False Arguments, Part. 2:
Anti-Anti-Stigma

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It’s taken me a while to write part 2 of this series, and honestly I’ve been torn between several compelling topics.   But, here I land.  Just a brief re-cap before I get rolling:  The foundation of this ‘False Arguments’ series is that sometimes I, you, we… all get drawn into arguments and belief systems that are based on a particular starting point that is assumed to be, or acted upon, as if they are valid.

For example, when people engage in the same-sex marriage debate, their starting point is generally ‘Should people vote to legalize marriage between two people of the same gender?’ Arguments for ‘yes’ or ‘no’ votes typically follow.  However, the very question (or at least, how it tends to be approached) presupposes that same-sex marriage should even be up for vote.  On the other hand, those who believe that it is a civil right might argue that such rights should not be subject to popular vote at all.

What’s this have to do with stigma?  ‘Anti-stigma’ is one of those phrases bandied about by people in all corners of the conversation on ‘mental health,’ and it generally goes unquestioned.  Many refer to the ‘awful stigma of mental illness,’ as if it were something practically tangible.  But what assumptions underlie the concept of ‘stigma’ in this context?

Interestingly, the medical definition of stigma (at least, according to www.dictionary.com) is as follows:

‘A mental or physical mark that is characteristic of a defect or disease’

In this lovely definition, ‘stigma’ appears to have little to do with how others perceive or treat a person, but rather seems to be speaking about the symptoms of a disease itself.  Now, surely, not everyone who speaks about ‘stigma’ is operating within the constraints of this particular definition, but most do generally seem to be saying, “You should not judge me or treat me differently because of my mental illness.”  Take a moment to watch the following ‘anti-stigma’ video featuring Glenn Close.  No, really.  Watch it.  It’s only about a minute long.

One can only assume that the intended message is something along the lines of what I described above, though other conceivable messages include, “Look, even famous people have mentally ill family members, and aren’t they so brave for admitting to it?” or, “We had a big budget and reasonably good taste in music and this is what we did with it.”  But what on earth is the point?  Is it ‘destigmatizing’ to have human beings walking around in psychiatric label-laden t-shirts next to their arguably strengths-based label-laden friends and family?  The numbers of congratulatory remarks toward Close about her ‘courage’ for appearing in the commercials are also perplexing in their way.  Why SHOULD it be scary for a famous, wealthy, white, well-established actress to reveal that someone ELSE in her family is labeled with a psychiatric diagnosis?  Are we expected to blindly laud her for wearing a t-shirt with the risky label of ‘Sister’?  Personally, I think this might be more along the right track.

glenn close dopey

In all seriousness, I think it WOULD take courage for Close, Ron Howard and others involved in this particular campaign to admit that they were ‘dopey’ (sorry, I was limited in the words I could make out of ‘bipolar’ and ‘sister’!) for using their money and power to lead us further down this wrong track.  I hope that they come to that revelation and find that courage soon.  In the meantime, I hope everyone else will join me in wondering whether or not anti-‘stigma’ is even worth talking about anymore.

In 2010, the American Journal of Psychiatry (as produced by the American Psychiatric Association [APA]) printed an article titled, “A Disease Like any Other?“ It explored the results of a research study that evaluated (among its other points) the current ‘state’ of ‘stigma’ in our culture.  In the process, the researchers acknowledged that, “Clinicians, advocates, and policy makers have presented mental illnesses as medical diseases in efforts to overcome low service use, poor adherence rates, and stigma.”  Wonderful.  It would seem that the APA has now finally acknowledged that the medical model is an intentional creation and not an objective reality.  (If only they would so clearly acknowledge that psychiatric labels themselves are also subjective man-made concepts!)  Their conclusions are also helpful and include:

“More of the public embraces a neurobiological understanding of mental illness. This view translates into support for services but not into a decrease in stigma.”

Although no one’s quite been able to put their finger on it, most seem to recognize there’s a problem lurking in this process.  While the APA and others involved are now onto renewed explorations (including suggested initiatives to offer more “positive stories” as reportedly proposed in an article titled ‘Stigma: Alive and Well‘ and featured on the American Psychological Association’s website) in this hard-fought war on ‘stigma,’ I have another thought.

Perhaps the problem is that the idea of developing and then promoting a solely dog tailmedicalized way of understanding our distress is creating the very ‘stigma’ it seeks to eliminate.  For me, it conjures up images of a dog chasing its own tail.

Round and round we go.  Did the concept of mental illness itself create the stigma toward the concept of mental illness?  Is it our reaction to the labels or to the people (or to the labeling of the people) that is the problem?  The relentless othering of people expressing strong and yes, sometimes frightening human experiences, emotions and pain seems the most relevant.   The question can no longer be ‘How do we break down stigma?’  Instead, it must evolve into ‘How do step off of the merry-go-round of psychiatric labeling of which stigma is but a part?’  (And how do we do that, even if that merry-go-round continues to spin at a breakneck speed?)

In February of 2013 the Connecticut Mirror featured an article very much connected to this topic.  It was a highly imperfect article in some ways, but there were two great things about it.  First, it featured the impressive work of my friend and colleague, Deron Drumm and several others at Advocacy, Unlimited.  Second, it asked the question, is it ‘stigma’ or is it discrimination about which we should really be talking?  And, here’s where I’ll go further than the article did.  It spoke to the issue of ‘stigma’ verses discrimination against those with ‘mental illness.’  Instead, I will go so far as to say that it is NOT about the ‘stigma’ or discrimination we direct toward those with so-called mental illnesses, but about how we discriminate against people who have been labeled by a system over which they have no control.  It’s about how our culture decides what are and are not acceptable ways of being in and moving through this world.  What are the socially proper ways to harm yourself and/or express your pain?

The best way out of the game is to stop playing altogether, and to acknowledge all experiences – even the more unusual and/or extreme ones – as human.    The best way to flip the conversation is to talk about discrimination and the phenomenon of othering, rather than to assume we must continue to exist within a ‘mental illness’ and ‘stigma’ framework that seems to largely be working against us.

And, let’s not kid ourselves.  This is not just about erasing lines and boxes and treating one another better.  It’s about power.  As another friend and colleague, Sean Donovan (check him out here speaking at a recent rally sponsored by the aforementioned Advocacy, Unlimited) has pointed out to me, there is no ‘legal standing’ for ‘stigma,’ but there certainly is for discrimination.  Apparently, all 50 states allow their bar associations to ask applicants seeking to be licensed as a lawyer about their mental health records.  Connecticut just passed a law that would prohibit people who have voluntarily requested admission to a hospital for help with emotional pain from purchasing a gun.  Outpatient Commitment laws regularly allow for people to be forcibly medicated and hospitalized.  People lose jobs, homes, children, health and liberty on a daily basis.  Do we fight these by whining about ‘stigma,’ thus essentially accepting the framework of ‘mental illness’ in the same breath?  Talking about this thing called ‘stigma’ and the anti-‘stigma’ campaigns it begets sure does keep us busy.  Instead, we need to invest our limited resources in taking hold of our power and fighting for our rights with all the heart and energy we can muster.

