Stigma: Changing the Conversation and Changing Lives

Renee Binder, MD
APA President

I was reminded recently of the death of an acquaintance who was at the top of her career when she died suddenly after complications from surgery, according to her obituary. I later learned that she had died from suicide, possibly in response to her struggle with chronic pain and resulting depression. 


Stigma serves as a barrier to seeking treatment often because of fears of discrimination. A few years ago, a patient requested that I not keep any records and wanted to pay me in cash. He was concerned that if his psychiatric records were ever discovered, his career could be negatively impacted. Were this man’s concerns legitimate? In a more public incident Sen. Tom Eagleton was forced to withdraw as a candidate for vice president in 1972 after it became public that he had suffered from depression and undergone ECT (electroconvulsive therapy). 


According to the Merriam-Webster Dictionary, the definition of stigma is a set of negative and unfair beliefs that a society or group of people has about something; it is a mark of shame or discredit. 


How can we begin to address mental health stigma? Here are several ideas: We need courageous spokespersons who are willing to come forward and talk about mental health issues that they or their families are experiencing. Former Rep. Patrick Kennedy is one such champion. He has openly discussed his struggles with mental illness and substance abuse and how treatment has helped him lead a productive and rewarding life.

We can learn from the LGBT community and their struggles with stigma and negative stereotypes. They have taught us that “coming out” by public figures and celebrities can decrease stigma.




Another way of combating stigma is for my fellow mental health professions, psychiatrists and others, to take responsibility for examining the language that is used by the media and in our society. Words such as “lunatic,” “crazy person,” or “maniac” convey images of people who are out of control and dangerous rather than people who are experiencing a mental illness and deserve our compassion and support in getting effective treatments. 


Mental health professionals and others can take an active role in drawing attention to language and advocating for more appropriate, compassionate and less stigmatizing language. Mental health care is an essential part of health care. Almost everyone will suffer from a mental health problem at some point in his or her lifetime.. But for people to be willing to access the mental health care they need, we have to continue the fight against stigma.


If we are successful in addressing stigma, and we must be, then not only will we change the conversation, we will also change people’s lives and change the culture. We will finally reach the point where all of us can openly talk about someone’s death by suicide and encourage people with mental health problems to seek the help they need without fear of judgment or harmful repercussions.


By Renée Binder, M.D., APA President 

The Power of Words: Addressing the Stigma of Mental Illness

Jenna Bowen, medical student, University of Wisconsin

Reviewed by Claudia Reardon, MD

Crazy.  Insane.  Deranged. Mad.  Lunatic. —Misused as nouns, adjectives and
lay-diagnoses, their use perpetuates stereotypes of the wide variety of people
who experience mental illness.

Maybe you know someone or, more likely, a number of people who
experience depression, anxiety, bipolar disorder or other brain disorders.  According to the National Institute of Mental
Health, 1 in 4 American adults and 1 in 5 American youth experience a form of
mental illness every year. People with mental illness are teachers, accountants,
neighbors, sisters, fathers and friends. Anyone you know could be experiencing
mental illness, but afraid to come forward and be treated. Maybe that person is
you.

People living with mental illness continue to have an identity
that is beyond a diagnosis, similar to other medical conditions. While managing
mental illness may be challenging at times—similar to challenges faced by
people with diabetes, high blood pressure, or other medical illness— there is
greater difficulty in getting the treatment needed because of feelings of shame
and stigma surrounding mental illness. However, treatment for mental illness
works. Research shows the majority (65 percent to 80 percent) of individuals
with mental disorders will improve with appropriate treatment and ongoing
monitoring. People with mental illness need to know that they will continue
to be seen as people – your brother, best friend, daughter —and not “crazed” or
“insane” if they appropriately seek help for a treatable medical condition that
they happen to be experiencing.

Bring Change 2 Mind, an organization aimed to end stigma and
discrimination surrounding mental illness, offers recommendations to reduce
your impact on the stigma surrounding those with mental illness.

• Use "person first" vocabulary. When we say a person is
  schizophrenic, we make their mental illness fully define their identity.
  Instead, be clear that this is a disease that individuals manage and live with—
  "He is living with schizophrenia."


• Avoid the verb "suffers" when discussing mental illness.
  Instead, choose, "lives with mental illness" or "is affected by
  mental illness."


• There are many phrases and terms; "crazy,"
  "nuts", "psycho", "schizo", "retard"
  and "lunatic" that may seem insignificant, but really aren't.

