My thoughts on there being ‘no stigma’ around mental illness

Last Sunday, the Observer published a piece by Elizabeth Day which appeared to claim that stigma around mental illness no longer existed.

She certainly didn’t sugar the pill.

“I don’t view mental illness as a scary, strange thing or as a form of weakness. Do you? I doubt it.”

“…bandying around the term “stigma” in reference to mental illness is unhelpful…can’t we just ditch the word?”

“…let’s stop saying there’s a stigma attached to it.”

Unsurprisingly, this went down like a sack of lead balloons with the mental health community. Amongst the fervent criticism was a typically evocative piece by Charlotte Walker.

And who can fail to understand the outrage? Research persistently shows that around 90% of people with a mental illness experience the effects of stigma.

However, in a follow-up piece published on her own blog today, Day tries to clarify her ideas. I’ll assume she’s being genuine in this and not resorting to tactical repositioning. She starts by stating that the real message of her piece was that mental illness is no longer a taboo subject (though the word ‘taboo’ is used once and ‘stigma’ is used eight times). She then goes on to assert that she would never deny that people with mental health problems still experience discrimination, but stigma, something different, is largely a thing of the past.

She reminds us of the definitions of stigma that she used in the original piece:

“…a Greek term that referred to the marking – by cutting or burning – of socially undesirable types such as criminals, slaves or traitors.

and

“…the phenomenon whereby an individual with an attribute which is deeply discredited by his/her society is rejected as a result of the attribute”.

It is here, for me, that the confusion and uproar has arisen. Day’s definition of stigma and the way she interprets it, as well as her obvious lack of appreciation of the prevalence of what others see as stigma are both askew with reality.

Day appears to believe that stigma simply denotes the process of society highlighting an intrinsic, internal flaw in someone (though her chosen definitions do not make that clear):

My issue with the term “stigma” is that it makes the condition itself a negative thing. It places the responsibility for bearing it with the person who has depression. It makes depression the mark of an outcast, of a tattooed outsider, rejected by the wider society.

However, we know that stigma it is a rather different beast to that. The now generally accepted conceptualisation of stigma is Thornicroft’s suggestion that it encompasses problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination, which Day sees as something altogether separate) – all of which are external to the person with mental illness. Though the results of stigma can be felt horrendously, the stigma itself comes from someone else and is inflicted upon a sufferer.

And even if we do work with her more narrow definition of stigma as a process whereby people are laden with blame for their conditions, it’s hardly as if society’s image of mental illness is as unblemished as she thinks it is.

“I simply don’t think the majority of right-thinking people believe [that mentally ill people are bad] anymore.”

Though in science and philosophy (areas which Day may be more familiar with than severe mental illness) we may have moved past the notion of mental illness being worthy of moral judgement or reason for scorn, the real world is sadly still rife with punishment and abuse simply for being unwell.
Moreover, appropriating the term stigma for her own ends (whether knowingly or not) was to steal a word belonging to a group of people for whom it  means something powerful and meaningful, who use it to understand their experiences with depth, pain and hopefully strength. This semantic hijacking is disrespectful. Providing a dictionary definition of stigma to justify it does nothing to negate that.

A final thought – whatever the cause of the misunderstanding, wherever the fault lies, there was a certain word missing in Day’s follow-up, a word that can have such healing power – sorry.

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About Alex Langford
I am a psychiatry trainee based in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

13 Responses to My thoughts on there being ‘no stigma’ around mental illness

  1. self harmer says:

    I’ve just got back from a&e…. more stitches to over abused arms. The Dr that stitched me up introduced himself by apologising for the wait as he’d been helping a sick person.

    My brains still in a weird state and that’s honestly all I can remember of the whole experience, with any real clarity. Mostly because I’m still trying to persuade myself he wasn’t being nasty. The reality is I’m convinced he was accusing me of wasting his time.

    Maybe things’ll seem different if I ever get to feel sane again. Probably not though. In my experience, most don’t see mental health issues as real problems.

    • elvis jones says:

      You think he/she was insinuating your problems were not real? Ask him if it was somebody he knew (that he had just helped), then wink and smile conceitedly. That’ll flummox them!

