Mental Illness and Stigmatization

mlhodges's picture

Biology in Society Senior Seminar

Bryn Mawr College, Fall 2010

Session 6

 

 Mental illness and Stigmatization

 

  • Why does mental illness stigmatization exist?
  • What causes stigmas? The “disease” or the “label”?
  • How are stigmas detrimental to the public? Who do they affect?
  • What is the most effective destigmatization force available?

“Stigma is of concern to social scientists largely because of the egregious effects it has on almost all levels of society. Stigma represents a social injustice that deprives people of their humanity, leads to violence, and results in robbing individuals of the opportunities that are rightfully theirs.”

-Corrigan, P. On the Stigma of Mental Illness. 2005.

Where do stigmas exist?

People from around the world who had been diagnosed with schizophrenia were interviewed and asked to describe how stigma and discrimination manifested their lives:

From India: “My parents support me but we can’t tell any of our neighbors. It would hurt my sister’s chances of being married.”

From Canada: “If I apply for the job and tell them I have schizophrenia, I won’t be hired. If I don’t tell them and they find out, or I suffer a relapse later, I will be fired.”

From Japan: “Women with an illness like this will be kept at home to do domestic chores, while we men are sent out of the house.”

From the UK: “The only way I found out the doctors had diagnosed me with schizophrenia was because I managed to read it upside down on my medical notes! No one had told me and finding out that way was very frightening. I felt very alone.”

From the US: “The doctors left me waiting in the emergency room, fighting my delusions for six hours; they said other people’s problems were more serious than mine.”

-Sartorius, N. and Schulze, H. Reducing the Stigma of Mental Illness. 2005.

What similarities do we see? Differences? Why? Are stigmas a cultural phenomenon? 

The Diagnosis of Mental Disorders:  A Question of "Illness" or "Health"?

---Keep in mind: According to WebMD, a mental disorder is: a psychological syndrome or behavioral pattern that is associated with subjective distress and/or objective impairment. ---

TV Show: “How Mad Are You?”

In 2008, a British reality program called “How Mad Are You?” was broadcasted on tv. Plot: 10 volunteers lived together for a week in a castle in Kent and took part in a series of challenges. 5 had a serious mental illness (OCD, bipolar disorder, eating disorder, anxiety disorder), 5 did not. Challenges were meant to provoke latent symptoms and ranged from group bonding exercises to specific psychological tests.

Example of a challenge meant to screen for an eating disorder: Volunteers took photos of each other wearing white lycra suits and the images were stretched out of shape. They were then asked to shrink them back to the way they saw themselves.

Volunteer’s Response: Yasmin, 36, was an amateur rugby player and was one of the larger members of the group. She exaggerated her own size by only 8%, which was less than anyone else in the group, however, she really agonized over the task. It took her twice as long as the others to complete it, plus she told the panel it was her least favorite challenge of the week.

Based on her reaction to the task, do you think she has an eating disorder? 

Panel’s Response: Ian Hulatt, a psychiatric nurse and mental health advisor, felt her reaction was character, not illness. Mr. Hulatt said, "That was probably in response to how she feels about social messages about her being overweight in our culture," he says. "That wasn't sufficiently out of context or unusual to make us feel it was a pathological problem."

To think about:

-Most disorders have symptoms that in a milder form can just seem like character traits...How pessimistic do you have to be before a psychiatrist says you have depression? How much insecurity makes you schizophrenic?

 

Where should experts draw the line? When is something an “illness”? When is it “health”? What role does this “gray area” in diagnosing someone with a mental illness play in generating stigmas?

 

Returning to the goal of the show: Could a panel of experts — a psychiatrist, psychologist and a psychiatric nurse — tell the volunteers apart?

They could not. The experts correctly identified only two of the five people with a history of mental illness. And they misidentified two of the healthy people as having a mental illness.    Why?!

The participants’ most dramatic symptoms — immobilizing depression, agitated mania, relentless hand washing and so on — had been treated and were under control. “The public needs to realize that you cannot just look at someone and make assumptions,” explains Mr. Hulatt.

