The stigma of mental illness

Mental illness and those who suffer from it and even those that treat it are stigmatised.

The ideas challenged in previous blogs – that mental illness does not exist [1], is trivial [2], that treatments don’t work [3], that people with mental illness are somehow to blame for their problems [4], and are dangerous [5] – are wrong. They further increase the burden upon sufferers and their carers, and reduce financial support for services and research.

 Which is worse: mental illness or the stigma that goes with it?

For many sufferers and their carers stigma and discrimination make their problems worse and make it harder to recover.[6,7] For example, in a recent survey, the vast majority (79%) of a world-wide sample of people with depression reported having experienced discrimination in at least one aspect of their lives, and a third had been avoided or shunned by other people, because of their mental health problems.[8] Similarly, almost one-half (47%) of people with schizophrenia said that stigmatisation of their illness had made it difficult to make or keep friends, and more than one-quarter reported that it had made it difficult to get or keep a job.[9] No other group in society could be treated in this way without a public and political outcry.

As Norman Sartorius, a former director of the World Health Organization’s Division of Mental Health, said “stigma does not stop at illness; it marks those who are ill, their families across generations, institutions that provide treatment, psychotropic drugs, (and) mental health workers . . . “ .[10] It may even be that “the stigma attached to mental illness is the main obstacle to the provision of care…” .[11] The attitudes and beliefs that underlie the stigmatisation of mental illness are difficult to disentangle, but understanding them might allow us to challenge prejudice and discrimination more effectively.

A call to action

The time has come for a zero-tolerance policy of the stigmatisation of mental illness in all its manifestations. The stigma that was until recently attached to cancer has been defeated – probably through some combination of enhanced awareness and improved treatment. Mental health workers need to work with each other, service users and carers towards that goal. Just about every rational person now accepts that biological, social and psychological factors are important in the genesis and management of mental illness. Service users and care providers of various backgrounds may have philosophical differences about the relative importance of one approach over the other, but we all share an important common interest – defeating stigma.

What to do?

We should all take every opportunity to challenge the myths and misunderstandings impacting upon those with mental illness. And we should proactively promote the evidence for the benefits of treatment and seek a fairer distribution of health and research resources for mental health. Celebrities who ‘come out’ about their mental ills seem to help. Perhaps helping those who are or have been ill to do the same might be the best way of reducing prejudice and discrimination. Realistic accounts of mental illness, especially from the silent majority of people who have been ill and responded to treatment and returned to their previous social situation, are needed [12]. So are stories about research breakthroughs and novel approaches to treatment. If not shared, personal narratives of treatment success and recovery will not be heard. All agencies concerned should routinely challenge the myths about mental illness, and promote more truths, with the aim of reducing the stigmatisation, prejudice and discrimination against sufferers and those associated with them. 

REFERENCES

  1. http://mentalhealth.mvm.ed.ac.uk/2015/03/mental-illness-exists/
  2. http://mentalhealth.mvm.ed.ac.uk/2015/03/mental-illness-is-common-disabling-stigmatised-and-under-treated/
  3. http://mentalhealth.mvm.ed.ac.uk/2015/03/treatment-for-mental-illness-works-if-people-get-it/
  4. http://mentalhealth.mvm.ed.ac.uk/2015/03/mental-illness-and-violence-more-sinned-against-than-sinners/
  5. http://mentalhealth.mvm.ed.ac.uk/2015/04/mental-illness-is-not-deliberate/
  6. Mental Health Foundation. Stigma and discrimination. 2014. [Web-site: http://www.mentalhealth.org.uk/help-information/mental-health-a-z/S/stigma-discrimination/] Accessed 20th April 2015.
  7. Lawrie, S. Psychiatr Bull 23, 129-131 (1999).
  8. Lasalvia, A. et al. Lancet 381, 55-62 (2013).
  9. Thornicroft, G. et al. Lancet 373, 408–415 (2009).
  10. Sartorius, N. Lancet 370, 810-1 (2007).
  11. Sartorius,N. et al. World Psychiatry 9, 131-44 (2010).
  12. Lawrence R, Lawrie S. BMJ 345, e6994 (2012) http://www.bmj.com/content/345/bmj.e6994

 

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