“You’ll be fine as long as you can avoid going native.” These were the words spoken to me when I said I might be interested in psychiatry. If we were being unkind (and possibly correct) we would say that this statement belies evidence of stigma against mental illness and those who deal with it professionally. It even hints at the idea that mental illness is somehow contagious or catching. Who knows how such an “infection” could be spread. Be careful when sneezing while depressed I suppose their advice might be.
If we were being more forgiving we might decide that this person was merely showing a concerned attitude, highlighting the difficulties inherent in having a mental illness and in being responsible for the health needs of those experiencing it. Either way, this brief conversational snippet can be used to highlight not only the stigma against those with mental illness but the spread of that stigma to those that care for them.
Stigma can be described as a sign of disgrace setting a person apart from others. Erving Goffman, noted sociologist, defined stigma as, “the process by which the actions of others spoils normal identity.” It is common for people with mental illness to feel invisible or that their needs are not being met. They feel people assume they’re “benefits scroungers” and that they should “pull themselves together”. Casual language used to describe mental illness is decidedly negative. He or she is described as going “crazy”, “loony” or “psycho”. I haven’t seen the film, Psycho, but I suspect the emphasis isn’t on hugging. Media portrayals of mental illness reinforce stigma with images of violence with mental ill-health.
Family members of those with mental illness are affected with so called “courtesy stigma” or stigma-by-association. But when thinking about courtesy here, think less about opening doors for others and more about unnecessary guilt. Many relatives feel it necessary to hide the mental health problems of their nearest and dearest. In one study of 156 parents and spouses of people experiencing a first-admission to hospital for mental health problems, 50% reported making efforts to conceal their relative’s illness from others.1
Secrecy can act as an obstacle to presentation and to the treatment of mental illness at all stages. As such when social resources are mobilised, people with mental health issues and their families may be removed from potential support. It follows that poorer outcomes are likely.
Depending on the illness and its severity, the help and support provided by friends and family can be of great importance when it comes to successfully treating mental health problems. But families must remember there’s only so much they can do and that their own lives are important. Families must realise they are not to blame, that it is ok if they feel stress when a loved one has a mental illness. As such stigma by association must be reduced to aid this process. The Royal College of Psychiatrists and Rethink Mental Illness has some great resources for aiding families of those with mental illness with this in mind. So does Mind of course.
Logically an increase in the accuracy of information available would be an ideal way to reduce courtesy stigma. If it was widely known that stereotypes such as that of the “violent mental patient” or the “neglectful parent of a mentally ill child” were false then it would seem stigma could be reduced. However research on reducing mental illness stigma, highlights the importance of what information is used.
In one study participants who were told that mental illness had a genetic basis were more likely to assume that people with mental illness were dangerous compared to individuals told that mental illness was explained by social factors. Additionally those told mental illness had a genetic basis were more likely to stigmatise the families of those with mental illness.2. If we are going to use an information-based approach to reduce mental illness stigma we are going to have to be very careful about what information is used.
Ultimately then we can see that while it is obvious that those with mental illness need support and would benefit enormously from stigma reduction, the same can be said of family and friends who will be providing the majority of this support. The familial and social networks of individuals with mental illness are the backbone of their support and we mustn’t let stigma create an invertebrate system of isolation for these caring individuals.
1. Phelan, J. C., Bromet, E. J. & Link, B. G. (1998) Psychiatric illness and family stigma. Schizophrenia Bulletin, 24, pp115–126.
2. Read. J. & Harré. N. The role of biological and genetic causal beliefs in the stigmatisation of “mental patients”. Journal of Mental Health. 2001. 10 (2), pp 223-235.