Removing the Stigma of Mental Illness

Hello, and welcome!

Dealing with a mental health problem can be a stressful and lonely experience for an individual. In addition to dealing with the symptoms of the illness, people often have to deal with the stigma surrounding their condition.

This blog looks at the stigma associated with having a mental illness, and the impact this has on the quality of life of the individual.

Stigma often results from a fear of the unknown, and therefore education can go someway to removing stigma. The additional pages in this blog provide information on a range of mental health problems, in an attempt to increase awareness and reduce some of the misconceptions.

I hope the information in this blog will provide a valuable source of information for you, regardless of your work setting. Its aim is to increase awareness, challenge attitudes, and to provide information which can be helpful in dealing with those suffering from a mental illness - whether it be a work colleague, a student, a friend or family member.

Rachel

Definition of Terms

Stigma
Before we consider what damage stigma can cause to someone with a mental health difficulty, we must firstly consider what 'stigma' means.

The most basic definition, as given by the Collins English Dictionary, is that Stigma means a distinguishing mark of social disgrace.

Many writers have explored the concept of stigma in great detail, and many have come up with their own definitions. One such definition is given by B. Link and JC Phelan in their paper 'Conceptualizing Stigma' (published in the Annual Review of Sociology, vol. 27). They suggest that stigma occurs when "elements of labelling, stereotyping, status loss and discrimination co-occur in a power situation that allows the components of stigma to unfold".

This definition suggests that stigma is a set of various process and conditions, which when combined cause stigma. It highlights the fact that stigma is not just about the attitude towards a person, but also how they are treated, and what effect this treatment has on the persons life.

Mental Health Difficulties - A Definition
While writing for this blog I was unsure about what all encompassing term I should use for describing the various disorders/illnesses I address. In some cases I refer to mental illnesses but realise that this is not always the preferred term. Many of the sources of information included here have their own preference. Some examples include Mental Health Problems, Mental Health Disorders, Mental Health Difficulties and Mental Illnesses.

'AVision for Change - A Report of the expert group on mental health policy in Ireland' (2006) gave the the following definition for what they class as Mental Health Difficulties

'The full range of mental health difficulties that might be encountered, from the psychological distress experienced by many people, to serious mental disorders and illnesses that affect a smaller population.'

As this definition suggests, mental health difficulties encompasses a wide and varied group of illnesses and disorders. The World Health Organisation classifies these in the 'International Classification of Diseases'. The classification of mental illnesses is confusing and not without its problems. Definitions are often confusing for someone without a medical background. In addition classification can sometimes be a driver of stigmatisation - when a person becomes labelled with a specific 'title'.

In its most basic, mental illnesses can be broken into the five most common catergories:

Mood disorders (depression, bipolar disorder)
Psychotic disorders (schizophrenia)
Eating disorders (anorexia nervosa, bulimia nervosa)
Anxiety disorders (social anxieties, phobias)
Personality disorders (obsessive compuslive disorder)

This blog will contain information and resources on a few of the lesser understood conditions, in an attempt to raise awareness, and perhaps reduce the stigma surrounding them.

I am in no way an expert in mental health difficulties, and this will be a journey to increase my own knowledge and challenge my own perceptions and attitudes - I hope that this blog will also challenge you, the reader.

The following article published in the Irish Medical Times in September 2010, gives a good overview of some of the issue of stigma in an Irish context: Stigma of Mental Illness

Stigma - Discrimination and Social Exculsion

The World Health Organisation states that Stigma is one of the biggest problems faced by those dealing with severe psychiatric disorders.

Stigma can result in people being discriminated against, leading to social exclusion. A vision for change, Report of the expert group on mental health policy states that social exclusion happens when people cannot access education or employment, and become dependent on state benefits as a result. The issue of discrimination was highlighted in a recent research study commissioned by Amnesty International Ireland, and undertaken by the School of Nursing DCU. This report titled Hear my voice: the experience of discrimination of people with mental health problems in Ireland highlighted how widespread the problem is. The main findings of the report were:

When asked about discrimination, participants most commonly provided examples pertaining to the workplace. Issues mentioned included being bullied, having to explain gaps in their employment history, inflexible working arrangements and disregard for their qualifications and work experience. 36% felt they had been treated unfairly when looking for work, and 42% felt they had been been treated unfairly when it came to keeping their jobs.
A little over a third of all respondents felt they had not been treated equally in their education.
Socially, many of the respondents found they encountered discrimination especially when it came to making and keeping friends (62%), by people in their neighbourhood (40%) and in their overall social lives (37%).
Perhaps most surprising was the level of unfairness participants felt about how they were treated by those closest to them. Amazingly 60% felt the received unfair treatment by their families, 46% in their role as a parent, and 42% in their marriage/divorce.

