After having just finished my second year studying psychology in Dublin, it feels a bit odd to be writing an article as a part of the Change Your Mind campaign. My own mind is still in essay-mode so I apologise in advance if my writing comes across more as an assignment than an article. I’m passionate about mental health so naturally I jumped at the opportunity to write a piece on stigma.
The OED defines stigma as “A mark of disgrace associated with a particular circumstance, quality, or person.” Although this definition is adequate, the nature of stigma is ultimately derived from the experiences of those who have faced it first-hand. This is particularly important in relation to mental health where the voices of service users have too often been disregarded. But I digress. I won’t patronise you, the reader, by recounting how and when stigma raises its ugly head. Rather I’d like to discuss the impact of stigma in various spheres relevant to mental health. The first of these is the individual and their access to mental health services.
Whether a person experiencing mental distress has received a diagnosis or not, stigma can be a significant problem. The shame and guilt that stigma can inflict upon a person only serves to exacerbate their distress. That alone is reason enough to eliminate stigma. But the impact of stigma is even more pernicious. Stigma can also deter people from seeking help. People may avoid accessing services out of fear that they may face further stigmatisation, preferring instead to keep their distress hidden away. Unfortunately this course of action often prolongs their suffering. It is not always the individual who is deterred by stigma from seeking help; family and friends may also be implicated. In his recent book Skrinks, psychiatrist and former president of the American Psychiatric Association Dr Jeffrey Lieberman describes a lady who was admitted to the hospital where he worked. He quickly discovered that the lady had been experiencing symptoms of schizophrenia but her family were too ashamed to contact the relevant health services. Instead they hid her in a room for over thirty years, only admitting her to a hospital when she contracted a severe skin rash. In that time she could have been receiving treatment but instead, due to stigma, she was confined to prolonged isolation and the deterioration of her condition. This is obviously an extreme example but it proves just how damaging stigma can be to individual wellbeing.
Stigma can also have a political impact. This is particularly important as politicians so often decide where society’s resources are invested. If mental illness is ridiculed and hidden away from view, politicians (as well as legislators) will not give it the attention it needs. This fact is evident today.
While for some of you Dublin may seem a world away, the impact of stigma in politics can be felt closer to home. While mental illness accounts for 28% of the disease burden in the UK, mental healthcare only forms 13% of the NHS’s budget. Stigma can harm individuals by eroding the resources the government commits to mental healthcare. This is why it’s so important for organisations such as Niamh to continue their sterling work in putting pressure on politicians to make mental health a priority and to eliminate stigma.
Another area relevant to stigma is academia. While academia may seem far removed from people’s real life experiences of stigma, teaching and research certainly have a role to play. Where funding for mental health research is directed and how this research is disseminated will subsequently influence how people understand mental health. With recent technological advances in genetics and neuroscience, a biomedical paradigm of mental health (and mental healthcare) has become dominant. Large sums of money are devoted to researching the brains and genes of people who experience difficulties with their mental health. While such research is certainly valuable, its overemphasis often comes at a cost to research on other aspects of mental health; it’s relationship with oneself, their family and wider society. In this age of evidence-based healthcare, the design and evaluation of treatments (pharmacological and psychotherapeutic) for mental illness relies heavily on up-to-date, peer-reviewed research. Where the biology of mental health is overrepresented, psychosocial treatment modalities may be pushed into the background. An overemphasis on the biology of mental health can also directly contribute to stigma. As clinical psychologist (and my personal role model) Prof. Richard Bentall wrote in an open letter to Stephen Fry regarding his recent programme on mental health: “The more that ordinary people think of mental illness as a genetically-determined brain condition, and the less they recognise it to be a reaction to misfortune, the more they shun mental health patients. The biomedical model of mental illness, which your programme showcased, makes it all too easy to believe that humans belong to two sub-species: the mentally well and the mentally ill.”
I’ve only touched on the impact of stigma in three spheres relevant to mental health, but its impact is significant and pervasive. Personally I remember how reluctant I was to access mental health services when I experienced an episode of depression. The thought of having my name on official documentation and being formally regarded as mentally unwell made me uncomfortable to say the least. If it wasn’t for the dedicated and encouraging efforts of my mother I may never have sought help. I know now that mental ill-health is nothing to be ashamed of but I’m aware that while stigma exists, there will be others who find themselves in the same position: quietly struggling and feeling unable to reach out. That’s why I volunteer with Niamh and why I’m writing this article, to raise awareness of mental health and ultimately eliminate stigma. Only by showing solidarity and working together to speak-out can we achieve these aims.
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