By far, one of the largest and most profound obstacles faced by those with mental illness, especially serious and persistent mental illness, is the associated stigma. Often, those living with serious mental illness aren’t seen as individuals with distinct values, and personalities, they are seen as their disease. They are their labels; depressed, schizophrenic, or bi-polar, or crazy, and once labeled, how does a person begin to resume a normal role or position in society? Stigmatized people, including those suffering with mental illnesses, are often discriminated against and targeted by harassment, threats, and even violence, and, sometimes, their own friends and families don’t understand and may tend to devalue the individual.
Compounding the issue, stigma is a two-fold process, there is the public stigma and there is
self -stigma, which is the internalization of the public stereotype. The result of stigma is that it robs people of the opportunities characteristically considered basic to a satisfying quality life such as a good education, decent jobs, safe communities and living environments, decent health care, and associations with diverse groups of people, as well as reduced sense of self-efficacy and self-determination. The stigmatization is justified on a large scale by a misconception that those people,” in this instance the stigmatized group being those with mental illnesses, are somehow responsible for their condition, that it stems from some type of character flaw, poor behavior, laziness, or incompetence, and there is a perception of an inherent danger and criminality in those so afflicted simultaneous with a belief that they are ultimately in control of their disease and disability.
For those with severe mental illness, the discrimination is often obvious and seemingly accepted by a large portion of society. However, for those with less obvious mental illnesses, such as depression, a sense of self-stigma often keeps people from seeking prompt and appropriate treatments which has a negative impact on their chances at a timely and possibly permanent recovery. Though such stigma has become near universal, it exists due to a differentiation between mental illness and physical illness, one which did not always exist and has evolved to become very clear cut. According to an article in the British Journal of Psychiatry, “the distinction between mental and physical illness” is “ill-founded and incompatible with contemporary understanding of disease.” It further states that such distinctions may cause those suffering with illnesses as well as those in helping positions to “ignore what may be important causal factors and potentially effective therapies.”
Anytime stigma is associated with a condition, it allows situations to flourish which devalue entire groups of people and reduce the amount of resources available to such groups. This comes up time and again in social work. Disenfranchised groups and “their” issues are pushed to the periphery of society and with that push, the resources allotted them are often scant and sub-par. In word, health care reform has taken steps to narrow this gulf by allowing equal provisions in coverage of mental illnesses to those afforded for physical illnesses. Let’s hope it carries it out in practice.
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Given medical privacy laws, disclosure of one medical status does not have to occur. Unless one has a blatant psychotic break at work, or attempts suicide in public, the ability to identify a person as mentally ill is not possible. It is not unusal now for most people with mild mental health disorders (ones that do not cause significant impairment in functioning) to simply get pills from their primary care doc.
Those suffereing from mental illness that get stigmatized usually do so because their illness is poorly controlled. If someone rides the bus all day chanting “I am Jesus, I will save you”- and this is true story- well, people are going to give them a wide berth.
Same person well controlled on anti-psyhcotics maybe able get a job at Starbucks and no one will be able to tell– employers cannot question your medical history.
I am of the opinion that going to a family MD for a pill prescription instead of to a specially trained, qualified, mental health professional further supports the view that stigma is alive and well, including self-stigma. Specialists exist for a reason; they have specialized knowledge and training. We go to specialists for everything else, it should as easily be a given for mental health. No one would go to a dentist for a broken bone. Also, having laws on the books doesn’t mean attitudes have changed, or discrimination has ceased. Jails are full because people break laws. A person who applies for a job needs to answer holes in employment history, and that can be very spotty for someone dealing with mental health issues. And people sometimes pay out of pocket for mental health treatment for fear that their employer will find out.
According to the National Alliance on Mental Illness, (NAMI) “Mental illness is a leading cause of disability, yet nearly two-thirds of people with a diagnosable mental illness do not seek treatment and people of color in the U.S. are even less likely to get help.†Stigma against mental illness is a well-documented, world-wide phenomenon. It effects quality of life and prevents people from seeking treatment. In fact, the World Psychiatric Association’s 6th annual International Together Against Stigma Conference will take place February 12-14, 2013, in Tokyo, Japan.