The choices we make, the next steps we take, and the language we use are all critical.  It’s our move and the stakes are high.  I hope you will join me in being anti anti-stigma, and allow the tail to wag (or lead) the dog no longer.

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

70 COMMENTS

  1. Sara,

    Thank you for this insightful piece. To me, Sean Donovan’s comment gets to the crux of the matter: “there is no ‘legal standing’ for ‘stigma,’ but there certainly is for discrimination. Apparently, all 50 states allow their bar associations to ask applicants seeking to be licensed as a lawyer about their mental health records.”

    I have always felt that the stigma debate was a deliberate red herring in mental health. The stigma bandwagon was and is perpetuated by those who want to excuse the colossal failings of a poor mental health system, to lower the hopes, dreams and achievable goals of its victims. If NAMI, for example, would legally challenge discrimination in law, rather than diverting us with “feel good,” but meaningless, anti-stigma campaigns, then the 80% of people living with a mental illness who are unemployed (NAMI stat) might actually be achieving their dreams. NAMI is not the only entity, of course. Anti-stigma campaigns let psychiatry and pharma off the hook. (Pity our victims, don’t ask questions.)
    Best regards,
    Rossa

  2. Very good arguments, Sera. I hope you send this piece to Glenn Close and Ron Howard and the others involved in the campaign. I always knew there was something wrong with the campaign but couldn’t quite put my finger on it. You articulated the problem perfectly. It needs a wider audience. Posting on MIA is great but you really are preaching to the choir.

  4. Thanks, Sera, for another great piece. For more than 20 years, I’ve waged a war against the word “stigma,” arguing that the more logical way to discuss this is to talk about prejudice and discrimination. “Stigma” puts the onus on the labeled person, while “prejudice” and “discrimination” puts the emphasis where it belongs, on the attitudes and behavior of the perpetrators. No one, for example, talks about the “stigma” of being African-American, they talk about prejudice and discrimination
    against African-Americans.

    And over the last decade or more, research has shown that so-called “anti-stigma” campaigns don’t work to change attitudes; in fact, they frequently make things worse. So why do government agencies and some non-profits keep funding things as insulting as Glenn Close’s campaign?

    • Thanks, Darby! And great points, especially the example of ‘stigma of’ vs. ‘discrimination against.’ I know this anti anti-stigma voice has been around for a while, but it’s amazing how many people who I would generally consider as being ‘in the same political ballpark as I’ still don’t seem to see the problem with the concept of stigma… There are so many ways that money and energy are wasted in the world of ‘mental health.’ Imagine if it all just got poured into alternative supports, housing, etc.

  5. Wonderful article! Nicely unpicking the issues. Stigma being the result of prejudice. Prejudice being the result of ignorance and faulty beliefs. In this case the faulty belief being that unusual mental phenomenon are best explained medically. Prejudice then leading to discrimination.

    A dreadful circle twisted into a knot with medical thinking holding it all together.

    The Glenn Close bring change to mind campaign isn’t well known about where I am in the UK but the similarly named and well funded timetochange campaign suffers from some of the same features. Luckily not all of the timetochange material is of the same ilk and people working inside timetochange have produced some creative as well as provocative material selling more nuanced messages….

    One option is to work within these organizations and ironically change them from the inside to make them fit for purpose… I know good people who have made that choice….

    “reasonably good taste in music” I think that’s what you call damned with faint praise…

    Thanks for bringing this issue up….

    • Ill have to check out the UK based campaign you mentioned. Working from within is a choice many have made, including those for whom I have a great deal of respect. It can be tough to know when you are fighting for rather than contributing to, though. Thanks for reading!

    • Ooo, Just got an e-mail from Glenn Close herself (haha!) saying the following:

      “Our community is strong but we want our collective voice to be louder! In support of Mental Health Awareness Month this May, we’ve partnered with Time to Change, England’s largest program challenging mental health stigma and discrimination, to create a new PSA based on one of the U.K.’s most effective social media campaigns.”

      Very interesting.. Wonder what they’ll come up with!

  6. I’ve wondered about the logic of Glenn Close acknowledging her sister and nephew’s issues with different mental illness disorders in this video that screams more stigma, not less! I suppose it was done with good intentions but does Ms. Close really think this is de-stigmatizing her relatives? I think when we, as a society, can look at and treat the root causes for the MANY types of mental illness just like the many types of cancer this will be progress. When westernized nations can embrace proven, actually more cost- effective ways to treat severe mental health disorders like the Open Dialogue Treatment used for the last twenty years in Lapland, Finland vs the drug medical paradigm of treatment in America which includes warehousing people who experience traumatic life altering events in locked psych wards, this nation could truly destigmitize our fellow human beings by helpimg them to work through their problems. There are no words to adequately describe the pain seeing a loved one experience the horrific anguish of a severe mental disorder with the rush to judge, assign some DSM coding ( so insurance companies will pay up) with its forever stigmatizing label while witnessing the horrific side effects psychotropics do to the mind and body. I wish Ms. Close instead would consider researching, like I have, the research and findings Mad In America stands for because this grassroots movement is the BEST way she could truly help her relatives and all the other sisters, brothers, sons, daughters, mothers, fathers, nieces, nephews who need our unconditional love and support instead of more stigma that shouts “I have a mental disorder” and ” I am the sister of a person with a mental disorder”.

    • The Open Dialogue approach does in fact have some incredible lessons to teach us (particularly how their approach has led to the dramatic reduction of the ‘schizophrenia’ diagnosis. I do worry that the way it is coming to the US is in bits and pieces and that replication is really challenging between where we are at philisophically and our litigous nature. It’s also, of course, just one of many places where we can learn about creating fundamental systems change. So many issues, not enough time! Thanks for reading. 🙂

  8. This was a great piece. As I said several times, as a result of having been involuntarily committed http://www.madinamerica.com/2013/01/ny-times-invites-readers-to-a-dialogue-on-forced-treatment/#comment-19770 I have had my life seriously limited. Not only I cannot own guns, even if I wanted to, but there are many other things that I will not be able to do. You mention law licenses, let me give you a few other areas,

    – Jobs that require some sort of security clearance. I am not talking about government jobs only; many companies that do work for the government on sensitive matters require their employees to go through a clearance process as a condition to employment.

    – Running for office or any other activity that would expose you to public scrutiny.