  2. elvis jones says:

    In regards to the blog above, I don’t think her claims would confirmed by most unwell people. It feels as if she knows she is forcing it, then trying to justify her actions by using flippancy and petitioning for collusion with the interviewer, who can see through it. I feels as if she was more interested in trying to put her stamp on the dynamic of anti-stigma attitudes for her own fame and posterity.
    Of course, the more dependent we become on others for a sense of how to act, think and respond, the more inauthentic we become. It takes bravery to be honest with yourself and others for it may expose you to criticism, ridicule or social exclusion. Sometimes though, it can liberate others to live a more authentic life away from the herd.

  3. haroldamaio says:

    http://psychiatrysho.wordpress.com/2014/08/27/my-thoughts-on-there-being-no-stigma-around-mental-illness/

    My thoughts on there being ‘no stigma’ around mental illness

    To exist, stigmas have to be taught

    The now generally accepted conceptualization of stigma is Thornicroft’s suggestion

    It is not “generally accepted.” It is his prejudice. He is responsible for teaching it.

    Harold A. Maio, retired mental health editor

    • Knowing Prof Thornicroft and his work, I’m not sure he’s one to prejudge anything!

      As for stigmas having to be taught, I thought that they were more likely to stem from people *not* being taught?

      • elvis jones says:

        Stigma is learnt but not taught?

  4. elvis jones says:

    Next time I want to know about REAL people, I will discuss what is in the paper. NOT. Are people so fucking stupid that they all they can do is read and discuss the shite in the papers? Is that all patients mean? Why.are people even discussing crap written by some hack?

    • self harmer says:

      I guess because a lot of people believe what they read in papers.

      As a crazy person who is unable to work. I am a lazy, good for nothing who is happy to live off others hard earned cash…… to an awful lot of people. Unfortunately my reputation – and that of 1000`s of others, is largely publicised through the press. We are all judged, tried and convicted without any trial.

      • elvis jones says:

        Sounds like The Daily Mail. I thought we were supposed to be a proud nation that defeated the Nazi’s?

  5. elvis jones says:

    I have concerns that Dorset Healthcare and the Parlaimentary Ombudsman are not investigating Serious Complaints which may be criminal, but have made a serious error of judgement when allowing an individual to continue to work of whom they were fully informed where they enacted further acts of abuse, including the supply of a false statement to the police for the purposes of obtaining a criminal conviction by deception. The victim had reported abuse perpetrated by a senior employee.

    It is not difficult to work out. I guess it must be awful, having to acknowledge your track history of deceit and exploitation. Perhaps trying to discredit victims is not always the best line of action, but you think telling lies to your staff wins respect. Does it?

  6. elvis jones says:

    It would be interesting to know their public response -after all they are so transparent and absolutely committed to being honest. Well, what is it? How are you going to manage a public examination? How will you be able to reconcile your private behaviour with your public? With some difficulty I should imagine.
    Don’t make me go for full public disclosure.

  7. elvis jones says:

    Dorset healthcare are actively engaged in the emotional abuse of a person diagnosed with emotionally unstable personality disorder, a history of recurrent severe depression, overdose, self mutilation. A DBT therapist supplied a false statement to the police stating that her client had no mental health problems and that allegations against her were false -and then continued with false treatment dates and facts. The CPS dropped the charge of harrassment against me because they found her an unreliable witness.
    Dorset Healthcare have a proven track record, in writing, of lying in relation to serious complaints. They copy letters to other staff members with incorrect facts, then send the letter which gives the actual facts privately and unofficially.
    So the facts are these: Ron Shields is actively involved in serious and sustained emotional abuse of a patient. He is aware, therefore he is responsible for it. There is nothing he can say that will convince the public otherwise, so he had better salvage some vestige of credibility before it overshadows his career, and the beleagured reputation of the organisation.

  8. Dinah says:

    Hi Alex. My thoughts on the topic from across the pond: http://www.psychiatrist-blog.blogspot.com/2014/09/eliminating-stigma-with-psychiatric.html

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