Things may be changing, slowly, for issues such as mild depression and anxiety, but stigma keeps too many people from seeking prompt appropriate treatment. In fact, we often criminalize mental illness…but that is for another entry.
The behaviors of certain mentally ill people due result in arrest- mostly due to self-medicating due via illegal drug abuse. Eliminating long-term institutional care, along with making it nearly impossible to committ someone via EP, has resulted in prisons being used as last resort for people that really are not capable of self care. The perfect storm of unrealistic liberal expectations with cost-cutting cheapness in government. That’s why homelessness has climbed as well.
The family physician actually increases access to care, and reduces stigma- it’s much more stigmatizing to have to see a psychiatrist vs. a regular doctor. Truth is many mental illnesses are biological in nature- hence, a trained physician is the best person to turn to. That is what equity looks like- regular medicine being able to treat multiple disorders, including ones of the brain.
The main reason folks with mental illness don’t seek help is that they do not believe there is anything wrong. That’s one of the most common features in working with the mentally ill- they are not wrong, the world is, and if they seek treatment they are admitting they are “crazy.” And you will never remove self-stigma- can you think of anything more frightening that realizing your mind, and your very perceptions of reality, are diseased and inaccurate?
Therapy does have a role in helping people cope; I’ve had great planning sessions with clients over things like what to do when Satan uses your toothpaste; but sadly, those are not cures.
And spotty employment history- even physical ailments will make employers reluctant to hire; what if you get ill again? And they have valid concerns. Can’t legislate against that in a fair manner- people need reliable help to support their families.
I think we may have to agree to disagree. The most effective treatments for things like depression and anxiety have been shown to be talk therapies sometimes with a combination of medications. Medication alone has not shown to be as effective, especially long-term. A pill cannot cure a skewed schema due to a chaotic childhood, nor can it help someone work through grief, or teach emotional regulation, it can only help control biological conditions while lending other support to the individual through therapy.
Stigma and Mental Illness
Like stigma and rape, the above is victimizing.
The article’s attempt to be positive was overwhelmed by its negative references.
Harold A. Maio, retired mental health editor
Actually, in my opinion, you are both correct. You are talking about different aspects of this very complex group , lumped under the brush of Mental Illnes
To be succinct, I will use the 1/3’s theory( a third are controlled with meds/a third are not/and a third are somewhere inbetween).Michael is talking about 1/3 and Michelle is talking about ALL but primarily the third that are not controlled. Having “grown up” professionally, before institutions were considered(“cruel”)inappropriate……………………………………..there is no place but jail,etc for those who for whatever reason are inable to find their highest level of stability! Drugs have improved many time over, and therefore the ability to live a “relatively” normal life is more possible for than ever.
Finally, I think we need to look at major mental illness vs. depression( yes, including bipolar II disorder)….these are those illness which can be treated by a generalist, but when tx is not successful , then they should be referred to Psychiatrist for treatement or at the very least consultation( to find the correct medications and find stability for the best result)………………….without PCP’s involved the numbers are too great……….BUT for major/persistent mental illness….this can ONLY be stablized to its best , by a Prescribing Mental Health Professional……………….fyi…………………………….de
Could you elaborate on your comment please, Harold Maio? sincerely interested.
uh, found my answer http://www.theguardian.com/media/mind-your-language/2011/nov/07/mind-your-language-mentally-ill-stigma
I will have to chew on that in my mind – I need to know this because I talk to people in residential treatment for addictions about ‘stigma’. I admit to not being so clever that what you have written would be obvious to me after reading it. Are you saying that by using the word stigma we are being prejudiced because we would have had to conceptually categorized a group of people, the “the”? Or is the word stigma or categorizing a response to this ‘group’ the prejudice? You think we should use the word (and diretion) prejudice instead of stigmatized? Or we shouldn’t try to speak in a general way about the impact of societal negative stereotypes.
Thanks
Candice
When someone directs a prejudice, they often call their prejudice someone else’s “stigma,” reserving definition for themselves: I define you.
