience mentally ill people are more likely to be of danger to themselves  than to others.

The cumulative effect of this widespread stereotyping is stigma – society-wide prejudice and discrimination. I’ve seen it in persons and in policies. I think this stigma is one of the reasons for the deterioration of the mental health system, as described in my last post. We now have federal legislation that supposedly establishes parity of treatment for mental illness with physical illness, but I haven’t seen that result in any significant improvement in mental health treatment. Addiction to opioids has become a public health epidemic, but some people have no compassion for addicts, due to stigma. They thinks addicts are bad, or morally weak, individuals who don’t deserve help.

Writers who should know better -notably book reviewers and film critics – still don’t seem to know the difference between schizophrenia and “split personality” (now known as dissociative identity disorder). Schizophrenia is characterized  by a disorganization or distortion of thought processes, not by the development of separate identities. I think that fear is at the root of the stigma attached to mental illness. At some level all of us fear losing control, because we know that if we were to lose control of our minds, anything could happen to us. So we tend to avoid looking at mental illness too closely. It’s too disturbing.

Another basis for the widespread fear and resulting stigma comes from media depictions of “insanity.” From Alfred Hitchcock’s classic horror film to the books and films about Hannibal Lector, the term psycho – a prefix that has come to be used both as a noun and an adjective – has taken on an aura of threat. Many people don’t know the difference between psychosis (being out of touch with consensus reality) and psychopathy, also know as sociopathy.  A sociopath commits antisocial acts and has no sense of conscience about the harm done. When psychopathic people do horrible things, many people think of them as “crazy” or “sick,” rather than simply evil. While psychosis is recognized as a medical condition, psychopathy doesn’t appear to be one.

One of the forms stigma takes is the attitude, “I want mentally ill people to get the treatment they need, but not in my neighborhood.” The acronym NIMBY is well known in the mental health community: Not In My Back Yard. I remember some years ago reading a letter to the editor in a local newspaper from a man warning readers to beware of allowing people in their neighborhoods to become “mentor families.” Mentor families are families who are willing to take in a mentally ill boarder – someone they’ve already gotten to know and trust. The letter writer apparently didn’t like the idea of having mentally ill neighbors, or wanted to know who they might be and where they lived. I wrote a reply in which I told the silly man that if he lived in a neighborhood of any size, he already has mentally ill neighbors. And that’s no reason to be scared. Mental illness isn’t  a rare thing, and most mentally ill people aren’t a threat to anyone.

Speaking to the House Education and Labor Committee in 2007 about her 35 years of mental health advocacy, Rosalynn Carter observed, “When I began, no one understood the brain or how to treat mental illness. Today everything has changed – except stigma, of course, which holds back progress in the field.” Progress in the field is exactly what we need. We need to systematically address stigma as a part of the problem, and restore community services that not only prevent more expensive episodes of inpatient treatment, but improve the quality of life for people with mental illnesses.

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