So about a month ago, this video was posted on the UOIT Student Mental Health Services Facebook Page:
“Diseases of the body garner sympathy, says comedian Ruby Wax — except those of the brain. Why is that? With dazzling energy and humor, Wax, diagnosed a decade ago with clinical depression, urges us to put an end to the stigma of mental illness.”
I saw this and in doing so I was inspired. I wondered “Yeah, why is that?”
Ruby Wax urges us to put an end to the stigma of mental illness – and it is certainly a good thing that there are people like her to champion this cause – but she never addresses the reasons why there is a stigma in the first place. While I enjoyed the video, I was disappointed that she did not answer the question that she asked.
It seems to me that everyone wants to try to solve a problem without understanding the cause, but what we have to understand is that there is a reason that people hold this stigma. If we’re going to bring an end to the stigma, we’re going to have to understand why it is that there is a stigma in the first place. With this understanding, it is possible to come up with a solution that reaches the core of the problem, instead of just treating the symptoms or preaching to the choir.
So what is the cause of the stigma? This is what I hope to answer, at least partially.
First, I read an article from Feldman and Crandall (2007). Their experiments determined that the three main causes of mental health stigma are as follows: Danger – referring to the extend by which the mentally ill person is a danger to themselves or others, Rarity – referring to how rare the mental disorder is perceived to be, and Responsibility – referring to the degree by which people believe the mentally ill person is at fault for their actions and for their condition.
Danger makes intuitive sense. Rarity of the disorder was an interesting result, and the correlation is not totally clear yet (the rarer the condition, the more likely people were to hold a stigma towards people with that condition). However, I’d like to discuss Responsibility, and I’d like to open the discussion up with a question.
Where does personal responsibility begin where mental illness is concerned?
The example that crystallized this concept in my mind was one of a man with bipolar disorder. His expression of bipolar disorder caused him to act in a hypersexual manner despite the fact that he was married. This strained their relationship, because despite the fact that this guy has bipolar disorder, actions have natural consequences.
So over time – as the issue comes up, sympathy trickles down. A condition that cannot be helped is blamed repeatedly for an action that bothers those who must deal with the consequences. The condition starts to sound more and more like an excuse with each repetition. Even the guy who suffers from Bipolar Disorder begins to wonder if he is just using it as an excuse to cover the possibility that he is unfaithful.
For some, there is no patience for this at all. Recognize that there are people in the world who do not believe that mental illness is a thing, particularly with subtle conditions that do not leave a physical mark. Conditions like Asperger’s Syndrome, ADHD, Bipolar Disorder, Depression, and others immediately sound like excuses to them. People like this need to be convinced otherwise, and it isn’t going to happen by yelling at them and telling them they are wrong. Understanding things through their point of view is the hard way, but it is also the right way if you want to change their mind (as I have said – and will continue to say – many times).
Often I see the comparison between mental and physical illness, as stated by Ruby Wax. As I continued my investigation, I found an interesting thought on the subject.
If I had a cold, what are the expectations that other people have of me? They would expect that I act in a way that facilitates a healthy recovery and would do what they could to facilitate that. Perhaps they would suggest I take medicine or make me soup. They would expect that I stay in bed, keep warm, take medicine, and do what I need to do to return to good health. They would be frustrated if I did anything to further compromise my health or if I did anything that endangered the health of others. If I went to work while I was sick, I would not be productive, I would not facilitate recovery, and I would potentially get other people sick.
My condition is that I am unwell, and the expectation of others is that I get better.
I am autistic. What are the expectations that other people have of me? They expect that I act in a way that facilitates good conduct and that I improve upon the weaknesses of my condition (i.e. that I act in a way that facilitates a healthy recovery). This expectation has hovered over me all of my life, and it is probably why I maintain a personality that prizes self-improvement. Perhaps at first they will accept autistic behaviour, just as they would accept that I am incapacitated when I am sick with physical illness. Every action taken regarding me is made understanding I am not well, but expecting that I improve with time – just the same as if I was sick with physical illness.
Perhaps my childhood would have been easier if I grew up in an environment where my condition was fully accepted and my behaviours were indulged, but if that were so I would not function as well as I do. My childhood would have been easy, but adulthood would be impossible for me. Instead, I was made to undergo various therapies with the purpose of influencing my behaviour and improving my motor skills.
My condition was that I was unwell, and the expectation of others was that I get better.
Perhaps I will never totally shake every aspect of my condition, but if I refuse to use it as an excuse and strive towards self-control, no one will ever know the difference. Having gone through this transformation, I know that it is extremely difficult – and yet I also know that it is possible.
But now that we have a somewhat better idea of some of the underlying causes, what can be done to end the stigma? Ending the stigmatic view of mental illness would certainly make things easier, given that social rejection makes mental health recovery that much harder. That said, there is no simple solution.
Education is of course a necessary component, but as I have said in the past we must be careful in the way that we apply education so that it does not become indoctrination. There are many things that could be done that would not be helpful. Preaching to the choir will inspire those who already believe, but will not helpful in changing fresh minds. If you want to educate people about mental illness, there are a few things that I would recommend as a starting line.
- Show people the difference between a mentally healthy brain and mentally ill brain. Demonstrate that mental illness is a real thing beyond reasonable doubt, because I can guarantee that there are people who doubt this. That said, do not teach this as dogma. Demonstrate its reality through the scientific method. Show them that mental illness is a thing, and show them how we know this, for nothing is worse to a skeptical mind than a dismissive response like “it just is” or “deal with it”.
- Answer questions to the best of your ability. If you can’t or won’t, find someone who can and will. Nobody learns anything if we don’t reach out to people who are open to being persuaded. Don’t be discouraged by resistance or questioning if you can help it.
- As part of the process of education, people should interact with mentally ill persons. Interacting with severely mentally ill persons helps to reinforce that mental illness is a real thing that needs to be dealt with. People are also more sympathetic when they personally know someone who is dealing with mental illness.
What can be done by those in the mentally ill camp do? It could be helpful for us to reveal our conditions to people we are dealing with, especially our friends. This can go a long way towards educating people about a particular condition, as knowing someone who personally suffers a mental health condition allows them an opportunity to ask questions and allows them to extend their empathy. That said, it could just as easily backfire if your friend is uninterested in listening or having their mind changed. My personal policy is to only reveal my condition if it is relevant to the conversation, but even then I am more likely than not to keep it to myself. While I cannot blame you if you decide not to reveal your condition, I believe that it is ultimately necessary for people to see us in the light of day.
That is all I have to say on the matter for now.