Mental Illness: Still Stigmatised! (I’m Shocked Too)

I happened to be browsing through The American Journal of Psychiatry the other day1 when I noticed an article discussing the persistence of stigmatised social attitudes about mental illness. Researchers conducted a study using brief vignettes and asking respondents to discuss their reactions to them2. The study found two interesting things:

The first was that a greater percentage of the population understands the neurobiological origins of mental illnesses. Not only do people have a better understanding of the origins of mental illness, but they are also more likely to recommend treatment for the people described in the vignettes. People support services for individuals with mental illness, in other words, although it’s important to note the publication this appeared in; it’s clear that these ‘services’ are heavily skewed towards psychiatrisation, and it’s also important to consider that this can correlate with increased pressure on people who choose not to pursue treatment.

The second thing they found was that although people understand mental illnesses better than they did before, there hasn’t been a significant change in terms of attitudes about mental illness. Despite social campaigns organised by a number of groups, social attitudes about mental illness are primarily negative and people continue to hold a lot of false beliefs about mental illness.

People understand mental illness better, but it hasn’t changed the way they think about people with mental illness. Given that 20% of people in the US experienced symptoms of mental illness in 2009, this is a disturbing finding. Many of the respondents probably had mental illness themselves, though not necessarily the illnesses discussed in the study, or know some of the one in five people who experience mental illness in the United States.

As the article itself says:

Public attitudes matter. They fuel ‘the myth that mental illness is lifelong, hopeless, and deserving of revulsion.’ …Attitudes can translate directly into fear or understanding, rejection or acceptance, delayed service use or early medical attention. Discrimination in treatment, low funding resources for mental health research, treatment, and practice, and limited rights of citizenship also arise from misinformation and stereotyping. Attitudes help shape legislative and scientific leaders’ responses to issues such as parity, better treatment systems, and dedicated mental illness research funds.

What this study shows is that beliefs about reduction of stigma appear to be erroneous, suggestive that campaigns to end stigma are, perhaps, not working as well as intended. Indeed, some of these campaigns seem to actively reinforce stigmatised attitudes about mental illness.

I write a lot about pop culture, here and elsewhere, both because I love pop culture and I think it’s important. This study reminds me of the information about mental illness that people absorb through pop culture consumption. What people learn about mental illness from pop culture is that it is scary and that people with mental illness are frightening and dangerous. But, ‘they’ can be controlled with the use of medication. Both of these attitudes are clearly reflected in the study, which tells us that more people support treatment while still feeling negatively about mental illness.

The increased understanding of the neurobiological origins of mental illness can be attributed to a lot of things, I suspect, but one of them may well be the popularity of mental illness storylines on medical dramas. House, for example, often uses mental illness and includes expository scenes with (some) medical information. This, along with Dr. Google, results in a lot more understanding about the workings of the mind. On the surface, this might seem to be a good thing, but not when it fails to be presented with a shift in depictions of mental illness.

It’s all well and good for people to learn that, for example, people cannot control or prevent the onset of schizophrenia, and that people with mental illness aren’t at fault for what is happening in their minds any more than people who have asthma are at fault for having difficulty breathing. This is an important thing to convey to members of the public. But when it’s paired with a storyline involving violence or deceit on the part of the patient, it still leaves people with the impression that mental illness is bad. It might not be someone’s fault, but people are still bad because they’re mentally ill.

This is why we talk about things like the depiction of mental illness in pop culture: Because people take things away from what they engage with and they apply those things to their larger lives. Someone who learns about mental illness primarily by watching, say, House or Grey’s Anatomy may learn more about the medicine behind mental illness, but doesn’t take away anything new about the human beings involved. When TV shows tell us primarily that mental illness is a frightening unknown that can be controlled with medication, that doesn’t do much to break down social stigma.

Campaigns attempting to destigmatise mental illness have used a variety of creative media for trying to get their point across, from having people with mental illness enter classrooms to talk to students to running advertisements. If you ask me, they might be more effective if they went straight for the heart of pop culture; getting more mentally ill people involved in consulting when it comes to how we are depicted, publicly addressing stigmatised depictions of mental illness in pop culture, and challenging creators of pop culture to integrate more positive and factually accurate depictions of  mental illness.

  1. No, really.
  2. If you’re interested in seeing a critique of the study methods, they handily printed an editorial in the same issue.