-Lidell, R. “How Mad Are You?” 2008. http://news.bbc.co.uk/2/hi/uk_news/magazine/7722074.stm

 

Is this a common fault of the general public? If it is, why? Does it come from the media? Ignorance? Fear? Stereotypes? Is this misunderstanding that Mr. Hulatt describes a primary cause of stigmatization? How can this be changed?

 

Informative websites:

Summary of class discussion (Annie)

Moira began class by taking us back to a particular conversation that occurred one of the first days of class, where professor Grobstein posed the question: “who here has a friend with an anxiety disorder?”. We thought about why the question has to be: who has a friend with an anxiety disorder? Perhaps it is asked this way because prof. Grobstein did not want to make anyone feel uncomfortable or singled out by asking it in a more personal way (“who among us has an anxiety disorder?”). The question then became: why does this have to be an uncomfortable topic/question? It was an interesting point to make, and allowed the discussion to move into talking about stigmatization of mental illness.

Next, Moira showed us quotations from people diagnosed with schizophrenia who live in different countries/within different cultures, and we talked about whether or not there were differences between what people were saying about stigmatization. We discussed the fact that most cultures exhibit one or another form of stigmatization, but what is stigmatized, and the way in which it is stigmatized, often varies from culture to culture. Some countries are more tolerant of behaviors exhibited by schizophrenics and perhaps this leads to a less intense/prevalent stigmatization compared to other countries where the illness is less tolerated.
We then went on to discuss what stigmatization actually is. I believe it was professor Grobstein (and I may be wrong) who offered the idea that: What stigmatization consists of is presuming the worst of something even when it’s not the worst of something.

Moira then went on to provide the example of the British TV show. She explained the premise of this show: that a group of people were housed together, half of whom had a serious diagnosed mental illness, and the other half who were documented as healthy. A panel of experts was supposed to identify the people who did have a mental illness and those who were healthy, based on observing their behavior in certain activities/tasks. The experts correctly identified only two of the five people with a history of mental illness. We discussed the implications of this study and decided it is a very nice illustration of stigma: the feeling people get that someone has something that is bad, even when you don’t know anything about the disease. Although these experts do know about the illnesses suffered by 5 of the individuals, they were incorrect in their conclusions. What does it mean that even experts couldn’t correctly classify these people?

We then talked about where stigma comes from. Some people in the class were of the opinion that it comes from fear, while others said that perhaps it wasn’t fear, but the idea of difference. We also said that perhaps the notions we have about certain mental illnesses are not incorrect, but they are such a small piece of the whole picture, which can lead to stigmatization.

Towards the end of the discussion we brought up the fact that often times, people with mental illness are seen as having a deficiency of some sort, as opposed to just being a variant.

 

Conversation and Implications to date (moira, 18 October 2010)

 

If we are to try and eradicate mental illness stigmatization, I think we need to first focus on changing peoples’ perception of the treatment options used to combat mental illness. Perhaps in addition to a doctor’s physical, everyone should be required to see a therapist before entering school and getting a job. (dfishervan)

…it seems like there is an awful amount of gray area around that threshold that can lead to one individual being diagnosed with a mental disease, while another is reportedly normal, even though there are few differences between their symptoms. I feel like this gray area is one of the major reasons behind the stigma that exists against mentally ill individuals. It is very easy for the individual who is on the verge of having a mental disorder, but does not have the diagnosis, to look down on another individual who does have the diagnosis. (smaley)

I find it troublesome that the gradient of mental health is so often presented to society as a dichotomy of "healthy" and "ill" and I know from personal experience that the arbitrarily chosen boundary between "healthy" and "ill" greatly impacts the way a person is perceived and treated…In my opinion, the only way this will change is if each of us reflects on our own behavior and feelings and recognize the similarities between the "healthy" and the "ill". There isn't that big of a difference. Of course, society most likely will never do this because it really all comes down to power. When we realize we're all a little weird we can no longer lord our "normality" over the "not normal" and claim for ourselves a higher place in society's hierarchy. (crystal)