    In other words, we are treated as criminals for the rest of our lives, except that we have committed no crimes whatsoever. We just had the bad luck of having had the wrong people as “advisers”, in my own case, of having had the “wrong parents”.

      • Thanks for your great work.

        In my case what I do is to stay away from any activity that would require me to disclose past use of so called “mental services”. In my area of expertise, it’s not unusual that some jobs require security clearance. I just pass on them. It’s hard enough to have been through the hell of commitment -and the abuse that followed-, so I don’t even want to disclose to anybody for professional matters that such thing happened because it would be very painful.

        I have just accepted that there are things in my life that I won’t be able to do unless the law is seriously changed or psychiatry is stripped from its current legal status.

        • I can certainly respect that choice! It sounds hard, but makes sense in many ways. Your story (or what I know of it so far!) is a powerful reminder of the layers of hurt the system can bring for people. It definitely doesn’t stop with what happens while you’re in the system.

      • I was extremely annoyed, to put it mildly, when my son’s meditation teacher wouldn’t take him on as a student until my son got “permission” from his psychiatrist. It is indeed scary if meditation centers are turning people away. It would be like the church (well acquainted with altered states)picking and choosing its adherents.

        • I’ve been asked on forms for courses if I have mental health problems.

          I find it annoying too.

          I used to answer then honestly but regret it. I might challenge them next time and ask why they want to know? A better question might be, “Do you have any additional access or suport needs to enable you to participate? But even then I’m not sure if there ia anything to be gained.

          • I’ve taken to refusing to answer those questions on medical forms for new physicians, or when I was pregnant with my second child, or during pre-surgery interviews… For better or worse, I’m too stubborn to just lie and say ‘no.’ I need to tell them how it’s none of their business and ask them why they’re asking. Those conversations generally go well. 😉

          • I have done my darnest to eradicate any reference past or present of my psychiatric history to new doctors.

            I’ve been drug free for 8-9 years and was told by other psychiatrists I was not nor had never been mentally ill but we know how this goes. The stigma of having been diagnosed as mentally ill is terrible and medical professionals who see this in our medical charts still continue to treat us as sub humans. I was refused necessary medical treatment because of what psyche drugs I was on.

            I see no reason to let any doctor know my past history because of the blatant stigma and the consequences I have first hand endured.

    • You’ll also find mental health questions on …

      * Driver’s license renewals in at least 2 states
      * Employment applications for companies that do business with the government — not jobs that require security clearance, just jobs with federal contractors

      And totally agreed to limit MD knowledge of p-doc involvement. It’s bad enough being treated like a woman … an older woman … add psych stigma and quality treatment is in the trash.

  10. Thanks for this article. I had been wondering when MIA would address this campaign. At first glance it seems well intentioned but I think you are right about the whole stigma versus discrimination viewpoint.I think it might be better if all of Hollywood and the arts would wear t shirts with their own diagnosis! I am quite sure there are many.
    I have often thought we should be using the Gay Pride and AIDS movement actions to speak and act within society. There are civil right issues especially now with voluntarily admitted folks unable to buy a gun. Not that I ever would just the same.
    All of this money wasted on smoke screens to mask the continuing down spiral of mental health treatment in the United States.
    What about a Stop the Madness campaign?

    • Thanks for reading, mcoma. Indeed, it took me way too long to actually put something out about this campaign. It’s far from new, but so many things to protest or challenge in some way and so little time. I just never could quite forget this one after having first seen it, so I finally got back around to it. I think you’re right that there is much to be learned from other rights movements, but way too many people still don’t seem to see the links between them!

  11. Bear with me. This is a long one, but in my defense, I am copying directly from Ethan Watters article on his book, The Americanization of Mental Illness, which appeared in The New York Times. http://tinyurl.com/yegml2q
    It is important to keep in mind that Glenn Close and Bring Change 2 Mind, champion the brain disease model of mental illness.

    QUOTE:

    But does the “brain disease” belief actually reduce stigma?

    In 1997, Prof. Sheila Mehta from Auburn University Montgomery in Alabama decided to find out if the “brain disease” narrative had the intended effect. She suspected that the biomedical explanation for mental illness might be influencing our attitudes toward the mentally ill in ways we weren’t conscious of, so she thought up a clever experiment.

    In her study, test subjects were led to believe that they were participating in a simple learning task with a partner who was, unbeknownst to them, a confederate in the study. Before the experiment started, the partners exchanged some biographical data, and the confederate informed the test subject that he suffered from a mental illness.

    The confederate then stated either that the illness occurred because of “the kind of things that happened to me when I was a kid” or that he had “a disease just like any other, which affected my biochemistry.” (These were termed the “psychosocial” explanation and the “disease” explanation respectively.) The experiment then called for the test subject to teach the confederate a pattern of button presses. When the confederate pushed the wrong button, the only feedback the test subject could give was a “barely discernible” to “somewhat painful” electrical shock.

    Analyzing the data, Mehta found a difference between the group of subjects given the psychosocial explanation for their partner’s mental-illness history and those given the brain-disease explanation. Those who believed that their partner suffered a biochemical “disease like any other” increased the severity of the shocks at a faster rate than those who believed they were paired with someone who had a mental disorder caused by an event in the past.

    “The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.” The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events. “Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.”

    In other words, the belief that was assumed to decrease stigma actually increased it.

    • Your comments was well worth the read. Since we ARE our brains, and since the medical model puts forward the proposition that our brains are inherently diseased/ defective, as opposed to merely responding to external trauma, what could be more stigmatizing, in the common-use sense?
      Stigma is all about expectations, as the experiment you cite aptly demonstrates. If we expect that someone is defective at the core of what makes them who they are, then it doesn’t matter what you call it, you have just categorized them as “other” and “lesser”. Stigma is about that.
      Sera’s article is terrific, and the responses are such a high calibre. Gourmet food for thought.

      • Thanks, jswood! I absolutely agree with your assertion on the relationship between ‘stigma’ and the idea that we are inherently broken somehow. It’s sort of mind-boggling that people think that somehow that would REDUCE stigma… Anyway, thank you for reading!

  12. “Perhaps the problem is that the idea of developing and then promoting a solely medicalized way of understanding our distress is creating the very ‘stigma’ it seeks to eliminate. For me, it conjures up images of a dog chasing its own tail.” SD

    “In other words, the belief that was assumed to decrease stigma actually increased it.” RF

    YES! Thanks for articulating this is such a readable and reasonable way. I really enjoy your posts here, because they do such a great job of drawing out the utterly absurd assumptions that the medical model and its reinforcing notions (such as “anti-stigma”)are based on in such a way that it is clear that not only are such ideas abusive, exploitative, and disrespectful…they are also just kind of “dopey” and illogical.

