FreePsychArticles #6  The Stigma of Mental Illness?

Let’s start by defining ‘stigma’ and start thinking about how it works in modern society.

stig·ma

“a mark of disgrace or infamy; a stain or reproach, as on one’s reputation.”

The idealism of current western democratic society attempts to refute and oppose stigmatizing anyone based on “race, color, creed, age, national origin, alienage or citizenship status, gender, sexual orientation, disability, marital status…etc.”   Legislation probably exists in most levels of  government, as well as nonprofit and  for profit businesses to prevent it.   But,  like anything else, people still function and maintain their personal attitudes that shape their decisions.    In spite of the great strides that have been made institutionally,  mental illness continues to occupy the least accepted and least understood of almost all the other human qualities.

First, let’s consider if it’s really so.    Most of us would say we treat everyone equally.   An article in the Los Angeles Times on November 3 stated:  “Public perception of mental illness and addiction has changed significantly — and for the good — in the last 15 years. That doesn’t mean, however, that people feel comfortable working or living near or being friends with someone with mental illness, according to a major new survey.”

There are over 319 pages on Google for the heading “stigma of mental health.”    The people least able to maintain, defend and advocate for themselves are among the most stigmatized people in the world.

IS MENTAL ILLNESS DIFFERENT FROM PHYSICAL ILLNESS?

It is well known a majority of mental illness  result from genetic factors like most chronic illnesses.   They tend to run in families.  These are the Major Mental Illnesses of Major Depression,  Bipolar or Manic-Depression,  Schizophrenia and the mental retardation of Downs Syndrome.    They are directly related to genes or cellular biology.

Another major cause of mental and emotional problems presents due to a problem in regulating emotions produced by  overwhelming traumatic experiences like war, major accidents and natural disasters.    The most well known being P.T. S.D. or Post Traumatic Stress Disorder.

A third large group of disorders are the so-called “Personality or Character Disorders.”   These are both hereditary and environmentally produced.   As the child is exposed to all the varieties of mistreatment, abuse and neglect by it’s parents, older siblings and caretakers maladaptive patterns of behavior are produced in the child.    These maladaptive ways of relating to others and the world around them become virtually permanent and are repeated throughout life.    In the child they are the best way to defend or adjust to the difficult and confusing treatment they receive, but lacking the knowledge or understanding of normal development hold on to these attitudes in the ‘belief’ they belong to their natural personalities.

The last major group are those caused secondarily by medical illnesses or exposure to toxins that effect the brain directly causing ‘confusional disorders or memory problems.’   These can be related to some cancers, poisoning, or alcohol and drug abuse or dependence.

The common thread tying all these together is alterations in brain function.    But the brain is a physical organ!   And all illnesses or physical problems are alterations in physical organs.    They don’t present in the same way because each organ or group of organs behaves and causes different signs and symptoms, for example,  a broken bone causes a problem in the use of the limb,  Lung disease effects breathing while eye problems vision and all the behaviors related to that.    But for some reason those suffering from disorders arising from the regulation of the brain carry the biggest stigma.

When a friend can’t walk, we find other ways to related to them.   If diabetic, we provide foods they can eat while we eat our food.   Heart attack victims are not suddenly considered weird.   Even blind or hearing impaired people have found their way into the main stream of society as they are able.  But how can we think of those who seem to have very different ways of thinking, feeling and behaving?

INSTITUTIONAL: YES,   PERSONAL:  NO

As mentioned laws have been passed, such as the American Disability Act, that makes it illegal to discriminate against anyone do to their disability.   But in the inter-personal world, we discriminate all the time.   And this is okay.  In fact it’s necessary to live.  We have a right to chose who we want to associate with and  get close to.   Yet, we have to be careful in our judgements and conclusions to avoid misjudgment and wrong conclusions.

Perhaps we believe if no one protests, it’s okay to do it?    We can make jokes and throw around words like “crazy, insane, schizophrenic or nuts” without any hesitation in public, in the media or among ourselves without expecting any reprisal.   If someone says or does something that doesn’t fit into our expert opinion of normalcy we can immediately peg them a “mental case” and thereby close our mind’s with a label that will probably remain forever.

WHAT GOOD IS MENTAL ILLNESS ANYWAY?

Strange question?   For those who believe everything has meaning because all things were created and maintained by   G-d it’s a logical question.   Why would G-d allow humans to be born and grow up totally incapable of doing much of anything?  Or why are perfectly normal and healthy people suddenly changed for life by terrible accidents?       Many of us have a hard time believing some things are just mistakes of nature.    We may never understand why these things happen but we can learn to understand what they mean to us.

One hint into the question is where we all come from.   We are born into the world totally dependent and helpless,   unlike many animals who  are born able to walk and function almost independently from their earliest days.

But Thank G-d, most of us do grew into independent, functional people who themselves can function and contribute to the greater good.

That early period of infancy and childhood has a parallel to those effected by mental illness and are unable to do much more than require help from others just to stay alive.    Both groups, babies and dependent adults require help,   attention, and consistency.

There’s a story of the Chazon Ish that illustrates the issue.   He was a greatly loved and respected rabbi throughout the world in the last hundred years.   Stories about him reach epic and miraculous proportions.

“The Chazon used to stand when developmentally disabled people walked in to his Beit Midrash synagogue.   Once one of his students  asked why ?   He explained that each person is born into the world with a special mission.  G-d provides each with the tools necessary to fulfill his particular mission.

When one endowed with a wealth of tools and attributes, such as intelligence, mobility, speech, financial abundance and the like, it can be deduced he or she has a greater mission of to perform.    The opposite is true.   One born with little or no tools for active achievement has a different type of mission.   Perhaps his ultimate mission is almost complete and his soul is reaching perfection.

As are all things, this person is G-d’s gift to the world for a reason.   We can assume if everyone was fully independent, healthy and without need, we would gradually lose the attributes of giving, caring, tolerance and attention.

Everyone could take care of themselves.   But enter into our lives babies, little children, elderly, frail people and those disabled to perform the active roles in life ‘for us.’  

Those with mental illness and the struggles of disability are exactly what we need to develop and grow into greatness.    They have come here for us to learn about the extremes of life and how to become patient, tolerant and giving human beings.

Perhaps we are running away from them and setting up boundaries between us and them to avoid exactly what we need to become fully self-actualized and complete our own personal spiritual missions.   But, we will never be able to escape them… because ‘they are us.‘

Gershon Freedman, M.D.