Be an advocate for those that you know, and the many that you
don’t know, who are living with some form of mental illness by breaking down stigma,
and being conscious of language surrounding brain disorders. To learn more check
out:

·        
Bring
Change 2 Mind

·        
NAMI
– Stigma Busters

·        
Resource Center to Promote Acceptance, Dignity and
 Social Inclusion Associated with Mental Health (SAMHSA)

·        
Mental
Health Terminology:  Words Matter

Spreading Hope!

By Matt Goldenberg
D.O.

@docgoldenberg 

“You treat a disease, you win, you lose. You treat a person,
I guarantee you, you'll win, no matter what the outcome.” 

I whole-heartedly agree with that statement. However, I
cannot take credit for those words. Those are the words of Robin Williams, or
more specifically, the words of his character in Patch Adams.



I want to discuss the disease called depression. I will start by first
discussing the diagnosis and the signs and symptoms of depression. I will then
follow up with my thoughts on the various treatment options for depression and
the strategies I employ with my patients to improve their outcomes. None of my
thoughts and suggestions should serve in place of a formal consultation with a
mental healthcare provider. However, I hope shedding light on mental health
diagnoses like depression will lift the veil and social stigma on these chronic
diseases that impact so many people.



Psychiatry has come a long way in the last decade. This is a time of continued
discovery and increasing public awareness. The leaders of our professional
organization, the American Psychiatric Association (APA), have suggested that we
as mental health professionals are under a microscope. I agree that we are
and I also strongly believe that we are up for the challenge. School shootings
and celebrity suicides and overdoses have increasingly put a focus on mental
health. Psychiatry has significantly improved the outcomes, treatment options
and the prognosis of patients with mental illness. However, we still are unable
to decrease the prevalence of the diseases we treat or prevent them. We know that
the brain changes during an episode of depression and our treatments help it to
return to normal (see the image below). Although we are getting closer, we
still currently do not have widely accessible blood or imaging tests that can
confirm our diagnosis or localize the area of disease.

I can say with certainty, however, we are able to accurately
diagnose patients. We are able to identify medications, psychotherapies and
other treatments that patients with a specific diagnosis or cluster of signs and
symptoms often benefit from. There is strong evidence that our treatments
decrease symptomatology and disability and improve quality of life, clinical
outcomes and a patient’s prognosis.



Psychiatrists are trained to view the patient as a “whole person”. Psychiatry
is a field of medicine whose assessment by definition includes all of the
biological, psychological and social aspects of a patient’s life. We listen for
the psychological and social factors that can contribute to disease.
Oftentimes, the “whole story” can be more telling than only focusing on
specific symptoms of a given disease. There is a saying, throughout all fields
of medicine, that “most patients have not read the textbook.” In other words,
patients usually do not present exactly as the textbook says they should.
Stress and psychological factors can mimic chest pain, shortness of breath,
gastrointestinal problems and a whole host of other diseases. If we do not step
back and get the whole story, we can miss the root cause or the exacerbating
factors of many manageable diseases which are of the mind.



Many of the diseases we treat, such as depression, are chronic illnesses which
require lifelong treatment. Our treatments can improve a patient’s mental
health and coping skills and decrease their symptomatology and substance use.
We know through decades of research that these are modifiable risk factors for
suicide. Therefore, Psychiatrists have the training and tools necessary to
decrease a patient’s risk of attempting suicide. Our treatments have the
potential to not only significantly improve the lives of our patients, but also
the lives of their families and everyone who comes into contact with them.
Anyone who tells you otherwise is misleading, misinformed or both.

I
hope this information and the blogs to follow will give you hope. Mental
illness can include symptoms which can be devastating and complications which
can be life-threatening.
However, it is important to state again, these are treatable diseases. If you
or someone you know, would like to talk to someone, call your primary care
doctor or your insurance company for a referral to a Psychiatrist. A true
multi-disciplinary team also includes therapists, psychologists, nurses and
social workers. You are never alone. You can call the national suicide helpline
24 hours a day, seven days a week (1-800-273-TALK (8255) or visit www.suicidepreventionlifeline.org).
There are also local crisis lines likely available in your area and are an
internet search away. If you are ever feeling unsafe, or fearing for the safety
of a loved one, you can call 911 or go to the nearest emergency department.

It is time for everyone to understand that there is no shame in getting help
for depression, much as there is no shame in getting help with diabetes or high
cholesterol. Even if you have never suffered from depression, there is
a lot you can learn.

Together we can raise awareness and spread truth and hope. I know that if we
spread knowledge, and ignore the misinformation, we will overcome the
complacency and ignorance that is so pervasive today. That is how we can best
honor those we have lost. That is how we can best prevent the next death from
mental illness and addiction.

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