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sunset

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Mental illness and stigma: Coping with the ridicule
MayoClinic.com

Archaic stereotypes and discrimination are painful reminders that mental illnesses are still stigmatized.

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.
- 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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Re: MSN article on Mental Illness and Stigma

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."

I hear this a LOT. :(

To the point that I even question myself about it. I wonder if I am choosing to be this way, even though I know that medication will help me. I worry that I'm not doing enough without it to fix myself, but I just don't think I can get over this on my own (although at the moment I don't really have any other option).

I do hope and wish that this stigma will go away. I guess each of us can do our part somehow? By getting the help we deserve and living the life we deserve to live, a good life. I think.
 

sunset

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Re: MSN article on Mental Illness and Stigma

Hi Janet, I heard that a lot too, but you know what?? I think people who say stuff like that, are just not educated enough or understand it at all to make an assumption like "Its all in your head". Really, what does that mean anyway?
I take it that they think we are dreaming all this stuff up, and love to be miserable.. They cant be serious...can they?

I dont think you are choosing to be this way as you mentioned. All of us wants to be healthy and happy and at least we are making an effort to get to that end.

I hope the stigma goes away too, and I think the more people are educated about different illnesses, it will lessen. In the meantime, we need to think of ourselves and continue therapy for as long as we need it.
 

foghlaim

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To the point that I even question myself about it. I wonder if I am choosing to be this way
i only read this a few min ago... and seeing that sentence.. i thought .. how many times have i said that to myself.. especially lately.. even today.. i thought i must be actually choosing to feel like this..

I'm glad you posted this Janet.. because I was beginning to convince myself that i was .. now that i know someone else had the very same thoughts..? ?and reading the article above.. has helped to change some of my thinking.? ?Part of my thinking was based around the stigma, and hearing ppl's (not so nice) comments on depression recently.

anyway.. thanks Janet.. *s*
and thank you Sunset for the article.
 

Halo

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I am so glad that I have read the posts on this topic because I am happy to know that I am not alone in my thinking. I too have thought that maybe it is all in my head and that I really CAN control my moods. I know that I cannot do without medication and that I cannot control my moods....especially when they are down. Do people reallly think that we would choose this for ourselves :?

What I tend to think when people say that it is "All in your head" or my favorite one "Snap out of it" is that that they just can't or don't want to understand and they don't like that we are not acting the way they want.

Anyway, thank again to NSA, Janet and Sunset for your posts.

Take Care
Nancy
 

healthbound

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My step mom recently suggested that I was somehow faking, making up or manipulating my depression and ptsd as a way to somehow get out of working. Ya, right.
 

foghlaim

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i think for me.. tis easier if someone in the street said something like that.. i think maybe i could ignore them,, but when it's closer to home... family members ect saying stuff like that.(and other things) . well.. it's just so hard.
 

healthbound

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Ya, and frankly, I'm sick of it. Stigma or no stigma, I've provided many resources and opportunities for them/her to learn more about it, but no matter what I do, she/they seem to need to see me in a particular and inaccurate way.
 

David Baxter

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My step mom recently suggested that I was somehow faking, making up or manipulating my depression and ptsd as a way to somehow get out of working.

One can attribute that to ignorance but it doesn't really excuse the fact that it's mean and cruel.
 

healthbound

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Maybe. I agree that it doesn't excuse being mean and cruel. I know the "routine" with them, but sometimes I still get affected by it. Guess I'm human after all. :blank:

For some reason, I have been feeling less tolerant of some of their comments lately. Probably best for me to write about it under another topic, though :eek:
 
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That is hard, healthbound.

I think some people just don't want to understand and they won't no matter what because it's easier for them to think the worst of someone. :(

I wouldn't wish any of this on anyone. :(
 

healthbound

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Hey Janet:). It does seem that while we've made strides with creating more awareness about certain issues, it is still very challenging for many people to let go of their familiar perceptions and ideas.

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.
I became aware of the signs that I was slipping into a serious depression about a year and a half before I finally told my doctor how serious it was. And I was seriously contemplating suicide for almost a year before I told anyone. Finally I wrote to an online support group in the UK. I eventually worked up the courage to tell my doctor. And when I finally told my family, it wasn't even acknowledged. Then later (as I mentioned) dismissed or perceived as something I was "making up" or whatever.

Just before I took my "leave" from work, there was a day when we had 2 "jumpers" on one of the main bridges and hours later another jumper on the other main bridge. Anyone living across the bridges had to wait hours before they could leave to get home because they stopped all traffic. I heard comments like,
-"Well, it's a good thing they stopped traffic, because if I drove by I'd be yelling at them to hurry up and jump because they're holding up traffic!"
-"I wish they'd hurry up and jump, I'm hungry for dinner"
-"Look at all the money their wasting - our cops and firemen could be out there saving real lives"

I couldn't believe it. I work in a very progressive company and didn't expect that there would still be such anger and ignorance. At that moment, I knew I couldn't tell any of my co-workers about my past (my sister's death) or my current situation.

However, I am extremely grateful for the John Nashes of the world because they have helped me and others take a slightly different look at mental health. And now that I've spent over a year working on my mental health I would not have a problem gently responding to some of those comments by saying, "Maybe we don't understand the full scope of what those people are dealing with". Or maybe even - "My sister took her own life at 20 years old. She was a beautiful, funny and caring woman. If stopping traffic for an entire week would have saved her life, I personally would have put up the barricades".

