The Stigma of Mental Illness

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The Stigma of Mental Illness
Vol. 24 •Issue 16 • Page 32
The Stigma of Mental Illness
Removing barriers to ae!tane an" treatment
#$ %arol M$ers
Sarah too& her o'n life a fe' "a$s before %hristmas. In Marh( she 'oul" have turne" )*. +un"re"s of
!eo!le atten"e" her memorial servie an" elebration of life. ,rom the outsi"e loo&ing in( Sarah a!!eare"
to have it all- a health$ an" loving 12.$ear.ol" son( a thriving art galler$( lo$al frien"s an" a ne' romane.
/nbe&no'nst to man$( ho'ever( Sarah ha" been "iagnose" 'ith bi!olar "isor"er. She &e!t it seret(
telling onl$ a fe' lose frien"s an" famil$ members.
Some frien"s sa' her !erio"s of "es!air( 'hile others onl$ &ne' the ebullient an" energeti Sarah.
0lthough she ha" been !resribe" me"iation for bi!olar "isor"er( Sarah misse" the eu!horia "uring her
mani e!iso"es. She sto!!e" ta&ing the me"iation an" "esen"e" into the "ar&ness of "e!ression(
'hih eventuall$ "rove her to suii"e.
Stu"ies "emonstrate that the stigma of mental illness !revents tens of millions of 0merians from see&ing
treatment. The"e" 2**) 1ational %omorbi"it$ Surve$ Re!liation foun" that fe'er than
half of those 'ho re!orte" mental illnesses "uring that $ear sought treatment( an" those that "i" 'aite" at
least a "ea"e( b$ 'hih time the$ 'ere more li&el$ to have "evelo!e" a""itional !roblems.
+insha'( Ph2( hair of the "e!artment of !s$holog$ at the /niversit$ of %alifornia.#er&ele$( states(
34iven the negative !ere!tions of mental illness( an" the shame( it is not sur!rising that !eo!le 'ith
mental "isor"ers "ela$ see&ing hel! for "ea"es. %onealment remains a ma5or means of o!ing.3
Consequences of Stigma
6hile nobo"$ 'oul" onsi"er ri"iuling a !erson 'ith breast aner or "iabetes( mental health "isor"ers
remain vulnerable to mo&er$. It is not unommon to hear 'or"s suh as 3shi7o3 or 3!s$ho(3 or 5o&es
about 3ra7$3 !eo!le 'hen referring to serious brain "isor"ers suh as shi7o!hrenia.
The stigma of mental illness ontinues beause the 'or" 3mental3 suggests that it is not the same as a
me"ial or !h$sial on"ition. To man$( the term 3mental3 im!lies that the illness is not a legitimate me"ial
on"ition( but rather a !roblem ause" b$ one8s o'n volition an" ations. Peo!le 'ith mental illnesses are
often tol"( 3it8s all in $our hea"3 an" the$ shoul" 5ust 3get over it.3 Mar$a +ornbaher( author of Madness(
asserts that one of the biggest misone!tions regar"ing !eo!le 'ith mental illness is the i"ea that the$
have a harater fla'( not an illness.
Stigma( b$ "efinition( is the shame or "is.grae attahe" to
something regar"e" as soiall$ unae!table. The four om!onents of stigma inlu"e-

9abeling- mentall$ ill( "erange"( ra7$:

Stereot$!ing- unstable( violent( un!re"itable:

%reating a "ivision- a su!erior 3us3 grou! an" a "evalue" 3them3 grou!( resulting in a loss of
soial status: an"

2isriminating against an in"ivi"ual on the basis of their label- housing( em!lo$ment(
The onse;uenes of stigma for mental illness an be more "evastating than the
"isor"er itself. Some of the "amaging effets of stigma inlu"e-

"en$ing that something is 'rong:

refusal to see& treatment:

re5etion b$ famil$( o.'or&ers an" frien"s:

em!lo$ment "isrimination:


being a vitim of harassment or !h$sial violene:

ina"e;uate or non.e<istent health insurane overage:

suii"e( an" resulting loss an" trauma for those left behin":

shunning an" isolation:


negative me"ia images:

