How to Talk Constructively About Mental Illness - Pacific Standard

How to Talk Constructively About Mental Illness

When public discourse links mental disorders with violence or "craziness," it adversely—and unfairly—affects the lives of millions of people.
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(Illustration: Sam Ward)

(Illustration: Sam Ward)

Seung-Hui Cho, Adam Lanza, James Holmes, Elliot Rodger: In the wake of mass shootings, we often blame mental illness rather than lax gun control for making those tragedies possible. A Washington Post survey of 1,001 Americans found that 63 percent cited problems in identifying and treating people with mental-health issues as the primary cause of mass shootings in this country, while just 23 percent cited gun control laws.

Years of research shows that the purported link between mental illness and violence is minuscule at most, yet public figures continue to say things like, "Guns don't kill people— the mentally ill do," erroneously equating medical conditions with murderous tendencies. This perception helps fuel stigmatization of mental illness. Unfairly profiled patients may be discriminated against when seeking employment or housing, and some report that their satisfaction with life as a whole is blighted by society's fear of their condition.

What to do about this problem remains a hotly debated topic. Studies have shown that meeting people who suffer from mental illnesses tends to reduce the associated stigma. But much of the research behind that finding is based on rickety methodology, including small sample sizes. Meanwhile, some experts have considered changing the name of certain conditions, including schizophrenia—the disorder the public most often links with violence—to try to wipe the slate clean for patients. While the science surrounding these issues often opens up more questions than it answers, asking those questions is the first step toward addressing the problem.

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STIGMATIZATION AFFECTS LIVES—AND SOCIETY AS A WHOLE—FOR THE WORSE

Up to 74 percent of people suffering from mental disorders in the United States and Europe do not receive help or treatment. Delaying care, however, can exacerbate symptoms. Why, then, do some people avoid help? Stigmatization seems to be one factor. A meta-analysis of around 140 studies involving more than 90,000 participants found that approximately one-quarter to one-third of those with a mental health problem do not reach out to a doctor because they feel ashamed or embarrassed, or they fear social judgment and employment discrimination. Stigma can affect anyone, but, according to the data, its silencing effects are most pronounced in Asian, Arab, and African-American people, as well as in young people and those who have jobs in military or, ironically, health.

—"What Is the Impact of Mental Health-Related Stigma on Help-Seeking? A Systematic Review of Quantitative and Qualitative Studies," Clement, S. et al., Psychological Medicine, Vol. 45, No. 1, 2014.

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RE-NAMING SOME CONDITIONS COULD ALLEVIATE THAT PROBLEM

Psychiatrists dread breaking the news to patients that they have schizophrenia—a disorder whose name popularly connotes a Jekyll-and-Hyde-like condition characterized by delusion, paranoia, "craziness," and even violence. That widespread and inaccurate belief is so ingrained that patients themselves can have difficulty comprehending the actual symptoms and pathology of the diagnosis. For this reason, Tomer Levin, director of the Weill Cornell Psychiatry Collaborative Care Center, and other experts are in favor of replacing the term schizophrenia entirely with something more descriptive and socially acceptable—for example, Neuro-Emotional Integration Disorder. Likewise, "anti-psychotic" medications could become Neuro-Emotional Integration-Enhancing medications.

—"Schizophrenia Should Be Renamed to Help Educate Patients and the Public," Levin. T., International Journal of Social Psychiatry, Vol. 52, No. 4, 2006.

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BUT WE'VE TRIED THAT BEFORE, WITH MIXED RESULTS

In 2002, Japan became the first nation to put the schizophrenia name-change strategy to the test. Because of the stigmatization associated with the condition, Seishin-Bunretsu-Byo (mind-split disease) officially became Togo-Shitcho-Sho (integration disorder). Studies conducted shortly after the change took place revealed that patients and their families reported more acceptance of the new name, and a survey administered to members of the Japanese public last year found that the new label is less stigmatizing than the old. Researchers point out, however, that mass media largely shapes stigmas surrounding mental illnesses. If reporters continue to emphasize a connection between mental illness and violence, then that association will likely stick, regardless of the name of the disorder.

—"Effect of Name Change of Schizophrenia on Mass Media Between 1985 and 2013 in Japan: A Text Data Mining Analysis," Koike, S., et al., Schizophrenia Bulletin, 2015.

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AND IN SOME CASES, CHANGING THE NAME CAN EVEN BACKFIRE

Outside of Japan, no one has carried out large-scale studies on how a name change might shift public perception of schizophrenia. So researchers from University College London sent 1,600 United Kingdom residents a survey containing the same vignette describing a patient with symptoms of schizophrenia. In some of the surveys, the patient was diagnosed with schizophrenia; in others, with integration disorder. The researchers found that the schizophrenia label was more associated with dangerousness than integration disorder. The respondents also said they would be more likely to keep clear from someone suffering from integration disorder. In this case, at least, changing the name might reduce some stigmas while inadvertently increasing others.

—"Renaming Schizophrenia to Reduce Stigma: Comparison With the Case of Bipolar Disorder," Ellison, N., Mason, O., and Scior, K., The British Journal of Psychiatry, Vol. 206, No. 4, 2015.

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REDUCING STIGMA MIGHT WELL COME DOWN TO DIRECT INTERVENTIONS

While experts debate whether schizophrenia is due for a name change, others are focused on designing intervention programs that directly target stigmatization. Three different strategies seem to hold promise. A group called Stigma Busters debunks erroneous beliefs about mental illness and protests stigmatization via rallies and public shaming. The Elimination of Barriers Initiative uses a less aggressive tactic—public service announcements—to eliminate stereotypes. Finally, contact—direct, face-to-face interactions with people diagnosed with a mental illness—also shows promise for changing attitudes. The group In Our Own Voice found that volunteers who interacted directly with a person diagnosed with a mental illness were more likely than a control group to find mental illness less threatening.

—"Three Programs That Use Mass Approaches to Challenge the Stigma of Mental Illness," Corrigan, P., and Gelb., B., Psychiatric Services, Vol. 57, No. 3, 2006.

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