I think those who are still miffed about mental illness may not recognize that those with mental health issues are their co-workers, managers, parents, teachers, entertainers, artists, computer geeks, top athletes etc etc etc. People they all admire and respect --- and even aspire to be like. The more those of us who battle with mental illness can gently continue to help create awareness and opportunities for education, the better. Errrr, that's my opinion, anyway :).

---excellent article, Dr B!
 

Halo

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Hey Healthbound,

I agree with your opinion totally. I too have heard comments about mental illness that irritate or even make me angry. I want to say something back to those people but then again if I do then they will figure me out and how I really am.

Just wanted to say that I agree with your comments....and sorry to hear about your sister.

Take Care
Nancy
 

ThatLady

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Anyone who would say something like "I wish they'd go ahead and jump! They're holding up traffic!" has a lot more issues than any of us here, I'd say. Ignorance is one of them, but it sure isn't the most glaring. I'm reminded of the old saw: "Those who live in glass houses shouldn't throw stones."
 
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-"Look at all the money their wasting - our cops and firemen could be out there saving real lives"

That is hard.

Like we're less than people or that we're a waste. :( Sad.

Ant that must be especially hard for you to hear, healthbound.

But hopefully there are many people who don't feel this way.

I worry that the stigma prevents people from getting the help they need and deserve.

I am glad that there is medication and therapy to deal with this. I'm just holding on until the day I can take medication and get some kind of help for myself. Because I can't fix myself alone.
 

healthbound

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Hey Nancy, TL and Janet :).

I'm sure they were trying to be funny.? I'm pretty sure if they knew the situation they would have never said such a thing, BUT I guess that's the point....there still is such a lack of awareness and therefore still an incredible stigma attached to mental health because there is still such a lack of accurate information communicated to the general public.

Another thing I found particularly interesting about that day was that the radio and TV never mentioned "suicide" or "jumpers" or even "jump".? They literally said "the situation on the bridge" and other very vague things.? This struck me as odd.? Like, if we can't even SAY the word "suicide" how can we become more aware of it --- and it's not just suicide.? I think we generally do the same for all mental illness.? We either use other words (myself included) or we sort of whisper them under our breath so even we can barely hear ourselves say the words.

However, the facts are that mental health issues are overwhelming prevalent in Canada and the U.S. as well as worldwide.

-1 in 5 people will experience a mental illness at some point in their lifetime
-According to the World Health Organization, Mental Illness is the leading cause of disability in Canada, the US and Western Europe
-8 of the 10 leading causes of disability are mental illnesses
-According to the Canadian Institute for Health Information - Hospital Mental Health database, 2003 the average length of stay for a patient in an Ontario Mental Health Hospital is 99 days
-The annual direct and indirect cost to the Canadian economy of mental illness is $14 Billion


In Canada, "Suicide is a leading cause of premature death".

In the USA, both Homicide and Suicide are within the top 10 causes of death, however Suicide kills more than 2 times as many people compared to homicide .
...Yet - every single time I turn on the news I seem to hear about someone being murdered.? What about the lives lost and forever-affected by the chemical imbalance killers or the mental illness murderers?

I do like that the article that Dr B posted gave suggestions about how we can do our little bit to help reduce the stigma.? Like all things that have been long misunderstood, every little bit of education and awareness helps reduce misunderstanding.

And who knows....maybe in another decade we'll be watching "Mental Health Hill" instead of "Brokeback Mountain".? OK, maybe there isn't that much stigma...or is there...? How hard did I work to conceal my depression and suicidal ideation?? And what about my father not even telling any of his friends or co-workers that my sister even died --let alone how she died.? I mean, he'd been with the same company for 30 years.? And what about me isolating over the past year?? I've always been a very popular and outgoing person yet, for the first time in my life, I completely isolated myself from everyone.? And still, I've only told a select few a bit about what's really been going on.?

I don't know if anyone would be killed simply based on their mental illness, but they sure would be ostracized, ignored, blamed, hated and disowned (my mom's father literally disowned and wrote her out of his will less than a month before he died because she couldn't manage her emotions or act the way they thought she should be acting around the time of his death.? She'd lost my sister 5years earlier).? And now that I think about it, it's very possible that we are sending ill people to death row rather than cold blooded killers.? ...ok...ok...now I really am opening up another can of worms? :eek:
 

foghlaim

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"OK, maybe there isn't that much stigma...or is there" i realise that this question was probably rhetorical (not sure if that's the right word) in the context of your post.

but over here... there is so much stigma attached to any form of mental illness, i think it actually adds to the mental illness.. if that makes any sense? causes the isolation etc..
 

healthbound

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Hey nsa, I agree 100%. I just hadn't realized the scope of the stigma until I wrote it all out. It's very sad. But, maybe it's also kind of exciting too. It means that there is room for us to contribute towards positive change if we want to. And not everyone has to be a martyr...we can all contribute in our own ways :)
 
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I like this part of the article:

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."

And this part:

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.

I'm going to try to focus on those things.

And I think it is absolutely wonderful that there are so many treatments and medications for mental health issues today. :)
 

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