Mark of shame :

Stigma of mental illness

Lionel Wijesiri

Mental illness is common in our country. According to a report one in every four Sri Lankans will have a mental health problem at some point in their lives. Mental illnesses account for a large percentage of hospital stays every year. Yet, in spite of the fact that every Sri Lankan adult knows someone who has been, or will be, affected by mental illness, few people know very much about it.

It is human nature to fear what we don’t understand. That is why mental illness is feared by many people. Unfortunately, it carries a stigma and because of this stigma, many people hesitate to get help for a mental health problem for fear of being looked down upon. It is unfortunate that this happens because effective treatment exists for almost all mental illnesses. Worse, the stigma experienced by people with a mental illness can be more destructive than the illness itself.

Myths

There are many myths about mental illness. Here are some of them: (1) People with mental illness are violent and dangerous. Wrong! Mentally ill people are no more violent than any other group. In fact, they are far more likely to be the victims of violence. (2) People with mental illness are poor and/or less intelligent. Wrong! Most mentally ill people have average or above-average intelligence. Like any physical illness, mental disorder can affect anyone regardless of social class or income level. (3) Mental illness is caused by a personal weakness.

Wrong! A mental illness is not a character flaw. It is an illness, and it has nothing to do with being weak or lacking will-power. (4) Mental illness is rare disorder. Wrong1 Mental illness is not a single disease but a broad classification for many disorders. Anxiety, depression, schizophrenia, personality disorders, eating disorders and organic brain disorders can cause misery, tears and missed opportunities for thousands of Sri Lankans.

One need not look far to find evidence of the stigma of mental illness. A few years ago, at a sales staff get-together in my company, I observed what happened when a bright young executive made the frank disclosure that she suffered from bipolar disorder. Other colleagues, who had previously been engaged and excited about learning about her achievements, became extremely uncomfortable, refused to make eye contact with her, and were quiet and withdrawn. I could not understand what happened. All the executives around her were well-educated young men and women, some even with MBAs. They were been groomed for the future. Yet the stigma remained! It took us four months and three full-day workshops (two attended by medical specialists) to put the matters right.

Strategy

Persistent efforts to reduce the stigma associated with mental illness haven’t succeeded as well as hoped, suggesting that new strategies might be necessary. That enduring fear of mental illness is precisely what we should work to combat. What we need is a systematic plan which could well boost compassion for the mentally ill from the grass roots upwards.

For decades, a number of state and voluntary organizations have been trying to persuade the public that mental illnesses such as depression, alcohol dependence and schizophrenia are neurobiological disorders, not just people behaving badly, hoping that harsh judgments would subside.

So what might be the next strategy to reduce this pervasive stigma?

I believe part of the answer lies in stories, “having people with a condition tell their story. This should include a “way-down story” and a “way-up story”: “the way-down proving you are a person with a mental illness and the way-up proving that you have recovered.”

Most people with serious mental illness do recover, so that’s why way-up stories are so important. I suggest that these stories be told to key power groups - instead of trying to change popular opinion, trying to change important power groups like landlords and employers.

Stigma may be obvious and direct, such as someone making a negative remark about another’s mental health condition or the treatment. Or it can be subtle, such as someone assuming another could be violent or dangerous because that person has a mental health condition. These and other forms of stigma can lead to feelings of anger, frustration, shame and low self-esteem - as well as discrimination at work, school and in other areas of your life.

Negative Perception

For someone with a mental illness, the consequences of stigma can be devastating. There are number of harmful effects of stigma. A person can try to pretend nothing is wrong, refuse to seek treatment. The person may be rejected by family and friends, discriminated at school or work-place, be subjected to physical violence or harassment etc.

Independent studies show that the stigma of mental illness prevents hundreds of Sri Lankans from seeking treatment. It was found that fewer than half of those who reported mental illnesses during a year sought treatment, and those who did waited at least half a decade, by which time they were more likely to have developed additional problems.

Given the negative perceptions of mental illness, and the shame, it is not surprising that people with mental disorders delay seeking help for decades. Concealment remains a major means of coping.

Change

While there is a strong recognition that prejudice based on race, ethnicity and gender is a social problem that we need to understand and address, such recognition has not been given to prejudice - or its consequences - based on mental illness. This is why, I believe, a radical change of thinking is so important.

Depressed teenager. Google

A far brighter future will emerge when knowledge replaces ignorance, when effective treatments supplant custodial care and inadequate community intervention, when legislation mandates equality and when contact with the realities, rather than the stereotypes of mental disorder, taps people’s empathy.

Much needs to be done to compel people to break the stigma of mental illness.

The grass level community organisations should work closely with the Government to help end the stigma of mental illness through greater public awareness and outreach as well as the recognition of the importance of funding to the mental health community.

It is amazing how many people who have a mental illness or have it in their family sit in lonely silence until they hear someone like us tell our story. It may only be privately to us that they reveal the existence of mental illness in their life, but it is a start in their releasing this burden and a significant step in their healing process.

The most powerful antidote for the internal effects of stigma and discrimination is spiritual strength. However, the spiritual strength will diminish, however, unless it is constantly nurtured through giving and receiving loving care in our relationships with others. Thus it is of major importance that each of us should attempt to develop a welcome and spiritually nourishing environment for those affected by mental illness.

We know that these are difficult times and tough choices have to be made. But when the mental health system is overburdened and the number of people entering the system is burgeoning, it is important to keep the vital community safety net in place. Stigma produces silence. Silence allows stigma to go on unabated. We do need more than talk to stop stigma, but it would be a huge step toward its elimination if the voices of those affected by mental illness could be heard.

We have already changed the way we refer to women and people with physical disabilities. Why stop there?