Stigma and mental illness

Dr Meesha Haorongbam *

In 2013, Jennifer Lawrence won the Oscar for best actress for her role in Silver Linings Playbook where she portrayed a woman with borderline personality disorder. In her acceptance speech, she remarked "It's just so bizarre how- in this world- if you have asthma you take asthma medication. If you have diabetes you take diabetes medication. But as soon as you have to take medication for your mind there's such a stigma behind it."

Sadly, stigma against mental illness is prevalent throughout the world. Mental illness is still a taboo topic in many households in Manipur. Some even seem to be unaware about the very existence of mental illness.

Various derogatory terms are used to refer to mentally ill people- psycho, screw loose, nuts, mad, crazy, freak, loony etc. Locally, such people are called "angaoba" and psychiatrists are termed as "angaoba gi doctor". Words used to describe mental illness and mentally ill people matter. For negative words form a barrier to health seeking behaviour and helps to reinforce discrimination.

In a general hospital, when a patient is enquired regarding which department they would like to consult, it is usually answered with a whisper of "psychiatry". Family members or the patients themselves prefer to not have their diagnosis out in the public.

For instance, a person who consulted me vehemently insisted on not revealing his disorder to his family members. In spite of repeated reassurances that his family members' support will ensure a better prognosis, he claimed he wouldn't want his family's reputation to be tarnished on account of him taking antidepressants.

The World Health Organization has defined health as a "state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity." Inspite of the word "mental" being enshrined in the definition of health, mental health has been pushed to the periphery.

Any person will readily consult a healthcare professional when he/she develops any physical illness. But when it comes to mental illness, only a quarter of the population will seek professional help.

This attitude is, in a way, understandable. Medical doctors dealing with mental health, i.e. psychiatrists, have always been relegated to a secondary or even a tertiary role. They have even been referred to as "alienists".

Psychiatry, for ages, was considered as a pseudoscience and is still, in many parts of the world, treated as a step-child of medicine. When such a belief is prevalent amongst healthcare professionals, is it any surprise that the general population view psychiatrists and mental illness with scepticism?

Another reason for stigma could be the roots or origin of psychiatry. Ancient people tended to blame unexplainable phenomenon on the wrath of Gods, or a curse, or bad karma or witchcraft. This was truer for psychiatric illnesses than any other illnesses.

Certain mental illnesses are still commonly believed to be due to demonic possessions. The cure for "insanity" was even more horrific- bloodletting, incantations, exorcism, amulets, etc.

The fear of such practices led to people hiding their illnesses; for who would want their family members to go through the ordeals of being ostracized by society. Print and electronic media also plays a very important role in stigmatization of mental illnesses. They have been criticized for disseminating negative stereotypes and inaccurate descriptions of those with mental illness.

At the other end of the spectrum they tend to trivialize those with mental illness. Movies tend to portray those with schizophrenia as violent, those with obsessive compulsive disorder as nitpicking behaviours that annoy people around them etc.

Though there have been some hits along the way, the misses far outnumber them. Compare for instance the warm, caring surgeon, Dr. Carson, in Gifted Hands to the can-read-your-mind-like-a-book cannibal psychiatrist, Dr. Lector, in The Silence of the Lambs.

The World Health Organizations estimates that one in every four people will have a mental disorder at some point in their lives. This number is only expected to grow. But only two-thirds of those affected, and lesser still in developing countries, seek professional help.

Stigma and discrimination have been cited at the top reasons for refusal to seek help. Mental failure is not a personal failure. In fact, if there is failure, it is to be found in the way we have responded to people with mental disorders. Victim blaming is quite rampant when dealing with a mentally ill person. This is something we never do to those with physical illness.

For example we would never say "It's just cancer. Get over it". Mentally ill people, meanwhile, are constantly told to get over it, it's just a phase, it's an excuse for laziness, it's their choice, they just need some fresh air etc. This idea that one can snap out of mental illness stems from the belief that such illnesses do not exist or that it is completely under one's control.

It has been proven that mental illness is due to chemical imbalance in the brain the way diabetes is due to a hormonal imbalance. Neither asked for it. Yet we stigmatize the former and sympathise with the latter.

In the early 20th century, cancer was a hushed diagnosis- a disease too terrifying and too stigmatizing to be revealed to others. The later part of 20th century and early 21st century saw HIV/AIDS go through the same fate. Thankfully, extensive awareness campaigns have helped to gradually lift the veil of stigma from these diseases.

One can only hope that the same holds true for mental illness. Various mental health professionals have been working tirelessly to educate the masses on mental health and there has been some amount of positive change in the way we talk about and deal with mental health.

It's worth remembering that we still have miles of journey left to cover. If you or anyone you know has any sort of mental illness here's what you can do:
1. Do not hide either from people around you or from your illness.
2. You are not your illness. You are not a schizophrenic. You have schizophrenia. Your illness does not and should not define you.
3. Get the treatment you need. Do not let the fear of being labelled with a mental illness stop you from getting help.
4. Talk openly about mental health.
5. Educate yourself and others. Far too often stigma arises from misinformation. The only way to combat that is through education.

"Mental illness is nothing to be ashamed of but stigma and bias shame us all"- Bill Gates