Stigma follows mental illness

By KRISTI EATON

VIEW ON HEALTH

Sitting at a restaurant recently, my friend, who is currently in medical school, began telling me about her upcoming rotations. She was detailing the different hospitals she would be working at over the next few months. The first, a local psychiatric hospital, is one I know well. As a pre-teen, I spent months there as an in patient, partial patient and out patient for treatment for anorexia. Sharing this information would have been a logical progression to the conversation, but my friend did not know about my past struggles with anorexia, or that I still struggle with depression and obsessive compulsive disorder. As she was talking, a debate was raging in my head: That's a place I know well. I should tell her about it, and she might as well know a little about my past. Wait, she may get the wrong idea about me when she hears that I was treated at a psychiatric hospital.

I pushed aside the doubts and insecurities and told her I suffered from anorexia and knew the hospital very well. As is the case nowadays when I tell people about my experience, she said she never would have guessed mental illness is something I struggle with. Peoples' image of someone suffering from anorexia, OCD and depression is probably very different from the stable, mostly happy and self-sufficient person that stands before them. It took me many years to realize I do not need to be ashamed of my mental health. Despite that realization, however, I still struggle with sharing my story. Telling friends, significant others and acquaintances you suffer from depression, or that you were once hospitalized for a mental illness, is not the same as telling someone you had cancer at one time or another disease like multiple sclerosis. Unfortunately, in spite of the growing education and understanding regarding mental illness, there is still a major stigma attached to it, and studies show the stigma attached to mood disorders and other illnesses can have a profound effect on quality of life and coping with the disorder.

"Most people don't know much about mental illness. There are a lot of misconceptions and stereotypes fueled by stereotypes or inaccuracies in the news, entertainment and advertising media," said Bob Carolla, a spokesman for the National Alliance on Mental Illness.

MENTAL ILLNESS: A LEGITIMATE DISEASE?

I was first diagnosed and hospitalized for anorexia nervosa a few days after my 11th birthday. Anorexia nervosa, characterized by extreme weight loss through excessive dieting or exercise, a distorted body image and an intense fear of gaining weight, is an illness that affects as many as 10 million females and 1 million males in the United States. Anorexia has the highest premature fatality rate of any mental illness and, according to some studies, people with anorexia are 10 times more likely to die compared to people without the disorder. The most common complications that lead to death from the disorder are cardiac arrest and electrolyte and fluid imbalance. The disease is more often than not coupled with depression, and its sufferers have a higher than average risk of suicide. In addition to anorexia, I was diagnosed with depression and obsessive-compulsive disorder, too. The doctors and counselors at the psychiatric facility told me I should keep the anorexia a secret. It's an illness to be ashamed of, they seemed to be implying. So, at four feet nine inches tall and 54 pounds, I tried to hide the anorexia from classmates and society at large. Looking back, I don't think I was fooling anyone, with my skeletal arms and legs, pale skin and sunken eyes. Not to mention the fact that I threw my lunch away most days, became emotional at the drop of a hat and was sometimes taken out of school for days at a time. I continued to keep secret the anorexia for the four years I suffered from it, which made me feel like I was hiding a major part of my life and who I was.

A new study seems to back up the feelings I had at the time. Researchers from Case Western University found that adolescents between the ages of 12 and 17 who are diagnosed and taking medications for mood disorders may face social isolation. The study found that at least 90 percent of the youth in the study reported feeling some sort of stigma because of the illness, leading to shame, secrecy and limited social interaction.

And youths are not the only ones who feel the pain of mental health stigma, although adults seem to judge people with mental illness based on the severity of the disorder. People with schizophrenia are more likely to have trouble carrying on tasks of daily life compared to people with depression, adults surveyed said. But all viewed people with mental illness -- no matter how severe -- as less competent and more violent than others.

"The results continue to reflect an underlying stigma towards persons with mental health problems, an exaggeration of the impairments or 'threat' posed by these disorders, and a startling negativity toward individuals with substance abuse problems," said Bernice A. Pescosolido, of Indiana University Bloomington, who led the study looking at mental health stigma.

More Americans do believe mental illness has a genetic component, eliminating the stigma, but that hasn't changed the tolerance level for the mentally ill. According to the Mayo Clinic, the term "mental illness" itself is a stigma, because it implies a distinction between physical illness. But, actually, the two are related, according to Mayo.

"In fact, neuroimaging studies show physical changes in the brain associated with mental disorders, suggesting a biological basis," the non-profit medical practice reported. "Some mental health advocates propose switching to less stigmatized terms, such as behavioral health or brain disorders or brain illnesses."

Those who suffer from mental illness are sometimes believed to bear some responsibility for their condition.

For decades, researchers believed anorexia was an illness primarily caused by societal forces like media images of impossibly trim models, as well as psychological factors, such as low self-esteem or feelings of a lack of control in life. This thinking has trickled down to the general public. Although studies are proving otherwise, many still believe anorexia afflicts only upper-middle class Caucasian females during their teenage years. Often people view it as a disease born of selfishness, greed and vanity.

"You just want attention," some people would say to me. Or, "How can you starve yourself when you are well off and so many go without in this world?"

This belief that I was bringing on the illness myself often made me wish that I could simply tell people I was battling cancer; I had many of the same outside symptoms -- weight loss, not eating and sunken eyes-- and people would be more understanding because the cause of cancer, at least, could be definitely traced to biology. Nobody chooses to have cancer. It chooses them. That's much easier to explain to people than why I was slowly trying to kill myself by exercising up to eight hours a day and not eating.

PARENTAL IMPACT

In addition to the school environment and peers, parents can be either positive or negative players in the fight against stigma, according to the lead author of the study looking at mental illness stigma on adolescents.

"Parents, who embrace and love their children for whom they are and accept the illness as part of their child's being, help their children overcome these stigmas," said Derrick Kranke, the lead author of article the appearing in Children and Youth Services Review.

However, one of the most damaging misconceptions for people with mental illness is that they are more prone to violence, but Carolla said, "the U.S. Surgeon General has indicated that the overall likelihood of violence by a person living with mental illness is low and the contribution of mental disorders to the total level of violence in society is exceptionally small. In fact, people with mental illness are more likely to be victims of violence."

FIGHTING THE STEREOTYPES

Carolla, who is also the director of NAMI's Stigmabusters program, said there three basic strategies to combat mental illness stigma in today's society: praise, protest or personal contact.

Praise rewards or reinforces media images "who get it right" in portraying mental illness, he said, pointing to the Substance Abuse and Mental Health Services Administration's annual Voice Awards, which honor film and television writers and producers who incorporate positive and accurate portrayals of people with mental illnesses into their scripts, programs and productions. He also noted actress Glenn Close's campaign against stereotypes. Close's sister, Jessie Close, suffers from bipolar disorder.

Protesting negative portrayals of mental illness is another strategy.

"Protest empowers people with mental illness who speak out. It's a great feeling but is considered least effective in changing attitudes," Carolla says, "although it often changes behavior" because people think twice about their decisions.

He says personal contact, where a person meets someone with mental illness, is found to be the most effective in battling stigma.

I like to think I'm doing my part by fighting back against the stereotypes of those with mental illness. The friend who I shared my history of anorexia with said she would never have guessed I suffered from a mental illness like an eating disorder. Maybe, after seeing that I am a well-adjusted person living a normal life, her perception of mental illness will change.