…the line between "normal" and "abnormal" is often a blurry one. How can we actually distinguish between people who classify themselves as more than tidy, and people who are said to have OCD? How can we distinguish between people who inherently dislike fatty foods and are conscious of their appearance and people that have an "eating disorder"? I think the stigmatization of "mental illness" is both an interesting phenomenon, and an unfortunate one. Conditions such as depression and bipolar disorder are organic disease. Because they are organic, how are they different from any other common ailment? Is it the fear of the unknown/the unclear threshold between "healthy" and "not-healthy" that causes stigmatization? (adowton)

…I would like to suggest that inasmuch as “illness” and “normalcy” are very contrived things, “illness” and “normalcy” are also real - mental illness exists and is as real and problematic as physical illness. Like Annie has said already, the problem is not so much the illness as it is the stigma of the illness. Unfortunately I have no ideas about how to go about abolishing it. (kwarlizzle)

It is disheartening that societies around the globe tend to cast out those who vary from the norm. People with “mental illness” are different from what is accepted as the norm but to stigmatize them is insulting. Some of the greatest minds in history have been persons who have been treated for their illness, i.e. John Nash, Picasso, Vaslav NijinskyIt seems that we are always trying to send “mentally ill” patients out for treatment but perhaps it is us that are in need for treatment for this phobia we have associated with individuals who are different. (Colette)

In order to combat the stigmatization that exists against mental illness…

  •  Most importantly, society must eradicate the leering gap between “mentally ill” and “not mentally ill”, because more often than not, there is not a significant difference between the two artificial “categories”.
  •  It is necessary to change outsider’s perceptions of the treatment options available to those that struggle with a mental illness.
  • Mental illnesses, just like physical ailments, are “real” problems. Ignorance about the legitimacy or significance of mental illness is unacceptable and causes the public to fear the unknown. The public must be educated on the “gray area” associated with diagnosing mental illnesses.
  •  Society must realize the members of the public that have developed a phobia of the individuals who “seem to be different” from others are the members of society that are truly in need of treatment.

 Continuing conversation in on-line forum below

 

Comments

Colette's picture

 It is disheartening that

 It is disheartening that societies around the globe tend to cast out those who vary from the norm. People with “mental illness” are different from what is accepted as the norm but to stigmatize them is insulting. Some of the greatest minds in history have been persons who have been treated for their illness, i.e. John Nash, Picasso, Vaslav Nijinsky.

            Presently it seems that the best “medicine” to cure these individuals so that they may be more acceptable is to send them away for therapy or treat them with drugs. This is absurd because people should be accepted for who they are no matter what the circumstances. If they are putting themselves or others in harms way, then perhaps resorting to these methods of treatment would be acceptable otherwise it is ridiculous. In addition, by forcing individuals to participate in these “treatments,” we are playing into the stereotype that these individual need to be fixed and hence therefore promote the stigmatism that comes with mental health disorders. A person in harms way when he or she cannot survive on their own and must be institutionalized to merely survive-fed, clothed, and sheltered. Drug therapy is used to shorten the recovery phase.

            It seems that we are always trying to send “mentally ill” patients out for treatment but perhaps it is us that are in need for treatment for this phobia we have associated with individuals who are different. At the very least, there needs to be some neutral ground and I think Dakota’s suggestion that “in addition to a doctor’s physical, everyone should be required to see a therapist before entering school and getting a job”  is a good plan however, there will never be enough therapists to see all job and schools applicants.

When experimenting with humans, there are ways in which all participants can be fully informed and whether they choose to listen or not are their responsibility. For instance, writing out a script when explaining the risks and guidelines then recording it and playing it for each participant may be one way to eliminate any biases researchers would typically have when presenting an experiment that they would like to do. It is not right or useful to target any group of people as subjects because of their likelihood to participate. This is a big ethical problem to deal with  since it would be considered taking advantage of peoples weaknesses to get what they want. I found Prof. Grobstein’s ideas of communism and “jury duty,” making everyone participate, to be an interesting approach to neutralizing participation.

