Stigma of mental illness

On managing the stigma of mental illness, see S. Onken and E. Slaten, Disability Identity Formation and Affirmation The Experiences of Persons with Severe Mental Illness, Sociolo cal Practice 2 (June 2000) 99-111 E. Wright, W. Gronfein, and T. Owens, Deinstitutionalization, Social Rejection, and the Self-Esteem of Former Mental Patients, of Health and Social Behavior 41 (March 2000) 68-90. 

The selective serotonin reuptake inhibitors (SSRIs) are established and accepted antidepressants. Their easy tolerability and simplicity of use have led to their widespread use it has been estimated that at least 50 million people who would not otherwise have received treatment for their depression have received these drugs. It appears that the proportion of patients treated with tricyclic antidepressants (TCAs] has remained relatively stable and the contribution of the SSRIs has been to increase substantially the size of the patient pool receiving treatment for depression. It is fair to say that the advent of the SSRIs has facilitated more ready discussion of depression and has reduced to some extent the stigma of mental illness. The development of the SSRIs has made it more acceptable for patients to come forward for treatment, although... 

The responsibility of caring for a patient usually falls on members of the family. Thus, they are not simply uninvolved bystanders. For example, it is not unusual for family members to prompt the patient to make the initial appointment with the therapist or physician. Because of the stigma of mental illness and the patient s worries about burdening family members, the family may not be fully informed on the health status of the patient. This lack of knowledge may be related to conflictual relationships in the family and a patient s preference to keep family members uninformed. 

The instruction to let go of the shame attached to mental illness can be exceedingly hard to follow. Cultural attitudes are changing, but not nearly fast enough to insulate most sufferers from the stigma that multiplies the pain of mental illness. As the stories in this book have shown, most interviewees were extremely cautious in revealing their problems. At the same time, many of them successfully shed the self-blame that typically accompanies emotional illness. They speak best for themselves ... 

Stigma and misinformation can also extend into medical practice, where many depressed patients present with medically unexplained symptoms. Somatization is the term used for such use of physical symptoms to express emotional distress, which may be a major reason for misdiagnosis of mental illness by medical and psycho-... 

Corrigan PW, Watson AC, Miller FE. 2006. Blame, shame, and contamination The impact of mental illness and drug dependence stigma on family members. J Fam Psychol 20 239-246. 

In short, then, the concept of mental illness constitutes the general stigma class of Institutional Psychiatry, with specific psychiatric diagnostic categories or entities —such as addiction, psychopathic personality, or schizophrenia serving as members of this class. 

The stigma attached to mental illness is pervasive and affects the lives of people with mental illness. It makes the patient reluctant to come forward and ask for help. It makes rehabilitation after an episode of illness difficult. It contributes to the loss of self-esteem of the person who has the illness, a consequence that is particularly nefarious because it often blocks full recovery. Stigma also affects the members of the family, making them reluctant to admit that one of them has a mental illness and may need treatment, ft demeans institutions in which treatment is provided as well... 

As nylon and the plastics revolution became a part of modern life, the figure of Carothers receded tragically into the shadows. The horror of his death, the social stigma attached to mental illness and suicide, and prevailing social codes that discouraged the discussion of personal tragedies contributed to an atmosphere of secrecy that surrounded his life. As late as 1979, the Encyclopaedia Britannica credited Father Nieuwland with the discovery of Neoprene. 

The onset or exacerbation of a mental illness can also have a centripetal pull on families. However, because of its stigma, it can also have a centrifugal effect. For example, many patients attempt to hide their depression or anxiety to avoid burdening their families or to protect a secret, such as an affair, that is associated with the distress. Whereas a physical illness, like cancer, can lead to an outpouring of family support, the shame that accompanies mental illness can often fracture relationships and contribute to significant loneliness. When we encounter these fractured relationships, we attempt to open communication, educate the family, and increase social support. 

Mental illness still carries a sense of stigma, shame, and blame that goes well beyond that found in almost any other type of illness. It is perhaps fair to say that this is no small part because of the difficulty one has with conceptualizing the brain. Unlike the heart or the kidney or the liver, which can be broken down fairly easily into form and function, to most people the brain remains unfathomable. The problem is it does so much. It governs our beliefs, values, emotions, actions, and aspirations. Perhaps unsurprisingly, then, the worst thing that can happen to a person is failure of the brain. 

Clients and their family members are faced daily with the stigma attached to mental illness. Many people view the mentaUy ill, especially people with schizophrenia, as dangerous. The use of words like maniac, schizo, and psycho by uninformed media enforces this viewpoint. The media often present the mentally ill as dangerous individuals just waiting for the opportunity to explode, when in reality people who do not have such illnesses commit 95% of all homicides. Those with schizophrenia are more likely to harm themselves than someone else (Ferriman, 2(KX)). This tendency to harm oneself often rests with the guilt that many clients feel as they blame themselves for their illness. 

---