    “Anti-stigma” reminds me, ontologically, a lot of “tolerance” in that it implies that something is wrong that must be accepted or put up with. You can’t have an anti-stigma campaign without reinforcing the existence of a stigmatizing mark, just like you can’t have a tolerance campaign without supporting the belief that there is something to be tolerated.

    Thanks again for a great piece of reading!

  14. I did follow your link to Sean Donovan’s speech and many others in Hartford, CT in front of the Capitol building on behalf of Advocacy, Unlimited’s youtube channel. The content and quality of thought and delivery is quite high, yet the true amount of interest in psychiatric survivor testimony is pretty low. For shame. Many, many unwitting others are being set up by the system to follow in the footsteps of today’s survivors in greater rather than lesser numbers. Society could prevent this by listening.

    I agree that almost any and all discussions of psychiatry can come down to power differentials. In the “Change a Mind” video with Glenn Close, Ms. Close speaks rather than her silenced and labeled “mentally ill” sister. The sister is written on and talked about without having her own say. It is my hope that the silenced and unnamed sister may one day join our ranks at MIA as a self-determined woman.

    • Hi Emily,

      I’m curious about your comment. As I think back to that day, it seems to me that almost everyone who spoke (Sean, Oryx, myself, Greg, Deron, Daniel, and others I don’t know as personally) all identify as ‘psychiatric survivors,’ though some of us may identify with different words. Am I misunderstanding what you mean?

      Thanks,

      Sera

      • Hi Sera, I don’t think I spoke clearly. Something that I expressed to you in person is that I’m very interested in leadership for post-psychiatric narratives, psych survivors, what have you. There are millions of Americans who sincerely believe they need to take psych meds for life–I until relatively recently used to be one of them–and that audience needs to be reached. The overwhelming deep-pocketed powers that be seem to have that CT will soon get into the AOT camp.

        Having seen the youtube videos, I see that there is indeed wonderful leadership, but few outsiders are taking notice. I’m overwhelmed with gratitude that such earnest and talented voices are braving cold and rejection to speak difficult and marginalized truths, yet I’m chagrined that there is not more of an audience to hear it (that day and by watching it online). Lack of media attention allows for many, many others to follow in the survivors’ footsteps of being incapacitated by psych treatment. Those were my thoughts. 🙂

        • Thanks for clarifying, Emily! I totally agree that it would have been great if there had been more press (I guess there was one person early on, but I don’t know what happened with any related footage) and more access to non ‘choir members.’ I think there ended up being about 100 people there that day which was pretty good, given the weather… But they were largely people already on a similar page. That said, there were a number of people who went who were at their first rally ever and I think that seeing that we could find that voice and taking part in the event was really impactful. 🙂 Anyway, thank you again for clarifying!

    • P.S. I should add that while I was a little uncertain how to understand your first paragraph, I particularly appreciated your second paragraph. Your observation is really important about Close’s sister, and I’m just going to hold onto my little fantasy that she’ll find her way to read this blog and all the comments somehow. 🙂

    • I like the way you hit the nail on the head about stigma by noticing that the sister was written on (superb!)and talked about without having her own say. It may simply be her being in the shadow of her celebrity sister, who is fawned over by the media, but it also may be very tied to when somone knows you have a mental health label, you will be treated differently. In my blog a while ago I linked to an interview with Glenn and Jesse Close in the Ottawa Citizen. It was a fawning interview with Glenn, really, who did most of the talking. Jesse, who presumably can do her own talking if encouraged, got stigmatized in a most unflattering way (see below), as if she was feebled minded, not capable of dressing herself and needs a support dog to accomplish simple tasks. For some strange reason, that interview is no longer available online. It is truly dopey logic to think that going around with tee-shirts that say, in effect, “I’m with Stupid,” is going to stop people discriminating against you.

      “I didn’t put two and two together as far as mental health,” said Jessie Close, sitting close to her sister on a couch in an Ottawa hotel room, her black top flecked with hair from her tiny dog that accompanies her on speaking engagements.”

  16. I find it interesting that the disability movement in America is fractured. Each disability, disease or syndrome is isolated from one another. In the sixties there was a joint movement of folks from all areas and that was the birth of the ADA. Since then competition for money and celebrities and brand name socially approved disabilities has been the norm.Mental Health issues still cause great fear and the fear factor is being raised exponentially.AIDS is the only area that has done well in harnessing support despite overall fear.AIDS has no behavioral tag associated with it whereas Mental Health continues to be seen in that light.The United States has a large incarcerated population much larger than in the past and I fear that the trend will be for this to happen to the Mental Health system. It’s so hard to organize when so many or so over medicated and have bought into the medical model. The new initiative from the White House is of concern in that Defense Department monies will be used rather than from the Veteran Administration. Maybe a gathering all interested parties in one place may initiate the beginning of a strong movement.

    • I’m with ya on wanting to strengthen the movement, mcoma. But I’m unfortunately also with you on how hard that is to do with all the blind belief in one particular model, and difficulty there is in introducing other options when one is so hard to reach because of a mixture of shame, indoctrination and/or medication. There’s so much to be concerned about, it gets overwhelming at times! But I believe that if we keep getting our ideas ‘out there,’ doing the work, and creating the beacons by which to draw more people in and gather our numbers… Well, it’s really all we can do most of the time.

  17. Thanks for the article – Perhaps next step is to focus on
    TRAUMA and its many symptoms – which are essentially the same as those found in the DSM series – and the many non drug therapies available.
    “A compulsion can develop to repeat the circumstances of the original trauma. This can result in an individual placing him/ herself (or others) in harm’s way due to an unconscious effort to achieve a better outcome of the traumatic circumstances.”1
    “Trauma can occur from a variety of causes, including maltreatment, separation, abuse, criminal victimization, physical and sexual abuse, natural and manmade disasters, war, and sickness. Although some individuals who experience trauma move on with few symptoms, many, especially those who experience repeated or multiple traumas, suffer a variety of negative physical and psychological effects. Trauma exposure has been linked to later substance abuse, mental illness, increased risk of suicide, obesity, heart disease, and early death.” 2

