Mental Illness and Stigmatization

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:

• Mental Illness: The Stigma of Silence - http://www.huffingtonpost.com/glenn-close/mental-illness-the-stigma_b_328591.html  
• Mental Illness Stigma Persists Among Americans - http://www.medscape.com/viewarticle/729174
• Mental Health - http://www.webmd.com/mental-health/default.htm
• Despite Deeper Understanding of Mental Illness, Stigma Lingers - http://www.npr.org/blogs/health/2010/09/17/129937437/still-a-stigma-for-mental-illness
• Exploring Mental Health, a Serendip resource

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 Nijinsky…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. (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