February 2012


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By Professor Gerard Hutchinson

A mental health problem is no longer labelled as madness and no longer defines the person who experiences it. In fact, it defines all of us. It is an inevitable function and consequence of life. As an experience, it enriches the world because it forces everyone to seek a greater understanding of themselves. Your mind is the most powerful and significant thing you possess. We must seek to nurture it, save it and allow it to grow and prosper. We must therefore fight what would destroy it. The greatest enemy lies within ourselves, the desire to be right, to be better (than others), to be in control (of others).

A world without prejudice, mindless discrimination and feelings of superiority is fundamental for the development of the mind. Development that would be open and even, mindful and joyful. Development that would truly embody the best of being human.

Goffmann (1963) remarked in his landmark work on stigma that the difference between the normal and the stigmatized is a matter of perspective not reality. Those who engage in stigmatization, also defeat themselves from seeing the value of the struggles for dominion over one’s mind. It is a battle that we all engage in either consciously or not and establishes the integrity of our lives. Open your mind and save it. Save your mind and save your life.

Stigma represents a belief system that can affect every other belief system an individual holds and can cause significant impairment in the awareness of what obtains in the world: a position that will become increasingly maladaptive in a world driven by information and openness.

Stigma against mental illness needs to be addressed by mental health professionals first. People who have mental health problems must feel comfortable and confident about seeking help. They must not feel that the act of getting treatment compromises their personhood. Education about stigma and discrimination must therefore start there.

Secrecy and shame are some of the consequences of this lack of personhood and has to be addressed in all the social circles where the individual may find him or herself. Personal education must be aligned to public education and engagement with the media about the representation of mental illness. In the same way that racism, ageism, religious discrimination and homophobia are discouraged in the society, mental health problems should be viewed similarly. Anti-stigma campaigns for other stigmatizing illnesses such as HIV and cancer can incorporate mental illness so that people can feel more pressured to manage their mental health in the same way as they are pressed to manage their physical health.

Adorno (1950) described prejudiced people as being those who struggled with ambiguity, had rigid authoritarian personalities and were ethnocentric. Challenging each of these through education and discussion would diminish the level of prejudice in the society toward most things. The Royal College of Psychiatrists published a report in 1999 encouraging advocacy at several levels, self, peer-group, legal, family and public as a means of combating the negative stereotypes associated with mental illness. Feelings of helplessness and self doubt compromise the person who is seeking mental health treatment from attempting to reengage with society in a capable way and so further undermine the sense of self worth. The sense that one’s future has been irrevocably compromised by the existence of this problem, needs to be addressed firstly in the mind of the person with the problem and then with each surrounding layer of support to prevent isolation and social exclusion. As recently as 2010, John Grohol reported on two studies showing that stigma was, if anything, increasing in North America, including among medical students

In Trinidad and Tobago and indeed the Caribbean, little has been done to address the issue of stigma and how it affects the daily functioning of those in the mental health treatment system.

In Jamaica, the process of treating the mentally ill in a general hospital has been applied successfully in rural settings (Hickling et al, 2000), but the perception of madness being either a sign of personal weakness or of some kind of supernatural malevolence persists. This perception is deeply embedded in culture and folklore and is extremely difficult to dislodge (Byrne, 2000).

This can be extended to other kinds of discrimination and to societal perceptions of disadvantaged groups. The notion of stigma is particularly associated with HIV/AIDS in the Caribbean and there does need to be a spreading of the net to include the beliefs and prejudices that create stigma in all its forms. A Google search of stigma in the Caribbean would reveal a first page of items solely related to HIV. Media engagement, advocacy and the realization that fulfilment of one’s potential in any sphere and indeed the capacity to lead a normal and healthy life is not permanently compromised by any of the perceived stigmatizing attributes.

I would suggest that the philosophy that should be espoused is that there should be no barriers to education, employment or any social activity for those with mental health problems.

Of course this has to be founded on adequate treatment and follow-up resources being made available with the appropriate supports when things threaten individual and community stability. There is some concern over whether mental health problems should be included under the umbrella of disability. The fear that this would increase the stigma associated with mental illness is significant but it would also facilitate the mobilization of social resources to assist in the return of those afflicted to normal productive life. Success in these terms would reflect societal definitions of living well such as completing tertiary education, getting and keeping jobs and having functional relationships. These definitions are not necessarily associated with peace of mind and well-being, even in those without a history of mental health problems and can themselves be sources of significant life stress. However, for someone to believe that they cannot aspire or indeed attempt to engage in these activities is a far more tormenting hell. This is so particularly when the effects of stigma almost automatically and permanently preclude participation in these activities.

While the burden of stigma falls on those with mental health problems, it is created by the attitudes of the wider society. It has been theorized that stigma against others is created to reaffirm one’s own preferred identity. In the context of the mentally ill, it serves to celebrate the absence of these problems among those conferring the stereotypes and the resulting prejudice and discrimination (Hutchinson & Bhugra, 2000).

This is a dangerous illusion, as it is now clear that everyone is potentially vulnerable to developing mental health problems and that no one is therefore safe in absolute terms. Recognising this risk has led to a widespread increase in the popularity of yoga, meditation and yes, even counselling therapy, as people battle with the demands of contemporary life and seek some respite for their over-engaged minds. This alone should engender greater empathy with those with more serious and debilitating mental health problems and lead to an acknowledgment that attending to their concerns and providing healthier social spaces for them to function would not only save their minds, but yours as well.

The role of the media cannot be overestimated (Benbow, 2007). The use of prejudicial language, over-generalisations and the creation and perpetuation of stereotypes all contribute to the stigma of mental illness.

Success stories of mental health interventions need to be highlighted so as to encourage people to seek help as a progressive and important step in self development.

The use of the media as a developmental tool is critical in this regard. It is significant to note that Mussolini considered cinema his biggest weapon in the spread of fascism across Italy and Europe (Phillips, 1976). Its influence in shaping the attitudes and sensibilities of its audience has grown exponentially with the expansion of access though the worldwide web and the cross streaming of media product.

One of the greatest challenges is to diminish the associations between mental illness and sexual perversion on one hand and mental illness and violence on the other. The real message here is that untreated mental health problems can lead to both of these, but more open and accessible mental health treatment would likely improve the social fabric in a way that would naturally lead to a reduction in these socially inappropriate behaviours. Restoration and maintenance of personhood in all its dimensions with respect of the right of every other to be, must remain our goal as we seek to improve ourselves individually and socially.

This is the second in a series on mental health issues by Professor of Psychiatry, Gerard Hutchinson. Professor Hutchinson is the head of Department, Clinical Medical Sciences, School of Medicine, Faculty of Medical Sciences, EWMSC, UWI.