Ending Mental Health Stigma

As I write this article, my heart is filled with the hope that the readers are able to understand mental health better and we reach a step forward towards ending the stigma attached with mental health. This article is not about my story. It is about the struggle of every individual who has or is suffering from mental illness.

At the age of 17, I was diagnosed with panic disorder. I feel blessed to have the fortune of receiving the treatment I needed. I also acknowledge the fact that there are millions of people in this world who are not fortunate enough to receive the help they need and my heart goes out to each such individual. While struggling with my mental illness, I was forced to deal with the toxic stigma attached with mental illness. Unfortunately, I am not the only individual who has dealt with the judgement and shame that comes complementary with mental illness. Even today, there are millions of people fighting a battle with not just their illness, but also with the stigma attached to their illness. So, my question is simple and one worded “WHY”. Why is mental health stigmatized?

Ervin Goffman, a psychologist and writer defines stigma as “an attribute that is deeply discrediting, that reduces someone from a whole person to a tainted, discounted one”. In simpler words, stigma refers to a mark of shame or discredit. Mental health stigma refers to societal disapproval, or when society places shame on people who suffer with mental illness. It is the negative attitude or discrimination against someone based on their mental health condition.

Stigmatization of individuals with mental illness has a long tradition and the word “stigmatization” itself indicates negative connotation. In ancient Greece, the word “stigma” was used to mark slaves or criminals. For centuries, society did not treat the patients of mental illness much better than slaves or criminals. During the Middle Ages, it was believed that mental illness was caused by demonic possession, witchcraft or an angry God. Abnormal behavior was viewed as a sign that the person was possessed by a demon. There were several treatments for a person possessed by a demon. The most common treatment was exorcism, often conducted by a priest or other religious figures. Another extreme form of treatment was trephining. A tiny hole was made in the skull of the afflicted individual to release spirits from the body. Most of the people treated in this manner died. Other practices involved the execution or imprisonment of mental illness patients. From the late 1400s, a common belief was spread by some religious organizations that patients of mental illness had made a pact with the devil and committed horrendous acts, such as eating babies. These people were believed to be witches and were burned at stake or thrown into penitentiaries and madhouses where they were chained to the bed or wall.

“The problem with the stigma around mental health is really about the stories that we tell ourselves as a society” – Matthew Quick

The stigma attached with mental illness has mainly two types; social stigma and self-stigma. Social stigma, also known as public stigma refers to prejudice and negative stereotypes against patients of mental illness. Social stigma results in discrimination. Whereas, self-stigma is the process in which an individual with mental illness internalizes the stigma. This results in low self-esteem and self-efficacy and delays the individual’s recovery. Both these stigmas have created a reluctance in people to seek help due to the fear of being shunned or rejected by others.

The stigma attached to mental illness is ubiquitous. There is no country, society or culture where people with mental illness have the same societal value as someone without a mental illness. They face difficulties in accessing basic life necessities such as obtaining employment or renting an apartment. A survey in 2011 revealed that almost nine out of ten individuals with mental illness had experienced discrimination in England. Far more than any other type of illness, mental disorders are subject to negative judgements and stigmatization.

Imagine, society blaming people for being diagnosed with illnesses such as cancer. Holding them responsible for their condition and making them feel guilty for a situation that is in no way their fault. Wrong and heart wrenching, right? For centuries, patients with mental illness are treated like this. Ervin Goffman, a psychologist and writer, has written in his book “The Presentation of Self in Everyday Life”, that “society is organized on the principle that any individual who possesses certain social characteristics has a moral right to expect that others will value and treat him in an inappropriate way”.

Many studies and surveys have revealed that individuals suffering from mental illnesses are among the most stigmatized, discriminated, marginalized, and vulnerable members of our society. Mental health patients often say that the stigma attached with their illness and the discrimination they experience makes their difficulties worse and makes it harder for them to recover.