7 Comments

  1. Just curious, but I don’t suppose you’ve been watching Mental? I thought the first season did a good job of showing the different issues involved, but I’d be interested in hearing the perspective of someone better versed in these things than I am.

  2. Some time ago, I was reading the results of a study that said that the stigma of mental illness in the US had actually increased in proportion to people understanding its neurobiological origins. The problem is that, in the the popular mind, the understanding of mental illness as neurobiological tends to set people with mental illness apart, as “other,” with processes outside of the person’s control.

    The author contrasted attitudes about schizophrenia in the US with attitudes in Mexico, and found much more inclusion in Mexico. He found that family members of schizophrenics often called them “nervios,” nervous ones, which at first glance seems dismissive, but it was often in the context of “yes, I’ve been a nervio at times myself.” In other words, family members and, by extension, community members, saw schizophrenia as something akin to what they had felt at some time in their lives (though they themselves were not schizophrenic) and did not consign the person to the realm of scary other. I believe that this is what people popularly call “empathy.” ­čÖé

  3. There are two other real issues with campaigns that focus on neurobiological aspects on mental ill health. The first is that in a society which is already loaded with ideas about people with mental ill health being dangerous, folk struggle to differentiate between “people cannot control or prevent the onset of schizophrenia” type messages and “people with schizophrenia cannot control their behaviour.”

    There was a major UK study on this earlier this year… sorry I can’t find it for you just now. I shall have a proper look later. But it found that the messages from such anti-stigma campaigns made people more sympathetic to people with severe mental ill health, but less comfortable being around them, working with them and so on.

    The other problem is that a lot of these campaigns, even by mental health charities who should know better, tend to focus on changing doubt and fear to *sympathy* rather than respect and acceptance. So there’s this whole “just like any other illness” vibe – but that’s about trying to squeeze people with mental ill health into a mold which is already a bad fit for people with chronic physical illness. To make all our stories tragic and harm-warming, but to keep us firmly “other”.

  4. The other problem is that a lot of these campaigns, even by mental health charities who should know better, tend to focus on changing doubt and fear to *sympathy* rather than respect and acceptance.

    I recently read a book about schizophrenia, which was on the one hand awesome (it introduced me to lots of writers and activists who have/have had that diagnosis and say lots of cool things) and on the other hand terrible (I had to put up with the author, who is a doctor whose sister had schizophrenia).

    Not only was the dude all for forced medication/hospitalization (“people with schizophrenia aren’t violent…unless it boosts my argument”), and seemed to think that meds were Charlie the Magical Status Quo Unicorn, but was always going on about how we should end stigma. And then he would say things like “the mental health system is more thought-disordered than the people it’s trying to help.” Repeatedly. It did not occur to him that using mental illness as a shorthand for “does not make sense” or “ridiculous” is, in fact, stigma.

    What makes this even more amazing is that one of the awesome people this dude quoted from, Dr. Frederick Frese, has pointed this out:

    “Since the time when we were very young we have all been conditioned to accept that if something is crazy or insane, its worth to us is automatically dismissed. We live in a world that is held together by rational connections. That which is logical or reasonable is acceptable. That which is not reasonable is not acceptable.”

    Oh–and the dude is always talking about people “suffering from” schizophrenia (I would really like anyone who’s talking about someone else to treat this word like a bomb that’s about to go off in 30 seconds–don’t mess with it unless you are MacGuyver), and says at least once that we need to speak for schizophrenics because they can’t speak for themselves.

    The whole book reinforced this dynamic of: “People with mental illness need our understanding and sympathy, and need us to take care of them, and and if they disagree with us, they are irresponsible consumers.”

  5. Thanks for this article; I’m sharing it around today.

  6. Tera- I read that book. It was annoying.

    One thing I do think needs to be addressed when anyone talks about stigma is the way that different mental illness carry different kinds of stigma. Addictions carry a certain kind of stigma, which is dramatically different from the stigma of depression or schizophrenia. I wish I had time to go into details, but I fear it would be a monster-sized post if I did. I’m in grad school to become a therapist now and next semester I am taking psychopathology. I will be very curious how each disorder is addressed as we go through the DSM (our textbook). When I took the class in undergrad, it was so clear which patients other students might fear, which they pitied and which they hated. As someone with some of the disorders, it was eye-opening and frightening. If this theme reoccurs, it will be even more frightening, as everyone in my grad school is going to be a mental health professional.