Stigma and mental health: a one-sided conversation

L0026693 A man diagnosed as suffering from melancholia with strong su

A man diagnosed as suffering from melancholia with strong suicidal tendencies. This is what people thought people with mental illness looked like before they all started looking out of windows with their heads in their hands. 

What is stigma?

Stigma is basically a word for discrimination. Slightly more technically, stigma has been described as a sign of disgrace that is perceived to set a person or group of people apart from others. It’s also a Greek letter, although everyone that uses it in that way is rubbish. Stigma can affect many groups, including people with mental health problems, the elderly, and a third less serious group that I was going to include as a joke, but didn’t because it would increase stigma too much.

The casual use of language stigmatising mental illness is exceedingly common. If you’re a bit angry you might be described as mental or psycho. If you put a book away you might be called obsessive compulsive. Media portrayals reinforce stigma by constantly associating images of violent and homicidal individuals with mental ill health. The Eurovision song contest recently got in on the stigmatising act by parading a person in a Eurovision-themed straitjacket for so called crazy fans and having one of the hosts proclaim “You know what they say – crazy is the new black.” Which is definitely saying like, “Half a cup of thunder makes the bears look at the handbag” and “You don’t have to be crazy to use stigmatising language, but it…oh…I see…I’m sorry.”

Even children’s television seems to have gotten in on the act. A study in the British Journal of Psychiatry found that during just one week’s worth of children’s television, 59 out of 128 programmes contained one or more references to mental illness. Terms like “crazy”, “mad” and “losing your mind” were commonly used to portray that a character was losing control. Six characters were identified as consistently shown to have a mental illness. These characters were almost totally devoid of positive characteristics. Luckily, children aren’t impressionable and don’t learn or pick up attitudes easily.

Does it really matter if people are offended?

In the great scheme of things, not really. Overall, it’s probably not good to upset people, although that largely depends on context. If you’re using abusive language and someone says your awful because of you’re abusive language and this upsets you, then you’re upset doesn’t matter a Katie Hopkin’s opinions worth. If someone with severe anxiety is offended because you’ve told them to “stop worrying”, then that does matter. You’re belittling a potential illness, and ignoring and heightening their distress. We’ll deal with these cases of offence on a case by case basis until we’ve Gervaised the lot of them.

Stigma

I really wouldn’t recommend searching for “prejudice” in order to find images for your blog post.

However, this isn’t really about people being offended. It’s about the harm that can be caused by language and attitudes. Stigmatising attitudes towards people experiencing mental illness are responsible for substantial additional distress, as well as reduced employment and social opportunities. In addition, stigma can lead to hate crimes, a decreased ability to access appropriate healthcare and reluctance to seek appropriate help (if that help is even available). In fact, the stigma surrounding mental illness has been identified as the primary barrier to providing mental health care and the delivery of treatment. It turns out that if large portions of society hold negative beliefs about a group that aren’t necessarily true, then that group suffers.

So I’m banned from using certain words?

Not at all, but it would be nice if you thought about what you were saying and the impact it might have. Unsurprisingly in a matter involving language and society, there’s a lot of nuance involved. If I privately say “my cat is going bananas” while my cat does something adorable like climbing up the curtains or becoming non-fictional, then I’m probably not doing any harm. If I loudly proclaim to a crowd that another person who is shouting “has gone schizo” then that’s another matter. I don’t know who’s listening, who might be upset and who might avoid social situations or potentially getting help to avoid similar judgement. If you don’t believe in the potential impact of your words in this setting, perhaps you should look at the research, or at least have more confidence in yourself. You can make a difference!

Well, what other words can I use?

I’m pretty sure there are quite a few words that aren’t stigmatising towards people with mental health problems. There’s probably a word for that situation. I’ll check the dictionary. Anyway, a bit of variety in your insults will make you look more intelligent, which is always nice.

Sanakniigu

A good source of awful words.

Why are people so thin skinned?

It’s not really about being offended (as discussed previously), but if we’re talking about people with certain diagnoses then there is evidence that negative terms can have greater impact than in people without those diagnoses. For example, much research has shown that people with clinical depression have what’s called a negative cognitive style. That is to say they’re much more likely to focus on or attend to the negative aspects of any personal experience and to an extent may be unable to focus on positive or neutral aspects. Conversely, other studies claim that this tendency differs across individuals with the depression with some people focusing on negative information, while others pay equal attention to negative and positive information but remember negative information more efficiently than those without depression. Either way, telling someone with this problem to just ignore the bad stuff isn’t helpful. Like telling someone with their foot caught in a bear trap to just walk it off.

I have a mental illness and it doesn’t affect me like that!

That’s good. However, there are other people who it does affect.

Isn’t this just being pedantic about language?

“Just”?!

But you got several phrases regarding mental health wrong!

Probably, and I apologise for that. I daresay I’ll do it again, but I’ll try and do better. Which is hopefully what we’re all trying to do. Not you though. You’re perfect. You’re hair is particularly good.

