Should we destigmatize mental illness?

• Author: Vatz, Richard E.

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THERE IS no more common cry in the mental health world than the cry to destigmatize mental illness. Over and over, primary players in mental health argue that the stigmatization of mental illness sufferers is the cause of underdiagnosis of those so afflicted and unfair treatment of the mentally ill.

The Congressional Quarterly has described the following "victories" in the fight against the stigmatizing of the "mentally ill":

* The National Stigma Clearinghouse, a network of advocates for the mentally ill, successfully campaigned against giving comic strip hero Superman's killer a psychiatric illness.

* The National Alliance for the Mentally Ill oversees a network of 500 "stigma busters" who wrote in to protest talk show host Geraldo Rivera's comment comparing certain mentally ill people to "werewolves."

* The Carter Center of Emory University's Mental Illnesses and Entertainment Media Initiative asks television and film producers to avoid stereotypes of the mentally ill.

Stigma is a term defined by the American Heritage Dictionary as "a mark or token of infamy, disgrace or reproach." As used by the mental health industry, though, it invariably means an unfair, inaccurate, and dysfunctional reputation tied to a notion of mental illness that lacks any voluntary component. This view, in turn, is tied to the medical model stating that all of mental illness is analogous to physical illness that happens to people, eliminating any element of choice, control, or discretion.

Those in mental health fields see the stigmatization of mental illness as the reason that many people do not seek professional help. They point disparagingly, for example, to polls such as one conducted in 1991 by the National Institute of Mental Health in which 43% of respondents regarded depression as a personal failing, rather than an illness. They also cite cases such as that of Vincent Foster, the Clinton Administration aide who reportedly avoided seeking psychiatric help for fear that the stigma would cripple his reputation.

The American Psychiatric Association (APA) has been behind a push to destigmatize mental illness. In May, 1994, for instance, they featured celebrities such as actors Rod Steiger and Suzanne Somers and humorist Art Buchwald, who attended the Presidential Symposium at the APA annual meeting, titled "Stigma and the Celebrity." In the July 1, 1994, Psychiatric News, the APA newsletter, they unanimously decried the stigma associated with mental illness.

In the piece, Steiger claimed that the stigma of mental illness "is as big a prejudice as racial or religious prejudice." He urged psychiatrists to apprise patients of the additional burden of stigma, and Buchwald noted wryly that "stigma may be terrible, but it sure brings out a crowd."

It is nearly impossible to pick up a copy of Psychiatric News or any article written by someone in the mental health field without finding some references to stigma. The July 21, 1995, Psychiatric News, for example, reports that the APA, in urging the U.S. Supreme Court to overturn a Colorado law forbidding extension of civil rights protections to gay men and women, filed a brief maintaining that "government measures that foster such stigma, as by pointedly foreclosing opportunities for political participation for gay people, only exacerbate those psychological harms."

There also is the aforementioned National Stigma Clearinghouse, an organization founded in 1992 that is "concerned with portrayals of people with mental illnesses," which attempts to "track and, if necessary, protest terms and images in the media that unintentionally hurt millions of Americans." That organization, too, believes that the fear of stigma can exacerbate the symptoms of mental illness. Nowhere in any of the anti-stigma literature is there any consideration of the view that eliminating stigma could foster in some...