The branding that devalues
Stigma against the mentally ill is getting both worse and better, as attitudes polarize
'In no other field, except perhaps leprosy," a Canadian report on mental illness said 45 years ago, "has there been as much confusion, misdirection and discrimination against the patient as in mental illness … Down through the ages, [the mentally ill] have been estranged by society and cast out to wander in the wilderness. Mental illness, even today, is all too often considered a crime to be punished, a sin to be expiated, a possessing demon to be exorcised, a disgrace to be hushed up, a personality weakness to be deplored or a welfare problem to be handled as cheaply as possible."
It is unsettling and frustrating that the world has not changed much since then.
Mental health is one of the most pressing problems for us to deal with as a country, as a people and as individual Canadians. There is no health without mental health. One out of five of us is living with a mental illness. But most people are too embarrassed to admit it. That is because of stigma.
Stigma consists of the negative ways in which people living with mental illness are labelled. This labelling is so pernicious that people living with mental illness are often seen as nothing more than the illness itself. In fact, the Greek word stigma means a mark or brand, by which an animal or slave could be identified. When we classify people by their illness, we dehumanize them.
Mental illness still has the taint of leprosy. Many people report that stigma — particularly the ways that they are treated by family, friends and co-workers — often causes them more suffering than their illness itself.
When I was the chair of the Senate standing committee on social affairs, science and technology, which produced in 2006 the first national report on mental illness, Out of the Shadows at Last, we heard heart-wrenching stories about the impact of stigma. We heard about the shame that people living with mental illness suffer. We heard about their losing friends and contact with family. People were wary of telling their friends because of their fear that the friends would react badly and abandon them.
Parents admitted to being too embarrassed to acknowledge that their child was living with a mental illness. In a recent study, 38 per cent of parents said they would not admit to anyone — even their family doctor — that they had a child with a mental illness.
We also heard about humiliation at work — all because of mental illness.
But stigma is not just name-calling. It's also "sticks and stones" that can have concrete consequences. According to a Scottish study, people with mental health problems reported experiencing more than twice as much harassment as the general population. The perpetrators were typically neighbours and teenagers. Almost all those surveyed said that the harassment had made their mental health worse. Almost one in three moved as a result.
People living with mental illness are also less likely to report any offence or crime committed against them, because they report that police are unsupportive. And if they do press charges, they often end up being branded "unreliable" witnesses in court.
British research confirms that 80 per cent of people with longer-term mental health problems are out of work. So poverty and small, fragile social networks add to their problems. In Canada, it is no better. Almost half of us believe that if someone at work was dealing with depression and missing work, they would be more likely to "get into trouble and maybe even fired."
Current research has found that the public is generally better informed about mental illness than it was a few decades ago. Researchers at Columbia University report that there is greater awareness of mental illness and its biological underpinnings, as well as the availability and effectiveness of treatment.
The bad news is that, in lockstep, there has been a corresponding increase in stigma, discrimination and social distancing. Increasingly, the public is attaching stereotypes, such as "dangerous and incompetent," to people with mental illnesses.
The reason for this apparent paradox is that in the past, fewer people thought about mental illness at all. Most people did not give it much consideration. As more people hear about it, many who were neutral are led to take a position, for better or worse. In effect, they divide into two camps: those who are sympathetic and supportive because they understand the issues better, and those people who become more fearful, prejudiced and hostile as they hear more about the subject. Fortunately, a large majority become more sympathetic, while the negative group is considerably smaller.