Thursday, September 4, 2008

Redwood City Daily News: Empathy slow to replace stigma of mental illness

By LJ Anderson / Daily News Columnist

The World Health Organization calls them among the most neglected people in the world: people with mental health disorders. It is not uncommon for them to experience inhumane treatment, if they receive treatment at all; to be blamed for their illness; to have their human rights abridged; and, to be shunned.

Stigmatization, particularly, occurs at all levels of society and culture.

Stephen Hinshaw, Ph.D., is professor and chair of the Department of Psychology at UC-Berkeley. He is the author of numerous articles and books including, "The Mark of Shame: Stigma of Mental Illness and an Agenda for Change."

Q: How great is the stigma associated with mental illness, and why does it exist?

A: History shows that mental illnesses have been stigmatized throughout history.

In the 20th and 21st centuries, the public's knowledge of mental illness has increased, as science has learned more about mental illness, and its causes and treatments. Surprisingly and distressingly, however, stigmatizing attitudes have not shown a corresponding decline.

If anything, severe mental illnesses may be more stigmatized than 50 years ago.

So, the question is "why"? Intriguing evidence exists that humans may be "programmed" via natural selection to reject fellow humans who appear contagious, threatening or "different."

In short, some components of prejudice (racial or related to mental illness) are almost hard-wired. Still, such fears and biases can be overcome.

Second, the former models we had to explain mental illness (such as evil spirits or personal weakness) served to increase such responses.

Third, media accounts of mental illness are highly stereotyped - routinely portraying mental illness in terms of dangerousness and incompetence.

Fourth, our policies foster discrimination. For example, you get a higher level of coverage for lung disease than for depression, bipolar disorder or schizophrenia.

In many states, a history of mental illness means that you lose custody of your children, the right to vote, hold office, serve on a jury or drive a car. So, there are both "biological" and social/policy reasons for the tendency to stigmatize those with mental illness. But the fact that a mere label (psycho or ex-mental patient, etc.) can incur stigma, over and above any direct behaviors that are threatening, shows how psychological the processes are.

Are attitudes improving? At one level, yes - people talk about therapy, or Prozac, etc. more than before. But even so, severe mental illnesses are still among the last things anyone would want to happen to them, and as a result, people with those behavior patterns are avoided and blamed.

Q: Does the stigma vary, depending on the type of mental illness?

A: Yes, even though the general label of "mental illness" incurs stigma, in and of itself. Schizophrenia probably generates the most stigma, but bipolar disorder, depression and eating disorders do, as well. Even "milder" forms of mental illness (e.g., ADHD, anxieties) are stigmatized, however, in part because we expect that such "normal seeming" people should be able to "get it together" and overcome their problems.

Q: How does this stigma affect those with mental illness, especially as it relates to seeking out treatment?

A: This may be the most pernicious aspect of stigma, sometimes termed "self-stigma."

Mental illnesses are debilitating enough, causing sufficient impairment that they are now considered the most debilitating illnesses on earth, over and above cancer, HIV, etc.

But when one adds the shunning, the deprivation of rights and the shame associated with stigma, the situation can become unbearable.

Research shows that even when you take into account the pre-existing level of mental illness, or impairment, in a person, the stigma can add to the tendency to fail to seek treatment, to stop treatment, to maintain silence, and to limit his or her life opportunities.

Q: What is your personal experience with the stigma of mental illness?

A: My father had lifelong, severe bipolar disorder, beginning at age 16. It was misdiagnosed for 40 years and led to his placement in unspeakable mental hospitals. After his episodes, he was "normal" and was, in fact, a philosopher as well as a sensitive parent. But his doctors told him never to tell me or my sister about his mental illness ("children can't understand"), and so we grew up in silence about his episodes and absences.

Even when he went against medical advice and began to disclose to me, after I started college, it took years for me to tell anyone else, and I was greatly fearful about my own risk for "going crazy."

Q: What could be done to diminish this stigma?

A: It will take work at different levels to conquer stigma. At the level of policy, we need parity, and we need to get inherently discriminatory laws off the books. Now that public mental hospitals are almost entirely closed, we need funding for community programs to bolster deinstitutionalization. For society overall, we need empathy, not fear and blame.

In the media, a different and more realistic set of images of people with mental disorders - the true stories, neither heroic nor demonic - need to be told.

Families, blamed for causing mental illness (via faulty parenting) for much of the past 100 years, need advocacy, education and support. Individual treatment is important, too.

That is, part of the answer lies in a more accepting society, but mental illness is indeed an illness, requiring treatment. Overall, work at any one level won't be enough. We need top-down (policy) and bottom-up (acceptance) procedures.

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