Sickness and Stigma: Are we talking about mental illness the right way?

Mental health stigmatization is a real problem in the United States, and one that resonates deeply. Almost everyone knows someone suffering from a mental illness of some sort or another; whether they know it or not. In recent years, campaigns to end the stigmatization of mental illness have tirelessly crusaded to earn those with mental illness not only adequate care, but also validation that their sufferings are real. Their strategy lies within the name itself: mental illness. By convincing people that it was just that, an illness, a disease, one that could happen to anyone, people would be more likely to believe it wasn’t the victim’s fault.

This campaign has been incredibly successful. So successful in fact, that, when asked what the cause of mental illness was in the United States, most respondents will mention “chemical imbalance,” or “brain disease.” These phrases are more than just buzz-words, they have truly been successful in making people believe that mental illness is something far out of the victim’s control; more similar to the flu than a bad attitude. So great, we must think, we did it. We ended stigmatization. Unfortunately, it appears, we may have been wrong.

Actually, a body of research highlighted in Watter’s Crazy Like Us: the globalization of the American psyche, growing in tandem with the movement, reveals that framing mental illnesses as diseases or biomedical conditions actually increases stigmatization (Watters, 2010). One study, in a dramatic and stark way, found this disturbingly true. Participants were asked to teach another participant, secretly a confederate, how to do a certain task. The only way they could communicate when the confederate was doing it wrong was through a small electric shock, of which they could control the severity. When told that the confederate had a mental illness due to biochemical imbalance, as opposed to life events, people administered the shock more frequently and were quicker to increase the severity of the shock (Mehta & Farina, 1997) (See figure below).

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It’s hard to speculate as to why this effect is present. It could be possible that the analogy of mental illness as a disease is taken too literal; that people believe they too will become afflicted if they associate with a mentally ill individual. It could also be true that these individuals are therefore more likely to be seen as “out of control.”

While the intent in categorizing the mentally ill as biomedical cases is no doubt benevolent in nature, these results should have given us serious pause. The tendency to take a negative view of those with a “biomedical” mental affliction should raise a red flag, but it should also bring to light other problematic ways of thinking about this issue, particularly our visceral reaction to admitting that chemical imbalance may sometimes have less of a hand in the development of and especially treatment of mental illness than we think. Although cognitive behavior theory has proven to treat many mental illnesses, we still are hesitant to admit that a particular way of thinking is alone the cause of the affliction. While often times it is not, and it requires a variety of different treatments and also depends on the illness itself, doesn’t it seem a bit hypocritical that we acknowledge we can fix faulty ways of thinking to make a person better, but are hesitant to admit that faulty ways of thinking got them there in the first place?

Furthermore, by insisting that mental illnesses are real because they are independent of actions and feelings of an individual, implies that we should only have sympathy for victims because it wasn’t their fault; that they should be totally innocent in the process in order to feel validated, or to be treated. To add some perspective, a football player chooses to play the sport, even with the knowledge of the physical violence and risk or injury involved. Yet, when injured, although we may not understand the reasons behind the motives to play football, we treat the injury and no one questions that it even is an injury, even if it is the player’s “fault.” Why should this be any different from mental illness? What if it is the person’s choices that lead to their affliction? Why should that make a difference?

Finally, there are those who suffer from mental illness who feel disheartened by the comparison. Why should everything they’ve experienced, struggled with, and perhaps been victorious over boil down to simply “chemicals?” There is neurochemistry involved in everything we do, from religion to friendship to love; and yet no one would ever dare to reduce these experiences and emotions down to molecules and neurotransmitters. They’re too human. Mental illness shouldn’t be any different. Depression, anxiety, schizophrenia, etc., these experiences too are human, and are often an important part of the life story of those afflicted. Reducing mental illness to chemical factors beyond control can inadvertently trivialize the massive struggle, the valiant battle that those who suffer fight every day. It confirms their fears; that mental illness is out of our control, that there isn’t anything they can do that matters.

So how should we be referring to mental illness, then? It’s complicated, and rightfully so, because it’s a complicated issue. This should be highlighted above all else. There are lots of different known causes and effects, and likely even more unknown causes and effects; different effective treatments and, above all else, different mental afflictions. Schizophrenia is very different from autism, and yet we often use the same vocabulary to talk about them as if they’re the same. So I don’t have an answer for the one definitive way that we should be talking about this issue, but I do know that we should be better keeping these complications in mind before we unite on a decision of how to talk about mental illness collectively—before we understand the effects of our words.

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References

Watters, E. (2010) Crazy like us: The globalization of the American psyche. New York, NY, US: Free Press

Sheila Mehta and Amerigo Farina (1997). Is Being “Sick” Really Better? Effect of the Disease View of Mental Disorder on Stigma. Journal of Social and Clinical Psychology: Vol. 16, No. 4, pp. 405-419.

 

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