When Anti-Stigma Backfires

John McManamy Health Guide
  • This is the second in a series exploring stigma. We’re all against stigma, right? Here is how the National Alliance on Mental Illness (NAMI) looks at the issue (from their website):


    Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. ... Mental illnesses are not the result of personal weakness, lack of character or poor upbringing.


    I’ve always had considerable trouble with the diabetes analogy. Yes, mental illness is mediated through the biology of the brain, but the comparison to a breakdown in pancreatic function is oversimplistic and can lead to unintended consequences. 

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    In a Jan 8 2010 NY Times article The Americanization of Mental Illness, author Ethan Watters pointed out how good intentions can lead to bad results. The article is based on his book, "Crazy Like Us: The Globalization of the American Psyche." According to Watters, the western notion that mental illness is a no-fault “brain disease” may have the opposite effect of increasing rather than reducing stigma. Citing the research of Sheila Mehta of Auburn University, Watters notes:


    The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events.


    The author cites a four-decades long study that found a steady rise in the American public in their perceptions of schizophrenia as dangerous. Meanwhile, in Turkey:


    Those who labeled schizophrenic behavior as akil hastaligi (illness of the brain or reasoning abilities) were more inclined to assert that schizophrenics were aggressive and should not live freely in the community than those who saw the disorder as ruhsal hastagi (a disorder of the spiritual or inner self).


    Watters cites the research of anthropologist Juli McGruder from the University of Puget Sound who spent years in Zanzibar studying families of those with schizophrenia, where spirits are “coaxed out” with acts of kindness.


    Says Watters: “Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.”


    So how do we prefer to be identified? Just about all of us would opt for “human being.” We have all been through it. We know how dehumanizing it can be when the people charged to help us are more interested in the diagnosis rather than the person. It’s as if the sum total of “me” doesn’t exist, just a slice of “me.”


    Those who take a particularly dim view of psychiatry would do away with labels, altogether. Here is the money quote from an April 27, 2012 Washington Post article by psychologist Paula Caplan:


    As the patient labeled as bipolar told me: "If I had never been diagnosed, I probably would still be married, would live close to family and friends and not be so lonely, and would not be living on the financial edge."


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    But many of those who would do away with labels would also do away with the whole idea of mental illness. Thus, once again in the name of eliminating stigma, we see the propagation of stigma. Only this time, instead of being dehumanized, our pain and suffering is trivialized. It’s all in our heads. Once again, we find ourselves marginalized.


    This is where I would ordinarily suggest some kind of middle way, but I’m more interested in learning from you. We’ve all been down many roads, often walking side-by-side. Please feel free to share your stories. 


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    Previous article:

    The Crazy Thing About Stigma

Published On: July 27, 2013