    Trauma: Immediate Symptoms
    Hyper-arousal – Increased heart rate, sweating, difficulty breathing, cold sweats, tingling, and muscular tension. Increased repetitious thoughts, racing mind, worry.
    Constriction – Hyper-arousal is accompanied by constrictions in our bodies and a narrowing of perceptions.
    Dissociation & Denial – Protects us from being overwhelmed by escalating arousal, fear and panic. This softens the pain of severe injury by secreting endorphins, a natural opiate. Denying an event happened, or acting as if it was unimportant, is also a way of protecting us from pain.
    Feelings of helplessness, immobility, and freezing – Overwhelming helplessness is a brake on the nervous system’s accelerator, hyper-arousal.
    Trauma: – Early Symptoms
    Hyper-vigilance, Intrusive imagery or flashbacks, Extreme sensitivity to light and sound, Hyperactivity, Exaggerated emotional & startle response, Nightmares & night terrors, Abrupt mood swings, Shame & lack of self-worth, Reduced ability to deal with stress, Difficulty sleeping, Trauma:
    Later Symptoms, Panic attacks, anxiety, and phobias, Mental ‘blankness’ or spaced-out feelings, Avoidance behaviors, Attraction to dangerous situations, Addictive behaviors, Exaggerated or diminished sexual behaviors, Amnesia or forgetfulness, Inability to love, nurture, or bond, Fear of dying, or having a shortened life, Self- Mutilation, Loss of sustaining beliefs.
    Longer to develop symptoms
    Excessive shyness, Diminished emotional responses, Inability to make commitments, Chronic fatigue or very low energy, Immune system problems, Psychosomatic illnesses, Chronic pain, Fibromyalgia, Asthma, Skin disorders, Digestive problems, Severe PMS, Depression, feelings of impending doom, Feelings of detachment, alienation, isolation, Reduced ability to formulate plans. 3

    1. Healing Trauma by Peter Levine Ph.D. (pgs. 20-25) ©2005
    2 Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014 – pg. 8
    3. Healing Trauma by Peter Levine Ph.D. (pgs. 20-25) ©2005

  18. Hi MHAdvocate, Yes, trauma tends to be the perspective I speak from the most! There’s so much meaning and understanding to be found there… My only worry is that we not force that perspective on everyone. Any one perspective treated as the answer to all is likely to lead to oppressive attitudes and feelings of being silence! Thanks for reading. 🙂

    • Trauma is not the only underlying cause of psych problems, but it certainly is a major one – and one which includes those without a mental health diagnosis – who often find themselves in jail, prison and marginalized as we are. A broader scope would also include:A. Utilizing the Koran algorithm (Devised at Stanford from 1988-1991)to help determine if physical maladies are the source of the problem.
      B. Test for thyroid, Adrenal and pituitary gland functioning, which can help to determine if the metabolism is functioning correctly. Often depression and other problems can be traced to an underactive thyroid, overworked adrenal glands or a pituitary gland which isn’t operating properly.
      C. Perform Hair Test Hair Tissue Mineral Analysis which can help to ascertain if client has deficiencies in any necessary mineral or has toxic substances in their body, which can manifest as psychological problems.
      D. Perform a Chiropractic Examination which can identify, diminish or eliminate blockages in the flow of Cerebral Spinal Fluid. This fluid circulates through the skull and spinal column, bathing the brain in needed nutrients and flushing out waste material.
      E. Making cognitive / cognitive behavioral therapies more available. Here I would also recommend viewing the video series How to Deal With Difficult People prior to receiving the therapy as I believe it can improve success rates as well as understanding some so called ‘symptoms’ from a different perspective.
      I also urge research onto cranial sacrial therapy which gently increase the flow of cerebral spinal fluid to the brain.
      Much needs to be done, but we shouldn’t expect any help from the drug companies or their pimps in making recovery the expected outcome.

  20. I would have loved to read the whole article but I have to admit there are too many words on the page for me to go through (“of all the things I’ve lost, I miss my mind the most”) — so please pardon me if I make a point similar to others’, I only skimmed the article and replies.

    I find that stigma comes down from the self-appionted “mental health” professionals and institutions. My experience (primarily with CAMH) was that they were patronizing and cared more about forcing us into some theoretical rubric that served them, or their research, but was certainly not aimed at truly trying to understand.

    I also feel that trauma is the cause of much more than is the alleged neurochemical imbalance. If anything, it would be the former that precedes the latter. That, and a lot of noise in the head.

    I did watch the video which is commonplace within the silly celeb culture that is so pervasive nowadays. What stayed with me, though, was the loneliness of not having another human put their arm around one’s shoulder. Whether Glenn Close was genuine or disingenuous, the image that stays with me is that, of one person’s arm placed across another’s shoulder.

    • Thank you for taking in what you could! 🙂 I can completely relate to how hard it can be to read through long posts and lots of comments. I have a hard time, myself, focusing for long enough to do that and often have to really struggle to keep bringing myself back to what’s in front of me. I’m not always successful!

      I agree with you re:trauma, though as I mentioned in the comment above, I’m cautious about saying that trauma is the cause of everything for everyone either.

      I can appreciate what you say about the arm imagery!

  21. Thank you for your thoughtful and insightful article. Personally, I am also uncomfortable with messages such as the one projected in this video. Still, when it comes to social stigma, I feel it IS a relevant issue because it is shame projected, and when a community projects shame onto members of its society, that can be quite traumatic, and, in fact, literally crazy-making. I think of The Scarlet Letter, which, to me, is a perfect depiction of the destructive, oppressive and cruel forces of stigma.

    I took a government sponsored vocational rehabilitation agency to task at the EEOC several years ago, and succeeded in proving that they were not only taking discriminatory actions against me due to their stigmatizing beliefs against mentally ill people, but that they were downright culturally incompetent. It was traumatic for me, not because I took any of this personally, but because it was directly and unjustly interfering with my right to work and earn a living. (I never cared who knew what about me, been talking about it all my life, even made a film telling my story of healing from mental malaise due to trauma, hoping to encourage others to wake up to the toxic social dynamics in which they might be embroiled). During the short time I was at this agency, I attended staff meetings where I heard clients being laughed at and pitied, and never, ever talked about as though they were human. Indeed, it was a blatantly dehumanizing environment.

    Ironically, they did me a favor by firing me, because I was still naïve at the time and I felt working was the most valuable action I could take for myself. I realized later that the best way I could show myself respect was to turn the tables, and not only mirror them to reflect their negative impact on clients, but that I could actually walk away–as opposed to buying into the illusion that I was, somehow, dependent on them and ‘the system’–feeling validated by my perception and courage to address this head on. Once I was able to prove that I was the target of blatant discrimination via their stigma-fueled beliefs, I was then free to eschew this toxicity and find a more enlightened and spiritually healthful community. This is how I found my personal empowerment.

    I succeeded in this endeavor, and now, 8 years later, I am grounded, focused, productive and part of a mutually loving and supportive community. To me, ‘to stigmatize’ is to project shame onto others due to falling outside a cultural norm—this would be how I define it, in action—and is what I see mostly causing people to suffer needlessly. I believe ‘stigma’ to be well-woven into the fabric of society, in general. I feel it is the cause of a lot of anxiety, defeatism, and feelings of hopelessness and powerlessness. I read a quote a couple of years ago which I loved, which said, “Before you diagnose yourself with depression or low self-esteem, make sure you are not surrounded by assholes.” I think this speaks to a lot of family and social trauma. It is up to us to find our way out of these cages, and from my experience, it is certainly possible, though it’s quite a process, due to our compulsion to repeat. I found hope in knowing that it was up to me to discern where it felt good to be, and where it did not, based on the healthfulness and open-heartedness of a community. This is how I achieved the mental health, balance, and clarity that I enjoy today.

