Two stories published in the past week by our news team gives me reason to be a little pessimistic about the gains we’ve made in terms of educating folks about mental health concerns.
The first article entitled, Depression Stigma Higher in Medical Students, examined mental health attitudes amongst medical students — you know, those folks who should be the most open-minded about these disorders that have significant roots in the brain. Of course, from the title of the article, you already know the study’s findings.
In a survey of 505 medical students, researchers found that not only do the future doctors have higher rates of depression than in the general population (not surprising, given the stress of medical school), but they have something a little less expected — higher rates of stigma about depression too.
The results also revealed that 53.3 percent of medical students who reported high levels of depressive symptoms were worried that revealing their illness would be risky. Almost 62 percent of the same students said asking for help would mean the student’s coping skills were inadequate.
The second article, published yesterday, suggests that Stigma for Mental Illness High, Possibly Worsening. How could this be? Educators and mental health advocates have had 15 years of reaching millions of people through the Internet, something never before available in the history of humankind.
The results of this study showed that while more people are understanding that there may be neurobiological causes of mental disorders, we’re still a long way off from removing the prejudice and discrimination that accompanies a mental disorder diagnosis:
However, the results show that although believing in neurobiological causes for these disorders increased support for professional treatment, it did nothing to alleviate stigma. The results show that, in fact, the effect increased community rejection of the person described in the vignettes.
Pescosolido said the study provides real data for the first time on whether the “landscape” is changing for people with mental illness. The negative results support recent talk by influential institutions, including the Carter Center, about how a new approach is needed for the fight against stigma.
What’s the big deal about stigma? So what if people are discriminated against because of their diagnosis?
Well, for one, the stigma keeps people away from seeking treatment. If you’re afraid of how your family, friends or coworkers might react to a psychiatric diagnosis, you’re far less motivated to actually seek out help to get the diagnosis (and the accompanying treatment) in the first place.
And if prejudice and ignorance weren’t enough, people with such diagnoses still face discrimination — in employment, housing, medical care and social relationships.
As the article notes, this can negatively affect the quality of life for someone with depression, anxiety or bipolar disorder. And the people that love them.
It’s hard to fight the stigma of mental illness when health professionals still act in a way that shows they are happy to carry on the misconceptions and mis-perceptions about people with depression, anxiety, bipolar disorder, PTSD, schizophrenia or some other mental disorder. And it’s a bit depressing to see how a decade’s worth of education, information and social networking online have seemingly just moved the needle only a tad in defeating the ignorance surrounding mental disorders.
Here’s to hoping the next decade sees a far greater and more positive impact.
22 comments
Very interesting. Coincidentally, I just wrote my own version of “Does Psychology Have A Social Stigma?”
http://www.theemotionmachine.com/does-psychology-have-a-social-stigma
In it I surveyed 600+ individuals and found that 25% “thought about seeing a psychologist, but were too afraid or had too much pride to follow through.”
This doesn’t surprise me in the least. Sadly, I don’t think this will ever change, in part because the press love to equate mental illness with violence. “Mentally ill mom drowns her children!!” “Mentally ill man blah, blah, blah…” Unfortunately, when many people think of mental illness they think of high profile violent cases.
Organizations like TAC don’t help either. Most people with mental illness aren’t going around harming other people, but you certainly won’t get that idea from listening to the media or organizations like TAC.
DocJohn,
I can fully understand why you’re distressed by these findings. But, I can tell you from first hand experience, it’s not news to me. As a teacher, I’ve only disclosed once, and not in any detail. And that disclosure got me fired, inappropriately. Indeed, the school department had to pay me a hefty fine as a result. I’m not allowed, as a result of the settlement, to disclose the terms and the final sum of the settlement. I moved on.
But, I certainly learned a lesson….
Don’t tell…anything at all.
Because you live this world, you think there’s been change. I live in another world…the world of education. And believe me, if word gets out that there is *any* mental health issue at all — particularly today with the “No Child Left Behind” laws and the “Race to the Top” competition for federal dollars; the charter school movement, (the shame that it is), and Teach for America — with it’s 5 week trained pseudo-teachers who steal the jobs of highly qualified teachers…. Well, I can assure you, there *is* no change at all. It’s worse than ever.
