Mental illness: how do we deal with stigma?

[David]

I came across this article on The Guardian the other day:

http://www.theguardian.com/commentisfree/2014/apr/04/fort-hood-shooting-military-ptsd-violence

It's not the first of its kind I've read. Name a mental illness or disorder, and there's probably a few articles fighting back against the associated stigma that goes along with it. Some, including this one, go as far as to deny a causal link between a disorder and negative behaviour, or do their best to downplay it.

Obviously it's good to confront negative stereotypes, particularly when they're not based on reality. People should be treated with dignity and not put into a little box because they suffer from a certain condition. I'm very happy that our society has moved on from outdated notions of mentally ill people being evil, or demon-possessed, or "just lacking in personal responsibility" and started to treat them more kindly, and I very much hope we continue to make progress on that front.

There is another side to this issue, however, that complicates the discourse on mental illness a little. It seems that the closer we examine human behaviour, the more we discover that antisocial behaviour has roots in disorders. Indeed, some might take the radical view—as I do—that pretty much all criminal behaviour has roots in dysfunction of some kind, a fair proportion of which is caused by psychiatric problems.

Here's the dilemma: if we come to understand that at least a lot of negative behaviour has roots in mental illness, how do we square that with our desire to not stigmatise the mentally ill? Because, it seems to me that having certain kinds of mental disorders does make you more likely to commit antisocial acts and that it's reasonable for friends, family and the wider public to be aware of that. And that is, in its way, a form of stigma.

So, what's the conclusion? Reducing stigma is an important goal, particularly when it's based on ignorance or exaggerated presumptions, but I'd be wary of trying to dissociate mental illness from harmful behaviour altogether. The problem there is that we simply create another wrongheaded distinction between 'good' people with mental illness and the 'evil' people who commit criminal acts. The stigma just gets shifted.

The reality is that mental illness is a handicap, just like growing up in a low socioeconomic background, having a disability or being the victim of abuse. It doesn't guarantee that you will have a bad life or that you will hurt others physically or emotionally, but—depending on the disorder or the life experience—it probably does increase the likelihood of that happening. That should make us feel more empathetic, not less, both towards those who do their best to overcome that handicap and those who fail to.

You may not agree with this, so I'm interested in your views: do you think the stigma faced by mentally ill people is a problem? If so, what can we do about it?

[Tannin]

I have difficulties with the whole notion of mental illness.

Decades ago, the great iconoclast Thomas Szasz wrote a series of powerful works to debunk the whole myth of mental illness as a convient fiction invented by the orthodox and powerful to stigmatise, debase, and control those without power, particularly those who challenged their safe, clean orthodoxy and rebelled against the dead hand of social control. Szasz peppered his works with explosive true-life examples of obviously sane people crucified by the mental health industry, and labelled as "insane" or "mentally ill".

Szasz was hugely controversial, but immensely thought-provoking, and his work threatened to turn the entire mental health industry upside down. It was really only the rise of biochemical explanations for abnormal behaviour (whatever the hell "abnormal" is) that stopped the runaway freight train of Szasz-led reaction to the appalling cruelty (worse than any prison) and hopeless unfairness of mental health "treatment" as it was in those days. (Helped, I should add, by some unwise exaggerations in the case made by Szasz and his supporters.)

Szasz fell out of favour, the fashion turned, and (so far as I know) he is now almost forgotten. Sadly, we also seem to have forgotten the powerful and lasting insights his work brought into the way we stigmatise and label "madness" and - much more importantly - into why we stigmatise and label "madness".

We tend to regard mental health issues as something internal to the "sick" person, who "has something wrong with him". Or, if we are a little bit smarter than that, we look beyond the immediate situation and go looking for historical circumstances surrounding that individual (early family life and so on). Both of these perspectives have merit, and both can be useful as a guide to action. But we fail miserably to address the problem in the round if we neglect to look at the other side of that same coin, which (as Szasz so memorably pointed out) shows that the notion of "mental illness" is socially constructed, as is the attribution of "mental illness" to any particular group or individual, and most importantly of all, that this social construction is not without purpose and does not take place by accident: it is part of the vast social machinery of deviance and control, part of our universal struggle to define ourselves and define others in ways which seem most advantageous to our individual selves.

Disclaimer: you might read this as some sort of anarchic denial of either medical science or social order. It is neither. It simply recognises the manner in which this society and all other societies known to history operate, and in which (it is virtually certain) all possible future societies will operate too. To vary, one individual from another, is inevitable. To operate at all, a society must constrain and direct those individual variations in some way, and that always must involve consequences. That basic is not in dispute, and cannot be disputed on any rational grounds. The only matters where dispute is possible lie in the ways in which these individual variations may be rewarded and punished. That is the battleground. Always has been, always will be.