In this report the participants spoke about the difficulties in interacting with friends, colleagues and family members. Many felt they were misunderstood and their illness made it difficult to maintain intimate relationships.

This report highlights that those living with a mental health disorder face prejudice on a daily basis. This can cause feelings of shame, hurt and isolation. The following video was published on YouTube. The person being interviewed (Phil) is one of the people appearing on a large advertising campaign run by Amnesty International in 2010. Here he talks about the attitudes towards those who suffer from depression:

Stigma - A Problem with Attitudes?

It is clear that the stigma surrounding a mental illness can be as damaging as the illness itself. According to recover.ie (a schizophrenia information website) stigma can have many negative effects including:

lowering self-esteem
disrupting family relationships
affect a persons ability to socialise, obtain housing and become employed
cause a person to feel ashamed and excluded
can prevent a person from seeking the help they need
can cause hurt and isolation

The site also states that, in order to reduce the discrimination and prejudice of those living with a mental illness, we need need to confront and challenge social attitudes and increasing knowledge.

In 2007, the HSE published a report on the findings of a study into the attitudes and awareness of mental illness in Ireland ( Mental Health in Ireland: Awareness and Attitudes). The report highlighted the level of fear people had of being labelled if they ever developed a mental health problem, with a staggering 62% stating that they would not want anyone to know.

52% of those surveyed felt that those with a mental health problem should not be allowed to do important jobs such as doctors, nurses etc. Less than half of all respondents believed that they should have children. Contradicting this however, was that 81% believed that they should have the same rights as everyone else.

If you are interested in reading more about the stigma of having a mental health disorder there is an excellent book written by Graham Thornicroft titled 'Shunned, discrimination against people with mental illness' which is published by Oxford University Press. The book details the experiences of discrimination encountered by people with mental health problems, and looks at what needs to be changed to remove the stigma. Thornicroft suggests that a lack of knowledge (ignorance) is a core problem. He suggests that the level of knowledge of mental health disorders is extremely low, even in the economically developed countries. He also suggests that there is a lack of knowledge as to how to find help if needed.

The following extract from the book (pg. 187) highlights some of they common myths about mental illness:

schizophrenia means split personality
all 'schizophrenics' are violent and dangerous
people with serious mental illness are completely disabled
it's all the fault of the genes
they can't work
they are incapable for making their own decisions
once people develop mental illnesses, they will never recover
psychiatric disorders are not true medical illnesses like diabetes
mental illnesses are brought on by a weakness of character

Finally today, I leave you with the following speech posted on the headsup.ie website (a mental health promotion website for young people) which was given by someone with bi-polar disorder for the See Change campaign:

http://www.headsup.ie/?p=541

How you can help...

In the previous postings, I highlight the effects stigma can have on someone suffering from a mental health condition. The additional pages in this blog provide information on some of the lesser understood mental illnesses, as well as directing you to further resources available. It is clear that knowledge can remove some of the fear and ignorance surrounding mental health problems (a point highlighted by Graham Thornicroft in his book 'Shunned, discrimination against people with mental illness).

It is the responsibility of everyone (from individuals to health care providers, media, government and so on) to increase knowledge and tackle the stigma of mental illness. By reducing this stigma we can reduce the discrimination encountered by mental illness sufferers. Many mental illness websites, highlight the importance of support and understanding in aiding the long-term well being and health of someone with a mental health problem.

The following is a HSE information booklet, which is a useful and practical guide for friends and families who are supporting someone with a mental illness: The Journey Together

There is also a great booklet published by Schizophrenia Ireland, which is an excellent tool for explaining a mental illness to a child. The document can be found on shineonline.ie website - you will find it listed under publications and it is titled 'Learning about mental illness for children'.

Mental illness can affect anyone, at any stage of their lives. Having access to accurate and useful information is vital, and the following pages will direct you to some of the most practical and user-friendly websites published in Ireland.

Frank Bruno, Boxer (Diagnosed with Bipolar Disorder)
(Image source: London Evening Standard, 30.11.10)

Halle Berry, Actor (Suffers from Depression)
(Image source: womenandtalent.com, 28.11.10)

Syd Barrett, Band Member of Pink Floyd (Diagnosed with Schizophrenia)
(Image Source: schizophrenia.com, 30.11.10)