Isn’t It Time to Remove the Stigma Against Mental Illness?
We were having dinner (outside) with some friends we had gotten to know recently. When asked whether he wanted a glass of wine, he declined and after the server left, told us that he was a recovering alcoholic. None of us made any comment, the conversation continued on other topics as if he had not told us something significant about himself, or at the very least his past.
Later on, I wondered what our reaction would have happened if he said, “I can’t drink wine because I am taking medication for bipolar illness, or my schizoaffective disorder..." or some other mental illness? I suspect that in this circumstance also, no one would have said anything, but would this statement have made us regard him differently? Would there have been a momentary adjusting of our perceptions, and then a deliberate (although unspoken) effort to avoid even an unconscious response to perceive him differently... indeed, to think of him as "other."
The public, you and I, are still challenged by the need not to stigmatize those with mental illness, especially the disorders that may require hospitalization. And we are not helped by the depiction in the media of those with such disorders. A very popular Israeli series, Shtisel, is an example: In an episode in the most recent season, the father-in-law makes it very clear to his son that the latter made a huge mistake in marrying someone with mental illness, even though she was being successfully treated for it. Moreover, it is not unusual for someone on a television crime show who has committed a violent act to have his behavior understood as caused by his schizophrenia...Is the viewer to believe that this is typical behavior of people with this mental disorder?
In fact, even advertisements for antidepressants tend to stereotype those with mental illness. When they are depressed they are shown huddled in a room, or hiding their true feelings behind a mask with a smiling face on it. Then when they are better, they are painting or volunteering or, of course playing with a dog or grandchild. The individual is either struggling with depression, or enjoying life to the fullest; nothing nuanced about the depiction.
What the media (television, movies, advertisements) do not fully depict is the public stigma many people with mental illness face, and how this affects their self-perception.
According to an insightful paper by Corrigan and Watson, those who have serious mental illness not only have to contend with the often disabling symptoms of their disease, they also have to confront covert (and sometimes overt) prejudice, and often misconceptions about their mental illness. As a result, they may find themselves less likely to find jobs, and as a consequence less likely to have adequate healthcare and housing. Moreover, social isolation, not only for them but also for their family, may be a consequence of their illness. The mother of an adult child who is known to suffer from bipolar disorder told me that on occasions when the extended family gets together, excuses are made not to invite them, "Just in case something happens."
Corrigan and Watson also point out the difference in our attitudes toward people suffering from a physical illness, compared to those with a mental disorder. The former are shown sympathy and offered support. Often when one hears someone describing a disease, be it back pain or cancer, the response of, “Yes, I had it..." or "I know someone who had it...” is common; indeed it seems as if an entire neighborhood has had a bad back, or asthma, once the disease is mentioned. But rarely does one find the same response when a mental illness is mentioned. We may compare the efficacy of treatment for back pain, but rarely does a conversation focused on the varying efficacies of antidepressants, or the skill of a psychiatrist.
Studies quoted by Corrigan and Watson indicate that the public often thinks that mental illness is not worthy of a sympathetic response. Indeed, the patient is thought to be at fault for not being able to rise above the symptoms, as if a better attitude and resilience would overcome behaviors caused by neurochemical changes in the brain.
What is puzzling about the dual stigmas, public and personal surrounding mental illness, is that mental illness is so common both in the U.S. (and globally). It is hard to find someone who has not experienced mental illness, or who knows someone who has. According to a government website Healthy People 2020, about 18 % of adults in the United States 18 years of age and older have suffered from mental illness, and over 4% experienced a mental illness that was seriously debilitating. This number increased significantly during the pandemic (see cite below).
And yet I suspect that few of us would share our past struggles with depression, or obsessive compulsive disorder, or generalized anxiety, with fellow employees or casual friends. And we would be even less likely to mention a hospitalization for a severe mental illness. The silence surrounding a diagnosis of mental illness is reminiscent of the attitudes, not so very long ago, surrounding the diagnosis of cancer. Indeed, the stigma was sufficiently prevalent to prevent employees from mentioning even their recovery from cancer to an employer. Indeed, even today cancer patients may be told that their cancer is a consequence of their unhealthy lifestyle, and so in a sense, they are still being stigmatized for developing the disease.
It is unclear, however, how we are to remove the silence and secrecy surrounding a personal struggle with mental illness. Organizations to help those with mental disorders such as NAMI or Mental Health America offer support groups for patients, family members, and friends. These groups are peer-led and offer opportunities to share problems, including the isolation both patient and family may experience. But it is necessary to reach beyond the circle of friends and family to make us as comfortable with someone who is suffering from, for example, bipolar disorder, as we would we someone who has high blood pressure.
Perhaps the pandemic has helped us communicate our personal distress, depression, anxiety, and other mental disorders to others without fear of being shunned, because so many of us have been experiencing the same symptoms. I have a friend whose anxiety about being exposed to COVID-19 prevented her from leaving her apartment for months; another became extremely sad and could not find pleasure in anything. Both of these individuals seemed to be experiencing symptoms of mental disorders, but the response of those who knew them was to express sympathy and empathy, not stigmatization. Let us hope that as we emerge from our months of isolation, anxiety, and in many cases grief, we retain our understanding that those with emotional disorders are just like us, and may even be us.