"isouragement( "isa!!ointment an" lo' e<!etations for life: an"

ost to soiet$ at large- lost em!lo$ment( re"ue" !ro"utivit$( riminal ativit$( vehiular
ai"ents( "omesti violene an" gro'ing substane abuse.
Basis in the Brain
In a surve$ of nearl$ 1*(*** /.S. a"ults( about 6 !erent meet the riteria for a seriousl$ "ebilitating
mental illness( "efine" as one that substantiall$ interferes 'ith a !erson8s abilit$ to funtion in normal roles.
This is om!arable to rates of heart "isease an" aner. ,urther( a!!ro<imatel$ half of those surve$e" 'ill
"evelo! a mental "isor"er at some time in their lives.
Mental illnesses are ause" b$ a ombination of
fators- genetis( in"ivi"ual biolog$ an" life e<!erienes. 1euroimaging stu"ies in"iate !h$sial hanges
an" abnormalities in the brain assoiate" 'ith mental illnesses. P=T sans of shi7o!hreni brains sho'
that the !refrontal orte<( tem!oral lobes( thalamus an" erebellum are h$!oative.
The thalamus( 'hih is
loate" in the enter of the brain( reeives sensor$ information from subortial strutures an" sen"s this
information to the orte<. The thalamus !la$s a role in mo"ulating attention an" arousal. The erebellum(
!reviousl$ believe" to !erform onl$ motor funtions( is no' &no'n to be ative in s!eeh( memor$ an"
faial reognition.
1an$ %. 0n"ereasen( M2( Ph2( hair of !s$hiatr$ at the /niversit$ of Io'a %ollege of
Me"iine an" one of the !ioneers of brain imaging tehnolog$ for the stu"$ of mental illness( e<!lains(
3Shi7o!hrenia is a "isease of "istribute" iruits an" it is a "isease in 'hih "istribute" iruits are
misonnete". The$ are not funtioning together in an organi7e" 'a$. The$ are getting information( but
the$ are sen"ing it to the 'rong !lae( or the$ are sen"ing it to the right !lae but not ;ui&l$ enough( or
the$ are not using it effiientl$ in that !lae one it gets there.3
Promoting Awareness
0lthough the stigma surroun"ing mental illness is still ;uite !revalent( there is an e<!an"ing !ubli
a'areness an" ae!tane of mental "isor"ers an" their biologial basis. Man$ elebrities( artists(
athletes( 'riters( 1obel Pri7e 'inners an" !olitiians are "islosing their e<!erienes 'ith mental illness.
>a$ Re"fiel" ?amison( Ph2( !rofessor of !s$hiatr$ at ?ohn +o!&ins /niversit$( reveale" her !ersonal
aount of bi!olar "isor"er in her boo& An Unquiet Mind. >itt$ 2u&a&is( 'ife of former governor of
Massahusetts Mihael 2u&a&is( suffere" from severe "e!ression an" substane abuse for man$ $ears. In
her boo& Shock( 2u&a&is shares her battle 'ith "e!ression an" ho' eletroonvulsive thera!$ 'as
suessful in treating her "isabling on"ition.
0a"em$ 0'ar".'inning atress Patt$ 2u&e has !ublishe" t'o boo&s on bi!olar "isor"er( an" s!ea&s to
au"ienes aross the nation about her bi!olar "isor"er. 2u&e has ma"e it her life8s mission to s!ea&
o!enl$ about her battle an" vitor$ over bi!olar "isease. 2u&e states( 3'hen I began treatment( I 'as so
blesse" to reeive so muh su!!ort( an" that8s 'hen I "ei"e" that it8s 'rong to &ee! this a seret. @ou
have to tell.3 2u&e 'as not "iagnose" 'ith bi!olar "isor"er until her 3*s: ho'ever( one she starte"
lithium( her life "ramatiall$ hange" for the better.
Seeking Parity
2isrimination from health insurers is un"oubte"l$ one of the ma5or barriers for those 'ith mental illness in
obtaining effetive an" timel$ treatment. Bn Marh )( the /.S. +ouse of Re!resentatives !asse" a mental
health !arit$ bill b$ a vote of 26C.14C. The bill 'oul" re;uire health insurers to !rovi"e the same level of
overage for mental illness an" substane abuse as for other me"ial on"itions( an" 'oul" not !ermit
insurers to harge higher o.!a$ments an" "e"utibles or im!ose other "ifferent stan"ar"s on mental
health an" a""ition osts.