[David]

Szasz's ideas seem interesting, but having read a little more about him I think I'd disagree with many of his conclusions.

In some sense, I agree that the concept of mental illness is quite relative—simply a deviation from the perceived norm—but something that can also make behaving functionally in society very difficult. Until recently, I was a friend of an older woman with paranoid schizophrenia. Contrary to the assumptions that I might have once had (here we get back to the problem of stigma), she is an intelligent, articulate person with many interesting viewpoints and a fascinating background. I did not know she was ill until several months into our friendship, when she began talking about her history with psychiatrists (who she believed were part of a broader conspiracy to lock her away). I was heartbroken to receive an email from her a few weeks ago stating that she believed I had impersonated a lover of hers on the phone and that she never wanted to see me again.

Now, Szasz might say that this is not unhealthy behaviour per se, just the sort of thing that society might want to suppress because it doesn't know how to deal with it. I suppose it's all a matter of perspective; certainly, given her history, I'm not sure how much her diagnosis or whatever treatment she's received has actually helped her. But clearly, this behaviour is hurting her—I'm sure I'm not the first friend she's cut off like this. And then there's the potential of self-harm, a common issue for sufferers of schizophrenia. However you look at it, it's a destructive condition, and if there were a remedy for it, it would seem for the best to apply it.

Szasz, who seems to have been an ardent libertarian, advocated individual freedom, but I suspect that what that would actually translate to in reality is abandonment. And with illnesses like depression or bipolar, that would have just been a return to the old days of people being told to pull their socks up and stop moping. It seems clear to me that the way those illnesses are treated now is much, much better for everybody involved.

I guess this has all strayed a little from my original point, but I'll try to get back on track: disorders may, in many cases, be different from physical illnesses in that it's only social norms that make them harmful. But maintaining social order is far from a trivial goal, and the harm caused by those discrepancies is real harm. Treatment, of some sort, is a necessity. To avoid the crude, often ineffective treatment of jail cells, I'd advocate more categorisations, more diagnosis and more preventative treatment. I guess that puts me and Szasz quite at odds.

[Tannin]

So how would you distinguish between that woman and, say, the woman standing outside the sexual health clinic holding a "contraception is murder, come to Jesus" sign? Which one is more deluded? Which one is more likely to seek help or get help? Which one is more dangerous, to herself, to her friends and family, and to society as a whole?

[Tannin]

[David]

[Tannin]

I should have his two most famous works if you want to borrow them, David. They are quite short and though I haven't opened either one for almost 30 years, if my memory is to be trusted, perfectly readable.

Re religious belief, you should know all about the appropriate "treatment" for mistaken religious belief - you posted an illustration of precisely the normal treatment of the "insanity" of protestant belief, never mind even more evil things like reckoning pendulums work according to the laws of time and gravity, over in the other thread.

[David]

Thanks for the offer! I'd be very interested in doing so (although I should warn you I read books at a glacial pace). I'll be up in your general area in a few weeks, I think, so perhaps we could catch up sometime around then.

[think positive]

[HAL]

The first one is usually the best one. Thanks for telling me. I never thought about it that way.

[think positive]

My pleasure Hal, though the first one is usually more of a learning experience, the 2nd is better

[HAL]

You are one of the most polite people I know.

[think positive]

[think positive]

•Free Will: God gave his children the right to make up their own minds as to who they would be, and some chose to be rotten.

• Imperfect Supreme Being: God struggles valiantly to cope with a universe filled with random events (chaos), but as powerful as he is, he can't undo every awful thing the moment it happens.

• The Devil: An evil entity preys upon the weak of will, winning many of the flawed to his side where they are first welcomed, then sent out to do his bidding. While God is ultimately fated to win the final battle against this adversary, until that time the entity's minions wreak havoc.

• Incomprehensibility: "Good" and "evil" are human constructs born of Mankind's limited understanding of the universe. Were people capable of seeing things through God's eyes, they would grasp the morality and rightness of all that now leaves them aghast in horror and riddled with unease at its seeming unfairness.

Read more at http://www.snopes.com/religion/einstein.asp#GTdZ9OSMw5aFdwyZ.99



Navy SEALs are always taught

1) Keep your priorities in order and
2) Know when to act without hesitation.

A Navy SEAL was attending some college courses between assignments. He had completed missions in Iraq and Afghanistan. One of the courses had a professor who was an avowed atheist and a member of the ACLU. One day he shocked the class when he came in, looked to the ceiling, and flatly stated, "God, if you are real, then I want you to knock me off this platform. I'll give you exactly 15 minutes."