Mental disorders are widely present in individuals all across the world. One in four people have mental illness. Presently over 800 million people in the world suffer from some form of mental illness. In India, more than 90 million people suffer with mental disorder. Due to the stigma attached with mental health, more than 80% of these individuals do not seek the help they need. Just like any other illness, mental illness has the tendency to deteriorate if untreated. A delay in treatment can worsen the condition of the individual and if untreated for a long time, these individuals often indulge in deleterious activities like substance abuse, self-harm and even suicide at worst. According to the World Health Organization, more than 1 million people die from suicide every year, which is one person every 40 seconds.

“The root of this dilemma is the way we view mental health. Whether an illness affects your heart, your leg or your brain, it’s still an illness, and there should be no distinction” – Michelle Obama

Unfortunately, we live in a world where if you break your arm or leg, everyone runs over to sign your cast and sends you best wishes. But if you tell people you’re depressed, everyone runs the other way. We are so open and acceptive to the idea of any body part breaking except for the brain.  The symptoms of depression, anxiety, OCD etc., may not be as clear to see as the symptoms of a broken bone but this does not mean that these illnesses are not serious or damaging.

Individuals with mental disorder often struggle to do the bare minimum. Imagine, not having the energy to get out of bed in the morning. Individuals struggling with depression often struggle to do the bare minimum of even waking up in the morning. Imagine, an unwanted thought being involuntarily repeating in your mind. Individuals struggling with OCD struggle with unwanted repetitive thoughts that pushes them to act compulsively or repeatedly enact an activity in order to get rid of the thought. Imagine, walking into a room full of people thinking everyone is judging you. Individuals struggling with anxiety often struggle with social anxiety and fear going to crowded spaces. Imagine, being utterly scared of crossing the road. Individuals struggling with schizophrenia often struggle with irrational fears that hinders them to perform basic life activities. Imagine, binge eating only to puke it all out later. Individuals struggling with eating disorders like bulimia or anorexia, view themselves as overweighted. To prevent gaining weight, they force themselves to vomit the food out or overexercise.

People with mental illnesses are silently fighting a battle every day. It is the society who fails to see and recognize their struggle. It not only fails to recognize their struggle; but also makes their lives difficult. The society often labels individuals with mental illnesses as; “crazy”, “mad” or “insane”. They are made to feel unwanted and unaccepted by the society and are often viewed as attention seekers or difficult to deal with and are isolated by the society. People view mental disorders like depression and anxiety as self-inflicted and often pass remarks like “its all in your mind”, or “don’t overthink it”. Often, when individuals struggling with mental illness tell their family or friends about their illness, people often don’t believe them. Imagine, having one of the hardest conversations of your life and your family and friends respond with, “you’re not sick”, or, “you look fine to me”. Every time an individual’s struggle with mental health is invalidated, the idea that they should struggle in silence is reinforced.

“What mental health needs is more sunlight, more candor, more unashamed conversation”. – Glenn Close

While talking about mental health stigma, we cannot overlook the fact that millions of people don’t have the accurate understanding of mental illness. So how do we expect the stigma attached with mental illness to end when most people don’t have the right understanding of it?

For instance, there is no doubt that we have heard or come across terms like depression, anxiety, OCD, bipolar disorder, post traumatic stress disorder (PTST), eating disorder, schizophrenia etc., at least once in our life. However, how many of us know what these terms precisely stand for? The probability of even one person out of ten, knowing the actual meaning of the mentioned term is quite low. Depression, anxiety, OCD, bipolar disorder, PTST, schizophrenia, eating disorder etc., are mental disorders. Mental disorders or illnesses, refers to a wide range of mental health conditions that affects a person’s mood, thinking and behavior. Sadly, in today’s time, the misuse and misinterpretation of these medical terms is very common. It comes as no shock that people often pass remarks like “Is she Bipolar”, or “Is he depressed” or “That’s so OCD”. Mental health conditions are very commonly used as figure of speech. Most people think OCD is a condition where an individual is extremely organized and even a slight disorganization exasperates the individual. However, this is an inaccurate understanding of OCD. OCD is a mental disorder categorized by intrusive, unwanted and disturbing thoughts that can cause individuals to ruminate, and feel guilt and shame. These thoughts usually cause individuals to act compulsively in order to get rid of the thoughts. Symptoms of OCD stretch much farther away than just the fear of germs or the need to be organized. Compulsive behavior, agitation, ritualistic behavior, anxiety, irrational fears, repetitive movements, continuous repetition of thoughts, hypervigilance are some of the other serious symptoms of OCD. This is a small example of how mental illness is misapprehended.