No one’s prejudice is someone else’s “stigma.” I decline to be defined by someone’s prejudice, instead I address that/their prejudice.
Prejudice against rape survivors, until late in the 20th century here, was called the survivor’s “stigma.” Women, empowered, told us to end that word association.
Following that pattern only makes common sense. End that word association entirely, no matter against whom it is directed, or by whom it is diercted.
At the heart of directing a “stigma” is who holds the power of definition. No one’s prejudice is someone else’s “stigma,” they do not define, unless a victim of their prejudice permits them to do so.
I do not.
Until late in the 20th century people defined survivors of rape as carrying a stigma. Empowered women told us to end that word association.
That is the pattern I follow: End that word association no matter who directs it, and no matter against whom.
Thank you, I get it.
Actually, everyone is wrong. Mental illness, dysfunction, disorders, and afflictions are not biological or genetic. The “genetic” or “biological” link is simply due to generation after generation of mentally ill parents utilizing their dysfunctional behavior to pass on their mental illness to their children, which is how 95% of mental illness is caused, created, and formed. Even in cases where there is a “genetic” link there must be some form of abuse, neglect, or trauma in the child’s environment in order to produce a full blown mental illness. How a child is raised is the key for absolute sure. Parental arrogance is what has kept this mental health epidemic thriving. It is like inviting a firestorm to question ANY parent’s parenting style and EVERYONE is afraid to confront a parent about how they are speaking to or treating their child. All parents think that they are perfect parents and society reinforces that with the unproductive and harmful ideal that children should “always respect their parents.” What an oxymoron for society to insist that children should always respect their parents yet it is also taught that “respect must be earned.” How does that parental trap, parental arrogance, and parental worshiping fit into an abused or neglected child’s way of thinking? It does not fit and this ridiculous and harmful attitude that parents are “Godly” or “untouchable” leaves abused neglected children forced into “respecting” their parents who 100% do not deserve any respect.
In fact the only reason why drugging children is so overused and abused is simply to pacify the parents and NOT to actually help the child because the child is put right back into the environment that caused him/her to act out in the first place. A child’s upbringing and environment is what determines his entire future because their brains, personality, and entire psyche are being permanently formed from the time they are born until they are 20+ years of age. Children watch and learn everything from their parents or caregivers and learn a small portion from school or peers.
Just like the children mentioned above, adults are drugging themselves instead of seeking the underlying cause of their mental illness, afflictions, disorders, and dysfunctions. When an adult child tries to point out or expose the mental illness that is prevalent in most families they will get bullied or ostracized by the rest of the family and forced into silence, usually at the direction of the matriarch or patriarch who are the culprits of the abuse and/or neglect, and the epidemic cycle continues. The ones who stand up to the abuse are always further abused so silence has become the accepted norm.
The biggest, most crucial, and most important thing that needs to be done to improve mental health which is usually caused by and created from poor parenting, childhood trauma, abuse, and/or neglect, is to focus on the underlying cause of mental illness and that is poor parenting, yet parenting is NOT considered important, which is a travesty. In fact daily I see parents screaming about having more “rights” to raise their child(ren) without interference, but those “rights” are at the expense of millions of children who are unlucky enough to be born into a bad and unhealthy environment. It’s really luck of the draw whether you are born into mental health hell or born into a healthy environment that will provide you with the personality, psyche, and mental health that will empower a child with the skills needed to be a happy, healthy, and productive member of society.
Also, the police are expected to be the psychiatrists of the world and prison is where the mentally ill are housed. There is nothing else that can be done with such mentally deranged individuals who are dangerous to themselves and to others. The worst part is that most seriously mentally ill individuals are indeed able and willing to produce children who they will 100% abuse or neglect which will 100% guarantee that those children will grow up to become burdens to society with their own mental health issues. It’s all a big cycle that everyone ignores while pointing the finger at everyone and everything other than where it should be pointed and that is the parents and parenting. Society is way too afraid of offending a parent than to face the reality that parenting is the key and every parent every day makes crucial parenting mistakes/errors that permanently and adversely affects their child’s mental health and their entire future.
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