In fact, a bigger problem is that throughout this post I’ve essentially referred to people with mental illness as a homogenous group. This obviously isn’t true, just as it wouldn’t be for any large group of people. It also potentially marks a large proportion of the population (1 in 4 is often bandied about, although I can’t find a good reference for that figure) as an outgroup. I certainly don’t want to do that, and a large part of reducing stigma should probably be in getting people to consider that the group they’re stigmatising contains as much variety in personality as any group they consider themselves a member of, that that group contains people just as capable of experiencing harm as they are (more so in some cases) and that their words have the power to impact real-world events. Easy done.

Are you finished yet?

Yes.

 

Image credits: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org A man diagnosed as suffering from melancholia with strong suicidal tendency. Lithograph, 1892, after a drawing by Alexander Johnston, 1837, for Sir Alexander Morison. 1837-1892 By: Alexander Johnstonafter: Alexander Morison and Byrom BramwellPublished: [1892]

By Ilja.mos – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=46665757

 

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7 thoughts on “Stigma and mental health: a one-sided conversation

  1. Interesting.
    I think that language may have evolved over the last few decades so that some words that were very specifically linked to mental health (e.g. ‘crazy’) are now seen as having moved away from the source and are now perceived to mean ‘unconventional, wild abandon, etc.’ – and often with a very positive slant (Prince: ‘Let’s Go Crazy’). So there’s probably a grey area. It’s certainly not a medical term. ‘Mad’ can often mean very angry, or a range of other emotions. ‘Madness’ also wanders across a few definitions, from a lack of rational thought to a fine north London beat combo.
    But ‘mental’, ‘psycho’, ‘schizo’ etc. are clearly grounded in modern terminology to describe mental health and are far more serious.
    I watched Hitchcock’s Psycho recently and the bit at the end where they discuss Norman’s mental health is truly toe-curling, as well as providing a terrible, undramatic end to the film.

  2. It’s difficult. People with no direct experience have two problems. On one hand they just don’t understand what it’s like to have a mental disorder. They may have experience of prejudice, through racism, say, but they may not relate that experience to the experience of being mentally disordered. I find this understandable.

    On the other hand there are long standing negative attitudes (fear, disgust) towards people who have, shall we say, “lost their reason”. Folk beliefs about madness or whatever we want to call it have a long history and inform societal attitudes. The adoption of terms from the medical profession belies the lack of sophistication in the way the average person understands being mentally disordered. Anyone who acts unpredictably may be perceived as a threat for example. And one of the main ways that people deal with this kind of stress is through humour and communal laughter. Maybe for us there’s nothing to laugh about, but imagine how stressful it is to be watching it happening from the outside! People are going to need to let off steam and they often do that through having a laugh.

    Constantly seeking new words that are not stigmatised, to my mind, just reinforces the sense of stigma. If I’m constantly saying to people, “you can’t refer to me with *that* word”, then I may well be breaking any nascent connection and putting them on the back-foot. Not all of the old terms are genuinely stigmatising. “Melancholia” for example is quite serviceable. “Hysteria” not so much. A lot of the DSM terminology isn’t helpful either. Try explaining “Borderline Personality Disorder” to anyone! And sometimes a technical term which is meaningful is trivialised by constant incorrect use – like Post-traumatic Stress Disorder or schizophrenia.

    On the other hand I appreciate some precision in how people use words and I don’t think of pedant as a pejorative. Communicating clearly is a valuable skill.

    Humans are social and tend to identify with the group and against outsiders. If we are mentally disordered then our behaviour usually fails to meet group norms. This results in being perceived as an outsider. It’s unfortunate, but is quite understandable.

    In asking for understanding and tolerance that goes against inherited attitudes and cultural prejudices we are asking a lot of people. Of course it means a lot to us, but without a frame of reference they might not appreciate why. And powerful social forces tend to undermine our efforts to encourage empathy.

    I have the experience, but I’m also subject to these limitations and also find it difficult to empathise at times and use words loosely and/or facetiously. It’s not unknown for me to employ black humour. Context is important. And I guess those of us who do suffer from mental disorders also need to empathise with those who don’t. It ought to be a two way street. I think endless pictures of smiling happy people on posters intended to de-stigmatise mental health problems are counter-productive. If I’m suffering then I am really not smiling and looking healthy. I look, feel, and *act* like shit. *That’s* when I need empathy and tolerance, not when I’m all happy.

    • I think this is all more or less right, and I certainly agree that there are inbuilt reasons why people assign others to out groups. Going against this behaviour may be difficult, but nobody said it wasn’t. It’s obviously doable e.g. See other slowly changing prejudice, and so must be done in this setting. Even though it will be gradual and tricky.

  3. Pingback: Stigma | myinnerworld484

  4. I really enjoyed reading this post. LANGUAGE is the source of a number of misunderstadnings. We over-simplify language as if it doesn’t effect meaning when it truly does. One cannot escape the emphaisis and meaning that words carry.

    • Glad you enjoyed it. Words are obviously capable of a lot of harm, a lot of good; with a lot of complexity surrounding which is which. All of this is the context of societal beliefs, services available and so on. Pretty hard to unpick it all.

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