    • Thanks for posting, Alex. That’s a great quote (‘Before you diagnose yourself…’) Some of this gets to be about semantics. I would agree that there are probably meaningful ways to talk about ‘stigma,’ but more often than not I think it’s a distraction from the much more tangible activities of discrimination and oppression.

      I really appreciated what Faith said in her above remark: ““Anti-stigma” reminds me, ontologically, a lot of “tolerance” in that it implies that something is wrong that must be accepted or put up with. You can’t have an anti-stigma campaign without reinforcing the existence of a stigmatizing mark, just like you can’t have a tolerance campaign without supporting the belief that there is something to be tolerated.”

      I think she makes a really important point, because in my experience most anti-stigma campaigns seem to be arguing that we should accept the ‘mental illness’ that so many of us are questioning the very existence of… I think back to the poem I included in my first ‘False Arguments’ post about the shackles. It’s as if the system has come along and put these shackles on people in the form of diagnosis and then asked others not to judge them for the shackles… That’s my experience of the systemic version of the anti-stigma conversation.

      But I’ve said this all already and I can also appreciate your point. 🙂

  22. Thanks, Sera. What makes this topic even more semantically challenging is due to how the issue of stigma in the mental health field has been co-opted and greatly deflected by many mental health advocacy groups, as I guess most of us realize. I’ve seen first-hand how they shamelessly and knowingly manipulate these issues as a way of getting funding.

    In my film, Voices That Heal, I do not at all suggest that stigma is about accepting or tolerating anything. Instead, I make the argument that the entire mental health field is grossly misguided, and is basically defined by how it categorizes people inappropriately and dangerously. In addition, they send out publically these stigmatizing messages about their clients, precisely as a way of controlling how we perceive, as a culture, what is ‘mental health’ vs ‘mental illness.’ Extremely clever and oppressive tactics! I centered the film around the issue of ‘stigma’ because at the time, I was working with one of these agencies, and this was the common topic. They did not sponsor my film because, in the end, I took a different approach–one that they could not support because what I espouse in the film would endanger their funding. The professional ‘advocates’ I’ve worked with, just like the system, are always about money and control, and never about authentic support and healing. I discovered this clearly as I traversed the system, as so many others have. I’m in California, and I know that this is the case here because advocacy, too, is sponsored by the CA Mental Health Services Act, disbursed by the system! So, in essence, professional ‘anti-stigma’ groups are funded by the very people doing the stigmatizing, which creates an extraordinarily oppressive and discriminating environment. It’s the craziest hamster wheel ever that I’ve seen. So I got neither funding nor support with distribution, but I stuck to my guns, and made the film I which I believe to be truthful.

    I honestly do not feel that the issues which have been put into this vague category of ‘mental illness’ are something that the mental health field knows how to address in any significant way. I believe that our lives are about energy, heart and spirit. Once I got this and practiced it–thanks to spiritual work and Chinese Medicine–I was able to heal my brain from trauma of medication, discrimination, oppression, and social stigma.

    I hope you will watch my film, which is posted on YouTube, and see how I illustrate the workings of stigma as a tool for the kind of discrimination and oppression that leads to mental health issues, both individually and en masse. I really think this entire field has had us all snowed, and chasing our proverbial tails. Thankfully, that’s all behind me now. My work is all about helping others find their emotional freedom, to address their own oppressive thoughts. Healing is all about self-responsibility. We create our own lives. If we can accept this, then we are in complete control of our experience. I know with certainty we all have the capability of reprogramming ourselves away from what we’ve internalized from those we turned to in trust, only to have them betray us with negative projections, making us easy targets for the oppressors. I truly desire for everyone to be on that path. It’s really such a relief from all of this. At least, that’s been my experience…

  25. Thank you for this post! You describe the medical model’s flaws so succinctly in this quote: “The best way out of the game is to stop playing altogether, and to acknowledge all experiences – even the more unusual and/or extreme ones – as human. The best way to flip the conversation is to talk about discrimination and the phenomenon of othering, rather than to assume we must continue to exist within a ‘mental illness’ and ‘stigma’ framework that seems to largely be working against us.”

    As a writing and rhetoric student, I’m terribly frustrated by how medical/diagnostic terminology is used to frame alternative ways of thinking and feeling. The diagnostic model just deepens stigma; others may acknowledge that a diagnosis is not a person’s fault, but the diagnosed person still seems sick, defective, and potentially dangerous. Psychiatric diagnoses are responsible for so much discrimination, so an “anti-stigma” movement operating within that model is doomed to failure.

    Like you’re saying, we need to reframe what’s now called “mental illness” as being a facet of human experience that’s often subjected to discrimination.

    Thanks again for this post!

  26. “Stigma” is spelled with a D
    and pronounced “discrimination”.

    The link below contains strong language but I wanted to share a piece I blogged some weeks ago…

    Every event listed in the poster is a real one that has happened to me or to a friend.

    “Stigma” is just a new label invented by a system bereft of useful ideas so it can divert attention away from that fact.

    “Stigma” also serves as a tool for those running the system to blame people for not seeking for [their] help.

    http://recoverynetworktoronto.wordpress.com/2013/02/08/fuck-stigma/

      • Thanks Sera, Tina

        I liked “wot you rote” too..
        I like the piece about predjudice and discrimination and discrimination we can [try to] legislate, predjudice is a slippery-er fish.

        Time2Change in UK is well funded and well organised-they recently very quickly raised 82,000 signatures protest against a newspaper headline in The Sun that drew an apology [of sorts] but as you’ve observed they’re mostly of the get diagnosed get drugged ilk. Rufus Mat recently wrote an article about it [I think it’s on MIA].

        Methinks its time for plain speaking round “stigma” I propose a campaign title: “cut the crap”.

        Here’s another aspect – Doctors beginning to recognize their part, perhaps, and may even get close to the nub of the problem, but hiding behind a fancy falutin’ name “diagnostic overshadowing” as if it’s less harmful – I wonder how it would go down if it were “racial overshadowing” or “gender overshadowing” etc.

        http://recoverynetworktoronto.wordpress.com/2013/10/24/when-doctors-discriminate/

  27. I tend to take a fairly holistic veiw of illness. Stuff with physical symptoms may or may not be physical in origin. I’m a nurse, I’m training as an NP and I’m also about 1/2 way through a healing touch certification. I’ve also gotten ministerial credentials in a very experiential-based “church” (I put it in quotes because the paperwork to create the official recognition by the state of MN was … well it was paperwork).