The 6hite +ouse has o!!ose" this bill( stating that a less.e<tensive version
'as !asse" unanimousl$ b$ the Senate last Se!tember. The bill is no' in onferene ommittee for
la'ma&ers to resolve the "ifferenes in the t'o versions before legislation an be offere" for final
ongressional !assage an" sent to Presi"ent #ush.
+ouse S!ea&er 1an$ Pelosi( a %alifornia 2emorat states( 3Mental illnessDillness of the brainDmust be
treate" 5ust li&e illness an$'here else in the bo"$. There is no shame in mental illness. The great shame
'oul" be if %ongress "i" not ta&e ation an" ensure that in"ivi"uals 'ith mental health illness an"
a""itions are given the attention( treatment an" resoures the$ nee" to lea" health$ lives.3
OTs Can Play a Role
%hanging the stigma of mental illness begins in"ivi"uall$: 'e annot suessfull$ a"voate for those 'ith
mental illness if 'e "o not fae our !ersonal !re5u"ies an" misone!tions. 0s health are !rofessionals(
it8s im!erative 'e un"erstan" that mental illness is a result of a brain "isor"er as 'ell as onomitant
environmental fators suh as !overt$( abuse an" violene. 6e must e;uate mental illness 'ith other
"isor"ers an" "iseases suh as "iabetes( aner an" heart "isease.
9anguage an be !o'erful in maintaining the status ;uo or hanging our !ere!tions of those 'ho have
mental illness. Bne again( labels that reate stereot$!ing ontinue to be !ervasive. 6e nee" to be a'are
that our o'n thoughts( suh as 3he8s a 'ha&o3 or 3she ats li&e a shi7o(3 nee" to be re!lae" b$ 3he8s
agitate" no'3 or 3she8s halluinating an" ma$ nee" a me"iation a"5ustment.3
It8s also im!ortant for !eo!le not to e;uate themselves 'ith their on"ition. So instea" of sa$ing 3he is
bi!olar(3 sa$ 3he has bi!olar "isor"er.3
The me"ia has a !o'erful influene on our attitu"es( either in a
negative or !ositive 'a$. ,or e<am!le( the me"ia often "e!its the mentall$ ill as "angerous an"
un!re"itable. +o'ever( the realit$ is that onl$ a sub.grou! of !eo!le 'ith mental illness are violent. In
fat( !eo!le 'ith mental illness are more li&el$ to be vitims of .violene an" rime( rather than
!er!etrators. 6hen 'e enounter negative messages from the me"ia Ftelevision( movies( omi stri!s(
greeting ar"sG( it is our res!onsibilit$ to hallenge them b$ 'riting letters of !rotest that i"entif$ the
!roblem an" offer solutions.
0ess to mental health servies is often absent or ina"e;uate in "iagnosing( treating an" !rovi"ing
ongoing su!!ort to those 'ith !s$hiatri on"itions. Bn a !olitial level( 'e an beome a"voates an"
ativists for hange 'ith insurane overage. #$ ontating our state re!resentatives on the im!ortane on
voting in favor of the mental health !arit$ bill( 'e an have a "iret im!at on the !olitial !roess. =ven in
the u!oming !resi"ential eletion( health are reform is a to! agen"a item.
0s ou!ational thera!ists( !ossessing a holisti vie' of mental illness that integrates its !s$hosoial(
ognitive( s!iritual an" !h$sial elements enables us to em!o'er our !atients in attaining the highest
;ualit$ of life !ossible. The roots of ou!ational thera!$ are embe""e" in treating those 'ith !s$hiatri
on"itions. 6e have the tools( s&ills( &no'le"ge( em!ath$ an" res!et for those 'ho suffer from mental
health hallenges. 6e an hel! !revent trage"$ an" loss( li&e that of Sarah8s suii"e( b$ e"uating others
an" 'or&ing to remove the stigma of mental illness.
Carol Myers, OTR, has practiced occupational therapy for 25 years. She currently orks in a lon!"ter#
care facility ith a psychiatric population in $oulder, CO. This article is dedicated to her friend, Sarah, and
fa#ily ith the hope of a %etter life for those ith #ental health issues.

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