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This is the handout I used in a presentation I did on stigma last year. Unfortunately, stigma is just as common now, if not more, than it was just a short year ago. Education never ends.
STOMPING OUT THE STIGMA AND MYTH
MENTAL HEALTH AND ADDICTION
1) WHAT IS STIGMA?
A. A HISTORY LESSON
B. WHO DOES STIGMA AFFECT?
C. WHAT ARE THE COSTS OF STIGMA?
D. VOCABULARY
2) COMBATING STIGMA
A. KNOWLEDGE IS KEY
B. OVERCOMING FEAR
C. SMALL STEPS
D. AS A SOCIETY
E. YOUR PART
3) RESOURCES
A. RIGHTS AND RESPONSIBILITY
B. ORGANIZATIONS
4) A WORD ON ADDICTION
Mental illness has been present for centuries. It is reported that the first psychiatric hospital-known then as “insane asylums”, was built in Baghdad in 705. Probably the best known asylum was founded in London. Bethlem Royal Hospital, now known to most as “Bedlam”, was first established as a hospital in 1330.
In 1403, Bedlam admitted their first nine “mentally insane”. Reports of severe inhumane treatment were made against Bedlam. There was the use of physical restraints, trephining (drilling holes in the head to release the “demon” of insanity) and overall neglect.
Those deemed “dangerous” were chained to floors and walls. A select few were permitted to be released for brief intervals to beg in the streets; returning their “income” to the facility. In the 18th century people would go to Bedlam (also called the Madhouse), pay a penny and watch the “freaks”. They were permitted to poke sticks at and throw things at the “lunatics”. In 1814 the asylum had 96,000 such visitors.
Thankfully, Bedlam has since been moved and re-established as a mental health and addiction recovery hospital. On a positive note; the doctors at Bedlam eventually stopped using the word “lunatic” and exchanged it for “patient”. The category of curable and incurable patients was also established.
In 1834, the United States had it’s first model of a “moral treatment” facility founded. Although the Brattleboro Retreat was much more humane than Bedlam, the research of brain disorders had a long way to go.
By mid 1940, the mental health system took a wrong turn yet again. The use of electro-shock and insulin shock were widely used, as were the procedures known as frontal lobotomies. These treatments were likened to the Bedlam brutalities.
It wasn’t until 1950 before the first psychiatric medications became available. With that came the formal compilation of the Diagnostic and Statistical Manual on Mental Disorders (DSM). In 1952 there were approximately 170 diagnostic categories in mental illness. In the latest edition of the DSM (1997), there were 297 categories. It’s estimated that by the next printing in 2012, there will likely be over 400 categories!
It’s no wonder that with those kind of numbers, the mental health field is one of the most rapidly growing employment areas. Not to mention the cost to us as a society (please see attachment B1).
Now, if only we could change the stigma behind mental illness and brain disorders.
Most people fear what they don’t understand. So it is with mental illness and brain disorders. As we’ve already seen, many times those with these diagnoses are treated poorly. Being looked upon as a social outcast or misfit is nothing new to the mentally ill. Often times they are ridiculed for not being able to “just get over it” or thought of as bringing it on themselves.
Before we can understand the stigma of mental illness, perhaps we should clarify exactly what mental illness is. According to a2zpsychology.com; mental illness is “….any disease of the mind or brain that affects a person’s thoughts, emotions, personality or behavior”. The article goes on to state; “…everyone experiences mood swings or finds it difficult to think clearly from time to time. A mentally ill person has severe symptoms that damage one’s ability to function effectively in everyday activities and situations”.
I personally disagree with the latter portion of that statement. I feel it would be more appropriate to say that those with a mental illness SOMETIMES have severe symptoms that may cause them to have a harder time of handling life’s situation as effectively as they could if they were not having those symptoms.
As we noted; the DSM has many classifications of mental illness. Those are broken down into broad categories. Those categories include (not limited to); delirium, schizophrenia, eating disorders, dissociative disorders, substance disorders and mood disorders. Then those are broken down into smaller categories.
For example; depression is a mood disorder, but can be broken down into sub categories such as SAD (seasonal affective depression/disorder), also known as winter depression. It can all get very complicated and involved. Which, by the way, can complicate the treatment or medication choices of these illnesses.
Another point to keep in mind. Many times there is more than one diagnosis per person. This is often referred to as co-occurring illness. This is commonly seen in those with a substance addiction. There may be an addiction to methamphetamine, as well as bi-polar illness for example. Often it’s like the old adage “what came first; the chicken or the egg?”
