When I was young, my family would often travel to a nearby town to visit family friends. As a child, it was not my favorite pastime and I often felt forced to play with the kids in the family which at that age was a chore. However, the father of the family was the big mystery at the time. He was there but not often seen and when, he looked troubled and disheveled. I one day asked my mother what was wrong with him and why he never said hello or ever looked happy, an obvious question for a ten year old boy trying to understand. I asked this question in front of the man’s wife and was met with stony silence and a glare from my mother that could have knocked a wall down! Later, she explained to me that he is suffering from depression and we do not talk openly about that and I was to apologize to to the man’s wife next time we visited them. What this did for me was to instill a feeling that the man was suffering from some zombie-like disorder that would eventually turn him to some kind of serial killer… I was in fear of him. Given that this was the early 70’s, one might think that times have changed and they have to certain extent but the stigma around mental health issues continues unabated, so much so that a recent report from the WHO concluded :
One in four people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.Treatments are available, but nearly two-thirds of people with a known mental disorder never seek help from a health professional. Stigma, discrimination and neglect prevent care and treatment from reaching people with mental disorders.
That is truly shocking but hardly surprising in a world where mental health issues are seen as a sign of weakness and sufferers are often discriminated against by employers, sometimes family and friends and society in general. Where I live, not many people would admit they they are seeing a therapist or being treated by a health professional for fear of this being revealed. Health insurance companies here often exclude psychotherapy in their policies and increase premiums greatly when it is included and applied for. Often any treatment offered is insufficient in terms of amount of sessions covered to make any real difference. People tend to struggle on, brush it under the carpet or attempt to deal with it in their own way… often with disastrous results.
I am fairly sure that situation exists in other countries too. The message is… it is too complicated and costly to treat mental health issues. Is it then any wonder that people do not seek treatment? I have clients who, when invited for a job interview, have a major concern about whether any issues they have had will need to be revealed or will be found out!
There are lots of different types of stigma, and overcoming them requires different strategies. In a paper recently published in Psychological Medicine, Sarah Clement and colleagues from King’s College London neatly outline some of the ways in which it can be categorised. It seems to me that when mental health stigma is discussed in the media, we’re mostly talking about either experienced or perceived stigma – in other words, situations in which people have directly experienced unfair treatment, or opinions on the extent to which people in the general public have stigmatising attitudes towards mental illness. But there are other types – including what Clement and colleagues refer to as anticipated stigma (where someone presupposes the way in which they might be perceived or treated), treatment stigma (the perceived implications of seeking or receiving treatment) and internalised stigma (in which you hold stigmatising views about yourself). When celebrities suffer from depression and mental health issues, talk of depression and suicide is near constant in the media. In short, depression is everywhere. Does that mean that it’s easier for someone with depression to talk about it? While talking about depression in the media might help with perceived stigma, it’s not necessarily the case that it will help with other forms.
Stigma and discrimination can also worsen someone’s mental health problems, and delay or impede getting help and treatment, and their recovery. Social isolation, poor housing, unemployment and poverty are all linked to mental ill health. So stigma and discrimination can trap people in a cycle of illness. The situation is often exacerbated by the very media that we talked about in the last paragraph. Media reports often link mental illness with violence, or portray people with mental health problems as dangerous, criminal, evil, or very disabled and unable to live normal, fulfilled lives.
This is far from the case. Most people who experience mental health problems recover fully, or are able to live with and manage them, especially if they get help early on. However, research states that nearly nine out of ten people with mental health problems said that stigma, perceived or otherwise played a major role in the decision-making process concerning treatment and the willingness to seek it.