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Mental illness and stigma: Coping with the ridicule

You've probably heard the words, tossed out loosely, without a care — words like "psycho," "schizo" and "wacko." Or you've seen the jokes on television about "loony bins" and characters in straightjackets. You might even have read about the government official who quipped that a congressman must be "off his meds and out of therapy."

But if you or a loved one has a mental illness, you know that these words and gimmicks aren't just harmless fun. Rather, they perpetuate the stigma attached to mental illness. Stigma is painful and shaming, but you can both cope with it and combat it.

Stigmatizing mental illnesses begins with a label
Stigma is a mark of disgrace or shame. It has four components:

~Labeling someone with a condition
~Stereotyping people with that condition
~Creating a division — a superior "us" group and a devalued "them" group, resulting in loss of status in the community
~Discriminating against someone on the basis of their label

Labels aren't always negative, though. In health, for instance, a diagnosis is, in essence, a label. A label can offer reassurance that your condition has a medical cause, and it can help steer you toward appropriate treatment.

Labels don't always trigger stigma. In fact, many illnesses are gaining broad acceptance, with survivors and advocates taking part in fundraising events or proudly wearing ribbons or wristbands to show their support. Breast cancer is a shining example. Survivors are no longer stigmatized, but rather celebrated and honored.

But some illnesses remain on the social fringe — shunned, mocked, disrespected and discredited. For many people, being diagnosed with a mental illness is akin to wearing a scarlet letter, an invitation for scorn and disdain.

Stigma fuels inaccurate perceptions of mental illnesses
Why do mental illnesses continue to be stigmatized? For one thing, the term "mental illness" itself implies a distinction from "physical" illness, although the two are intimately entwined. In fact, neuroimaging studies show physical changes in the brain associated with mental disorders, suggesting a biological basis. Some mental health advocates propose switching to less stigmatized terms, such as behavioral health or brain disorders or brain illnesses.

To some, "mental" suggests not a legitimate medical condition but rather something that results from your own doing and your own choices. People may blame you and think your condition is "all in your head." They may think that mental illness is an indication of weakness or laziness. That you're a "moral failure" or simply "can't cut it." That you should just "get over it."

Some people also believe that if you have a mental illness, you must be dangerous and unpredictable. This perception is often inflamed by media accounts of crime, although statistics don't bear out a connection between mental illness and violence. Some people also believe that those with mental illness are less competent, unable to work, should be institutionalized or will never get better.

As a result of such stigma, mental illnesses remain the butt of jokes in popular culture. Negative portrayals of people with mental illnesses fuel fear and mistrust and reinforce distorted perceptions, leading to even more stigma.

Some mental illnesses are more stigmatized than others. Schizophrenia, for instance, is more highly stigmatized than depression is. It's routinely mocked and misrepresented and is less likely to generate compassion. Depression, on the other hand, is less often ridiculed, perhaps because an onslaught of advertising for antidepressant medications has made the disorder more mainstream, thus more acceptable.

Consequences of stigma
For someone with mental illness, the consequences of stigma can be devastating — in some cases, worse than the illness itself.

Some people with mental illness don't seek treatment for fear of being given a label — a label that's almost impossible to ever shed. They believe that once family and friends find out about their illness, they'll be scorned. They may try to hide their symptoms and not stick to treatment regimens.

Some people with mental illness become socially isolated, locked out of their community by the shame and embarrassment that stigma triggers. Stigma also leads to social distancing, in which people refuse to rent rooms to someone with a mental illness, don't want them as neighbors or co-workers, and won't befriend them. Some people with mental illness have even been subjected to physical violence and verbal abuse.

People with mental illness face discrimination in the workplace, even though the Americans with Disabilities Act outlaws it. They may lose their job, be the subject of gossip by coworkers and get passed over for promotions.

And in many cases, health insurance coverage of treatment for mental illness is inadequate and far more limited than that of physical illnesses, such as diabetes or high blood pressure.

Celebrities help erase the stigma of mental illness
Not all the news is bad, though. Today, the stigma surrounding some mental illnesses is slowly eroding. That's due in part to greater public understanding of mental disorders and the biological basis that many of them have. As causes of mental illnesses and better treatments for them are discovered, stigma may fade even more.

Many celebrities are speaking out about their experiences with mental illness. Among them are Nobel Prize-winning economist John Forbes Nash Jr. (schizophrenia); actresses Patty Duke (bipolar disorder), Lorraine Bracco (depression) and Brooke Shields (postpartum depression); newspeople Jane Pauley (bipolar disorder) and Mike Wallace (depression); athletes Terry Bradshaw (depression) and Muffin Spencer-Devlin (bipolar disorder); writers Kay Redfield Jamison, Ph.D., (bipolar disorder), Art Buchwald (depression) and William Styron (depression); and such public figures as Tipper Gore (depression) and Kitty Dukakis (depression, substance abuse).

Celebrities who openly discuss their mental illnesses or write books about their experiences increase public awareness and help make it easier for others to reveal their struggles with mental illness.

You can cope with and combat the stigma surrounding mental illnesses
If you have a mental illness, you can decide who to tell, if anyone, and how much to tell. You may not be comfortable telling anyone anything at all about your condition. In some cases, though, you may fear the worst, only to be met with compassion and acceptance — not the ridicule and disdain you were anticipating. Being open about your condition may be a risk, but you may gain much-needed support and unburden yourself from a heavy secret.

Perhaps you want to actively combat stigma. You may only be comfortable pushing for more awareness and compassion within a close circle of family and friends, gently reminding them about the harm in jokes and stereotypes. Or if you're more comfortable tackling bigger challenges and facing bigger risks, you may decide to make your cause more public.

In either case, here are some ways you can cope with and help end stigma:

  • Get appropriate treatment.

    Don't let the fear or anticipation of being stigmatized prevent you from seeking treatment for your illness. For some people, a specific diagnosis provides relief because it lifts the burden of keeping silent and also underscores that you aren't alone — that many others share your same illness and issues.

    Surround yourself with supportive people. Because stigma can lead to social isolation, it's important to stay in touch with family and friends who are understanding. Isolation can make you feel even worse.

    Make your expectations known. People may not know how to support you, even if they want to help. Offer specific suggestions and remind people of appropriate language.

    Don't equate yourself with your illness. You are not an illness. So instead of saying "I'm bipolar," say "I have bipolar disorder." Instead of calling yourself "a schizophrenic," call yourself "a person with schizophrenia."

    Don't say you "are depressed." Say you "have depression."

    Share your own experiences. Speaking at events can help instill courage in others facing similar challenges and also educate the public about mental illness. Until you gain confidence, you may want to start at small events, such as talks at a support group or a local chapter of a national advocacy group.

    Monitor the media. If you spot stigmatizing stories, comic strips, movies, television shows or even greeting cards, write letters of protest that identify the problem and offer solutions.

    Join an advocacy group. Some local and national groups have programs to watch for and correct archaic stereotypes, misinformation and disrespectful portrayals of people with mental illnesses. [/list:u]
    Don't let stigma create self-doubt and shame
    In the face of insensitive comments or crude advertising gimmicks, it may be difficult to feel good about yourself. Remember that you have a medical condition, that it's not your fault and that effective treatments are available. Try not to feel shamed, embarrassed or humiliated if someone knowingly or unknowingly ridicules your illness. Therapy may help you gain self-esteem and put less stock into what others think of you.

    And if you're comfortable enough to speak up, you may be able to help educate people about the hurt that can result from stigmatizing mental illnesses. The tide is slowly turning.
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