Do NOT disclose! Anything!!! And be careful even what gets put on your health insurance record, to boot! Because, it *will* get back. Sadly….
You need to take a stress leave? If it’s more than 5 days, the employer has the right to know why. Privacy GONE! Hippa is a JOKE! You have NO privacy when it comes to the workplace. And it can, and *will* effect your job security.
That’s reality.
I wish it weren’t so. But, that’s why the stigma exists. Because it can, and will, come back to bite you in the behind.
And people should KNOW this truth.
So they can make an informed decision before they do anything to make a total mess of their lives.
This is my story. It’s my truth. I’m sure others have lived it too. The rose colored glasses need to come off, so people can honestly assess the damage they will do to their lives by disclosing their problems. It’s not pretty; it can be devestating.
Peace!
I completely agree with what you say about the incredible absence of privacy protection in the workplace! No one needs to know why any employee takes medical leave, be it for cancer, depression, or a stubbed toe. And don’t tell me there’s no stigma attached to a host of other chronic conditions, because there sure is! In today’s employer-powered work environment, being perceived as “flawed” or “weak” in any way puts you on the fast track to becoming not only unemployed but unemployable. What else explains the explosion in disability claims? No one wants to employ “sick” people; they’re “unreliable” (which was a moral pejorative the last time I looked). And of course, with more companies making fewer people do more work, the pressure to show up no matter what escalates to incredible levels. Workers are terrified of missing even one hour, much less one day, to take care of themselves or their families. As a result, they put off seeking care until they’re “hospital sick” or nearly so, when that hour or day off might have been all they needed. It’s a lose-lose proposition. But will it change?
As long as psychiatrists and psych hospitals treat their patients like criminals and their hospitals like lock down prisons how do you think the public views mental health patients? It seems to me the psych drs are going to have to change their attitude towards their patients first.
Cindy, excellent point. I can honestly say I’ve felt more stigmatized by how I was treated while inpatient than anything the public could do or say. You’re right the minute you walk through the door you realize really quickly that they view you as a criminal who has been bad, even if you have done nothing wrong. It’s all about compliance. So, if you dare say anything about how gluing a paper doily to a piece of construction paper makes you feel like a two year old, then you’re being bad. Because a “good,” compliant mental patient would want to sit and glue a doily to a piece of construction paper. And heaven forbid you inadvertently step over the black piece of tape on the floor in front of the nurse’s station. That’s a really big no-no.
Those places specialize in stigma. If they actually ran psych hospitals as places of refuge where patients are treated with dignity and respect people like regular hospitals operate, people might start to heal.
I can also say that prejudice against people with mental illness is still alive and well. Even though I am an LCSW, I would never disclose my mental health issues to my co-workers or my boss. It is something that is kept hush-hush. And trying to adopt a child has been almost nearly impossible. Even with just a diagnosis of depression, I have been heavily grilled and screened–and screened out.
There is always a profit in assigning a “stigma.” Sometimes it is publishing, “publish or perish,” and sometimes it is simply I am not this “they.”
Have we made progress in addressing mental illnesses? Without doubt. Are there people still profiting from claiming a “stigma?” Without doubt.
Are their intentions positive? Undoubtedly not.
Harold A. Maio
[email protected]
Kat: In similar circumstances here. There has been no alleviation of stigma in our field.
It is a continuing source of difficulty and sadness to me.
I can only hope that the future provides a different, more positive, and “happier” outcome for this issue.
doc john, I am not at all surprised by the studies findings. I went into a severe PPD after my last fertility treatment resulted in a miscarriage- I had been having ‘talk’ therapy through the fertility process; When my therapist had to submit a treatment plan for the insurance and listed ‘depression’ the answer was- when did you last try psychpharm? If I did not try medication then I couldn’t talk to my therapist! 4 years later- I not only couldn’t have another child- the one that I have was taken by my family because the medications made me worse! The stigma has hurt me incredibly; If I had been given hormones right away I would have gotten better rather than worse- but supportive therapy would still be needed; I lost my job because of the hospital stays- the drugs made me to “fuzzy” anyway . I plan on becoming an advocate to raise awareness of these issues within my state- I hear this story often!