 

Kwarlizzle's picture

I really like Crystal’s post

I really like Crystal’s post because it shows just how very obscure the line between “illness” and

“normalcy” is.

That being said, I would like to suggest that inasmuch as “illness” and “normalcy” are very contrived things, “illness” and “normalcy” are also real - mental illness exists and is as real and problematic as physical illness.

Like Annie has said already, the problem is not so much the illness as it is the stigma of the illness. Unfortunately I have no ideas about how to go about abolishing it.

Paul Grobstein's picture

straightening out the "mental illness" problem

Some very useful conversation, both in class and below.  Yes, there is an enormous grey zone between mental health and "illness," with a lot of cultural convention involved in the latter.  And yes, we could probably do a lot about "stigmatization" if we didn't generalize from particular behaviors to a whole person/"illness."  For more along these various lines, see

adowton's picture

I think both Crystal and

I think both Crystal and Sarah bring up very valid points. The idea that many behavioral characteristics seem to be defined as a mental illness after a certain point is an interesting one to me. Obviously, there are a certain range of symptoms that may be exhibited within the context of a specific mental illness, but as Crystal points out, and I completely agree, the line between "normal" and "abnormal" is often a blurry one. How can we actually distinguish between people who classify themselves as more than tidy, and people who are said to have OCD? How can we distinguish between people who inherently dislike fatty foods and are conscious of their appearance and people that have an "eating disorder"? I think the stigmatization of "mental illness" is both an interesting phenomenon, and an unfortunate one. Conditions such as depression and bipolar disorder are organic disease. Because they are organic, how are they different from any other common ailment? Is it the fear of the unknown/the unclear threshold between "healthy" and "not-healthy" that causes stigmatization?

Crystal Leonard's picture

personal experiences with the mental health gradient

I find it troublesome that the gradient of mental health is so often presented to society as a dichotomy of "healthy" and "ill" and I know from personal experience that the arbitrarily chosen boundary between "healthy" and "ill" greatly impacts the way a person is perceived and treated. I'd like to share a personal example that our conversation on Monday got me thinking about and that I think is relevant to this idea. My mother has been diagnosed with obsessive-compulsive disorder (OCD). This mostly manifests as a major preoccupation with symmetry and order. Everything in our house needs to be symmetrically placed in relation to other items, and my mom gets anxious when things are out of place. While it is annoying when my mom rearranges items in my room, and while my mom does spend a portion of each day ensuring her treasured symmetry, her compulsions are not actually disruptive to her life. She's generally happy and healthy, despite her "illness". However, people see my mother fixating on the position of an object and automatically judge her. I've witnessed how they get frustrated with her "weird" behavior, how they take her less seriously than they would have if she was "normal". Meanwhile, none of these people realize that my mom is not that different from "normal" people, myself included. I have never been diagnosed with any sort of mental illness. However, I've realized that I exhibit milder versions of the same behaviors of my mother. I don't actively obsess over achieving symmetry. However, I am extremely particular about the placement of items in my personal space. This goes beyond just being a "tidy" person. For example, I'm so particular that I can automatically tell if someone's been in my space without my knowledge because I notice the small changes in items' placements that might result if the person brushed up against something, etc. I recognize that this isn't "normal"; none of my friends or family are this particular, except for my mom. However, because my particular nature never manifests itself into noticeable "bizarre" behavior patterns or anxiety, I am "healthy". People see me and they think "tidy", "detail-oriented", "organized". They agree that my eye for small details will be very useful to me as a physician. My behavior is only a hair's breadth away from my mom's, but the way people characterize us is so different. I benefit from my desire for order, while my mom suffers for the same desire from the judgments of an ignorant society. In my opinion, the only way this will change is if each of us reflects on our own behavior and feelings and recognize the similarities between the "healthy" and the "ill". There isn't that big of a difference. Of course, society most likely will never do this because it really all comes down to power. When we realize we're all a little weird we can no longer lord our "normality" over the "not normal" and claim for ourselves a higher place in society's hierarchy.

