Stigma: Perpetuating Misperceptions

by David M. Edwards and Mary Allen

"A mark burned into the skin of a criminal or slave; a brand." This archaic definition of the word "stigma" conjures up images of inhumane treatment from a less enlightened age. But how far have we really progressed? While we no longer use a branding iron to mark members of our society whom we don't understand or who have broken our rules in one way or another, the stigma associated with certain people - in particular those with some kind of mental illness - can be just as persistent and debilitating.

Dr. Paul Fink, a past president of the APA and nationally recognized proponent of decreasing the stigma surrounding mental illness, recently spoke with Treatment Today about this pervasive problem.

"Stigma continues because it is irrational," Dr. Fink said. "People are afraid of the mentally ill. This has grown out of the feeling that they were witches in the 16th Century." Stigma is born out of ignorance, and in an endless cycle, "stigma perpetuates the ignorance." Unfortunately, it is our nature to fear that which we don't understand. "Sometimes mentally ill people, when they are very sick, are incomprehensible - that scares people."

Although stigma has its roots in the past, Dr. Fink believes a major reason it persists, in spite of significant advances in scientific research and medical understanding, can be found in media portrayals of mental illness. "There has been a tremendous amount of media hype that the mentally ill are violent. It turns out that 3 percent of the mentally ill are really violent, and yet 77 percent of mentally ill people depicted on television are depicted as violent." This grossly disproportionate representation is inextricably linked to the prevalence of violence in movies and television programs. "It is often used as a reason why a person is violent - because they are crazy."

The media can be a positive influence, however. Dr. Fink cited television programs on issues related to mental health, such as domestic violence, schizophrenia or manic-depression, as well as public service ad campaigns. "There were some wonderful ads that the American Mental Health Fund, which Jack Hinkley (John Hinkley's father) created after his son shot President Reagan," he said. Dr. Fink served on the board of the organization. "Unfortunately, we ran out of supporters and money, and we, like most of these charities, were short-lived."

Another source of stigma related to mental illness is the misapplication and popularization of clinical terms. "The whole misuse of terminology causes a tremendous misunderstanding of these illnesses," Dr. Fink said. "A word like depression means everything from a stuperous condition, in which the person can't function at all, to 'feeling blue' one day when you got griped at by your boss."

A somewhat different situation exists in relation to people with addictive disorders. Stigma against these people, according to Dr. Fink, is based on "the idea that it is a self-inflicted wound, and we should not be attentive to people who want to hurt themselves. If they wanted to stop, they could stop." This perception is related to a lack of understanding of the physiological nature of addiction. "The idea that addiction causes an alteration in the brain that makes it impossible for people to stop it without help is clearly not understood by the majority of legislators or the majority of people in society," he said.

"Remember, stigma is a form of ostracization," Dr. Fink said. "People, when they are under the influence of their drug or alcohol, are unsavory." Nevertheless, he believes the stigma associated with addiction is less persistent than with mental illness "because once a person is well put together they can live a good life. People can think of them as recovering."

Surprisingly, some of the people with the most discriminatory attitudes are doctors. "Physicians are the most prejudiced against the mentally ill," Dr. Fink said. "They just refuse to get it. The jokes, the continual put-downs, the relative disregard for our patients I think is rampant in the health marketplace."

The insurance industry also contributes to this stigmatization. Although some progress has recently been made (see "Legislation" in this issue), insurance programs in the United States have perpetuated the stigma against the mentally ill. "People don't want to get help because they don't want anyone to know, so they don't use their insurance; or they use their insurance and they feel very guilty and ashamed."

Dr. Fink believes that these attitudes are due, in part, to a general cynicism in our society. "It's not just exclusively the mentally ill. Anybody you can beat up, you beat up," he said. "We are in a very, very nasty time." This cynicism is exacerbated by efforts to cut spending in all areas of healthcare. "We are not concentrating on humane and compassionate issues. That is not the agenda of the United States. We are concentrating on money."

Given this rather bleak assessment of the current situation, what can be done to improve matters? According to Dr. Fink, one step would be to "raise consciousness so that people will not misuse the terminology. If we could eliminate the word "crazy" from people's vocabulary, it would be a major step in the right direction."

Another thing that would help is for people who are in a position to do so to use their influence to combat stigma. "There has to be a clear indication from the top that the mentally ill matter, that we are going to take care of them, that they are important."

In spite of the belt-tightening measures in progress, new ideas are having a positive effect. "What we hear most about nowadays is the cutting of funds for care and the reduction of the amount of care and the place of care. There are some very creative programs in the United States that try to make up for the loss of beds and the loss of inpatient care."

It is important to remember that people with mental illnesses deserve help just as much as someone with pneumonia or appendicitis. "Most of the severe mental illnesses are biological in nature, just like any other disease. We seem willing to support diseases where people can't be functional more than we are willing to support diseases where they can be functional. It is a real problem."

Copyright Quest Publishing Company, Inc. 1996.

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