Factors in mental illness can be; hormone’s, brain injury, genetics, illness, chemical imbalance, stressors, early life trauma, environment or medications taken during pregnancy that effect the baby. Developmental disabilities are often deemed as mental illness, when in fact these are considered a brain disorder.
The treatments are as vast as the illnesses themselves. Whether they receive therapy, behavior modification, medications or all of the above; the goal is for those with a mental illness as it is for all of us – to have a valuable, full life beyond being a statistic or a casualty of stigma.
In today’s society stigma of all kinds plays a role. But what exactly is stigma? Let’s see what good ol’ Webster had to say about it. “A mark of infamy, or token of disgrace; blemish, blot…” Also; “A mark indicating a defect or something not normal”. Disgrace, defect, not normal. All words that point to a lack of value.
I also find it interesting that the dictionary uses the word “mark”. Do people with mental illness have a neon sign on their forehead that says “crazy”? Is it automatically obvious that one has been diagnosed as “bi-polar” for example? The term “normal” always leads me to wonder who exactly deems what is or isn’t normal? Is discrimination of others due to their religion, ethnicity, gender or economic status “normal”? (some may say yes). Do we treat people with cancer as tho they are not worthy of respect, dignity or adequate health care? What about those with an incurable disease?
What about the family and friends of those who have been diagnosed? Are they treated as if they have the plague too? Absolutely! Consider Julie.
Julie has an 11 year old son who is diagnosed with schizophrenia. When Julie takes her son to the store he often walks the isles talking to an “imaginary” friend. When he was 3, this was thought of as cute. Now people just think he’s “weird” and wonder what his mother did to make him this way.
They ask each other why Julie can’t just control her kid or have him locked up somewhere. They go out of their way to walk with a little more space between themselves and “them”. Folks say things behind Julie’s back and sometimes even within earshot. Things like, “be careful, don’t get to close to them” or “stop staring at him” and even, “he’s crazy, don’t be around him”.
Julie has no real friends because no one likes to come to her house for fear of her son. And of course her son has no friends because the ignorance of their parents has been passed down to the children of the area. Julie can’t even work due to having to be available for her son, no one would hire her anyway because of the rumors in town A few people even feel sorry for Julie. Thinking that “someone” should do something to help them, but that someone is not going to be them; after all, they have their own problems and don’t want to get involved or have the neighbors see them around Julie.
What can they do anyway, they’re not trained professionals. Julie and her son are left alone to struggle in every sense of the word.
Alright then, what CAN we do? It’s a valid point that we are not all trained professionals and by no means have the skills (or the license) to perform lobotomies or practice psychiatry.
One of the greatest tools we have as a society is communication. But this same tool can be used as a weapon. It’s been said that the tongue is a two edged sword. Our words can soothe or destroy. This is so true in the language we use when referring to mental illness and those diagnosed with them.
Take a look at some of our words; crazy, mental, basket case, nuts, psycho, lunatic, retard, just to name a few-and those are mild compared to some I’ve heard. We may say these words innocently enough, but the representation they hold is not so innocent. When directly used to “define” a person; these words are poison. A key to changing our language is to change our view.
If you grow up speaking English and then you have to learn Spanish, it’s very awkward. Your mind thinks in English, yet your mouth is trying to speak Spanish. It takes time and practice. But it can be mastered.
Often people with mental illness are treated like they ARE the illness. If we know someone who has cancer, we don’t say; “Mary is cancer”. Instead we say “Mary has been diagnosed with cancer”. Why is it then that if we know someone who is diagnosed with bi-polar, we say, “Mary is bi-polar”? Let’s take a look at some “recovery language”.
Instead of saying:
“George is a manic depressive”. Try this; “George has been diagnosed as bi-polar”
Instead of; “Lisa is depressed”.
Try this instead; “Lisa has been sad lately.”
Replace; “Harry has gone psycho”, with: “Harry is having some mental health issues”
“Julie’s kid needs put in a nut house”, can be changed to; “Julie and her son are going thru some mental health problems, I hope they can find the help they need” or “I wonder if she could us some help or someone to listen”
As we become familiar with these alternatives, it will become second nature. Hopefully, overtime, we can influence others in their own study of this new language. We might even start viewing ourselves differently. When the fear and lack of understanding begins to fade, our tolerance and empathy for others will show brighter.
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