Its very simple really, until we start to provide quality care that is better covered by insurance we will maintain this stigma. If the basis of our health care can draw a line in the ammount of care you can receive or you pay far beyond what the average person can afford, then we will continue to view these illnesses as a problem and not the true illness that they are.
I am always saddened to read these stories of stigma even when I know this is a disease we do not tell anyone. My rose colored glasses tell me of a time when our employer values us as an employee and will offer help when needed, days off to relieve stress and time available for therapy when needed.
I have never found an employer like that, I have only found employers who criticise and condemn us. My worst experience was when I was being fired for what the employer said was drug use and threatened to call the state agency that registered me if I did not quit. I can only hope that one day he will get his come upens and only wished I could see it happen.
dr you must not be surprised over what you see or find about or the result of research work on stigma and discrimination against the mentally ill persons. The truth of the matter is that families of mentally sick persons are not helping matters neither are other health workers.In my own part of the world most of your friends and well wishers look at you twice when you in a social setting introduce your self as a staff of any mental health institution or best a psychologist. First they will class you as mentally sick and is the reason why you can handle the sick ones. To them it takes “a mad man to handle a mad man”. Others see you as a mind reader hence they are skeptical in dealing with you. The most educated person still believes that all mental illnesses are as a result of the fault of the sick person or worst still the punishment for his sins and therefore does not deserve any care,love mercy or treatment. Even the clergy also believes that it is spiritually connected and thus needs spiritual approach rather than medical approach.What shall i say when government is only paying lip service to mental health when compared to other departments of health where huge amounts of money, resources and attention are channeled.Too bad but we must not be deterred one day we shall get to the mark.The problem of the society is more of refusing to accept changes which is inevitable in life.
John, thank you for posting this. Now I can better appreciate the magnitude of the problem.
I advocate to reduce stigma with a blog I write about my life in recovery from schizophrenia called “Healing the Mind.” Lucky for me, only positive reactions have come from it both on and offline. If you’d like to see it, please visit http://www.imhro.org/blog/.
Thank you. Thank you for stating what is so obvious to the person suffering from any type of Mental Illness, but continues to elude MH professionals, Insurance providers and most assuredly, those who run even the most highly regarded Psychiatric Hospitals. To be treated in such a place, one must be willing to become incarcerated in order to receive treatment. They must be willing to be subjected to being strip-searched, treated like a felon, and asked to perform such tasks as going to the bathroom under the watchful eyes of a non-professional. Punitive treatment appears to be the common thread in all of these places. Oh, if the mentally ill would only “behave themselves!” Once referred to as asylums, many of these over-priced places pretend to be places where the mentally ill may be treated in a manner that, to many, feels “unsafe.”
Safety is exactly what mental health consumers are seeking when being treated in an inpatient facility. The irony is, many will leave these places completely traumatized and in need of more help then when they entered. Combined with the aforementioned stigma, they are now faced with a new set of issues with which they will struggle, and sadly, the odds of recovery will dwindle dramatically. It is my belief that the insurance companies are largely to blame, because many have the policy that “if you do not need to be locked-up,” you simply do not belong in a treatment facility. Not only have has this situation failed to improve, it has, in fact gotten worse.
The work of advocates for the mentally ill is just beginning.
The idea of privacy, such as in the hippa plan, is a complete joke! It is one thing for a psychiatrist or therapist to maintain your privacy, but what of the “aides” that these facilities are crawling with, who have no credentials, but are given the title of what is usually a three letter term that varies by hospital, who have no more experience than Joe Public in dealing with these patients. The frustration is never-ending, and my own blood boils as I write this.
If one is suffering from cancer, or from diabetes, that is an entirely different thing altogether. But, for the individual suffering any of the mental illnesses across the spectrum, they must suffer twice. Something MUST be done to change the entire system to support the mentally ill in an equal way. The scales are weighed against them as soon as a DSM diagnosis is made.
Where do we go from here?
I could write for days on this subject and it is one that has to be keep upfront.
I have dealt with stigma on so many levels, yet I see many glances of enlightened individuals.
I have been in lock-down units 3 times, but everyone I encountered was incredibly concerned and didn’t hestitate to question my perspectives. I was never treated with disrepect and I am sorry to read other have.
My son was diagnosed with schizoaffective disorder at age 12 and as a parent, dealing with his disease and suicidal attempts let me see many things and people from a different angle.