The lecture room fell silent. You could hear a pin drop. Ten minutes went by and the professor proclaimed, "Here I am God. I'm still waiting."

It got down to the last couple of minutes when the SEAL got out of his chair, went up to the professor, and cold-cocked him; knocking him off the platform. The professor was out cold. The SEAL went back to his seat and sat there, silently. The other students were shocked and stunned and sat there looking on in silence.

The professor eventually came to, noticeably shaken, looked at the SEAL and asked, "What the hell is the matter with you? Why did you do that?"

The SEAL calmly replied, "God was too busy today protecting America's soldiers who are protecting your right to say stupid shit and act like an asshole. So He sent me."
Read more at http://www.snopes.com/religion/einstein.asp#GTdZ9OSMw5aFdwyZ.99



A college class was led by an atheist professor, and every day he'd stand in front of his class and say, "Have you ever seen God?" to which nobody would answer. Then he'd ask, "Have you ever felt God?" and nobody would answer. Finally he'd ask, "Have you ever heard God?" and, like the other times, nobody would answer. He then would say, "It is obvious that there is no God."

One day a Christian student had been having an extremely bad day; her car broke down, her mother was sick, her boyfriend was out of town, and she'd gotten a bad grade on one of her exams. She had been fed up with her professor's little act every morning, so she decided to do something about it.

While the professor stood up at the beginning of class and did his thing, the student had an idea. She got up and said, "Professor, would you mind if I said something?" He said, "Of course not. This is an expressive classroom, and I think it would be fine if you spoke your mind."

The girl said to the class, "Have you ever seen our professor's brain?" and nobody answered. Then she asked, "Have you ever felt our professor's brain?" and nobody answered. Finally she asked, "Have you ever heard our professor's brain?" and, like the other times, nobody answered.

She then said, "It is quite obvious that our professor has no brain."
Read more at http://www.snopes.com/religion/einstein.asp#GTdZ9OSMw5aFdwyZ.99

Does evil exist?

The university professor challenged his students with this question. Did God create everything that exists? A student bravely replied, "Yes, he did!"

"God created everything? The professor asked.

"Yes sir", the student replied.

The professor answered, "If God created everything, then God created evil since evil exists, and according to the principal that our works define who we are then God is evil". The student became quiet before such an answer. The professor was quite pleased with himself and boasted to the students that he had proven once more that the Christian faith was a myth.

Another student raised his hand and said, "Can I ask
you a question professor?"
"Of course", replied the professor.

The student stood up and asked, "Professor, does cold exist?"

"What kind of question is this? Of course it exists. Have you never been cold?" The students snickered at the young man's question.

The young man replied, "In fact sir, cold does not exist. According to the laws of physics, what we consider cold is in reality the absence of heat. Every body or object is susceptible to study when it has or transmits energy, and heat is what makes a body or matter have or transmit energy. Absolute zero (-460 degrees F) is the total absence of heat; all matter becomes inert and incapable of reaction at that temperature. Cold does not exist. We have created this word to describe how we feel if we have no heat."

The student continued, "Professor, does darkness exist?"

The professor responded, "Of course it does."

The student replied, "Once again you are wrong sir, darkness does not exist either. Darkness is in reality the absence of light. Light we can study, but not darkness. In fact we can use Newton's prism to break white light into many colors and study the various wavelengths of each color. You cannot measure darkness. A simple ray of light can break into a world of darkness and illuminate it. How can you know how dark a certain space is? You measure the amount of light present. Isn't this correct? Darkness is a term used by man to describe what happens when there is no light present."

Finally the young man asked the professor, "Sir, does evil exist?"

Now uncertain, the professor responded, "Of course as I have already said. We see it every day. It is in the daily example of man's inhumanity to man. It is in the multitude of crime and violence everywhere in the world. These manifestations are nothing else but evil."

To this the student replied, "Evil does not exist sir, or at least it does not exist unto itself. Evil is simply the absence of God. It is just like darkness and cold, a word that man has created to describe the absence of God. God did not create evil. Evil is not like faith, or love that exist just as does light and heat. Evil is the result of what happens when man does not have God's love present in his heart. It's like the cold that comes when there is no heat or the darkness that comes when there is no light."

The professor sat down.

Read more at http://www.snopes.com/religion/einstein.asp#LDtx6T0lFKv4gDZC.99


now I hope you had the attention span to get all that!! cheers, gym time!

[Tannin]

^ TLDR