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10.23.13

The Enduring Stigma of Mental Illness

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HeadThe destigmatization of disease is among the most important public health achievements of the past century, one of the most dramatic examples of which can be seen with HIV and AIDS. In the early days of the epidemic, an HIV-positive status was linked with socially undesirable personal characteristics, e.g. homosexuality or Haitian ancestry, or “deviant” behaviors, e.g. promiscuity or injection drug use. Such stigma not only greatly increased the suffering of people living with HIV (PLHIV) (along with battling the disease itself, they also faced social marginalization and the loss of support networks), it also thwarted public health measures meant to stop the spread of the infection and care for those already ill. In the face of such overwhelming stigma, many chose not to get tested—or treated—for fear of others finding out.
While stigma still remains, civil society groups, joined much later by governments, have successfully reframed HIV and AIDS, empowering PLHIV rather than demeaning them. This is an incredible success story, taking place over just a few decades.
Unfortunately, mental illness has not enjoyed such a rapid destigmatization. Despite several decades of attempts to reframe mental health, those suffering from mental illness are still met with misunderstanding, stigma and fear. A recent front-page story in the Sun, the highest circulation newspaper in Britain, has highlighted the astonishingly high level of discrimination that still exists against the mentally ill. The alarmist headline, which takes up most of the Sun’s front page, decries “1,200 killed by mental patients.”
The headline sparked a flood of negative feedback from civil society and even UK MPs. Even the usually staid Lancet entered the fray, describing the true figures behind this panicked headline. Despite the implication of the headline, homicides committed by the mentally ill are in fact declining. Moreover, the mentally ill are far more likely to be victims than perpetrators of violence. One study found that a mentally ill person is five times more likely to be assaulted, when compared with the general population. Violence, stigma, and the suicidal ideations that sometimes accompany mental illness also lead to much higher, and rising, rates of suicide and other types of self-harm.
As the Sun’s headline illustrates, the mentally ill and their advocates face formidable challenges in dispelling stigma. While the experience of HIV and AIDS provides valuable lessons, there are two factors that make dispelling stigma among the mentally ill more challenging. First it can be difficult for those living with severe mental illness to advocate for themselves in public forums. Second, one of the most potent tools for AIDS campaigners was to humanize their subjects – to show that PLHIV were essentially the same as anyone else. Mental illness, on the other hand, can shape personalities and behaviors, reinforcing the “otherness” of the mentally ill, making compassion more difficult.
In the end, dispelling the stigma surrounding mental illness will require consistently challenging false or misleading information (such as the Sun headline), countering these attacks with contrary evidence. The vocal reaction to the Sun’s headline is an encouraging sign that, while stigma against the mentally ill still exists, many others are willing to stand up against discrimination, fighting prejudice with facts.

Comments

  • Katherine Record says:

    Excellent commentary on the dialogue that the mentally ill have not yet advocated for better access to treatment as the HIV movement did. Yet to distinguish the two by a shaping of personalities that results in otherness is short sighted. Untreated mental illness contributes to otherness that results in self-perpetuating stigma just as untreated HIV – and ultimately AIDS – did in the 1980s and 90s. Individuals with mental illness have failed to successfully fight this stigma because there is no adequate treatment – antipsychotics remain outdated, ineffective for many, and riddled with toxic side effects. When science catches up with the diseases that plague the brain, mental illness will shape personality only to the extent that untreated HIV causes wasting. In other words, when we treat disease, the individual no longer wears the diagnosis on his/her sleeve, and the stigma fades.

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