What anti-stigma really means

Call this one a brilliant thought that I had in the shower the other day.

There are plenty of anti-stigma campaigns related to mental health.  In many cases, the goal of these campaigns is simple, noble and necessary: to defeat “mental health challenges in the workplace and at home.”  This is vitally important work.

There’s good news related to that though.  In many areas, anti-stigma campaigns have already done their job.  For example, a poll taken in my home state of Pennsylvania (March 2017) shows high levels of comfort in terms of working with someone with a mental illness, a vast improvement over previous levels.  While there is still a long way to go, this poll shows significant movement in the area of mental illness.

I was thinking about this poll the other day, and it had me thinking: What does anti-stigma really mean?  Obviously we need to continue to work on critical areas like discrimination and access to healthcare, but I’d argue there’s more than that.

My argument is this: The most powerful sense of stigma is self-stigma.

Consider this 2012 article, which describes self-stigma as when “patients agree with and internalize social stereotypes,” resulting in:

•Patients often think that their illness is a sign of character weakness or incompetence.
•Patients develop feelings of low self-esteem and become less willing to seek or adhere to treatment.
• Patients anticipate that they will be discriminated against, and to protect themselves they limit their social interactions and fail to pursue work and housing opportunities.

As a result, patients find themselves less willing to seek treatment and social support, leading to lower rates of recovery.

This realization has had me rethinking how I approach the notion of anti-stigma campaigns.  Of course they should be focused on ensuring that all of society views people with mental illness not as sick freaks who are weak, but as real people suffering from real disorders that can be treated like any physical illness.  I want to push society to a place where all of us – those with mental illness and those without – view people who are suffering from a mental illness the same way that someone views a cancer patient.  No one who suffers from a mental illness should do so in fear, shame or silence.  They should talk about their therapy appointments the same way a cancer patient discusses chemo or someone with a broken leg discusses physical therapy.

I suppose, then, that what I am saying is this: Anti-stigma campaigns shouldn’t just address societal stigma.  They should address self-stigma as well.

As always, I welcome your thoughts – am I onto something here?  More importantly, have you found any anti-stigma campaigns that fulfill what I am describing?  Let me know what in the comments!

Google launches depression screening tool

I caught this over the weekend and found it to be very interesting: Apparently, Google has launched a tool that serves as a brief depression screening.

First, about the screening.  It is the PHQ-9, which is only nine statements.  It asks users to select the level of agreement with nine statements, ranging from “Not at all” to “Nearly every day.”  They include items like, “Little interest or pleasure in doing things” and “Feeling tired or having little energy.” The information can then be shared with the user’s health care provider and used to seek treatment.

This is noteworthy for many reasons.  The screening will pop up in the event that “depression related searches” are made, similar to the way that the number for the National Suicide Prevention Lifeline (1-800-273-8255) pops up for suicide related searches.  Given the prevalence of Google in modern life, this can, hopefully, help make people more aware of mental illness and steer them to treatment options.  This is also particularly important, given the spike in suicide-related Google searches.  That spike, incidentally, is tied to 13 Reasons Why on Netflix, a show I suspect I will be writing about in the future.

Indeed, I’d argue that the most significant reason that the availability of the depression questionnaire is important is because of the major rate of spikes in suicide that we are seeing.  Suicides are rising across the board, but particularly for young girls aged 15-24, who have seen suicide rates increase to 40 year highs.  Obviously, this is the generation that is the most technologically dependent, so increasing their awareness about mental illness and treatment options can be a very, very good and healthy thing.

As good of a thing as this is – and it really, really is a good thing – depression screenings are not without their problems.  There are some studies which report that versions of the PHQ can demonstrate “poor specificity in detecting major depression” or false positives.

That being said, for the sake of argument, let’s assume the absolute worst about the PHQ-9: That it leads to an unacceptably high amount of false positives for depression.  Google’s use of it is still a great:

  • First, false positives is very different than false negatives.  A single accurate, positive test about the PHQ-9 can steer people into treatment and give them the help that they so desperately need.
  • Second, it can help move positive views of mental illness in a positive direction.  Too many people still view mental illness as a weakness or something that can simply be conquered by willpower.  That, of course, isn’t the case anymore than a broken arm can be healed by well-wishes.  Having a source viewed as positively as Google advertise depression screenings can, hopefully, convince people of the importance of seeking treatment for mental health.

As always, I’d love to hear your thoughts.  Let us know in the comments!

The mentally ill are more likely to be victims of violence – not perpetrators

One of the common misconceptions of mental illness is that the mentally ill are a monolithic group of lunatics, running around, committing violent acts.  This is perpetuated in a variety of ways, including popular culture and the media, who tend to highlight and sensationalize the unfortunate incidents when someone when is mentally ill commits an act of terrible violence.

Of course, that isn’t the case at all.

Let me address this stigma in two parts.  First, as has long since been established, mental illness, like most physical disorders, exists over a spectrum.  Nearly 1 in 5 American adults has some form of mental illness.  Breaking that down further, however, reveals a far more nuanced picture.

First of all, I vehemently object to the idea that “mental illness” is a big block.  It comes in a variety of symptoms, severity and specific diseases.  As noted above, nearly 1 in 5 American adults have some sort of diagnosable mental illness over the course of a year.  Roughly the same number of 13-18 year olds fall into the same category.  Over the same time period, 1 in 25 adults suffers from a mental illness that is severe enough to qualify as a “functional impairment.”  At the same time, roughly 100,000 people, per year, have their first episode of psychosis.

So, first and foremost, let’s dispatch the idea that all mental illnesses are the same.  They  vary in a variety of respects.

Second, it’s important to keep this in mind: Being mentally ill makes someone far more likely to be a victim of crime, not a perpetrator of it.  I get that the popular stereotype of the mentally ill has led people to believe that this isn’t the case, but again, reality is very different than perception, and when you think about it, this makes sense.  Someone who is mentally ill is far more likely to lack complete control over their faculties, health, finances, etc.  As a result, they are vulnerable to society’s criminal elements.

Let’s take a look at the research.  According to a 2014 study by North Carolina State, roughly 24% of the mentally ill who were surveyed (out of 4,480) had committed an act of violence over the past six months – but 31% had been a victim of it.  Breaking it down further, of those who had committed an act of violence, 63.5% had done so in a residential setting, while only 2.6% had done so at school or the workplace.  This doesn’t make the act of violence any less important or tragic, but it does mean that the mentally ill are rarely a danger to the general public.  Unfortunately, it may mean that family members can be.

Taking this research a step further: According to governmental surveys, only 3-5% of violent acts come from someone living with a serious mental illness.  And this, again, makes an important distinction: A serious mental illness is more than just someone who gets periodically anxious.  It is defined as:

a condition that affects “persons aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within DSM-IV (APA, 1994) that has resulted in serious functional impairment, which substantially interferes with or limits one or more major life activities”

As a study from Washington notes, this leads to exaggerated views of the connection between mental illness and the general public.  This, in turn, leads to widespread stigma, discrimination, treatment avoidance and a lower quality of life for those who suffer from mental illness.

 

I suppose, ultimately, it comes down to this.  The mentally ill – from a mildly anxious teenager to the most severely schizophrenic homeless senior – deserve to be treated with basic human dignity and respect.  Stigma is so dangerous because it is pervasive, and any broad-based, inaccurate characterization of mental illness dehumanizes those who suffer and forces them to keep their illness in the dark.  Violence among the mentally ill is rare – tragically, becoming a victim of violence is a far more likely scenario.  It is vitally important to the destigmatization movement that we continue to fight back against all inaccurate portrayals of mental illness, including this one.