Even though there are several misconceptions about mental illnesses, there is no logical or scientific reason for the stigma attached with mental illness. Several studies have shown that stigma is the result of lack of awareness and knowledge about mental health. The lack of awareness essentially creates false connotation and negative perception. The root of the stigma lies in the very core of our society. It is an odd paradox that we live in a society where one can speak unabashedly and openly about topics that were once considered unspeakable, but still remains largely silent when it comes to speaking about mental illness. It’s as if talking about mental health is wrong. If we don’t even talk about mental health openly, how do we expect the stigma around mental health to end?

The media also holds responsibility in contributing to mental health stigma. The coverage of mental illnesses by the media has been consistently negative and imprecise. Television news, newspaper, entertainment programs, movies play a major role in disseminating biased information about mental illness and strengthens the negative stereotype about mental illness. It crystallizes a biased image of patients with mental disorder and portrays them as a threat to society or difficult to deal with. Despite playing a huge role in influencing people, the media continues to misinterpret mental illness.

There is no doubt that it is high time for mental health stigma to end. There are various approaches to end mental health stigma. However, everyone needs to understand that it is our responsibility together to build a society where individuals are not discriminated based on their mental health condition. Each one of us needs to play an active role towards ending the stigma. It is the only way to achieve a society where individuals are not afraid or ashamed of seeking help for their mental health condition.

As mental health stigma is the result of lack of awareness and knowledge, to end the stigma, it is extremely important to educate people about mental health. There are various strategies to achieve this. Educational campaigns are one way. These campaigns focus on spreading awareness and educating individuals about mental health. In 2009, a mental health anti-stigma campaign was launched in England. It was led by the mental health charities Mind and Rethink Mental Illness and was funded by the Department of Health, the Big Lottery Fund and Comic Relief. Educational campaigns often involve individuals who have suffered with mental illness to come forward and share their personal story, either through video clips or face to face in workshops, with an emphasis on hope and recovery. Such intervention can inspire people to seek help and also helps to change the perception of mental illness.

Educational institutes like schools, colleges, universities, etc. also need to conduct workshops to spread awareness about mental health. If the future generation is rightfully informed about mental health at a young age, the chances of their contribution in the stigmatization of mental health are much lowered. These institutions need to teach students to prioritize and take care of their mental health and to be acceptive of other individuals struggling with mental illness. Students should be provided with the facility of being able to consult a clinical psychologist if they’re struggling with their mental health. Mental health should be openly discussed by teachers and parents to ensure precise understanding.

As the media plays a major role in influencing people, it needs to rightfully depict mental health. The media should not be allowed to wrongfully portray mental illnesses and there needs to be strict actions taken against the wrongful portrayal of mental illness by the media. The media needs to use its platform in the right way by helping in spreading awareness about mental health. It should cover stories of individuals who have struggled with their mental health to give out hope to the one who are presently struggling. Television news and entertainment channels should also air debates and open discussion about mental health by doctors and experts.

Individuals who have struggled with mental illness should also try to come forward and share their experience. The experiences shared by individuals hold the power of inspiring and touching people more than any facts or statistics. When people talk about their struggle, it often helps as people are able to relate to it more. These experiences also help in spreading knowledge about mental health. They give the hope of recovery to individuals struggling with their mental health condition. The more people come forward and talk about mental health, the more awareness about mental health is spread.

At the end of the day, we must understand that change begins within. We cannot change others until we change ourselves. When every individual will think and act this way, the society will definitely change. We must remember the emphasis of being kind to others. None of us have any idea what others carry with them every day and what their life is like. So, we should try not to bring more pain and stress in the lives of others. It is not our job to determine if someone’s mental or emotional struggles are valid. Our job as a fellow human is to be compassionate and supportive of other people’s struggle, no matter how big or small we interpret their pain to be. Together let’s work towards replacing mental health stigma by mental health support.

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The author of this article is Ms. Aeshita Sharma.