    When someone is “mentally ill”, maybe they need a few days off. Maybe they need a better diet. Maybe they need to end a dysfunctional relationship. Maybe they need therapy. Maybe they need medication to assist with some aspect of their situation. Same as for “physically ill” – for someone with a cold, I’m more likely to suggest grapefruit juice and yogurt (if they tolerate it) than I am a drug. For someone with stresses in their life, I think dealing with the stress would be more effective than masking it with a pill.

    But that’s just me,

    Diane, RN, BSN, PHN, NP/student

  28. I think “stigma” as a word or concept is not inherently objectionable. In a recent human rights report the concept of “stigmatized identities” was used in a respectful way to describe LGBT, disability and other identities that society treats with particular dislike. I think it is often useful to call attention to the dislike or hatred that is a part of discrimination.

    But the “anti-stigma” campaigns around “mental illness” are as you say geared to feeding people into the medical model and encouraging people to seek treatment within a medical framework. It is as if to say, “we will put our arms around your shoulder so long as you accept ‘your’ label and take ‘your’ drugs.” The anti-stigma campaigns developed from a particular context and mind-set and can never shake it.

    I also agree that philosophically a campaign against “stigma” is in effect stigmatizing. It says “this condition shouldn’t come with a lot of baggage” but draws your attention to the condition rather than the mind-set of those who are stigmatizing. That is why discrimination, prejudice, “ableism,” etc. make more sense to focus on. And of course there is the legal aspect. Anti-discrimination is a powerful concept in the world (and as some of you know I have devoted my work to using and applying anti-discrimination in international human rights law to end psychiatric oppression).

    I think there is a need in society to address personal prejudices (and “prejudice” has also been at times rejected as being a non-legal term) and social stereotypes, as well as the legalized discrimination. Something that stayed with me from the movie Lincoln, which I know had many flaws and didn’t address the role of African Americans in the struggle for 13th amendment, was the depiction of a choice between “racial equality” and “equality under the law.” The latter was considered more acceptable by white men who didn’t see African Americans as actually being their equals as human beings. It is of course how our 13th & 14th Amendments got written and how our anti-discrimination law works to this day. There is famously no way to legislate change in attitudes.

    Yet, there is a need to change attitudes as a way of supporting legal change to be lasting and deep – and the Convention on the Rights of Persons with Disabilities incorporates an obligation on governments to conduct awareness-raising activities to combat negative stereotypes etc. I think other human rights treaties may also address this dimension, not certain. To me it’s highly debatable whether people especially in this country would trust any government-led awareness-raising campaign, but maybe that is too cynical. (Like everything else in the CRPD that is supposed to be done in close consultation with disabled people’s organizations, offering some checks on the result, but still like anything else it can be gamed by a government that selects favored organizations, or creates a co-opted organization, etc. – as I daresay we all know.)

    In any case, Sera, thanks for bringing this out and contributing to our own awareness-raising work.

    Tina

  29. Thanks to Tina for waking up the comment email system and reminding me of this wonderful post and discussion.

    The more I work on the “stigma” concept, the more committed I become to the notion that stigma is bundled up with “social distancing” and is part of the human operating system.

    As long as a condition is different, scary or culturally discounted, people will tend to stay a little distance away, or avoid/deny that they may be affected by the thing. The reason “education” doesn’t work is that education REINFORCES the classification/difference. Classification leads to us/them situations, and unequal results (discrimination).

    Hanging out with people and building relationships works along an entirely different channel — there’s “comfort” in knowing that someone else remains a whole valid person despite what they are experiencing. You can have a feeling of fellow-humanity, and you realize their essential quality is not “suffering” or “brave.” It’s that they are the person they are, the person you love and know.

    I think that true anti-stigma emphasizes common humanity, and what it takes to build strengths, and diversity of capacity and talents, and positive values like comfort, caring, charity, and support through difficult times.

    NAMI has a new campaign called “listen” that might actually be on the right track. I spend a lot of time trying to have people spend time building relationships with folks who use services and supports. Listening is a place to start. Sitting close together, and giving feedback that indicates you are truly listening are part of a process called “mentalizing,” or connecting and figuring each other out. Peter Block has techniques for conversations that build a feeling of community in his book Community: The Structure of Belonging. This sort of community-building is true anti-stigma work. It builds social capital, tends to equalize power disparities, and supports the notion that we all have a stake in this world.

    Regards to all. –pk—

  30. Who the hell wants broadcast they have an illness like its badge of honor? I am so sick of being coddled like this because of the label they slapped on my suffering. It is so infantile. We are adults, are we not?

    Look, people discriminate against people. I just found out a “friend” in the mental health agency I receive treatment at is a murderer who got off on NGRI. Should I not discriminate or stigmatize him? Turns out his friend is a child molester, but hell he got a dx so its ok, right? Fuck, yeah I am going to judge you I aint god! And just becuase u have a mental illness doesnt give you a get out of jail for free card, or does it?

    How do I know this guy didnt fake mental illness to get a reduced charge? This is whats wrong with the system. Because I have personal problems that I sought help for I am now lumped into a group of child molesters and murders. We have NOTHING in common, but some lame diagnosis from a bored psychiatrist. I am court ordered because I checked myself into a hospital and in order to get out I had to agree to years of being treated like a helpless baby. Lucky me! I get to take group therapy with molesters and sociopaths!!

    • love bug,

      Actually, to the contrary, most people diagnosed with DSM disorders are child abuse victims, not perpetrators, according to the medical evidence. Today, “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).”

      So profiteering off of covering up child abuse, by defaming and further torturing the victims of abuse, does actually seem to be the psychiatrists’ primary role in society today. But this does mean that it’s likely more people in your group therapy will be victims of child abuse, than be child molesters.

      I, for one, was misdiagnosed and poisoned, so the abuse of my child could be covered up for a religion that has apparently been taken over by sociopathic child abuse cover uppers.

      https://books.google.com/books?id=xI01AlxH1uAC&pg=PA20&lpg=PA20&dq=jesus+and+the+culture+wars&source=bl&ots=Uya2qJldoV&sig=sc538clwK3fYeeB2LvVNZDx_Lio&hl=en&sa=X&ved=0ahUKEwjWk-XszZXMAhWKNiYKHcseDs4Q6AEITTAH#v=onepage&q=jesus%20and%20the%20culture%20wars&f=false

      It does seem the difference between the Nazi psychiatrists and today’s psychiatrists is the Nazi’s claimed the Jews were “mentally ill,” and today’s psychiatrists claim child abuse victims are “mentally ill.” And the Nazi psychiatrists killed their “mentally ill,” and today’s psychiatrists create “mental illnesses,” and torture, their patients with the psychiatric drugs.