Again, he was well treated, he appreciated the people and professionals he came in contact with, but the most surprising group was the school system. OMG!
It is one of the poorest districts in the state, yet between them and the county services, he had such excellent care and treatment. The alternatives to school were amazing and he was eventually able to return to mainstream classes and graduate from high school.
Now as a suicide prevention advocate, I am sadly amazed at the amount of “head in the sand” attitudes from incredibly intelligent people. Doctors, lawyers, etc…people who should “know better” who say people who have a mental illness use it as their excuse for behavior.
Sort of along the lines of suicide “they would just find another way” if you want to use restriction to lethal means.
Don’t give up though, keep talking about it, about depression, mental disorders, how it effects you, because 1-4 of us are affected and you tell people, “you never know when it will affect you, be ready”
I am currently doing some research on stigma. In my research I have found that middle class and upper class people, particularly professionals and including academics, are amongst the most prejudiced people. There are better chances to be accepted by the working class people than by middle class professional people. Why is this so? It surely means that our education is failing those who suffer with depression or bipolar or other forms of mental disorders.
Something must be done as a matter of urgency. I think the best thing to do is to appeal to the conscience of academics so that they may get things moving. If changes happen in Universities then there is a chance that the reform may be introduced in the wider society. Problem is that Universities are amongst the worst places for prejudice and stigma. What to do?
A friend of mine wrote the following:
Their take seems to be that you should not be ashamed of ‘having a mental disorder,’ because it is caused by a biochemical reaction. I certainly don’t agree with that one.
I second this.
The doctors/healthcare professionals in mental health are the root cause as to why this stigma still exists. The pharmacutical companies are the next ones in line and then you have the insurance companies.
Ironically my church community were told lies about me being violent and insane and evil etc…by my ex wife who developed a delusional fear of my non-existant violence. Happily the police and courts were on my side and very understanding. They themselves said she was “crazy” and could understand how I became depressed…irony is a bitch. But mud sticks…She took all the money and the kids…not much an unmotiveted depressed fellow can do. There is great stigma in some churches while others welcome us as just normal broken people.
I’m not sure if comments are still open but I thought I’d try it anyway. First of all, why don’t we get those who work in the Psychiatric professions to change the label from “Mental Illness” to “Mental Disorders?” The stigma begins with the initial label. You’d think the Phd’s working in the Psychiatric field would have sympathetically worked harder for their patients to change that already.
There are a great many studies that show a direct correlation between genetic predisposition and mental disorders. The major disorders being Major Depressive Disorder, Personality Disorder, Bi-polar Disorder and AD/HD. Why are we still using the term, “Mental Illness” at all? What’s even sadder is when it comes to adults with AD/HD as it’s not even discussed among the Psychiatric community as legitimate let alone disagnosed and treated. The phrase, disorder, though, has a more positive connotation than does Mental Illness which, in peoples minds, translates as we are all aggressive psychopathic rejects that could go off the deep end at any moment. These disorders are outside of any particular person’s control and that is exactly what everyone needs to be educated about. They are a chemical imbalance in the brain and there is no reprogramming that those suffering from them can undertake on their own to change the chemical make up within their brains that’s mis-firing and/or depleted of essential ingredients such as dopamine and serotonin that wreak havoc between neuropathways when they’re not functioning properly. (not to mention the toll it takes on individual lives and interpersonal relationships!)
It’s true that mild depression is not necessarily hereditary but it carries the same stigma as any others that are certainly beyond the sufferers control. The miracle of science? They can be treated with the right medication!! Imagine that.
As Jerome pointed out, I have a suspicion too, that the religious community doesn’t understand any more than the general population does and there may even be more of a proclivity to see things in terms of the power of God to heal all of our sicknesses. As if our faith is not strong enough to cure us. I’m a Christian and I thought of doing my own survey to see what the statistics are when it comes to Christians reporting and seeking help for their mental disorders. I’m one of them who suffered silently for decades. It’s not a personal or spiritual failing to confess that something is just not the way it should be no matter how hard you pray about it. God wants you to get the help you need and deserve! People are born blind, deaf, mute and crippled, you just happen to have been born with a chemical imbalance in your brain and that’s not a sin!
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