smaley's picture

One thing that I found very

One thing that I found very interesting about our discussion of mental health, and stigmatization, was the difference between being diagnosed with a mental illness, and just have a unique personality trait. With a physical illness, it is often much easier to determine whether an individual has an illness of not. While the symptoms may vary from person to person, more often than not there is not much of a question as to whether or not the individual is ill. However, with mental illness, it seems much harder to determine whether an individual is ill or not, and the defining line seems to be somewhat arbitrarily drawn. Wisely, no one asked my opinion when they were deciding what the determining factors should be for diagnosing someone with a particular mental disorder. However, from my limited experience, it seems like there is an awful amount of gray area around that threshold that can lead to one individual being diagnosed with a mental disease, while another is reportedly normal, even though there are few differences between their symptoms. 
 
I feel like this gray area is one of the major reasons behind the stigma that exists against mentally ill individuals. It is very easy for the individual who is on the verge of having a mental disorder, but does not have the diagnosis, to look down on another individual who does have the diagnosis. Similarly, when seeing an individual on the street that seems to have a mental illness, I personally would be less likely to stigmatize that indidivual if I knew for a fact that they had a diagnosis, and they were receiving treatment. I’m not suggesting that everyone who has a mental illness should have to disclose that fact to everyone they meet. If there is some way to reduce stigmatization, I don’t know what it is. All I know is that I don’t believe it’s possible to get rid of stigmatization completely, due to the overly curious and judgemental nature of society.  
 

dfishervan's picture

Stigmatization of Mental Illness Treatment

It is interesting to look at society’s perception of mental illness in conjunction with our perception of “medical” illness. Society stigmatizes certain medical illnesses such as STD’s mainly because of the generalizations it has made on the means for contraction of these diseases. We know that most mental illnesses are organic and do not stem from a person’s violation of societal norms and yet, people with mental illness are still looked down upon. For the most part, those with medical illnesses are not stigmatized as a person cannot be responsible for consciously eradicating the disease plaguing their body without medical assistance. However, we tend to believe that a person with a mental illness is capable of curing himself or herself. Up until recently, I did not believe in therapy (although I supported its existence as it seemed to benefit many people) since I did not understand how paying someone to sit and talk would solve any problems. Even if talking with someone was a positive experience, I still felt that ultimately, it was the individual’s responsibility to act on what had been discussed. The pharmaceutical treatment provided to certain individuals with mental illness also worried me as this medicine was designed to alter someone’s mood and personality, a feature which I thought should be self regulated. While I commended people for getting help, I felt that relying on a therapist or prescriptions was a sign of weakness. If we are to try and eradicate mental illness stigmatization, I think we need to first focus on changing peoples’ perception of the treatment options used to combat mental illness. Perhaps in addition to a doctor’s physical, everyone should be required to see a therapist before entering school and getting a job. 

 

Paul Grobstein's picture

Stigma and mental health: other activities

From Active Minds, an on campus student mental health advocacy organization ...

This evening you'll find a silver ribbon outside your office door, which comes with a request that you wear it tomorrow (Tuesday, Oct. 5th). This is the National Day Without Stigma, which aims to raise awareness about the life circumstances of the one in four Americans who struggle each year with mental illness. The hope is that our wearing silver ribbons on campus tomorrow will both begin to reduce the stigma associated with mental illness, and help to open dialogue around issues of mental health at Bryn Mawr.  

Active Minds will also be tabling on Merion Green from 9 a.m. - 4 p.m. on Tuesday, with specific information about their organization and more general information about mental health; you can pick up extra ribbons there, too. In Thomas 110 at 9 p.m. on Tuesday evening, a panel of students will also be talking about their experiences with mental illness and stigma. 

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