  31. I know this is an old article but I wanted leave a comment anyway. I believe one of the reasons the mental health system is harmful both emotionally and mentally for so many is the stigma you receive from the very professionals who are supposed to be there for support and understanding. I really believe this is the core of the problem. One day I was googling “stigma from mental health professionals” and found a study that was done in Australia about this topic, it still takes on a pro mental health view but it does acknowledge that this is a huge problem and can be devastating to those looking for help and support.

    I posted this comment on psychcentral and thought I would copy and paste it here.

    “I don’t post alot on the forums, I’m mostly a lurker and it seems there’s alot of posts from people who feel they’ve been harmed in therapy and emotionally abused by the very people they went to for help, I guess I find it helpful because of my own experience and it left me feeling very hopeless, invalidated, and to be honest almost suicidal. I understand that many here feel that therapy has helped them and they’ve been fortunate enough to find a caring and compassionate therapist who didn’t do further damage or complicate the issues that brought them to therapy in the first place. But there are a lot of other people who are being severely harmed especially when it comes to attachment issues. My harmful experience was at a community mental health clinic, I don’t want to go into all the details and I did post about it a couple years ago under a different user name and then I deleted that account because of fear it would be recognizable. In fact my experience got even worse after that incident and I have no desire to return to mental health services again. I’m on my own and still dealing with the problems that initially brought me to therapy but also left to deal with the hurt and shame I feel as a result of everything that happened.

    Ultimately I think the core issue with the MH System and what I experienced as well as so many others is the stigma from the very people that are supposed to be supportive. It can make things even worse in some ways if you’re male, I’m not saying that women aren’t harmed too and of course they are but the problem with being male, which I am, is that they will make assumptions or have preconceived notions about you based on these mental health labels they put on you.

    I’m curious if many other’s here have felt that they were being stigmatized or made to feel less human or even dangerous when you’re not. Believe me I wouldn’t hurt a fly and I’ve never been dangerous, violent, or stalked people but I definitely felt treated that way at times and I think because of my PTSD it made the stigma even worse. Victim blaming is ********!

    I want to do something constructive with my hurt and anger, I’ve thought about starting a blog on what I see as major problems in the MH system but I don’t think I’m a very good writer, maybe I’ll try it anyway, it could be “therapeutic”.

    I copied the following text from an Australian study that was done in 2011 on stigma from mental health professionals towards their clients. Maybe it can give some other people a little validation about their own experiences.

    “Many consumers are subjected to stigmatizing attitudes from various health professionals. For example, across diagnostic categories, almost 29% of consumers reported that their treating health professional had shunned them. These figures rose to over 54% and 57% for consumers with post-traumatic stress disorder and borderline personality disorder respectively. Similarly, over 44% of consumers agreed that health professionals treating them for a physical disorder behaved differently when they discovered their history of a mental illness.

    This level of stigma is dangerous and unacceptable. The time has come to develop and deliver evidence-based mental illness destigmatisation programs in medical and other health care settings to ensure that consumers can be confident that they will be treated within the medical system with the respect they deserve.

    When this stigma is received from a health professional providing mental health services the impact is likely to impede recovery and result in poor outcomes for the individual.

    The impact of stigma is two-fold and includes public stigma and self-stigma. Public stigma is how the general population reacts to people with a mental illness; while self-stigma refers to the prejudice, negative feelings and negative impact that discrimination has on a person with a mental illness. Stigma impedes recovery by negatively affecting social status, self-esteem and social networks. This can result in poor outcomes for the individual, including issues such as unemployment, isolation, delayed treatment seeking and hospitalization. These impediments are likely to lead to feelings of social isolation and exclusion for a person with a mental illness. Contending with this on top of a mental illness is going to affect their self-esteem and level of distress, making recovery all the more difficult. When a person is being stigmatised by their health professional, these feelings are likely to be compounded, making treatment and recovery unlikely.

    Very little research has been conducted on the attitudes of professionals providing care to patients and clients with a mental illness.

    Mental health professionals often serve as role models and opinion leaders within the mental health sector, and they are the people consumers tend to see when they are at their most vulnerable and whom they rely on for help, understanding and support. In addition, many mental health professionals are educators whose attitudes and behaviors influence future, professionals. Therefore, how people with a mental illness view the various mental health professions, and vice versa, can have serious consequences for treatment and quality of life for these people.

    Stigma is a major barrier to recovery for people with mental health problems, their families and those working in the field of mental health. Stigma acts as a ‘social disability’ – often contributing to at least the same amount of, if not more, stress than the original mental health issue.

    In its ground-breaking report, Not for Service, the Mental Health Council of Australia (2005) reported that accounts of highly negative, dismissive and stigmatising remarks by health staff towards persons with mental illness were still very common. In addition, family members often felt discounted or ignored by health workers.

    A recurring complaint among participants in one survey on mental health consumers’ experience of stigma was that consumers felt that doctors and psychologists treated them as less competent and they were discouraged from setting high goals. In the same survey, respondents also gave examples of disparaging comments made by mental health caregivers. One respondent reported that staff in psychiatric facilities often spoke about patients with disrespect and sometimes mocked them. One comment from a respondent, about her experience in medical school, echoed many similar statements made by mental health consumers:

    The treatment of psych patients in all rotations was awful. They would laugh at them, poke fun at them on rounds, disbelieve any physical complaint they had.

    One UK report (Salter & Byrne 2002) highlighted the need for mental health professions to tackle stigma. It found that in spite of the way stigma affects the work of psychiatrists, the prevailing attitude of psychiatry towards stigma seems to be ‘one of inertia and resignation’. According to this report, none of the main texts of psychiatry mention stigma and, with only a few notable exceptions, psychiatrists have taken a low profile in local and national debate about mental health issues. Several years after this research was conducted, people with mental illness in the UK still report encountering negative attitudes from mental health professionals. People experiencing mental illness often feel patronized, punished or humiliated and many rate mental health professionals as one of the groups that stigmatizes them the most. “

    It’s ridiculous that a profession that’s supposed to be about healing, recovery, and safety harms so many people and the lack of self reflection and accountability is unbelievable.”

    Of course the study doesn’t acknowledge that they are the ones creating the stigma through their mental illness labels.

  32. Powerfully said, and what a difficult topic to tackle in the way you did! The over diversification of funding to useless programs has to stop and the medical model go away. Problem is there are alot of people who still want “help,” so there will always be an “expert” We need to minimize the divide in some ways and abolish it in others. Thanks, your writing is always so powerfully articulate and packed with facts!

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