Sticks and Stigma:

“How come every other organ in your body can get sick and you get sympathy, except your brain?” —Ruby Wax

According to the statistic available on the National Alliance on Mental Illness:

1 in 5 U.S. adults experience mental illness each year
1 in 25 U.S. adults experience serious mental illness each year
1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
50% of all lifetime mental illness begins by age 14, and 75% by age 24
Suicide is the 2nd leading cause of death among people aged 10-34″

Medical students, graduate students, and health professionals are already at a higher risk of developing severe mental illnesses to the point of them becoming a disability and also a precursor to suicide (especially in med students ). Enter the COVID-19 pandemic. Stress and anxiety have been on the rise for everyone.

Image from: https://www.statista.com/chart/21878/impact-of-coronavirus-pandemic-on-mental-health/

An extremely harmful behavior pervades society and represents an aggravating barrier to proper care-seeking and effective treatment of mental health illness. Stigmatization, the negative social branding of a person or group of people based on the traits associated with mental illness and misinformed beliefs about mental illness results in an immediate social and personal disadvantage to the people who have been diagnosed with a mental health illness, on top of the already crippling effects of having a mental disorder. According to a 2003 public report provided by the World Health Organization, mental illnesses account for disability (i.e the years patients live with the disability and by the negative effects on personal and professional life) in developed countries more than any other group of illnesses, including cancer and heart diseases. It denoted that 4 out of the 6 leading causes of disability are neuropsychiatric disorders: depression, alcohol-use, schizophrenia, and bipolar disorder. The report also predicted a growth in mental health disability in the following 20 years. The stigma and discrimination surrounding mental health illnesses only contributes injuriously to our collective mental health and hinders the potential success of the evidence-based treatments at our disposal. Stigmatization diminishes treatment participation by contributing to lower self-esteem and by robbing people of social opportunities and support.

Humans are naturally social creatures and in most cases rely on other humans as necessary resources for treating their physical and psychological ailments. For people suffering from mental health illnesses, this is always the case. However, this particular diagnosis makes it difficult for patients to feel like they can reach out for professional help or even talk openly about their illness. The Center for Disease Control and Prevention (CDC) analyzed the most recent data available for the District of Columbia (DC), Puerto Rico, and 35 states in the 2007 Behavioral Risk Factor Surveillance System (BRFSS). They found that 78% of adults with mental health symptoms, as well as 89% of adults without mental health symptoms agreed that treatment can help persons with mental illnesses lead normal lives. Yet, while 57% of all adults believed that people are caring and sympathetic towards persons with mental illnesses, only 25% of adults with mental health symptoms expressed the same. Why is this? Other studies evaluated by the CDC reported that approximately 25% of all US adults have been diagnosed with a mental illness and that nearly 50% of US adults will develop at least one mental health illness in their lifetime. Even when it has and continues to represent a serious, but treatable health problem across the US population, most people (including ones with a mental disorder) seem to recoil without empathy at the mention of mental illness.

Secrecy is an adaptive response to any source of personal or public embarrassment. Mental illness stigma represents such a source of shame to people suffering from symptoms that they would rather omit their pain and ignore their chances at recovery than express it and reach out, at the risk of being ridiculed, scoffed at, or discriminated against. They fear being turned into a stereotype or becoming defined by their disorder. But mental illness originates from a combination of neurobiological and environmental factors, it should not be viewed as a weakness inherent in somebody’s character.

Mental illness

How does a negative perception of mental illness hurt people with symptoms? A 2014 paper on the subject proposed two types of barriers related to stigma: a) person-level barriers and b) provider and system-level barriers. The former pertains to attitudes and behaviors undermining health decisions leading to treatment avoidance or dropping out prematurely. These attitudes usually stem from poor mental health literacy, beliefs of treatment ineffectiveness, lack of self-confidence, lack of support network promoting care-seeking, and perceived cultural irrelevance of treatments. The latter barrier refers to lack of proper insurance, financial constraints, staff cultural incompetence, and workforce limitations. Both barriers are influenced and enforced by stigma and prevent any chance at progress and recovery from initial onset of the illness. This issue becomes even more serious when one considers that people suffering from mental health illness are generally more prone to suicidal ideation and, consequently, are at a higher risk of premature death by suicide than people who don’t suffer from mental illness.

