Lets Break the Cycle of Myths, Stigma and Discrimination in Mental Health
By Dr. Mangala of Schizophrenia Research Foundation (SCARF)
When a mentally ill person requiring help and treatment is discriminated against and is made to feel like an outcaste exactly when he needs maximum support, it is not only harmful for the individual but for society at large. Any community or society which is not inclusive and gives credence to stigmas and myths can never prosper and even advanced treatment gets defeated in the process.
Advances in scientific research have brought significant changes in the lives of people with serious mental illnesses in the past six to seven decades. The neuro-biological nature of the illness has been established beyond doubt, there has even been a better understanding from various perspectives and all this together has definitely resulted in better treatment and improved outcomes in serious mental illnesses. But what do remain as the bigger challenges are the twin evils: stigma and discrimination.
Stigma, when defined, is a strong feeling of disapproval that most people in society have about something, especially when this is unfair (Cambridge dictionary). This sense of disapproval leads to discrimination, an unfair treatment irrespective of person and situation. When a person is labelled by his illness, he is seen as part of a stereotyped group.
Stigma is the negative stereotype and discrimination is the behaviour or outcome of this negative stereotype.
What causes stigma in mental illness ?
Myths, misconceptions and negative stereotypes associated with mental illness contribute to the stigma which is more challenging to deal with than the illness itself.
What are myths?
These are stories, with usually vague origins, that circulate amongst people to explain something that is unclear to one and all. They are commonly religious or supernatural in nature. Over a period of time these stories become beliefs held with conviction.
Where do these myths originate?
Lack of understanding of the scientific facts about mental health leads to ignorance. Ignorance easily forms the basis of the myths. And then these myths totally engulf the people with colourful stories.
Myths have always thrived in every civilisation for centuries. Some of the ancient myths even had a cultural bias. The earliest explanatory models of mental illnesses attributed them to Gods, demons and evil spirits for a lack of better understanding. Scientific understanding of mental health has made remarkable progress but this knowledge has unfortunately not permeated all corners of the society. So the myths happily continue to enjoy unbridled importance for a lot of people.
Much before medical science had made successful inroads in the treatment of mental illness, there were perhaps some understandable factors which fanned the myths. The fear of the unknown, an inability to comprehend the varied and complicated effects of the disease, at times even unpredictable behaviours as also a lack of proper treatment: these were some of the factors which contributed to the stigma associated with mental illness. But in the present scenario, when detection and treatment of mental ill-health have both been steadily on the rise, myths persist due to a lack of awareness as also because of irresponsible media representations.
Myths and mistaken ideas continue to re-emerge and change with the times. Modern myths are based on suspicion, not just superstition, and emphasise the “dangers” of treatment, including medicines, the centres providing mental health care and even the psychiatrists.
How do myths interfere with efforts to get help and treatment?
The adaptive response to private and public shame is secrecy. Secrecy acts as an obstacle to the presentation and treatment of mental illness at all stages. The illness becomes a source of shame, and so it must be hidden. Instead of availing useful help, affected persons may be condemned to a life of suffering that could have been prevented.
- When mental illness is perceived as a curse that must be endured without any prospect for relief, people don’t seek or expect help.
- Magical and faith healing practices delay access to scientific treatment, leading to a needlessly persisting disability.
- Failure to recognise symptoms and signs of the onset of any mental illness may also result in unreasonable blame, hurtful labelling and stereotyping.
- Problems arising from mental illnesses like certain odd behaviours or being disorganised and so on can be difficult for others to understand. This may result in unnecessary ostracisation instead of the much-needed support and care.
- Negative attributes like violence tend to be exaggerated and overemphasized, making those suffering from mental illness particularly vulnerable to the danger of being harmed.
Who are the people affected by stigma?
Patients, families and mental health professionals are all affected by stigma, in that order. While patients go through shame and discrimination, families get no support to take care of patients.
Mental health professionals are treated with fear as they are perceived to be “mind readers” and also with suspicion as they are considered abnormal (thanks to media depictions). Consequently, mental health treatment is also viewed with suspicion.
Some common misconceptions about mental illnesses are listed below:
Myth: Mental illness affects only a few people
Fact: Mental illness is common. It affects people of all ages, educational and income levels and cultures.
Myth: Mental illness is caused by personal weakness. It is a reflection of a feeble/ weak mind.
Fact: Mental illness is not a character flaw. It is caused by genetic, biological, social and environmental factors. Seeking and accepting help is a sign of strength.
Myth: People with mental illness should “pull” themselves out of it.
Fact: Mental illness is not caused by personal weakness and therefore is not “cured” by personal strength
Myth: People with mental illness are intellectually impaired.
Fact: Mental illness is not a reflection of impaired intelligence.
Myth: Once someone has mental illness, he will continue to suffer from it and never recover.
Fact: With the right kind of help, most people do recover and lead healthy, productive and satisfying lives
Myth: People with mental illness are violent and are often dangerous for others.
Fact: They are no more violent or dangerous than the rest of the population. They are more likely to harm themselves. Most are victims of violence
Myth: Mentally ill persons should be put away in institutions or chained for the safety of themselves and others..
Fact: With appropriate treatment and support, people with mental illness live successfully and independently in the community.
Myth: Mental illness can affect those in close contact with the affected people.
Fact: Mental illness is not contagious.
Myth: Mental illness is the result of past sins, a curse or the effect of evil spirits. Magical, religious methods offer relief.
Fact: Scientific medical treatments are the means to get relief for schizphrenia. Prayers, meditation help in coping. They have a supportive role only as in any other health problem.
Myth: Marriage cures mental illness for both genders. Pregnancy and childbirth can cure women..
Fact: Marriage is a usually more of a stress and can worsen the existing state of illness. Pregnancy and childbirth can cause/worsen mental illness.
Myth: Medical treatment promotes dependence on medicines and makes the person unproductive.
Fact: Medicines help in management of disabling symptoms. With improvement, the person resumes productive activity.
Myth: ECT (Electroconvulsive therapy) worsens physical/mental health. ECT is used as punishment for bad behaviour. It is dangerous to life.
Fact: ECT is a scientific treatment method. It is life saving in some conditions. It is used for specific indications. Its use is not widespread.
Myth: All medicines are sleep inducing.
Fact: Medicines are given to reset the bio-chemical balance in the brain. Sleep is an incidental side effect which is beneficial too. That is not the primary purpose of treatment. Please discuss with your psychiatrist if the side effects are distressing.
Myth: Counselling can be an alternative for medicines and ECT in the treatment of Schizophrenia and allied psychotic disorders.
Fact: There is no alternative for medicines in the treatment for Schizophrenia. Counselling cannot reset the bio-chemical balance. Only medicines can help achieve that. Counseling has a definite role to play in the treatment and management of other mental disorders and depression.
The list goes on. The stigma of mental illnesses may be even more challenging to deal with than the illness itself. Replacing ignorance with awareness and dispelling harmful myths is an essential task in the effort to transform stigmatising societies into supportive communities for persons with mental illnesses.