Can the Stigma of Mental Health Care Be Reduced?

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MENTAL ILLNESS, LIKE physical illness, is often the result of a combination of biological and behavioral issues. Some people are genetically predisposed to heart disease, for instance, and increase their chances for developing it by eating junk food and spending too much time on the couch. The same can be said for depression. But few people feel stigmatized by heart disease, while countless numbers of those suffering from a mental illness feel shame, embarrassment or guilt over their disorder.

The stigma of mental illness has profound effects on its diagnosis and treatment. A research review of 22 studies, published in the journal BMC Psychiatry in 2010, found that stigma and embarrassment were among the most-often listed reasons why young patients with mental illness did not adhere to their medication regimens. The stigma of mental illness stops many people from admitting their problems and seeking treatment in the first place.

There’s little doubt that this stigma has lessened in recent years. Numerous celebrities, athletes and other notable figures – including Dwayne “The Rock” Johnson, Lady Gaga, Brooke Shields and Michael Phelps – have talked about their mental health issues publicly, and journalistic coverage of mental illness has opened up the discussion in ways that were inconceivable in the not-so-distant past. That’s the good news, says Dr. Jerrold Rosenbaum, psychiatrist-in-chief at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School. “The bad news is that there is still considerable embarrassment and shame about mental illness, and a desire to hide when an individual suffers psychiatric disorders,” he says. Those feelings may not necessarily be coming from the outside. “But the individual still feels it,” he says.

Dr. Altha J. Stewart, president of the American Psychiatric Association and an associate professor of psychiatry at the University of Tennessee Health Science Center, agrees that stigma has been reduced, “but, unfortunately, not enough, despite our best efforts. Many people are still reluctant to talk about their problems or ask for help.” Certain groups may be more susceptible to this. “There is a stratification by demographics,” she says. “Young people feel stigma when trying desperately to feel liked. Minority groups feel stigma because there are differences within cultures about expressing these problems and in willingness to seek treatment.”

‘A Million and One Reasons’ Stigma Exists

“There are a million and one reasons why there is still stigma” surrounding mental illness, Stewart says. One is the perception of what mental illness is. “If you see it as a character flaw or weakness, you don’t want to be seen as weak or associate with that. Generally, in our society, that was the portrayal of people with mental illness.”

There’s also a strong desire not to appear different from others at work or among friends and acquaintances. “If you are trying to have a ‘normal’ life, you don’t want others you work with or come in contact with to think you have a mental illness,” she says.

Additionally, many people deny that they may have a mental illness. “People delay recognition of their symptoms, or they say they are just tired not depressed,” Rosenbaum says. “They don’t want to see themselves that way.” Many also believe they can handle the problems themselves. “They like to think they can change things through will,” he says. “They think they have more control over their brain than they do of their liver, kidney or heart. With coronary disease, you wouldn’t say you should clean the plaques out of your arteries yourself.” That is an especially big problem among military veterans, he says. “Their sense of strength and bravery – veterans bend over backward to not see their need for help.”

Solving ‘the Casserole Problem’

There was, for a long time, stigma surrounding other diseases, such as cancer. Thanks to better understanding of the disease and more public awareness, that stigma is for all practical purposes gone. “We now have walks and colors proudly associated with this disease, and people proudly say they are a survivor,” Stewart says. “We have campaigns for heart attack, stroke, Alzheimer’s. But with mental illness it is still fairly difficult to get people to talk about it and feel comfortable about it.”

Stewart calls it “the casserole problem.” When someone is being treated for some other disease, their hospital room will be full of balloons and cards, “and when they come home, someone will give you a casserole,” she says. “With mental illness, there are no visitors, and rarely does someone bring you a casserole. That is the dehumanizing way we deal with people with mental illness.”

However, Rosenbaum says, there’s a growing understanding of the genetic factors, early life experiences and behaviors that lead to these problems. “So people sort of get it: The brain, like the heart, is an organ, and it may be prone to disease but is also influenced by what you experience, your family, good health, good nutrition,” he says.

The best way to further lessen the stigma is to increase that knowledge. “The first thing we need is to keep working on the message that mental illness is a real medical disorder, a brain disease, and that we have effective treatments that people need to take full advantage of,” Stewart says.

 

The sheer number of people affected by mental illness should, over time, help lessen the stigma as well. “We have a saying in our department: No family goes untouched,” Rosenbaum says. “We are not a terribly empathetic country right now, but I see people transformed in their feelings as soon as they get touched by it. Even people who are blockheaded about it are changed when they are touched by it.” The best way to reduce stigma, he says, is be more open and mindful of mental health issues; “in our experience, people telling each other their stories, being more aware that the person to their left and to their right may be going through it, more understanding of why this happens is important.”

Stigma, he says, is a mark of being defective, but mental illness is so prevalent, “it is really more a mark of being alive. When you do the math of how many people you are strongly connected to, and see how many people are affected by mental illness, stigma makes no sense.”

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