There is no shortage of evidence that mental illness could interfere with daily activities and that the only way to get better is to seek and continue treatment, such as psychiatric and psychotherapeutic intervention. Granted, the usually severe dysfunctions and disabilities enabled by the insidious or abrupt onset of serious mental health illness (e.g. schizophrenia, bipolar disorder) will not always allow a person to fully recover or cope. It is possible that successful readjustment will imply accepting and learning to live with a lifelong handicap, even with the support of evidence-based treatment. This currently harsh reality represents a challenge translational research (i.e. basic to clinical) is rigorously attempting to overturn. Nevertheless, this is also a reality that some people with severe physical illnesses face and there is very little stigma getting in the way of seeking treatment if it’s accessible to them. It’s time to treat mental illnesses the same way.

enough

The best way to combat mental illness is to inform yourself, have a decent support network, and get treated. There are several strategies to combat mental health stigma:

1. Educate yourself and others about mental health. If you have internet access, there is no excuse for obliviousness if you want to learn about a certain topic, especially mental health. Acquiring an understanding of mental health empowers you to spread it, while enabling you to be more empathic and helpful to those who are suffering from illness. Moreover, you can help dispel ignorance when you detect it, which is one of the main sources of stigma. This is perhaps the most powerful strategy you can take since it will lead to changes in your thinking about mental health and guide you to adopt behaviors that turn you into a positive role model and resource for others who also care about advocating for better mental health. Start your education on mental health today by reading up on mental health info provided by the National Institute of Mental Health.

2. Talk openly about mental health. Openness is the best way to share your knowledge and personal experience of mental health. It takes courage to open up about your own experience with mental illness so be appreciative and listen carefully when others share with you. I like to think of it as a kind of group therapy when people can engage empathically and safely in discourse about their experiences with mental illness. It is an encouraging and healing way to connect with and learn about each other.

3. Do not label or stereotype people with mental illness. Stereotyping is not entirely useless since it provides a handy social characterization of something we may not fully want to understand or present in a nuanced fashion. Labeling people as “crazy”, “psycho”, or “bipolar” is a popular way of stigmatizing negative or erratic behaviors, instead of promoting a useful or empathic understanding of mental health. Being aware of the harm of stereotyping can help you become a conscientious ally to those who are truly struggling to take care of their mental health.

4. Encourage equality between mental and physical illness. Guys, it’s 2020. If you are out here thinking that your mental health has little to do with your physical well-being, you need to read the memo: our experiences as humans are as mental as they are physical, and if you don’t take care of one aspect of your well-being, it will affect the other. People who struggle with mental illness experience physical stress and ailments due to these conditions just as patients with physical illnesses may suffer great mental stress and even develop bouts of mental illness because of their condition. We cannot afford the expense of ignorance on this front: it is important that you recognize that both the mental and physical are products of the same biology. Having borderline personality disorder should be treated as seriously as having diabetes.

5. Choose empowerment over shame. This is at the heart of eradicating stigma. And if you have adopted the previous strategies in your fight against mental health stigma, then you are already erasing the mark of shame associated with being mentally ill. Those who experience any type of illness benefit greatly from the support of others and your encouragement could make a real difference in someone’s struggle to overcome their mental illness.

6. Become an advocate for policies that encourage better mental health. If you have the time, resources, and willingness, you can become an advocate for policies that actually make a difference in how mental health is being treated and viewed. Join organizations such as the National Alliance on Mental Illness in their efforts to advocate for better public policy on mental health and take their pledge to be stigma-free.

There are numerous organizations you can follow/support in order to help break the stigma surrounding mental health illness, raise money for research, and promote awareness, such as: National Alliance on Mental HealthNational Coalition for Mental Health Recovery, among many others.

References:

1. https://www.learnersdictionary.com/definition/stigma

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588649/

3. https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610943/

5. https://www.cbsnews.com/news/most-americans-think-there-is-stigma-associated-with-mental-illness-cbs-news-poll/

6. https://www.healthline.com/health-news/mental-health-treatment-hindered-by-stigma-030214#1

7. https://www.mentalhealth.gov/basics/what-is-mental-health

8. https://www.nimh.nih.gov/health/index.shtml

9. https://www.nami.org/Advocacy/Advocate-for-Change

10. https://www.nami.org/Get-Involved/Pledge-to-Be-StigmaFree

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