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.